Programa Nacional de Prevención y Control de Tabaquismo

Objectives

Cuba’s tobacco prevention and control programme is an intersectoral, multidisciplinary national strategy, initiated in 1988 following a 1985 anti-smoking campaign. It addresses health promotion, education, surveillance, cessation treatment, rehabilitation, research, evaluation, monitoring and legal enforcement, in response to tobacco’s substantial contribution to preventable disease and mortality.[1][2]The programme is intended for nationwide implementation over seven years, covering the general population and prioritising children, adolescents, young people, pregnant women, active and passive smokers, and health and education personnel.[2][3]

• Reduce overall smoking prevalence by 4% each year, with particular attention to adolescents, young people and pregnant women.[2]
• Reduce cigarette consumption per capita and lower smoking prevalence among health workers by 6% annually.[2]
• Reduce smoking initiation among children and adolescents by 1% annually and reduce passive smoking by 1.2% annually.[2]
• Prevent tobacco uptake among young people, protect non-smokers from environmental tobacco smoke, and provide treatment for people wishing to stop smoking.[4]
• Strengthen tobacco-control education in teacher and health-worker training, improve anti-tobacco curricula at all levels, and reinforce health and education workers’ role-modelling responsibilities.[5]
• Conduct two communication campaigns annually, initially directed at young people and health personnel.[5]
• Ensure cessation and rehabilitation services at health-area level, including natural and pharmacological replacement therapies and accessible public information.[5]
• Develop research on the socioeconomic, sociological, psychological and environmental determinants of tobacco use, as well as the reach, acceptance and effects of education and interventions.[6]

The programme combines population-level prevention with measures addressing tobacco-related health consequences, which include reproductive, respiratory, cardiovascular, oncological, dental, skeletal, emotional and immune effects.[7][8]Evidence cited in the material associates smoking exposure during pregnancy with restricted intrauterine growth, low birth weight and premature birth, supporting the prioritisation of pregnant women.[9]

Its legal and economic agenda seeks comprehensive tobacco-control legislation covering retail sales, advertising, promotion, sponsorship, sales in health, education and sports settings, health warnings, product constituents and tobacco pricing.[5]Proposed product measures include graphic health warnings covering 100% of one principal face of cigarette packets and maximum cigarette contents of 10 milligrams of tar, 1 milligram of nicotine and 10 milligrams of carbon monoxide per cigarette.[5][6]

Implementation

Implementation relies on coordinated, intersectoral action supported by a legal framework, institutional action plans and systematic oversight at national, provincial and municipal levels.[10][2][3]The Ministry of Public Health leads coordination, particularly through the National Centre for Health Promotion and Education and the Hygiene and Epidemiology area, alongside other ministry departments and participating institutions.[3]An intersectoral working group is supported by a permanent or ad hoc technical group comprising Ministry of Public Health specialists and representatives of other organisations.[3]

• Translate the national strategy into action plans for each participating institution, covering surveillance, information, education, communication, treatment access and legal measures.[2][3]
• Develop institutional plans, enforce legal instruments, promote smoke-free workplaces, train managers and incorporate compliance with the 2005 Executive Committee of the Council of Ministers Agreement No. 5570 into managers’ ethical codes.[3]
• Strengthen surveillance of tobacco use, exposure to tobacco smoke and compliance with tobacco-control legislation.[3]
• Establish a social communication strategy and reinforce tobacco education among teaching managers and positive role models among health and education workers.[3]
• Submit updated tobacco-control legislation, including bans on sales of individual cigarettes and packs containing fewer than 20 cigarettes, tobacco advertising, promotion and sponsorship, and tobacco sales in health, education and sports centres.[5]
• Remove cigarettes from the basic basket and increase prices for manufactured tobacco products in all currencies.[5]

The delivery model extends beyond health authorities to bodies involved in tobacco cultivation, production, consumption and marketing, as well as health promotion, education, surveillance, treatment, rehabilitation, research and enforcement.[2]Participating public institutions include ministries responsible for agriculture, domestic trade, justice, education, higher education, science and the environment, culture, finance, planning, labour and social security, transport, tourism, communications and other sectors, together with the National Statistics Office, the national sports institute and local People’s Power bodies.[3][11][12]

Social participation is envisaged through youth and student organisations, the Federation of Cuban Women, neighbourhood defence committees, small farmers’ organisations, the national workers’ confederation, public-health workers’ representatives, media and cultural organisations, and journalist and artists’ bodies.[5][12]This broad partnership reflects evidence from Ciego de Ávila and Matanzas that intersectoral, community-based work combined with a strong legal component can support participation, action and evaluation.[10]

Operational accountability includes annual evaluation of central government and organisational action plans, with systematic implementation monitoring by the Ministry of Public Health and provincial health directorates.[6]Surveillance is to track smoking prevalence, exposure to environmental tobacco smoke, smoking among health and education workers, and addiction initiation biennially, while marketing, consumption, prices, legal compliance and tobacco-attributable mortality and morbidity are assessed annually.[6]The material does not specify a dedicated programme budget, financing source, detailed resource plan or formal accountability procedures beyond these monitoring arrangements.[5][6]

Monitoring & Evaluation

The programme combines routine surveillance, periodic outcome measurement, annual review and multi-level implementation control. Its monitoring focus covers tobacco consumption, exposure to tobacco smoke, compliance with legislation, health effects and intervention impact.[2][3][6]

• Maintain systematic control of implementation at national, provincial and municipal levels.[2]
• Monitor tobacco consumption and use, exposure to environmental tobacco smoke, and compliance with current tobacco-control legislation.[3]
• Use annual outcome objectives to assess reductions in overall smoking prevalence, cigarette consumption per capita, smoking among health workers, smoking initiation among children and adolescents, and passive smoking. The programme targets annual reductions of 4% in smoking prevalence, 6% among health workers, 1% in initiation among children and adolescents, and 1.2% in passive smoking.[2]
• Track smoking prevalence among the general population and selected sociodemographic groups, exposure to tobacco smoke, smoking among health and education workers, and addiction initiation every two years.[6]
• Assess tobacco-product marketing, consumption and prices, legal compliance, and tobacco-attributable mortality and morbidity annually.[6]
• Evaluate annually the action plans of central government bodies and participating organisations. The Ministry of Public Health and provincial health directorates have responsibility for systematic implementation monitoring.[6]
• Use research to assess the socioeconomic, sociological, psychological and environmental dimensions of tobacco use, as well as the acceptance, reach and impact of educational messages and interventions.[6]

Surveillance is intended to involve the Ministry of Public Health and its relevant units, alongside the Ministries of Agriculture, Domestic Trade and Justice, the National Statistics Office, and the Cuban Centre for Youth Studies.[3]Programme coordination is led by the Ministry of Public Health, including the National Centre for Health Promotion and Education and the Hygiene and Epidemiology area, supported by an intersectoral working group and specialist technical groups.[3]

The evidence base includes smoking prevalence, environmental tobacco-smoke exposure, age of initiation, cancer incidence and mortality. Lung-cancer mortality was reported as 4,819 deaths, or 42.7 per 100,000 inhabitants, in 2007, compared with 4,484 deaths, or 39.8 per 100,000, in 2005.[4]Mortality data for malignant tumours of the trachea, bronchi and lungs for 1998 to 2007 were reported by sex using rates per 100,000 inhabitants, with the National Directorate of Statistics identified as the source.[9]

The source does not specify standard reporting formats, data-quality procedures, public reporting arrangements, sanctions for non-compliance, or formal accountability processes beyond institutional monitoring, legal-compliance surveillance and annual action-plan evaluation.[2][3][6]

Costing & Financing

No dedicated programme budget, costed implementation plan, financing source, resource-mobilisation arrangement, funding-gap estimate or economic assumption is specified.[2][3][5][6]

• Remove cigarettes from the basic basket, for which cigarettes accounted for 26.2% of sales in national currency in 2007.[5]
• Increase prices for manufactured tobacco products in all currencies as an economic tobacco-control measure.[5]
• Develop tobacco-price policy as part of proposed comprehensive tobacco-control legislation.[5]

The material therefore identifies price and product-availability measures, but does not quantify proposed price increases, estimate revenue effects, allocate resources for cessation services, communication campaigns, surveillance or enforcement, or identify funding responsibilities for participating institutions.[5][6]