331 solve7

College of Health Sciences
Department of Public Health

ASSIGNMENT COVER SHEET
Course name:

Chronic Disease Epidemiology

Course Code & CRN:

PHC331 -XXXX

The tobacco epidemic is one of the biggest public health threats the world has
ever faced. Being a leading cause of preventable diseases and deaths necessitates
actions through international collaboration.
Consequently, the World Health Organization (WHO) adopted the WHO
Framework Convention on Tobacco Control (WHO FCTC) in 2003 through
collaboration between 182 countries, and Saudi Arabia is a great party in this
convention, which developed MPOWER policies to face this rising epidemic.
Assignment title or
task:
(You can write a
question.)

In the light of this statement, read the attached documents carefully and
answer the following two questions: •

Use the WHO tobacco factsheet (link attached) to explore the WHO FCTC
and its MPOWER policies. (5 grades)

•

Use the attached Saudi Arabia factsheet (PDF file) to explore the smoking
prevalence and the implemented tobacco control policies in Saudi Arabia.
(5 grades)

Student name:

XXXXX

Student ID:

XXXXX

Submission date:

XXXXX

Instructor name:

XXXX

Grade:

……. Out of 10

Release Date:
Due Date:
Instructions:
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Length of the write-up should be at least 500 words or two pages.
The font should be Times New Roman, and the size should be 12.
Heading should be Bold.
The text color should be Black.
Line spacing should be 1.5.
Proper headings with numbers should be given for each segment
Avoid Plagiarism
Assignments must be submitted with the filled cover page (NO image format)
All assignments must carry the references using APA style using at least three
references.

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WHO-EM/TFI/182/E

Effects of meeting
MPOWER
requirements
on smoking rates
and
smoking-attributable
deaths

Saudi Arabia
This factsheet presents estimates of the effect of
implementing MPOWER policies consistent with
the WHO Framework Convention on Tobacco
Control (WHO FCTC). The estimates are based
on the Abridged SimSmoke model (1).

Smoking prevalence
Saudi Arabia is a high-income country with a population of more than 28 million in 2011 (2), of which 82.3% live in
urban areas (3). Based on the STEPwise survey conducted nationwide in 2005, the daily tobacco smoking rate (ages
15–64) is 24.2% for men and 1.4% for women (4). Based on this survey, the WHO standardized rate for smoking
prevalence is 38% for men and less than 1% for women. Based on data from other countries in the Region, Abridged
SimSmoke set the smoking rate for those aged 65 and above to half the rate of ages 55–64, and the rate for those
aged 15–19 to half the rate of ages 20–29.
Tobacco control policies
Protect people from tobacco smoke
Based on the 2013 WHO report on the global tobacco epidemic (5), which includes data from 2012, Saudi Arabia
had smoke-free legislation covering health care facilities, educational facilities and universities, government facilities,
restaurants and public transport, but none covering indoor offices. Legislation for restaurants, pubs and bars changed
from 2007. The compliance score was 8 of 10, an increase from previous years. Smoke-free policies were at the
second highest level in 2012.
Offer help to quit tobacco use
In 2012, there was no toll-free quit line with a live person to discuss cessation available in Saudi Arabia. Nicotine
replacement therapy could be purchased in a pharmacy without a prescription and was partially cost-covered.
Bupropion and varenicline were legally sold in 2012, but not in 2007. Smoking cessation support was available in
most health clinics or other primary care facilities and most hospitals, but was not available in the offices of a health
professional, most places in the community and some places elsewhere. National health insurance partially covered
the cost of support in health clinics or other primary care facilities, hospitals and other places elsewhere; however,
it did not cover costs in the community (data are not available for other places). Cessation programmes were at the
second highest level in 2012.
Warn about the dangers of tobacco
In 2012, Saudi Arabia had a law mandating that health warnings appear on tobacco packages. Warnings must cover
50% of the package, and be rotating and graphic. This was a change from 2007, when the law did not mandate
that the warning be rotating or appear on 50% of the package. Saudi Arabia had national anti-tobacco mass media
campaigns in 2011–2012. There was a national agency/technical unit for tobacco control and 100 full-time equivalent
staff. Government expenditure on tobacco control was approximately US$ 4.8 million (18 million Saudi riyals) in 2008.
Health warnings were at the second highest level and mass media campaigns were at the medium level in 2012.
Enforce bans on tobacco advertising, promotion and sponsorship
In 2012, Saudi Arabia had bans on direct advertising in local/international magazines and newspapers, and at pointof-sale. However, there were no direct advertising bans on national/international television and radio, billboards
and outdoors, and the internet. From 2007, point-of-sale advertising changed. The compliance score of direct
advertising bans was 8 out of 10. For indirect advertising, there were no bans on the free distribution of tobacco
products, promotional discounts, non-tobacco goods and services identified with tobacco brand names, brand name
of non-tobacco products used for tobacco products, appearance of tobacco brands and products in television and
films (product placement and non-product placement) and sponsored events. Advertising bans were at the lowest
level in 2012.

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Saudi
Raise taxes on tobacco
WHO’s comparable estimate for the price of a pack of 20 cigarettes of the most sold brand was 6.00 Saudi riyals for
2008 and 9.00 Saudi riyals for 2012; in terms of international dollars (purchasing power parity) the price increased
from US$ 1.97 to US$ 2.70. WHO’s comparable estimate for taxes as a percentage of retail price was 33.0% for 2008
and 22.0% for 2012; all taxes were import duties.
Key findings
The Abridged SimSmoke model for Saudi Arabia estimates nearly 3 million smokers (almost 2.9 million men and
100 000 women) in 2010, and projects more than 1.4 million premature deaths of smokers (more than 1.4 million men
and nearly 50 000 women) alive in that year. Without proper implementation of MPOWER tobacco control policies,
smoking prevalence rates will remain relatively stable and smoking-attributable deaths are likely to continue to rise.
•

Increasing cigarette excise taxes to 75% of the retail price would prevent much youth smoking and
reduce smoking prevalence by 15.5% within 5 years, increasing to 30.9% in 40 years, and ultimately
avert more than 450 000 premature deaths.

•

Stronger enforcement of comprehensive smoke-free laws is predicted to reduce smoking prevalence
by 9% in 5 years, increasing to 12% in 40 years, and avert more than 170 000 premature deaths.

•

A well-publicized and comprehensive cessation policy can reduce smoking prevalence by 1% within 5
years, increasing to 3% in 40 years, and prevent more than 43 000 premature deaths.

•

Strong health warnings can reduce smoking prevalence by 6% within 5 years, increasing to 12% in 40
years, and prevent nearly 260 000 premature deaths.

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A high-level mass media campaign is projected to reduce smoking prevalence by 3.5% in 5 years,
increasing to almost 4% within 40 years, and avert over 56 000 premature deaths.

•

A comprehensive marketing ban with enforcement is projected to reduce smoking prevalence by 4% in
5 years, increasing to 5% within 40 years, and avert more than 77 000 deaths.

Implementing the stronger set of policies suggested above, in line with the WHO FCTC, could reduce smoking
prevalence by 34% within 5 years, increasing to 44% within 20 years and 53% within 40 years. More than 1.5 million
premature deaths could be averted. The Abridged SimSmoke model incorporates synergies in implementing multiple
policies. A large tax increase accompanied by comprehensive marketing restrictions, a comprehensive cessation
programme and a mass media campaign would reduce smoking prevalence by about 40% by 2025, thus meeting
the global target.
Limitations
Abridged SimSmoke has been developed based on an extensively validated simulation model, providing support
for the estimates given above. However, the model has certain limitations.
•

It does not consider tobacco products other than cigarettes, such as smokeless tobacco, e-cigarettes and
shisha (waterpipe). If tax increases and other policies are only directed at cigarettes, smokers may substitute
to other tobacco products, which would offset some of the health gains from reduced smoking. If policies are
also targeted toward the use of non-cigarette products, then substitution to these products may be reduced.

•

Mortality risks for smoking are based on studies for the United States of America.

•

It does not include deaths from second-hand smoke exposure. In addition, there are costs associated with
morbidity and productivity loss due to premature death.

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It has been developed to use data from the biennial WHO global tobacco epidemic reports. The tobacco
control policy data are restricted to a specific set of policies and definitions. The model does not consider
policies directed at cost-minimizing behaviour, enforcement against smuggling, product regulation and youth
access.

References
1. Levy DT, Fouad H, Levy J, Dragomir AD, El Awa F. Application of the Abridged SimSmoke
model to four Eastern Mediterranean countries. Tob Control. 2016;25(4):413–21. doi:10.1136/
tobaccocontrol-2015-052334 ( accessed 24 April 2018).
2. World population prospects: the 2015 revision. New York: Department of Economic and Social Affairs,
Population Division; 2015.
3. World Factbook 2015. Washington DC: Central Intelligence Agency; 2015 (
publications/the-world-factbook/, accessed 3 September 2015).
4. WHO STEPwise Approach to NCD Surveillance. Saudi Arabia 2005. Riyadh: Ministry of Health
(Kingdom of Saudi Arabia); 2005 (
STEPS_Report_EN.pdf, accessed 25 April 2018).
5. WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising,
promotion and sponsorship. Geneva: World Health Organization; 2013 (
bitstream/10665/85380/1/9789241505871_eng.pdf?ua=1, accessed 3 September 2015).

© World Health Organization 2018
Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence
(CC BY-NC-SA 3.0 IGO;

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