The Analysis of the Content of Tobacco Control Policymaking and Legislation in Iran and Providing Policy Solutions

---

Extended Abstract
Background
Tobacco use is one of the significant causes of illness and death worldwide and has extensive social and economic consequences. While there is extensive scientific evidence on the prevalence of tobacco use and its economic and social effects, there is still a lack of understanding of how policy environments influencing tobacco control policies interact and how tobacco control policies are formulated and implemented, particularly in low- and middle-income countries. In order to optimally influence public policies that affect tobacco control, a complete understanding of the content of policy and legislation seems essential. This study aimed to analyze the policies and measures of tobacco control in Iran during the last four decades.
Methods
The present qualitative case study analyzed tobacco control policies in Iran in the last four decades (1983-2021). We analyzed tobacco control policy in Iran by reviewing relevant policy documents. The documents mainly included policies, laws, regulations, and national survey reports regarding tobacco use. The research community included all documents related to tobacco use and all key informants and policymakers. We collected the data using a data collection form based on the conceptual framework of the research. Data collection was conducted in 2022. Qualitative data were also collected by reviewing the documents. The initial identification of political documents (laws, regulations, by-laws, circulars, approvals, meeting minutes, plans, and bills of the Islamic Council of Iran and other reports) was conducted by reviewing the studies published in Iran and the reports of interviews with key informants. The documents were obtained from tobacco use policy-related centers, institutions, and organizations. Based on the data collection form, the final data were extracted from these policy documents using framework analysis. MAXQDA 11 software was used to categorize and analyze the findings. We enhanced the stability of the study using an experimental review and a detailed review of the data by an external observer. Regarding the reliability of the study, the researcher considered the following: the long-term involvement of the researcher with the research environment and his continuous observations in such environment, including building trust with the subjects of the research, the researcher tries to maintain his focus on the study.
Results
There seems to be some inconsistency between the interventions of the tobacco control convention and hookah control in the country. The policies recommended in the convention are based on tobacco control evidence. As a result, the policies on hookah use are not appropriately implemented, mainly due to the unique nature of this kind of smoking compared to cigarettes. The cigarette market is well-known, and cigarettes are packaged in compact packets with uniform characteristics everywhere; however, this does not apply to hookah. Compared to cigarettes, hookahs are available in various shapes and sizes, with less portability, and are often shared among several individuals. These differences indicate whether the WHO Framework Convention on Tobacco Control (WHO FCTC) can be applied to hookah and whether it is appropriate. For example, there is a need for strict labeling policies for hookah tobacco and its accessories, given what we know about its toxic ingredients. An evaluation of the warning labels on hookah tobacco and its accessories in several countries found that none of the hookahs purchased were FCTC-compliant. In addition, misleading descriptions such as “nicotine percentage” and “tar percentage” were also common on hookah tobacco packages. Since some of these countries, such as Canada and Germany, have imposed strict regulations on cigarette labeling, the abandoned and contradictory situation in the field of hookah labeling shows that some legal and enforcement agencies do not consider the WHO FCTC labeling regulations appropriate and enforceable for hookah. Another critical issue is that labeling is required on hookah tobacco packets and many hookah accessories. Labeling is an essential social aspect among hookah consumers; in a coffee house or coffee shop, the customers are served with ready-made hookah but unaware of tobacco quality. The prevalence of hookah use is a significant challenge to effectively enforcing the public smoking ban. Since the serving of hookahs generates a sizable profit for coffee houses and coffee shops, they are persistent in overturning the ban on smoking in enclosed public places. Considering the characteristics of hookahs, imposing restrictions on hookah advertisements may also be ineffective. Many of these advertisements feature hookah equipment, such as charcoal, and infer that hookah is a healthier alternative to cigarettes. Therefore, due to the disproportion between WHO FCTC and other methods of tobacco consumption other than cigarettes, the policies regarding smoking methods such as hookah need to be modified, and their sensitivity to such methods should be increased.
Conclusion
Iran’s comprehensive tobacco control policies are based on the WHO FTCT. These policies include pricing and taxation; providing smoke-free areas; monitoring tobacco production; imposing regulations on the disclosure of information about tobacco products; packaging and labeling of tobacco products; educating and informing the public; monitoring the advertising, promotion, and financial support of tobacco sale; establishing measures to reduce tobacco addiction and encourage the cessation of tobacco use; restricting illegal tobacco products trading, particularly among youngsters; and providing financial support for economically viable alternative activities.