Tobacco Control Legislation in Small Island Nations: Adoption of WHO FCTC Article 13 in the Federated States of Micronesia

Introduction: The national government of the Federated States of Micronesia (FSM) has targeted1 a 5% reduction in tobacco smoking prevalence by 2024 (adult baseline: 30.8%, and youth: 27.3% in 2014).1 The WHO Framework Convention on Tobacco Control (FCTC), ratified by FSM in 2005, facilitates the reduction of tobacco use through the implementation of evidence-based policies, such as the ban of tobacco advertising, promotion, and sponsorship (TAPS; Article 13). The national report (2020)2 to the WHO FCTC Secretariat on domestic TAPS policies does not provide a qualitative assessment of the legislative context, the existing loopholes, or how the local policy environment affects implementation and enforcement. This qualitative health policy analysis aims to fill in these gaps.

Methods: We employed the health policy triangle model3 on 308 documents collected from publicly available resources (see online Supplementary Appendix 1). We excluded 269 irrelevant documents or with repeat information. We collected the data between November and December 2020 (except the Global Youth Tobacco Survey, 2019,4 collected in 2022). The thematic framework approach5 informed the study analysis of 39 documents (see framework index in data availability statement).

Results: Adoption of TAPS Provisions due to International Commitments

All TAPS-related provisions were adopted and implemented in FSM due to commitments developed with international organizations. For example, following the Regional WHO recommendations for TAPS bans, several TAPS provisions were introduced during the 1993-1994 period (see Supplementary Appendix 2).

Five years after the WHO FCTC ratification, specifically, between 2010 and 2012, misleading descriptors on tobacco packaging were banned nationally, Chuuk State banned tobacco industry sponsorship and introduced fines for any violations, while Pohnpei State prohibited tobacco advertising and promotion, exempting advertising that either originated outside the state or was due to incidental media placement.

The WHO FCTC Secretariat’s assessment (2012)6 identified policy gaps and areas requiring further action (see Table 1). These recommendations facilitated the FSM Congress to create the Tobacco Control Act of 2016. The same year, Pohnpei also banned tobacco product displays at retail outlets.