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Key informants
Source publication
Background: In 2009, Canada adopted legislation (Bill C-32) restricting the sale of flavoured tobacco products, one of the first in the world. This study examines the agenda-setting process leading to the adoption of Bill C-32.
Methods: This research was conducted using a case study design informed by Kingdon’s Multiple Streams framework and Heclo’...
Contexts in source publication
Context 1
... design focuses on a bounded policy context in order to systematically examine the process surrounding the policy [23,24]. In-depth semi-structured qualitative interviews were conducted with key informants between July and October 2014 (n = 11) (See Table 1). Key infor- mants were recruited based on their known involvement in the legislative process leading to the adoption of Bill C-32. ...
Context 2
... design focuses on a bounded policy context in order to systematically examine the process surrounding the policy [23,24]. In-depth semi-structured qualitative interviews were conducted with key informants between July and October 2014 (n = 11) (See Table 1). Key infor- mants were recruited based on their known involvement in the legislative process leading to the adoption of Bill C-32. ...
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Citations
... Also, civil society, elected officials, and the media -possibly even as members of advocacy coalitionsmight play a role in problem learning (Béland, 2006;Fisher et al, 2018;Goyal et al, 2020). For example, Lencucha et al (2018) have demonstrated the role played by a non-profit organisation in spreading information about the 'problem' of tobacco consumption through a public awareness campaign. ...
... Also, social interaction -for example, through participation in common forums or venuescould aid policy instrument learning (Malkamäki et al, 2021). These mechanisms are also likely to differ at different stages of the policy process, such as from learning in the laboratory or model-based learning during policy formulation (Knoepfel and Kissling-Näf, 1998) to social interaction or trial-and-error during policy adoption and policy implementation (Hall, 1993;Arnold, 2014;Lencucha et al, 2018). ...
... Political parties -in the government or outside -might, for instance, learn about platforms or policy issues that appeal to specific constituencies. Illustratively, Lencucha et al (2018) highlight that the party in government found the 'youth' frame to be useful for enlisting support of The causes of the problem; identification of groups whose welfare is of greatest concern; the importance of causal linkages in different locales over time; the seriousness of the problem; the seriousness of specific aspects of the problem in specific locales Similarly, Matthijs and Blyth (2018) argue that policymakers learnt how to win an 'authority contest' rather than 'provide better macroeconomic outcomes' in the case of fiscal policy in the Eurozone in the aftermath of the 2008 financial crisis. In an example of non-learning in this stream, Dostal (2020) argues that policymakers in Germany did not pay heed to the difference in state-society relations while responding to the COVID-19 crisis based on the experiences of China and South Korea. ...
Policy innovation is considered important for addressing major challenges such as climate change and the sustainable energy transition. Although policy learning is likely to play a key role in enabling policy innovation, the link between them remains unclear despite much research on both topics. To address this gap, we move beyond a binary treatment of policy innovation and differentiate policy problem innovation from policy instrument innovation and policy process innovation. Subsequently, we synthesise the literature on policy learning with the research on the multiple streams framework (MSF), a well-known lens for explaining policy innovation. Like earlier policy learning studies, we distinguish several types of learning by posing the key questions of learning, but in the context of each stream of the MSF: who learns (actors), what (beliefs), how (modes), and to what effect (ripening). This new conceptualisation clarifies the relationship of each type of policy learning to the varieties of policy innovation. Further, it indicates that policy learning is likely to result in policy innovation if and only if it influences the coupling among the three streams during a window of opportunity – through policy entrepreneurship – and not otherwise. We conclude with the implications of this study for future research on policy innovation, policy learning, and the MSF.
... The most prevalent NGO 'inside' strategy targeting government and/or intergovernmental actors across the studies was lobbying policymakers, identified in 54 studies [13, 23, 26, 29, 32, 36, 40-42, 44, 48, 52, 61, 71, 72, 78, 82-85, 89, 93, 97-100, 103, 108, 109, 112, 114-116, 118, 120-135]. NGO lobbying in the literature included through formal policy processes such as submissions [13,32,89,93,98,99,130,132,134,135], and informal processes such as through hallway corridor conversations with policymakers [97,128,132,133]. One study reported, for example, on how NGOs in Lebanon formed an informal parliamentary friends committee for parliamentary allies of tobacco control [108]. ...
... NGOs were also involved in drafting legislation, policies and standards for government actors in 20 studies [13,37,40,61,68,83,90,91,111,119,120,134,135,[137][138][139]. NGOs in Myanmar, for example, helped draft the Environment Law and Environment Impact Assessment procedures by government, and contributed to Myanmar's submissions on international climate change negotiations [119]. ...
... Twenty-five studies (17%) attributed NGOs as making a substantive impact -that is, they significantly influenced commercial practices or government/intergovernmental policy and regulation [22,26,40,44,48,52,57,59,76,77,85,96,106,108,111,113,115,124,127,129,134,141,146,158,160] (see Table 4). A further 13 studies identified a partial impact on policy and regulation, in which NGOs temporarily influenced policy, such as halting mining licenses, or industry responded through voluntary actions [23,27,49,61,70,72,77,79,83,89,90,135,139,143]. ...
Background
Public health scholarship has uncovered a wide range of strategies used by industry actors to promote their products and influence government regulation. Less is known about the strategies used by non-government organisations to attempt to influence commercial practices. This narrative review applies a political science typology to identify a suite of ‘inside’ and ‘outside’ strategies used by NGOs to attempt to influence the commercial determinants of health.
Methods
We conducted a systematic search in Web of Science, ProQuest and Scopus. Articles were eligible for inclusion if they comprised an empirical study, explicitly sought to examine ‘NGOs’, were in English, and identified at least one NGO strategy aimed at commercial and/or government policy and practice.
Results
One hundred forty-four studies met the inclusion criteria. Eight industry sectors were identified: extractive, tobacco, food, alcohol, pharmaceuticals, weapons, textiles and asbestos, and a small number of general studies. We identified 18 types of NGO strategies, categorised according to the target (i.e. commercial actor or government actor) and type of interaction with the target (i.e. inside or outside). Of these, five NGO ‘inside’ strategies targeted commercial actors directly: 1) participation in partnerships and multistakeholder initiatives; 2) private meetings and roundtables; 3) engaging with company AGMs and shareholders; 4) collaborations other than partnerships; and 5) litigation. ‘Outside’ strategies targeting commercial actors through the mobilisation of public opinion included 1) monitoring and reporting; 2) protests at industry sites; 3) boycotts; 4) directly engaging the public; and 5) creative use of alternative spaces. Four NGO ‘inside’ strategies directly targeting government actors included: 1) lobbying; 2) drafting legislation, policies and standards; 3) providing technical support and training; and 4) litigation. NGO ‘outside’ strategies targeting government included 1) protests and public campaigns; 2) monitoring and reporting; 3) forum shifting; and 4) proposing and initiating alternative solutions. We identified three types of NGO impact: substantive, procedural, and normative.
Conclusion
The analysis presents a matrix of NGO strategies used to target commercial and government actors across a range of industry sectors. This framework can be used to guide examination of which NGO strategies are effective and appropriate, and which conditions enable NGO influence.
... As in the Ontario legislation, Bill C-32 defined little cigars as any cigar weighing 1.4 g or less or with a filter. Advocacy efforts for the flavour ban to include menthol cigarettes and flavoured smokeless tobacco were unsuccessful, 27 with the government stating that menthol cigarettes were not 'attractive' to youth and sales had been declining. 28 29 However, health advocacy was effective in countering tobacco industry opposition to Bill C-32. ...
... 28 29 However, health advocacy was effective in countering tobacco industry opposition to Bill C-32. 27 One effective advocacy approach was to show little cigars-in a wide variety of flavours and colourful packaging-to elected representatives on January 5, 2023 by guest. Protected by copyright. ...
Measures to ban or restrict menthol and other flavours in tobacco products are under consideration or newly implemented in an increasing number of jurisdictions across the world. As one of the world leaders, Canada’s experience in successfully developing and implementing such measures can be instructive for other jurisdictions. This paper explores the history of how Canada was able to implement tobacco flavour bans including menthol, examines some of the challenges and presents lessons learnt for other jurisdictions. The crucial motivation for these bans emerged from surveillance data showing high rates of flavoured tobacco use by youth, including menthol cigarette smoking, that was publicised by non-governmental organisations. Further data showed that early legislation in 2009 contained loopholes (cigar size exemptions and menthol exemptions) that limited the benefits of the legislation. Leadership by the provinces created an environment in which the federal ban on menthol ingredients in 2017 was a clear and obvious step to ensure implementation across the country. The Canadian measures have been successful at reducing the use of flavoured tobacco including menthol cigarettes and facilitating smoking cessation. Lessons learnt include the downsides of exemptions, the lack of a contraband issue (despite an existing supply in Canada), the benefits of availability of youth flavour prevalence data and the success of subnational regulations to advance national regulation.
... The themes identified in this case study are consistent with previous research on local, state, and national tobacco control policies that found that, among others, policy champions or change agents [7,[42][43][44], engagement with youth advocates [7,45], supporting data, and other localities previously enacting the policy influenced adoption [42]. Past studies also suggest that the absence of supporting data may have hampered states which attempted to adopt T21 early [6,7], but in later years, the IOM report proved powerful enough to elevate the attention of T21 as a tool to reduce youth tobacco use. ...
Despite the recent push for Tobacco 21 legislation in the US and the national adoption of Tobacco 21, there is a paucity of data on the process of policy adoption. To explore the key factors that served as facilitators or challenges to the passage of state T21 laws that apply to the sale of all tobacco products to anyone under 21 years of age, we conducted a comparative, cross-case study in ten states that adopted Tobacco 21 between 2016 and 2019. Stakeholders from selected states were identified via snowball sampling, and interviews were conducted from November 2018 to March 2020. Three primary factors emerged as facilitators to the passage of state T21 laws: (1) increased attention on e-cigarettes as the product driving an overall increase in youth tobacco use and depiction of an “e-cigarette epidemic”, (2) having at least one influential policy entrepreneur or champion, and (3) traction from other states or local municipalities passing T21 legislation. Challenges to T21′s success included (1) influence of the tobacco industry, (2) the bill’s low ranking among legislative priorities, and (3) controversy among advocates and policymakers over bill language. As e-cigarette rates spiked, T21 bills became legislative priorities, traction from other successful efforts mounted, and ultimately, the tobacco industry flipped from opposing to supporting T21 laws. Despite these favorable headwinds, advocates struggled increasingly to pass bills with ideal policy language.
... MSA has been applied in a number of policy arenas including public health (Lencucha et al. 2018), physical activity (Milton and Grix 2015) and gender violence (Colombini et al. 2016) and has evolved over time and place in response to a range of criticisms and refinements (Knaggård 2015). Rawat and Morris (2016) point out that this approach has been effectively applied to UK policy, especially in health, using primarily qualitative and case study methods. ...
... However, once the window is open, it does not necessarily mean that the outcome will be preferential to a particular interest group. For example, Lencucha et al. (2018) show how tobacco companies in Canada redesigned their devices or shifted to smokeless products to get around restrictions on flavoured tobacco, even though the political and policy stream firmly coupled to ban it. The 'agefriendly city' agenda in Belfast opened a type of discretionary window through the designation of WHO status, but as the analysis shows there are complexities to the way in which ideas travel through the streams, the barriers they invariably face and the extent to which they compete with other narratives to shape policy outcomes and political commitments. ...
This paper is concerned with the strategic policy processes, economic structures and tactics within which age and plac e programmes are formed, implemented and evaluated. The research draws on the Multiple Streams Approach to understand the relationship between problem identification, policy processes and politics and how they come together to respond to the needs of older people. Drawing on Belfast (UK) the paper examines the interactions between planning, health and social policies in the creation of an age-friendly city. The data questions the claim to age-friendliness given the way in which older people are increasingly shifted from the asset-rich urban core to the suburban periphery. It highlights the need to understand how structural processes, the property economy and an emphasis on speculative development have favoured policies based on gentrification in general and youthification in particular. The paper reflects on the limitations of the Multiple Streams Approach but also shows that the challenge of ageing and place is not simply one of weak integration or poor governance. The way in which interests, policies and politics shape better outcomes for older people needs to be factored into initiatives to create a more inclusive approach to urban planning.
... [1][2][3] While over 200 localities and two states in the United States have now implemented flavor bans on tobacco, very few countries have banned menthol cigarettes. [4][5][6][7][8][9] As an exception, Canada has implemented a now national ban to address the issue of high rates of menthol cigarette use among youth. 4 Other nations such as Brazil, Ethiopia, Turkey, and the European Union have passed regulations to ban menthol tobacco products and the EU directive is to come into force May 2020. ...
Background and Aims
The province of Ontario, Canada, banned the use of menthol-flavoured tobacco products as of January 1 st, 2017. This study aims to assess the longer-term impact of a menthol ban on smoking behaviour at two years, which is unknown.
Methods
Population cohort study with baseline survey (n=1821) conducted September-December 2016 and follow-up survey January-August 2019 among current smokers in Ontario (16+) prior to the menthol ban. Poisson regression was used to assess probability of quitting smoking by pre-ban menthol status, controlling for differences in smoking and demographic characteristics, with multiple imputation used to address missing data.
Findings
Menthol smokers were more likely to report having quit smoking (12% (daily menthol) and 10% (occasional menthol) vs. 3% (non menthol); p<0.001) than non-menthol smokers in the two years after a menthol ban. After adjustment for smoking and demographic characteristics, daily menthol smokers had higher likelihood of quitting smoking (ARR 2.08; 95% CI 1.20-3.61) and reported more quit attempts (ARR 1.45; 95% CI 1.15-1.82). Among those who attempted to quit, menthol smoking was not associated with relapse (daily ARR =0.96; 95% CI: 0.86, 1.07; occasional ARR= 0.99; 95% CI: 0.90, 1.08). However, there was a statistically significant interaction among menthol users who reported using other flavoured tobacco products one year after the ban (ARR=0.26 (95%CI: 0.08, 0.90)
Conclusions
The study found increased probability of quitting among daily menthol smokers and more quit attempts among daily and occasional menthol smokers compared with non-menthol smokers in Ontario two years after the implementation of a menthol ban.
... Theoretical models exist for analysing the agenda-setting process with the predominant ones including Hall et al.'s model and Kingdon model (Buse et al., 2012). The Kingdon model is considered the most suitable for NCDs policy analysis, having been used extensively in health policy analysis (Lencucha et al., 2018). Also, its streams are deemed best fit to understanding the agenda-setting process that reflects the sustenance of the NTCA on the policy agenda and its subsequent adoption. ...
... The model has been extensively used in health policy analysis (e.g. Lancaster et al., 2014;Whiteford et al., 2016;Lencucha et al., 2018). Kingdon conceptualized that policy emerges through the agenda-setting phase of the policy process by the aligning and convergence of three independent continuous streams (problem, politics and policy streams) at an open policy window (Kingdon, 1984;Buse et al., 2012). ...
... The disconnected nature of the Kingdon's three streams connotes that action is required to converge these independent streams at the policy window (e.g. Whiteford et al., 2016;Lencucha et al., 2018). Consequently, a primary role is played by policy entrepreneurs within and outside the government in shaping the course of these three streams and their intersection by connecting the problems and policy solutions with political opportunities (Béland and Howlett, 2016). ...
Non-communicable diseases (NCDs) have emerged as a public health issue of concern in Nigeria. The massive increase in tobacco use amongst different population groups is a common NCDs risk factor. To this effect, the National Tobacco Control Act (NTCA) was enacted following the WHO Framework Convention on Tobacco Control (FCTC). This article conducts a health policy agenda-setting analysis of the NTCA using the Kingdon’s multiple streams model and analyses its implementation using the Principal-Agent theory. The purposive and snowballing sampling methods were used to select and review relevant peer-review literature. Other data sources included gray literature, government reports, Non-Governmental Organization briefs and media resources. Though NTCA conforms to WHO FCTC, Nigeria only domesticated her obligation to this framework legislatively while the executive and administrative measures were found lacking. The challenges and gaps identified in the NTCA implementation include; revision of textual health warnings and lack of pictorial health warnings on cigarette packs, poor taxation, and the National Tobacco Control Commission’s (NTCC) lack of regulatory autonomy, hence, the poor policy implementation reported in this article. To effectively implement NTCA, a review of textual warnings, enforcement of pictorial warnings, regulatory autonomy of the NTCC and review of the tobacco taxation are suggested to help in the prevention and control of NCDs.
... Additionally, qualitative studies have sought to examine implementation and enforcement of other types of tobacco policies across various locations in North America. Several echoed findings from this analysis, including the value of education campaigns and media engagement 10 21 22 ; the role of local organisations, actors and partnerships [22][23][24][25] ; and strong enforcement mechanisms. 21 Key challenges resonant with our findings included issues with policy loopholes, 24 retailer opposition 10 and industry pushback and lawsuits. ...
Objective To identify recommended components for adopting, implementing and enforcing bans or restrictions targeting flavoured tobacco products.
Methods Between April and June 2019, semistructured interviews were conducted with 17 high-level experts across the USA and Canada with expertise in flavoured tobacco product policies. Participants included health department staff, researchers, legal professionals and local government officials. Interviews were recorded, transcribed and analysed for key themes.
Results Major findings were organised into four categories: programme planning and legislative preparations; education and community outreach; implementation and enforcement; and policy impact. Critical pre-implementation elements included using comprehensive policy language, identifying enforcement agents, examining potential economic costs, deploying media campaigns and engaging community partners and retailers. Recommended implementation processes included a 6-month preparation timeline, focus on retailer education and clearly outlined enforcement procedures, particularly for concept flavours.
Conclusions Flavoured tobacco policies have successfully limited sales, withstood legal challenges and become more comprehensive over time, providing useful lessons to inform ongoing and future legislative and programmatic efforts. Identifying and sharing best practices can improve passage, implementation, efficacy and evaluation of flavoured tobacco policies.
... During these processes, a large part of the solvent vapours containing the different flavourings adhere to the mucosal membranes along the surface area of the respiratory system. Unlike the food and vaping industry, the use of flavouring in conventional cigarettes is banned in most countries, apart from menthol that is still being used in some countries, so it is difficult to understand why they are approved for use in smoking's safer alternative 66 . The main issue relates to their mode of absorption and interaction with the surface mucus during inhalation, since a wide range of compounds are skin irritants at higher levels, with unclear consequences in the respiratory system. ...
Food flavour ingredients are required by law to obtain prior approval from regulatory bodies, such as the U.S. Food and Drug Administration (FDA) or the European Food Safety Authority (EFSA) in terms of toxicological data and intended use levels. However, there are no regulations for labelling the type and concentration of flavour additives on the product, primarily due to their low concentration in food and generally recognised as safe (GRAS) status determined by the flavour and extract manufacturers' association (FEMA). Their status for use in e-cigarettes and other vaping products challenges these fundamental assumptions, because their concentration can be over ten-thousand times higher than in food, and the method of administration is through inhalation, which is currently not evaluated by the FEMA expert panel. This work provides a review of some common flavour ingredients used in food and vaping products, their product concentrations, inhalation toxicity and aroma interactions reported with different biological substrates. We have identified several studies, which suggest that the high concentrations of flavour through inhalation may pose a serious health threat, especially in terms of their cytotoxicity. As a result of the wide range of possible protein-aroma interactions reported in our diet and metabolism, including links to several non-communicable diseases, we suggest that it is instrumental to update current flavour- labelling regulations, and support new strategies of understanding the effects of flavour uptake on the digestive and respiratory systems, in order to prevent the onset of future non-communicable diseases.
... The tobacco control programme in Canada has commenced and is being practiced since the late 1980s by the introduction of the US Family Smoking Prevention and Tobacco Control Act, prior to the FCTC initiated by WHO (Lenchucha, 2018). This initiative adopted the components of the rationalism during its development which incorporate the situational analysis of the current tobacco issues, problems and consequences of all available options identified from multi-stakeholder, and selecting the optimum rational decision. ...
