摘要：Objectives. We analyzed demographic and social network variables associated with the timing of ratification of the Framework Convention on Tobacco Control (FCTC). Methods. We compiled a 2-mode data set that recorded country participation in FCTC negotiations, as well as the number of individuals per country per year who joined an online tobacco control network. We used logistic regression analysis of these 2 data sets along with geographic location to determine whether exposure to prior FCTC adoptions was associated with a country's likelihood of adoption. Results. In the logistic regression analysis, higher income and more nongovernmental organizations (NGOs) involved in the Framework Convention Alliance (a network dedicated to the FCTC) were associated with being among the earliest adopters (for income, adjusted odds ratio [AOR] = 2.41; 95% confidence interval [CI] = 1.55; for NGOs, AOR = 1.66; 95% CI = 1.26, 2.17) or among early adopters (for income, AOR = 1.42; 95% CI = 1.09, 1.84; for NGOs, AOR = 1.23; 95% CI = 1.03, 1.45). Network exposure and event history analysis showed that in addition to income, the likelihood of adoption increased with increasing affiliation exposure to FCTC adopters through GLOBALink (an online network facilitating communication between tobacco control advocates). Conclusions. Public health programs should include a plan for creating opportunities for network interaction; otherwise, adoption and diffusion will be delayed and the investments in public health policy greatly diminished. Although the risks of tobacco smoking have been known for decades, the pandemic of tobacco use continues. There are now an estimated 1.3 billion smokers worldwide, along with millions more who use various oral tobacco products. 1 Tobacco is the leading cause of preventable death worldwide, resulting in about 6 million deaths per year. 2 Despite great progress in tobacco control, primarily in North America and Western Europe, the number of tobacco-attributable deaths is projected to grow substantially during this century, especially in low- and middle-income countries. In 1999, in recognition of the shift and growth in tobacco consumption and the potential for an enormous future burden of death and disease, the World Health Organization (WHO) member states initiated formal negotiations on an international treaty aimed at reducing this global threat. The Intergovernmental Negotiating Body (INB), which was charged with negotiating the text of the treaty, held 6 formal negotiating sessions in Geneva between 2000 and 2003. Over 170 states sent at least 1 delegate to 1 of the INB sessions. Scientific experts and representatives of advocacy networks also attended the negotiations, where they held seminars on technical aspects of the convention and distributed information to delegates. GLOBALink, an online network internationally recognized for facilitating communication between tobacco control advocates, was one such network. 3 In addition to the INB sessions, countless regional negotiating sessions and technical conferences were convened during the period. In May 2003, the 56th World Health Assembly unanimously adopted the WHO Framework Convention on Tobacco Control (FCTC). 4 The key provisions include a comprehensive ban on tobacco advertising, promotion, and sponsorship; a ban on misleading descriptors intended to convince smokers that certain products are safer than “standard” cigarettes (for example, the term lights in Marlboro Lights); and a mandate to place rotating warnings that cover at least 30% of tobacco packaging. The FCTC also encourages countries to implement smoke-free workplace laws, address tobacco smuggling, and increase tobacco taxes. The FCTC entered into force on February 27, 2005, 90 days after the 40th member state ratified the treaty. Further ratifications or its legal equivalent (acceptance or approval) continued over the next 4 years. As of May 2009, 168 countries were party to the treaty. The institutionalization of tobacco control within the WHO and the subsequent ratification of the FCTC by nearly all WHO member states provides an opportunity to analyze the system and network dynamics that facilitate global tobacco control diffusion. Diffusion refers to the process by which an innovation is communicated through certain channels over time among members of a social system. 5 The premise, which has been confirmed by empirical research, is that new ideas and practices spread through interpersonal contacts largely consisting of interpersonal communication. 5 , 6 Other researchers have investigated specifically how social networks provide the channels through which new ideas and practices, such as the FCTC, are spread. 5 – 7 Given studies of diffusion in other contexts, we hypothesized that the global diffusion of the FCTC has been partly driven by interpersonal communication and networking developed throughout the negotiation of the FCTC and facilitated through existing global tobacco control networks. In other words, we hypothesized that the extent of a country's participation in the FCTC negotiations and its citizens’ involvement in international tobacco control networks would be associated with early or late FCTC ratification. However, we also expected the predictability of these social network variables to be impacted to some extent by the structural and demographic aspects of states (e.g., location, population, income level, degree of political freedom, tobacco prevalence, and tobacco production). For example, a country with a high smoking prevalence may perceive tobacco control as more important and ratify sooner than a country with low prevalence. Conversely, a tobacco-producing and exporting country may view tobacco control as a threat to its financial success and resist ratification. Here we analyzed the structural, demographic, and social network variables that led individual countries to ratify the FCTC when they did and made a first attempt at specifying the driving forces behind global tobacco control diffusion.
