Could safer products such as nicotine pouches offer a solution to significantly high rates of tobacco use in Eastern Europe and Central Asia? Joining us today is Giorgi Mzhavanadze, an economist who has worked with Knowledge-Action-Change on the Global State of Tobacco Harm Reduction report, to highlight trends in tobacco use in the region.
Chapters:
0:00 - Coming up on today's programme 0:47 - Spotlight on EE&CA 3:19 - Smoking rates remain high 5:39 - What forms of tobacco are used in EE&CA? 6:55 - What is Nasvay? 8:32 - How do smoking rates compare across the region? 9:52 - Enforcement of tobacco control policies remains patchy 11:19 - GSTHR's mission to map regional tobacco useTranscription:
00:04
Joanna Junak: Hello and welcome. I'm Joanna Junak and this is GFN News on GFN.TV. Joining us today is Giorgi Mzhavanadze, an economist specializing in macroeconomics and health economics. He's an independent consultant who collaborates with research institutions on policy-relevant economic and public health research and has been involved in tobacco research since 2017. Over the past year, Georgi has worked with Knowledge Action Change on the Global State of Tobacco Harm Reduction Report, contributing to the section on Eastern Europe and Central Asia, where he examines regional trends in smoking, safer nicotine product use and harm reduction policies. Today, we will be exploring this region by asking Georgi a couple of questions. Hi, Georgi. Let's start with which countries are included in the Eastern Europe and Central Asia region in the report and what common elements connect them.
01:32
Giorgi Mzhavanadze: In our report, this region, Eastern Europe and Central Asia, refers to the following countries. It's Belarus, Ukraine, Moldova, South Caucasus countries, Armenia, Azerbaijan and Georgia, and Central Asian countries. such as Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. Collectively these countries have a combined population of over 180 million people and they share a common Soviet heritage which influence their healthcare infrastructure, economic and legislative frameworks as well. And many countries still follow Soviet-influenced public health models and have faced similar transitions since gaining independence in the 90s. And also additionally, the orientation of these countries towards broader international alliances nowadays significantly shapes their policies. For example, Georgia, Moldova and Ukraine have follow aspirations to join European Union, aligning with Western political structures and market economies, and this has impacted their tobacco control and taxation policies as well, which often reflect European Union standards, while countries such as Armenia, Belarus, Kazakhstan and Kyrgyzstan are members of the Eurasian Economic Union, seeking closer economic and political ties with the Russian Federation.
03:20
Joanna Junak: Okay, and what are the main challenges in tobacco control in the region?
03:26
Giorgi Mzhavanadze: First of all, the key challenge is the historically high prevalence of smoking among men. During the Soviet era, tobacco growing and production were state-run and consumption was actively encouraged by the state. After the Soviet Union collapse, global tobacco companies made significant investments in the region at a time when public health policy was not prioritized at all and tobacco control legislation in the region virtually was non-existent until the early 2000s. As a result, several countries in this region now rank among the top globally for male smoking. For instance, 56% of men in Georgia were current tobacco users in 2022. And close behind were Moldova, Kyrgyzstan, Armenia and Belarus, where every second man is a smoker. All of these countries placed within top 25 globally for tobacco use among men. And Georgia, for example, occupies a fifth position in this ranking. Another obstacle is inadequate enforcement of existing tobacco control laws due to limited resources. Additionally, misinformation often originating from health authorities themselves persist about new, safer nicotine products, leading people to believe that these products are as harmful or even more harmful than cigarettes. And finally, tobacco industry influence combined with reliance on tax revenues in these small economies can slow the adoption of stricter policies against combustible tobacco, leaving some regulations outdated or applied inconsistently as a result comprehensive tobacco control laws in this region were introduced only in the last five seven years and taxes on combustible products remain much lower compared to western standards so what are the most widely used forms of tobacco in the region Combustible tobacco products remain the most common form of tobacco use across the region. And recent data indicates that over 90% of tobacco users in the region primarily smoke manufactured cigarettes. In some lower income countries and populations, there is also market for hand rolled cigarettes because they are cheaper, partly due to lower taxation. Meanwhile, smokeless tobacco such as Nasuai is popular in some Central Asian countries. As of 2022, about one-third adults in Georgia, Moldova and Belarus were current tobacco users, while in Turkmenistan, for example, the prevalence was much lower at about 6%. And this brings the original average of tobacco use at 23% in Eastern Europe and Central Asia.
06:55
Joanna Junak: You mentioned Naswai. Can you tell us what it is and in which countries of the region it's highly popular?
07:06
Giorgi Mzhavanadze: Nasoai also known as Nasvar and it has also many different names is homemade smokeless tobacco product. It is typically a moist powdered tobacco often mixed with ash or select lime and placed under the tank or between the gum and lip. NASY is mostly unregulated and informally produced. It is cottage industry produced product, making it too hard to analyze the health impacts of the NASY. And health risks are not well studied, but concerns include oral health problems and potential toxicity from added substances. NASY is particularly popular in some Central Asian countries. countries, especially Tajikistan and Uzbekistan, where about 20% of men use them regularly, and in Kyrgyzstan as well, where about 10% of men reported currently use Nasoil. Also, it should be mentioned that in the region, not only use statistics, prevalence statistics of Nassau, but tobacco use is quite limited and data is limited.
08:32
Joanna Junak: OK, let's now talk about how smoking patterns and the population size of the country affect the number of tobacco users. What are the correlations?
08:45
Giorgi Mzhavanadze: Sure, logically, total number of tobacco users often correlate with population size. For instance, Ukraine has about 40 million people and a fairly high smoking prevalence leading to about 8 million total tobacco users, the highest count in the region. Ukraine then is followed by Uzbekistan with about 4 million tobacco user and Uzbekistan is quite interesting country because during the last 20 years it doubled its population and is one of the fastest growing country in terms of population around the world. In the region smaller countries like Georgia, Moldova or Armenia, they may have higher percentage of adult smokers and higher prevalence rates around 30%, but relatively fewer total smokers due to smaller population. Overall, there are about 23 million tobacco users in this region.
09:53
Joanna Junak: And which countries in the region have implemented comprehensive bans on tobacco advertising, promotion and sponsorship?
10:03
Giorgi Mzhavanadze: In Eastern Europe and Central Asia, most countries of the region have enacted comprehensive bans on tobacco advertising, promotion, sponsorship, which often extends to point-of-sale displays. Common restrictions throughout the region include a minimum age of sale, which is at 18 years, mostly health warnings on cigarette packs and various forms of public smoking bans. However, enforcement can be uneven and with some local shops, for example, still displaying tobacco products. It's also worth noting that In the recent wave of tobacco control legislations, which happened in this region during the last five years, many Eastern Europe and Central Asian countries have broadened their regulatory scope to include safer nicotine products, such as nicotine waves or heated tobacco products, or snus and nicotine pouches, subjecting these products to regulations and taxation similar to those applied to combustible tobacco.
11:20
Joanna Junak: Countries in the region, like others around the world, have implemented various strategies to improve tobacco control and harm reduction. What key strategies are mentioned in the report regarding the region we are discussing?
11:36
Giorgi Mzhavanadze: In our report, we mentioned several key strategies which should be implemented in the region. First, it's strengthening legislation and enforcement to ensure comprehensive coverage of all tobacco and novel products closing legal loopholes. And this is mostly concerning also taxation policies and gradually increase excise taxes on combustible cigarettes while keeping less harmful products more affordable to encourage switching and substitution and tobacco harm reduction in the region. It should be emphasized that in contrast with developed countries, developing countries around the world and developing countries in the region, see that safer nicotine products are much more expensive compared to combustible tobacco products. This makes the tobacco harm reduction and switching to safer nicotine products much more difficult for consumers and smokers in the region, especially for lower income countries. Public education as well, one of the key strategies. Launch large-scale campaigns to clarify the spectrum of risk among nicotine products and reduce misinformation and correct attitudes towards safer nicotine products in the region. And of course, last but not least, cessation support and medical support. uh cessation services in the region are de facto non-existent and improving access to cessation services and incorporating harm reduction into national tobacco control policies will uh much improve the situation around tobacco control and reducing smoking
13:41
Joanna Junak: Georgi, you mentioned that some safer nicotine products are much more expensive compared to combustible tobacco products, making them less accessible. So what potential role could other safer nicotine products play in harm reduction to help consumers switch to these safer alternatives?
14:04
Giorgi Mzhavanadze: Safe nicotine products, not only in the region, but globally can of course act as a lower risk alternatives for individuals who are unable or unwilling to quit nicotine consumption. And by removing combustion, the main source of carcinogens and health risks for smokers, SNPs can significantly reduce the harms linked to smoking. Our report suggests that in communities familiar, for example, with NASFY or similar smokeless forms in the region, these are countries in Central Asia, introducing regulated, less harmful options of smokeless oral products such as snus or nicotine pouches could help mitigate health risks. in these countries. And this strategy is most effective when paired with strong public education and appropriate regulatory standards to ensure product quality. However, we should mention that there is huge potential here to substitute the existing oral products like Nasvi, for which we don't know the health risks at the moment. As I told you before, these risks are understudied with safer oral products such as Snus and nicotine pouches but there are very high regulatory barriers for this and specifically in these countries kyrgyzstan uzbekistan and tajikistan of smokeless products are banned except nasa