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Students’ Opinion on Tobacco Control Laws & Policies in Batswana

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Tobacco is an agricultural crop, most commonly used to make cigarettes. It is grown all over the world and supports a billion-dollar industry. Its leaves are dried and fermented before being put in tobacco products. Tobacco smoke contains more than 4000 chemical substances including particulates and gases. Tobacco contains nicotine, an ingredient that can lead to addiction. There are also many other potentially harmful chemicals found in tobacco or created by burning it. Tobacco is a nervous system stimulant that triggers complex biochemical and neurotransmitter disruptions. It elevates heart rate and blood pressure, constricts blood vessels, irritates lung tissue, and diminishes the ability to taste and smell. According to the World Health Organization statistics, smoking claims 5.4 million lives each year and cigarette consumption has reached epidemic proportions globally. Over 15 billion cigarettes are smoked worldwide everyday. The World Health Organization (WHO) predicts that, if current patterns of tobacco consumption continue, more than 500 million people alive today will be killed by tobacco by 2030. Tobacco use is more than a health hazard; it is a quintessential challenge to sustainable development, with consequences for the environment, trade, taxation, social policy, direct and indirect health care costs, and power/gender/labour relations, both at the societal and household levels.

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Tobacco use has been identified as the world’s leading cause of preventable death. Smoking leads to a wide range of diseases including many types of cancer, heart disease and stroke, chest and lung illnesses and stomach ulcers. The control of tobacco is ancient practice from Pope Urban VII’s thirteen-day papal reign the world’s first known tobacco use restrictions in 1590 when he threatened to excommunicate anyone who took tobacco in the porchway of or inside a church, whether it be by chewing it, smoking it with a pipe or sniffing it in powdered form through the nose. Public policy can be generally defined as a system of laws, regulatory measures, courses of action, and funding priorities concerning a given topic promulgated by a governmental entity or its representatives. Smoke free policies include private-sector rules and public-sector regulations that prohibit smoking in indoor workspaces and designated public areas.

Every year nearly 2,000 Batswana are killed by smoking-caused diseases. The public health establishment was deeply concerned with rights, and emphasizes as a core principle the freedom from harm. Governments have made effort to reduce the harms caused by tobacco by adopting and implementing the tobacco control provisions of the WHO Framework Convention on Tobacco Control. Among the WHO FCTC’s tobacco control provisions are those that reduce the demand for tobacco as well as others that reduce tobacco production, distribution, availability and supply. Botswana became a Party to the WHO Framework Convention on Tobacco Control on May 1, 2005. However Tobacco use remains a major problem locally.

Despite the recent campaigns to eliminate smoking, the rates are still increasing world-wide. Exposure to passive smoking (PS) is associated with morbidity and mortality from awful diseases. Although many tertiary students smoke, little is known about their opinion towards the local tobacco control policies and exposure to passive Smoking, common places and sources of exposures. Passive smoking causes early death and health problems in children and adults who do not smoke. A smoke-free environment is the only way to fully protect non-smokers from the dangers of second-hand smoke.

Literature review

In developing nations, the tobacco industry has found a ready market, amongst an uninformed mass of customers and an underdeveloped legislative environment, ill-prepared and ill-equipped to counteract their influence in promoting tobacco use. Tobacco control policies are intended to keep up wellbeing by protecting nonsmokers from secondhand smoke exposure to, lessen the social agreeableness or tolerance of smoking, and help in averting youth and youthful grown-up smoking initiation, and increment smokers’ endeavors to stop smoking. In response to the worldwide danger, as of January 2006, 121 developing nations had confirmed the World Health Organization’s Framework Convention on Tobacco Control (FCTC), the primary worldwide general wellbeing settlement. The subtle elements of how this settlement will be actualized are simply starting to develop. However there have been difficulty in making these policies practical especially in developing countries.

According to WHOFCT protocol Tobacco control refers to a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke. Comprehensive policies to curb cigarette smoking generally employ some mix of taxation, education, and legislation/regulation in order to encourage prevention of smoking, cessation, and protection from environmental tobacco smoke for non-smokers. The WHO Framework Convention on Tobacco Control (FCTC) is the primary worldwide wellbeing bargain consulted under the protection of the World Health Organization. The FCTC was produced because of the globalization of the tobacco plague. It submits nations to execute a scope of tobacco control estimates, for example, a prohibition on tobacco promoting, assurance of individuals from used smoke, and the direction of tobacco items. Some articles from the WHO include Article 8 – Protection from exposure to tobacco smoke (Smoke-free environments), Article 14 – Demand reduction measures concerning tobacco dependence and cessation (Cessation programmes). Colleges and universities represent an important venue for protecting students, faculty, staff members, and guests from secondhand smoke exposure through tobacco control policies. Tobacco control policies based on sound research have been shown to be effective in reducing tobacco use in both developed and developing countries, bringing about unprecedented health benefits without harming economies.

The Government of Botswana has long recognized and accepted the need to sensitize its population to the harmful effects of tobacco. The Primary Health Care approach, adopted in the 1970s in Botswana after the 1978 Alma Ata Declaration emphasized this requirement. However, the theme “Tobacco or Health”, launching the first World No Tobacco Day on 7 April 1988 in Botswana, marked the beginning of an intensive anti-tobacco campaign in the country. Since then, World No Tobacco Day has been held annually on 31 May. In December 1992, the Government of Botswana enacted its first law on tobacco and tobacco products — the Control of Smoking Act (CSA). The intention of this Act is to control smoking in enclosed public places, which include licensed premises, government and private offices, health. The primary objective of the smoking policies is to ensure that people who do not smoke or who do not wish to smoke in their area are protected from tobacco smoke. No-smoking policies that allows protection of non-smokers while giving smokers a place to smoke. The low success of bans on smoking in areas may have therefore been more the result of the intensive anti-tobacco campaigns and government directives that followed immediately after the enactment of the legislation. Even though most organizations have these policies and laws, there are some practical difficulties. In Botswana has made progress on tobacco control in recent years. However, people continue to die and become sick needlessly, and the costs to society from tobacco use continue to rise. Botswana is facing a significant increase in the use of tobacco products. This has led to an increase in the prevalence of non-communicable diseases, which were predominantly observed in developed countries. Previous studies have shown that 18.3 percent of adults (ages 15-69) in Botswana smoke tobacco. Rates are much higher among men than among women: 31.4 percent of men and 4.9 percent of women smoke tobacco. The research also revealed 3.9 percent of adults use smokeless tobacco (men 1.5 percent; women 6.5 percent). Among youth (ages 13-15), 19.4 percent use tobacco products (boys 23.3 percent; girls 16.2 percent), 8.2 percent smoke cigarettes (boys 12.9 percent; girls 4.6 percent), and 15.2 percent use smokeless tobacco (boys 16.3 percent; girls 14.3 percent). Among youth (ages 13-15), 62.1 percent are exposed to secondhand smoke in public places (including on campus) and 38.5 percent are exposed at home.

Despite the growing issue of tobacco use in Botswana the government has not been without effort in the fight against tobacco use. In December 1992, the Government of Botswana enacted its first law on tobacco and tobacco products the Control of Smoking Act (CSA). Botswana was the first among the African countries to domesticate Article 8 of the World Health Organization Framework Convention on Tobacco Control. The Control of Smoking Act of July 1, 1993 is the primary law on tobacco control and covers many aspects of tobacco control, including but not limited to: restrictions on smoking in public places and advertising and sale of tobacco products. However law does not address tobacco packaging and labeling measures. Botswana became a Party to the WHO Framework Convention on Tobacco Control on May 1, 2005. The WHO Framework Convention on Tobacco Control (WHO FCTC) is the first treaty negotiated under the auspices of the World Health Organization. The Government of Botswana in recognizing that tobacco use is a health and development priority, has committed to strengthen national tobacco control laws by repealing the Control of Smoking Act of 2004 to be compliant with the WHO Framework Convention of Tobacco Control. The Botswana Government however has a current Tobacco Control Bill which will be finally be tabled in the 2018-2019 Parliament. The Bill is meant to protect people from devastating consequences of tobacco use. Smokers will no longer smoke their cigarettes in public places as it used to be. This means that there would be smoking areas, unlike before. If one is caught smoking in a public place, one would be fined.

Tobacco or cigarette use of university students and administrative policies concerning smoking are significant aspect of critical public health issues. The rise in cigarette smoking among students is a growing public health, education and social relations concern, especially in developing countries where efforts to prevent smoking are severely lacking. University students who smoke or use tobacco have higher rates of respiratory infections and asthma. Recent studies reveal that smoking among university students all over the world is on the increase. For instance, several studies among university students in the U.S. have found continued high rates of smoking, with almost 30% of students reporting smoking. Similar findings were obtained in Beirut Moran and Nichter, it was found that the university years have been characterized as a time of increased risk to smoking initiation and exposure as well as movement from intermittent or social smoking to more regular patterns of use. New policy initiatives and environmental design types have emerged along with anti-smoking policies at universities all over the world. Some of the crucial factors that contribute to smoking on campus include the lack of restrictions on smoking, the presence of social imitation, and the ease of purchasing cigarette are also crucial factors in Tobacco use. Most studies have revealed that there is a strong link between social influences and the behavior of smoking, between peers who smoke or peers who pressure others to smoke and the smoking status of an individual. Social influences are stronger among those who reported starting or increasing their smoking since coming to the university than among those who maintained or decreased their level of smoking. Most researches establish that original nonsmokers in the first year had also become smokers by the end of their course. Thus, it was hypothesized that more cigarette smokers would be found among the senior students as compared to the new comers. This means that more students will start smoking than quitting during their university years, despite the negative relationship generally assumed between education and smoking. More smokers than nonsmokers are likely to claim that smoking is an expression of freedom of choice. Considering the university student opinions of no-smoking policies, previous studies found that nonsmoking students have the most favorable attitudes toward no smoking. College and university campuses were considered smoke-free if they completely prohibited smoking in all indoor and outdoor areas, and tobacco-free if they prohibited both smoking and smokeless tobacco product use in all indoor and outdoor areas. Some studies indicate that there are high levels of compliance with smoking control laws, especially at the U.S. universities. According to the CDC as of November 2017, at least 2,082 U.S. College and university campuses had smoke-free policies. Among these campuses, 1,743 (83.7%) were tobacco-free. From the research conducted in the US schools, majority of respondents were women (61.3%) with no significant gender differences between campuses with different policies. There were significant differences by ethnicity across policies with the tobacco-free campuses having more Asian students. The study found strong support for all proposed policies among a large, nationally representative sample of US college students. Smoke free and tobacco-free policies on college and university campuses can help reduce secondhand smoke exposure, tobacco use initiation, and the social acceptability of tobacco use.

On the contrary, some studies found that the rapid growth in various laws restricting or banning smoking has not caused much of a backlash among smokers in the developing countries. Male students who are smokers have the least favorable attitudes towards policies. There are more non-smokers who support smoking ban in the school premises than smokers do and more smokers support “restrictions” than non-smokers do. Students’ opinion of the proposed tobacco control policies has not been measured, but it could provide valuable information with the potential to influence administrators ‘policy decisions. In most literature in this field of study the questionnaire was used to assess students’ demographic characteristics, tobacco use, opinion of proposed tobacco control policies, awareness of their school’s policy about smoking in student residences, and the current smoking policy of their residence. Demographic factors assessed were age, sex, and ethnicity, year in school, marital status, and residence (on-campus or off-campus). Surveys were mailed to students. Three separate mailings were sent within three weeks: a questionnaire, a reminder postcard, and a second questionnaire. Responses were anonymous. Cash prizes were offered to encourage response. In some cases focus groups were interviewed. Interviews were conducted at schools, community centres, and a market research facility. Participants were paid in cash or coupons in appreciation. Students were questions like if they were aware of the policies both their government and university had in place, if they lived in housing designated as smoke-free, and if not, whether they would like to do so. Cigarette smokers were asked to specify daily cigarette consumption and frequency of smoking. To assess attitudes regarding tobacco control policies on campus, students were asked, “To what extent do you support or oppose the following possible school policies about smoking?”.

Response options were strongly support, support, oppose, and strongly oppose. In one of the US relevant studies Students were asked about three types of tobacco control policies: clean indoor air (four items), tobacco marketing restrictions (two items), and tobacco sales restrictions (one item). Clean indoor air policies tested were smoking prohibitions in:(1) all campus buildings;(2) all parts of residence halls including student sleeping quarters; (3) on-campus restaurants or dining areas; and (4) on-campus bars or pubs. Marketing restrictions assessed were prohibitions on tobacco industry sponsorship of school parties or events and tobacco advertisements in student newspapers. Students were also asked their opinion of prohibiting the sale of tobacco products on campus. Responses were obtained from all schools.

Attitudes toward policies were divided into two categories: support or oppose. Bivariate analyses identified student level and college level characteristics associated with attitudes toward tobacco control policies. Significance was assessed with χ2 tests and χ2 tests of trend for categorical variables and t tests for continuous variables. More than three quarters of students supported a ban on smoking in all campus buildings, including residence halls and dining areas. Support for smoking restrictions in student residences, dining areas, campus bars, and all campus buildings was greater among lighter smokers.The purpose of previous research was aimed at providing fresh information and discussion in order to contribute to the accumulated knowledge about the cigarette smoking and problems related with prevention policies. Such information is helpful in developing comprehensive, effective and culturally relevant cessation programs. It also aimed at reminding all involved parties that they should pay proper attention to the urgency and magnitude of the problem and should act to initiate appropriate prevention and intervention programs. However the level of this field of study in developing countries is either very limited or not available at all. Universities present a venue for initiation for smoking given that policies in developing countries are not well implemented. Some of the researches on tobacco control reveal certain reasons for this occurring in developing countries. Many governments in the southern part of African countries are hesitant to curtail tobacco production and lukewarm toward controlling tobacco use, as they enjoy significant revenues from excise taxes on cigarettes and the export of tobacco leaf. Also they lack data to substantiate the magnitude of the tobacco epidemic and the effectiveness of interventions. Therefore the rising issue of increased tobacco use in universities is often not priority and the student’s opinion, attitudes and knowledge on tobacco control policies are often neglected. However tobacco control policies based on sound research have been shown to be effective in reducing tobacco use in both developed and developing countries, bringing about unprecedented health benefits without harming economies. The possible outcomes of this field of study given the strong level of public support for tobacco control, from a public health standpoint policy and law enforcement may be improved. Public opinion provides a framework within which to study the public’s influence. There is evidence that public opinion can translate into policy in significant ways, at least in some arenas. For example, much of civil rights legislation in the USA was enacted only after public support was expressed repeatedly and forcefully in the American mass media. There is some controversy about the relative impact on policy makers of public opinion versus interest group pressure versus research on policy makers. Public opinion is a significant force for policy change, in the USA. College students are at risk for tobacco use and initiation. The benefits of the information previous studies brought greatly outweigh the initial cost and change-related stress. Creation of a smoke-free environment would improve the health and wellness of students, employees, and visitors, would lessen costs related to health care and smoking product cleanup. Adopting a comprehensive smoke-free policy would also take the campus a step closer to implementing the tobacco-free environment recommended by the WHOFCTC. Tobacco control policy “encourages colleges and universities to be diligent in their efforts to achieve 100% indoor and outdoor campus-wide tobacco-free environment.”

In conclusion considering previous research and the benefit of research in this field of study it is important to acknowledge and appreciate that many developing countries have difficulty in implementing the set tobacco control policies. Therefore it is necessary to engage the public in this case the university students concerning local policies because this approach has proven viable in some of the first world universities. Individual perceptions are very important when the goal is to encourage adherence and compliance.

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