Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Community driven tobacco surveillance system: Engaging communities to monitor tobacco industry using a mobile app(EUEP European Publishing, 2021) Perera, C.N.S; Perera, K.M.N.; Wijesuriya, H.; Kandeepan, S.; Periyannan, D.; Lakmal, P.A.C.S.; Fernando, A.B.I.; Rajasuriya, M.INTRODUCTION: Centre for Combating Tobacco (CCT) is the tobacco observatory in Sri Lanka established under the FCTC Article 5.3. CCT has experimented several resource-efficient methods in low-resource settings. Sri Lanka, a developing lower-middle income country, reports user rates closer to 100% for smart mobile device and social media. OBJECTIVES: To effectively engage the public in monitoring tobacco industry interference and activities (TIIA) METHODS: “Tobacco Unmasked HotSpots” (TU-HotSpots) mobile app, was developed and launched in two stages. The preliminary launch (May 2018) was to pilot the app for feasibility and acceptability. A community network to monitor TIIA, Community-Driven Tobacco Surveillance System (CDTSS) using an upgraded app (based on the pilot project findings) was launched in March 2019. Freely downloadable from any mobile app store, TU-HotSpots enables registered users to report TIIA under three categories: “Report a HotSpot” (geographical location of TIIA (Articles 5.3, 6, 12, 13, 15, 16), “Interference through Media” (Article 13) and “Tobacco Industry contacted me” (Article 5.3). Data is fed to the TU-HotSpots Map, a website with an interactive map and a dashboard of interactive graphs and charts after reviewing and approval by the CCT team. RESULTS: Two evaluations done to explore the feasibility and acceptability revealed that 91.4% (n=54) agreed this app would be useful in tobacco control and 82.8% (n=48) stated that it would be accepted by the public. Inadequate technological knowledge and interrupted online connection were the perceived challenges for implementation. Active promotion using organized trainings among youth and field officers were the main suggestions for improvement. As at October 2019, 289 registrants reported 786 incidents; with 315 approved “Report a HotSpot” and 383 approved “Interference through Media” reports. “Tobacco Industry contacted me” category only had a one reporting. CONCLUSION(S):A mobile app coupled with an actively established community network is an effective tool to engage the public in monitoring TIIA.Item Tobacco industry targeting political giants in Sri Lanka: Presidential candidates 2019(EUEP European Publishing, 2021) Kandeepan, S.; Perera, C.; Wijesuriya, H.; Dias, I.S.; Periyannan, D.; Perera, K.M.N.; Rajasuriya, M.INTRODUCTION: The presidential election to elect the 7th Executive President of Sri Lanka was held on November 2019. Ceylon Tobacco Company (CTC), a subsidiary of British American Tobacco (BAT), holds the monopoly of manufacturing and selling cigarettes in Sri Lanka, which has a comprehensive ban on tobacco advertisement, promotion and sponsorship under the National Authority on Tobacco and Alcohol (NATA) Act. OBJECTIVES: To explore tobacco industry (TI) engagements of the 2019 presidential election candidates. METHODS: Investigative research techniques were used. Key informant interviews, news reports, online content, industry reports and community-level documentary evidence were used. A deductive data analysis approach was used based on the themes ‘type of engagement’, ‘TI investment’ and ‘potential impact’. RESULTS: All three top ranked candidates depicted a positive result. Two had a history of direct engagement with the CTC and the other declared support for beedi industry during the election campaign. The engagements of the candidate who was a former Defence Secretary included accepting sponsorships to construct police stations and Army welfare shops. Police are one of the authorized officers of the NATA Act and Sri Lanka Army distributed tax free cigarettes for its soldiers until recent past. The candidate who was a former Agriculture Minister accepted CTC sponsorships for renovation of water reservoirs. CTC cultivates almost all tobacco they need for manufacturing cigarettes and is accused of exploiting the Sri Lankan farmers during the process. One candidate was the guest of honour of the opening ceremony of a pilgrim’s rest in a Buddhist shrine constructed with CTC sponsorship (around 70% of Sri Lankans are Buddhists). All TI engagements of these leading politicians received positive media coverage. CONCLUSION(S): TI engaging main political figures in Sri Lanka has potential to cause serious policy implications, thus, highlights the need for a national policy for implementation of the FCTC Article 5.3.Item Tobacco industry interference against the single stick cigarette sales ban(EUEP European Publishing, 2021) Kandeepan, S.; Perera, K.M.N.; Wijesuriya, H.; Perera, C.S.; Rajasuriya, M.INTRODUCTION: Sri Lanka implemented 80% Pictorial Health Warnings and is planning to implement standardised packaging. However, a considerable proportion of smokers buy cigarettes in the loose form. Sale of cigarettes as single sticks promotes smoking among minors, beginners and poor due to high affordability and accessibility. In September 2018, Health Minister proposed to ban sale of single sticks as recommended by the Framework Convention on Tobacco Control. The proposal failed to gain Cabinet approval preventing its implementation. OBJECTIVES: This study aimed to explore the tobacco industry’s tactics in sabotaging the proposed ban on single stick sale of cigarettes in Sri Lanka. METHODS: Investigative research techniques were used. Content analysis was carried out on identified web posts and documents to determine the tobacco industry’s strategic involvement, their front groups and arguments used. RESULTS: First argument, the ban would reduce government tax revenue due to reduction of cigarette sales, was made by three parties: cigarette industry, media and Minister of Finance (MoF). The strongest advocate against the ban was the Tobacco Retailer’s Association (TRA), backed by the Ceylon Tobacco Company (CTC). TRA’s argued that retail business would be impacted, again because of reduced sales. TRA directly advocated MoF via a meeting. Third argument, used by the MoF was that the ban would increase beedi use. The cabinet rejected the ban as MoF and three other ministers opposed. CONCLUSION(S): CTC successfully interfered in the ban on single sticks cigarette sale through the TRA, media and the MoF, arguing that resulting reduced cigarette sales would generate a negative impact.Item Advocating university undergraduate students on implementing FCTC Article 5.3(EUEP European Publishing, 2021) Kandeepan, S.; Perera, K.M.N.; Wijesuriya, H.; Perera, C.S.; Rajasuriya, M.INTRODUCTION: Tobacco industry uses aggressive strategies to use to make people want to buy their products, especially youths. Therefore It is needed to enhance the knowledge about industry tactics among the youngsters. OBJECTIVES: Establishment of network with university undergraduates to combat tobacco industry interferences in public health in Sri Lanka. METHODS: Centre for Combating Tobacco (CCT) organized a series of advocacy sessions on Tobacco Industry Impact on Public Health and Framework Convention on Tobacco Control (FCTC) Article 5.3 targeting the university undergraduates in Sri Lanka. The first session was held on June 23rd, 2019. It was organized by a group of undergraduates currently working as volunteers with CCT to empower their peers in state university science stream faculties of the Western Province. In this session Industry’s impact on substance use and public health and direct and indirect promotion strategies, Tobacco industry interference in Sri Lanka, FCTC Article 5.3 and current activities by CCT to monitor tobacco industry interference on public health and implementation of FCTC Article 5.3 in Sri Lanka were discussed. Networking and establishment of action committees to support CCT activities with university undergraduate students were discussed. Results Opportunities for best practice strategies for tobacco interference control were identified. Policy adherence and enforcement was improved to raising the awareness with students. CONCLUSION(S): A majority of students supported the advocacy programme. A Network with university students was formed to combat the tobacco industry interference.Item Tobacco industry promoting its image makes use of religious practices in Sri Lanka(Sri Lanka Medical Association, 2019) Perera, N.C.S.; Lakmal, P.A.S.C.; Wijesuriya, H.; Fernando, A.I.B.; Dineshkumar, P.; Kandeepan, S.; Perera, K.M.N.; Rajasuriya, M.INTRODUCTION & OBJECTIVES: Seventy percent of Sri Lankans follow Buddhism, a philosophy that dissuades its followers from the use of psychoactive substances. The national tobacco control laws prohibit sponsorships promoting products and direct and indirect image promotion of tobacco products and its manufacturers. Recently, media reported of Buddhist religious practices that were supported by Ceylon Tobacco Company (CTC), British American Tobacco subsidiary holding monopoly in manufacturing and selling cigarettes in Sri Lanka. We aimed to explore CTC's engagement in religious activities and their potential impact. METHODS: This study is based on Tobacco Unmasked posts developed using investigative research techniques (keys 4 informant interviews and content analysis of photographs, media reports, websites and industry reports). Thematic analysis was used to explore the type of activity, CTC investment, potential impact and intensity of media coverage. RESULTS: Gangarama Wesak celebration zone, the main Wesak festival zone in Colombo, was sponsored by CTC proxies for three years. CTC sponsored construction of two pilgrims-rests in two popular pilgrimage sites, each ceremoniously declared open by the President and the Secretary of Defence. The direct interference in policymaking was noticeable in the "Bodhi-Pooja" which is said to be organized to empower the tobacco-farmers against the government's plan to eliminate tobacco cultivation by 2020. All these activities received wide positive media coverage. At community level, CTC financially supported numerous religious activities and infrastructure development of temples and worship sites situated in tobacco cultivation areas. CONCLUSION: Tobacco industry successfully uses religious practices to promote its image among the public and the policy makers at national and grass-root levels.Item Level of empowerment for tobacco control in a rural low-income district in Sri Lanka(Sri Lanka Medical Association, 2018) Perera, K. M. N.; Guruge, G. N. D.; Jayawardana, P. L.INTRODUCTION AND OBJECTIVES: Health is determined by a range of factors and health promotion incorporates enabling individuals and communities to have control over determinants of their health. Tobacco, a well-established determinant of ill-health, is portrayed as a factor that is difficult to be controlled Psychological empowerment for tobacco control encompasses an individual's sense of control over tobacco related issues, the foundation for strengthening community actions against tobacco. This study aimed to describe the psychological empowerment for tobacco control in Monaragla District.METHODS: The study used a cross-sectional descriptive design. Psychological empowerment was operationalized based on Zimmerman's definition into a 27 item scale under intrapersonal, interactional and behavioural domains. developed via a modified Delphi technique was validated for the local context. The interviewer administered tool assessed participants recruited via a multi-stage cluster sampling technique using a household (N=1160) survey RESULTS: Response rate was 98 6% (n=l 144). the majority (92 1 %; n=l054), felt they have a responsibility to participate in tobacco control even though only 21.9% (n=251) has ever participated in such activities at least once in their lifetime. Perceived mastery, motivation, competence, awareness and efficacy for tobacco control among participants were satisfactory. Interactional domain, assessing participants' preparedness to act, received the highest scores (M=23 5; SD=5 9) among all the domains.CONCLUSION: Perceived mastery, motivation, competence, awareness and efficacy for tobacco control were satisfactory. However, level of action did not match the levels of intrapersonal and interactional domains that reflect preparedness to act. Unused potential for tobacco control exists among the community to act against tobacco.