Challenges and lessons learnt from a workplace based program to control tobacco use in Tunisia 2009-2014

Abstract

Background Tobacco use has become the leading preventable cause of death worldwide. Therefore, Tunisia has ratified the WHO Framework Convention on Tobacco Control in 2010. Objectve: We aimed to outline an experience of implementing a workplace based program of tobacco control in Sousse, Tunisia (2009-2014) in order to identify barriers and recommendations for future interventions in low and middle income countries. Methods We conducted a quasi-experimental study among a representative sample of employees in Sousse, Tunisia with two groups, intervention and control. Our three years workplace program consisted of a collective intervention (Smoking free workplace, open sensitization day : films and workshops on tobacco harmful effects) and an individual one (Free clinics for tobacco cessation offering free nicotine replacement therapy products). Participants enrolled at the pre intervention and post intervention assessments belonged to two independant samples in each group. Results Overall, the intervention showed positive effets in improving the knowledge of the participants on the harmful effects of active and passive smoking and on light cigarettes. The intervention was associated to a significant increase of the employers involvment in tobacco control efforts. Regarding the smoking behaviors, in the intervention group, the prevalence of tobacco use decreased from 39.2% at the pre-assessment to 37.5% at the post assessment (p=0.43) with no substantial difference in the number of cigarettes consumed. Conclusions Despite the absence of positive effect of this project on smoking behavior, severall lessons may be deducted and it would be therefore considered as a corner stone. The fight against tobacco use is dependent on deep environmental changes. The role the employer is crucial but not sufficient. A multisectoral approach garanteeing an actual involvement of all the stakeholders and topped by a political will is strongly needed.

Keywords

• WCTOH