Name/Position: _________________________________________________________
Government Agency: ___________________________________________________
Is your agency concerned with public health policy in relation to tobacco control? Find out more by answering the questions below:
IS YOUR AGENCY INVOLVED IN:
Ο The development or approval of policies, programs, and projects that may be related to tobacco control?
Ο The development and/or implementation of health-related policies and programs?
Ο The promotion of the welfare of vulnerable sectors including protecting the sector’s health?
Ο The development or implementation of policies on tobacco taxes and/or licenses (e.g., collects taxes or fees on tobacco and related products or proposes measures that affect the rates of taxes, fees, and duties)?
Ο The registration and licensing of or collection of any type of information from tobacco companies?
Ο The development or implementation of government policies relating to the promotion of integrity, transparency, and accountability of public officials?
Ο The interpretation and enforcement of relevant laws or policies such as tobacco-regulation laws (e.g., smoking bans, advertising bans, tobacco smuggling, tax evasion), as well as laws that promote integrity, accountability, and transparency of public officials?
Ο The development and implementation of policies, plans, and programs relating to the alleviation of poverty and attainment of targets of the Sustainable Development Goals (SDGs)?
HAS YOUR AGENCY:
Ο Signed any contract with the tobacco industry?
Ο Accepted, supported, or endorsed policy drafts from the tobacco industry? Given awards to the tobacco industry?
Ο Entered into partnerships or agreements with the tobacco industry?
Ο Received contributions from the tobacco industry?
Ο Given any privilege, incentives, or benefits to the tobacco industry?
Ο Participated in tobacco industry’s “socially responsible” activities?
Ο Allowed any publicity of tobacco industry’s so-called “socially responsible” activities?
Ο Allowed interaction with the tobacco industry that is not strictly necessary for its effective regulation?