Doctoral Defence of Arti Singh on March 10th, 2023

The doctoral dissertation of MD Arti Singh in the field of epidemiology and public health, titled Tobacco Control in Ghana – Evidence from Qualitative and Cross-sectional Studies, will be publicly examined at the Faculty of Social Sciences of Tampere University at 12 o’clock on Friday, 10 March 2023. The public defence will be held in auditorium F114 of the Arvo Building, address: Arvo Ylpön katu 34, Tampere. The opponent will be Professor Pekka Puska from the University of Helsinki and the University of Eastern Finland. The Custos will be Adjunct Professor Tarja Kinnunen from Tampere University.

Tobacco use remains the leading cause of preventable death worldwide. More than 80 percent of the world’s tobacco-related deaths will be in low- and middle-income countries by 2030, and Africa is no exception. However, research on tobacco control policy and its implementation in several African countries including Ghana remains low. Using qualitative and quantitative approaches, MD Arti Singh examined three areas of tobacco control in Ghana; warnings on cigarettes pack; second hand smoke exposure among hospitality venue staff, and the sale of illicit cigarettes.

The World Health Organization Framework Convention on Tobacco Control provides a set of evidence-based and cost-effective policies to spearhead the global response to the tobacco epidemic. In order to reduce tobacco-related harm, governments need to take urgent action to fully implement the Convention.

Ghana was among the first few countries to ratify the Framework Convention on Tobacco Control. But the country has been slow to implement many of the articles in the convention. These include cigarette pack warnings; policies to reduce second hand smoke exposure and the illicit cigarette market.

Research shows that large, picture-based, or pictorial health warning labels on cigarette packages are an effective strategy to reduce tobacco use. The qualitative study conducted in 2014 – prior to the introduction of pictorial warnings in Ghana shows that both smokers and non-smokers felt a combination of both pictures and texts was more effective than just texts on their own or just pictures on their own in conveying the health dangers of tobacco.

“Pictures don’t lie, seeing is believing” (adult male smoker)

The behavior of smokers was most affected by health warnings and pictures of lung cancer, blindness, stroke, and throat and mouth cancer. Currently, all tobacco products sold in Ghana are required to have pictorial as well as text warnings.

Secondly, an assessment of second hand smoke exposure in hospitality venues in the three largest cities in Ghana indicated an improvement from earlier studies based on air quality measurements.

Hospitality venues in the capital city (Accra) had the lowest rate of compliance with the smokefree policy, and poorer air quality than hospitality venues in the other two cities.

With respect to the type of hospitality venues, hotels were found to be three times more compliant with the policy as compared to bars and pubs. Hospitality venue workers were supportive of a ban on smoking in public areas, including hospitality venues, notwithstanding inadequate knowledge and low compliance levels with the present policy.

Finally, an examination of illicit cigarette sales from a pack survey in eight cities including border and non-border cities revealed that one in five cigarette packs sold in Ghana was illicit. A large proportion of the illicit packs originated from border countries around Ghana including Togo, Nigeria, and Cote d’Ivoire.

Factors such as convenience stores, border towns, lower pack prices, and the northern zone of the country were found to be drivers of illicit cigarette sales in Ghana.

The findings provide a basis for policy dialogues to place tobacco control in Ghana’s national health agenda and constitute a case for better implementation of the Framework Convention for Tobacco Control. This is also in line with Ghana’s commitment to reduce premature death from noncommunicable diseases by one-third by 2030 within the United Nations Sustainable Development Goals.

The doctoral dissertation is available online.
The public defence can be followed via remote connection.