Qatar: warning about the dangers of tobacco (mass media campaigns)
Context
Qatar took the lead among countries of the Gulf Cooperation Council and the WHO Eastern Mediterranean Region by ratifying the WHO Framework Convention on Tobacco Control (FCTC) on 23 July 2004. In line with Article 12 of the WHO FCTC, the Ministry of Public Health in Qatar has initiated multiple nationwide anti-tobacco health awareness campaigns. These campaigns aim to educate the public about the harmful effects of tobacco use, including smoking and other forms of tobacco consumption. Despite observing a decline in tobacco use trends over the past five years, there remains a necessity to regularly implement such campaigns to complement the impact of other tobacco control interventions.
Initiative
In 2015, Qatar implemented the "Don't go up in smoke" national anti-tobacco health awareness campaign. The primary objective of this campaign was to encourage smokers to reconsider their habits and quit tobacco. It focused on highlighting the detrimental effects of smoking on individuals and those around them. The campaign targeted three main groups: adult smokers, young smokers and families. Emphasizing emotional relevance, the 2015 campaign aimed to evoke strong emotions. It was part of a broader healthy lifestyles campaign that ran from 2015 to 2017. The campaign utilized various communication channels, including newspapers, radio, television, cinema, the internet and social media platforms. It also employed outdoor print ads and transportation services. Following an evaluation of the 2015 campaign, Qatar conducted a new national anti-tobacco health awareness campaign in 2018 to optimize the outreach effectiveness. This latest campaign focused on achieving the following goals:
Encouraging residents to adhere to tobacco control laws and report violations.
Disseminating knowledge about the risks associated with tobacco use.
Discouraging youth from initiating tobacco use.
Providing the public with resources to support tobacco users in quitting.
The campaign was a collaborative effort involving three health entities: the Ministry of Public Health, Hamad Medical Corporation and the Primary Health Care Corporation. This partnership was significant as it marked the first time such a joint campaign was conducted in Qatar. The campaign was launched in two phases during 2018, with the initial release in May to June and a subsequent relaunch in December. The campaign was divided into two main themes: law and health hazards. During the summer season, the advertisements were prominently displayed in shopping malls and outdoor areas. In the winter season, the focus shifted to cinemas and key outdoor locations, particularly the popular Doha Souk Waqif.
The campaign activities were designed to coincide with World No Tobacco Day (celebrated on 31 May) and spanned the entire year, targeting peak times for maximum outreach. Communication was carried out in both Arabic and English languages through various media channels, including newspapers, radio, television, cinema, the internet and social media platforms, to reach as many residents as possible.
Newspapers. Press releases and print adverts were utilized in all eight newspapers in Qatar, strategically selecting high-visibility days of the week. Campaign images were also featured on online newspaper pages.
Radio. Ad spots were secured on all Arabic and English radio channels, airing in both morning and evening time slots for comprehensive coverage. Additionally, live radio discussions related to the campaign were conducted to engage with listeners.
Television. The campaign was broadcasted during the holy month of Ramadan and beyond, with a focus on religious programmes that garnered higher viewership during that period. Ministry of Public Health officials also participated in live interviews to discuss the campaign.
Cinema. Popular cinema theaters were selected to showcase campaign videos before movie screenings, with a total of 26 screens used for this purpose.
Internet. Online activities included social media platforms such as YouTube, Twitter, Instagram, Snapchat and Facebook, featuring live posts and click-to-link adverts. The campaign also utilized popular Qatar websites like QTickets, Mzad and Doha Mums, as well as blog discussions and debates on ILQ.
Successful aspects of the campaign
During Phase I, titled "Know the law", the campaign focused on highlighting the current tobacco control laws enforced nationwide. The objective was to promote stricter adherence to these laws, increase awareness about violations, penalties and fines, and encourage reporting of tobacco-related offenses. As part of this phase, a new hotline number was introduced to facilitate reporting of indoor smoking and other tobacco-related violations.
Phase II, known as "Health hazards (tobacco is poisonous)", centered on emphasizing the health risks associated with tobacco use and urging users to reconsider their habits. Feedback received indicated that the "Health hazards" campaign had a strong impact, particularly due to its eye-catching images and the revelation of tobacco's chemical content, which many people were unaware of. The campaign effectively conveyed the message that tobacco use is harmful, with a specific focus on the chemicals present in tobacco smoke and the detrimental effects on secondhand smokers.
The campaign's video and imagery depicting the health hazards of waterpipe tobacco smoking were particularly effective in raising awareness and dispelling misconceptions. One of the most widely shared images from the "Know the law" campaign depicted smoking in cars, informing people that it is considered smoking in an enclosed space as defined by tobacco control laws. In the "Health hazards" campaign, the image illustrating the impact of secondhand smoke resonated with many people, making it widely shared and relevant to their experiences.
Challenges and lessons learnt
The utilization of still images and videos in a different manner than previous tobacco campaigns proved to be more impactful and memorable. The direct approach employed in the campaigns was found to be particularly effective in motivating people to quit tobacco. However, the launch of the "Health hazards" campaign during Ramadan, coinciding with World No Tobacco Day, posed challenges as many residents were on holiday and social media usage was lower during this period. Future campaign cycles will take this timing into account. Social media and digital platforms were highly effective in raising awareness and facilitating public engagement and discussions on the topic. It is crucial to deliver clear and concise messages while considering cultural sensitivities. These factors should be incorporated from the initial design stages and in the delivery methods to ensure a significant impact and broad reach among the target population. Distributing the campaigns and materials in multiple widely spoken languages has proven highly effective in delivering the campaign and ensuring the messages are well-received.
Impact
The campaign had a positive impact as it was well-received by the residents, motivating many tobacco users to quit and seek cessation services. Social media platforms and blog discussions were filled with positive feedback and expressions of support for the campaign and the enforcement of tobacco control laws. By providing clear and insightful information about the health hazards of waterpipe tobacco smoking compared to cigarette smoking, the campaign contributed to the denormalization of tobacco use. Many residents, particularly young people, reported that they first became aware of these hazards through the campaign. The hotline launched alongside the campaign has been actively used, providing valuable information to enforcement officers. Additionally, the Primary Health Care Corporation and the Tobacco Control Center received numerous inquiries about the tobacco cessation services they offer following the campaign.
Next steps
The upcoming phase of the campaign aims to discourage young people in Qatar from taking up smoking as part of the broader goal of achieving a tobacco-free Qatar. Aligned with the objectives of the tobacco control policy to reduce tobacco use and prevent youth initiation, the next campaign, titled "Youth prevention" will primarily utilize social media platforms to convey the message of empowering young people to make healthy lifestyle choices and reject tobacco use. The campaign incorporates a dedicated TV channel and still images that will be predominantly promoted through social media to effectively reach the target audience. Extensive testing involving young people from diverse nationalities residing in Qatar has been conducted to ensure the campaign's acceptance and relevance among all youth residents. The campaign has already been filmed and produced, with plans for its release in the Summer of 2020, accompanied by a school-based programme that will be implemented throughout the academic year. Additionally, the campaign includes a specific module addressing the harms of waterpipe smoking, oral tobacco use and e-cigarettes.
References
MPOWER measures to reduce demand for tobacco
WHO Framework Convention on Tobacco Control
Story originated in 2019.
Kuwait: monitoring tobacco use and prevention policies
Context
On 12 May 2006, Kuwait ratified the WHO Framework Convention on Tobacco Control. To gather information on tobacco use within the country, national surveys were conducted in line with Article 20 of the WHO FCTC. By 2007, Kuwait became one of the first three countries in the Region to achieve the highest level of monitoring tobacco use, as measured by the WHO STEPS Survey (2006 and 2014) for adults and the Global Youth Tobacco Survey (2002, 2006 and 2009) for youth.
However, the data collected through WHO STEPS were limited to Kuwaiti adults and further data were required to fully understand the impact of tobacco on health in Kuwait. The absence of taxes led to lower prices and increased affordability of tobacco products, highlighting the need for continuous monitoring of tobacco use. Additionally, specific interventions were necessary to ensure the ongoing collection of reliable data for tobacco monitoring in the country.
Initiative
Under the National Tobacco Control Programme, efforts were made to ensure sustainable data collection in both the surveys for adults and youth. The following initiatives were taken:
The Undersecretary of the Ministry of Health took charge of a committee and determined that the School Health Department, in collaboration with the focal point for tobacco control would be responsible for conducting the Global Youth Tobacco Survey.
The funds for conducting the Global Youth Tobacco Survey were allocated through the National Development Plan Budget, overseen by the National Health Survey Committee.
A separate budget was allocated specifically for conducting repeated surveys among adults.
The National Health Survey recognized the importance of incorporating the WHO STEPS Survey as part of the National Health Statistics.
Challenges and lessons learnt
Encountering administrative challenges, one of which was linking the survey to a specific department rather than the overall programme, posed difficulties. The National Tobacco Control Programme and the School Health Department experienced changes in personnel, disrupting the planning and implementation process and causing delays in following the predetermined steps. While some delays could be tolerated, there was a risk of losing the allocated budget by the end of the fiscal year and missing the appropriate timeframe for conducting a school-based survey.
However, the key to overcoming these challenges lay in intersectoral collaboration. The collaboration between multiple sectors within the Ministry of Health, including the National Tobacco Control Programme, the School Health Department and the Preventive Medicine Department, along with the Ministry of Education, played a pivotal role in ensuring the successful execution of the 2016 Global Youth Tobacco Survey.
Impact
The effort made to ensure the ongoing surveillance of tobacco use among youth was of significant importance. This effort was crucial for the effective development of appropriate policies in this regard.
Next steps
Moving forward, the continued collaboration among various sectors within the Ministry of Health will remain instrumental in maintaining the monitoring of tobacco use among youth. Furthermore, plans are underway to repeat both the WHO STEPS Survey and the Global Youth Tobacco Survey in 2020.
References
Global Tobacco Surveillance System
MPOWER measures to reduce demand for tobacco
STEPS country data and reports
WHO Framework Convention on Tobacco Control
Story originated in 2019.
Kuwait: offering help to quit tobacco use
Context
Kuwait ratified the WHO Framework Convention on Tobacco Control (FCTC) on 12 May 2006 and as part of its national tobacco control strategy, it adopted a significant policy of providing assistance to nicotine dependents in quitting smoking. Demonstrating leadership in the Region, Kuwait became the first country to establish cessation clinics, with the initial clinic operating since the early 1980s.
By 1998, the Asma clinic was following established protocols and achieving success. In 2003, a ministerial decree was issued to expand the presence of cessation clinics nationwide. As a result, a clinic was established in each governorate, increasing the total number of clinics to six. Additionally, another clinic was opened to cater specifically to workers in the oil industry at the Al Shuaiba Industrial Area. These clinics offered free services, including medical assessments, nicotine replacement therapy and counselling, for four hours, twice a week, in the afternoon. The cessation success rates for these clinics averaged around 30% over a period of six months.
However, the clinics faced the possibility of closure. The reasons cited for potential closure included the perception that the clinics did not yield successful outcomes, the belief that quitting smoking "cold turkey" was the most effective method and doubts regarding the quality of assistance provided by healthcare professionals.
Initiative
To prevent the potential closure of the cessation clinics, several steps have been undertaken:
Compile evidence highlighting the significance of smoking cessation clinics for any healthcare system aiming to control tobacco consumption. This involved creating a comprehensive report that gathered evidence from relevant literature and incorporated the guidelines outlined in Article 14 of the WHO FCTC.
Conduct an audit of the clinics' operations and provide recommendations regarding the necessity of enhancing doctors' capabilities to meet international standards. This includes the development of patient information sheets and the implementation of a standardized protocol for clinic management.
Implement a training programme for doctors, nurses and health inspectors responsible for running the clinics. The objective of this programme is to enhance their competencies in delivering internationally accredited management within the clinics.
Revise and update the protocol for the treatment of nicotine dependence, ensuring it aligns with current best practices and guidelines.
Challenges and lessons learnt
The preservation of smoking cessation clinics faced various challenges that required immediate attention. These challenges included bureaucratic obstacles within the governmental sector, the need to navigate ministerial administrative restrictions and the importance of securing sustained financial support for clinic operations. Additionally, it was essential to involve doctors from general hospitals in the clinics' operations to ensure their success.
Throughout this process, valuable lessons were learnt, leading to corresponding actions being taken. A primary lesson was the recognition of the significance of incorporating scientific evidence into policy development and implementation. This evidence-based approach played a vital role in making informed decisions regarding tobacco control. Another crucial lesson was the value of constructive criticism in evaluating existing healthcare services and identifying areas for improvement. Acting upon this feedback, subsequent enhancements were implemented. Moreover, the WHO FCTC emerged as a crucial cornerstone in guiding effective tobacco control policies within healthcare systems.
To address the challenges, specific actions were undertaken. Firstly, a step was taken by submitting a scientific report that advocated for the importance of smoking cessation clinics. This report served as a robust defense, utilizing scientific evidence to underscore the clinics' significance and impact. Additionally, the constructive criticism received was embraced as an opportunity for improvement. This led to the implementation of targeted training programmes for healthcare professionals involved in the clinics, resulting in enhanced service quality. Collectively, these actions played a vital role in strengthening the effectiveness and impact of smoking cessation clinics, paving the way for improved tobacco control measures.
Impact
The approach used had a positive impact on the clinics in multiple ways. Firstly, the clinics continue to operate successfully, ensuring their ongoing provision of services. Additionally, there are plans in place to expand the number of cessation clinics, reflecting a commitment to future growth and development in this area.
Next steps
Moving forward, there are important plans to improve the cessation clinics. The National Programme will take over their supervision, ensuring a more coordinated approach. Certification through appropriate training will be required for clinic staff to enhance the quality of services provided. Expanding the training programme to involve doctors at all healthcare levels is also planned, aiming for a comprehensive approach to address tobacco dependence. Additionally, the objective is to increase the number of clinics and operate them in the morning at primary healthcare facilities for better accessibility. These plans demonstrate a strong commitment to improving the clinics and supporting individuals in their journey to quit smoking.
References
MPOWER measures to reduce demand for tobacco
WHO Framework Convention on Tobacco Control
Story originated in 2019.
Kuwait's commitment to tobacco control strengthened as ratification of protocol achieved with multisectoral collaboration
Context
Kuwait ratified the WHO Framework Convention on Tobacco Control (FCTC) on 12 May 2006, demonstrating its commitment to tobacco control. In line with its obligations under the WHO FCTC, Kuwait also signed the Protocol to Eliminate Illicit Trade in Tobacco Products in 2012. However, the process of ratification for this protocol was not finalized until 2019.
Initiative
The process of becoming a Party to the Protocol involved signing and ratifying it. For parties that joined later in the process, signature and ratification were merged. Due to the Protocol's nature as an international law addressing tobacco smuggling, it was necessary to bring the process to the national level. The Ministry of Health, being the leading stakeholder (as the Protocol emerged from the WHO FCTC), played a crucial role. However, other stakeholders such as the ministries of finance and commerce, as well as customs, also played significant roles in achieving the Protocol's ratification.
The National Tobacco Control Programme recognized the importance of engaging with the relevant partners. A copy of the Protocol, accompanied by a letter seeking their opinion on proceeding was shared. In 2015, Kuwait hosted the first regional meeting focused on the Protocol. Representatives from various sectors in all countries of the Gulf Cooperation Council participated in this three-day meeting. The Head of the WHO FCTC Secretariat and eight WHO experts provided detailed information about the Protocol.
The recommendations from this meeting were circulated and further communications were initiated to nominate a focal point. However, the collaboration encountered challenges.
In 2017 and 2018, WHO recommended involving the Ministry of Foreign Affairs, alongside the Ministry of Health to support in the ratification process. Responding to this recommendation, the Ministry of Foreign Affairs, alongside the Ministry of Health called on stakeholders in Kuwait to actively participate, resulting in the successful ratification of the Protocol and Kuwait becoming the 61st Party to the Protocol in February 2019.
Challenges and lessons learnt
Kuwait becoming Party to the Protocol was facilitated by the multisectoral coordination among various stakeholders and ministries involved in this process. Involving a stakeholder (Ministry of Foreign Affairs), alongside the Ministry of Health, who typically handles these matters, proved instrumental in advancing the ratification process and addressing the hesitancy and delays faced by certain stakeholders. Demonstrating committed leadership was crucial in driving the ratification process forward and ensuring its eventual success.
Impact
The involvement of an additional stakeholder, namely the Ministry of Foreign Affairs, alongside the Ministry of Health had a positive impact on the ratification process.
Next steps
Moving forward, the Protocol presents an opportunity to effectively control tobacco by addressing the reduction of its supply. This effort will necessitate increased collaboration among various sectors and a strong commitment at the national level.
References
MPOWER measures to reduce demand for tobacco
Protocol to Eliminate Illicit Trade in Tobacco Products
WHO Framework Convention on Tobacco Control
Story originated in 2019.
