When evidence is not enough: Political, legal, and coalition determinants of tobacco standardized packaging adoption in Brazil and globally
type: CreativeWork
description: ABSTRACTBackground Tobacco use remains one of the leading preventable causes of death worldwide, and reducing smoking continues to be a central public health priority. The WHO Framework Convention on Tobacco Control (WHO FCTC) has supported the diffusion of major evidence-based tobacco control measures, including tobacco standardized packaging (SP), a policy designed to reduce the marketing appeal of tobacco products, strengthen health warnings, and limit the pack’s function as advertising. Although evidence supporting SP has grown, adoption has been slow and uneven, particularly in low- and middle-income countries (LMICs). This uneven uptake highlights a broader policy challenge: how evidence and political commitment are translated through legal, institutional, and strategic contexts into adoption, redesign, or prolonged non-decision. Purpose The aims of this dissertation are: 1. To synthesize the global evidence on barriers and facilitators to tobacco SP adoption; 2. To examine how barriers and facilitators became consequential through agenda control, constitutional filtering, bicameral sequencing, and venue gatekeeping across Brazil’s Congress; and 3. To analyze how competing coalitions, their beliefs, and their strategic resources shaped SP outcomes across Brazil’s legislative venues. Methods In the first paper, I conducted a global systematic review of peer-reviewed studies on barriers and facilitators to tobacco SP adoption. I searched PubMed, Embase, and Web of Science for studies published in English between January 2005 and October 2025, screened records using predefined inclusion criteria, and extracted data into a framework integrating the Policy Dystopia Model, Multiple Streams Theory, and Strategic Action Typologies. In the second paper, I conducted a single-case, theory-guided process-tracing study of Brazil’s SP trajectory across the Federal Senate and the Chamber of Deputies. First, I reconstructed the dated legislative chronology from official congr…
abstract: ABSTRACTBackground Tobacco use remains one of the leading preventable causes of death worldwide, and reducing smoking continues to be a central public health priority. The WHO Framework Convention on Tobacco Control (WHO FCTC) has supported the diffusion of major evidence-based tobacco control measures, including tobacco standardized packaging (SP), a policy designed to reduce the marketing appeal of tobacco products, strengthen health warnings, and limit the pack’s function as advertising. Although evidence supporting SP has grown, adoption has been slow and uneven, particularly in low- and middle-income countries (LMICs). This uneven uptake highlights a broader policy challenge: how evidence and political commitment are translated through legal, institutional, and strategic contexts into adoption, redesign, or prolonged non-decision. Purpose The aims of this dissertation are: 1. To synthesize the global evidence on barriers and facilitators to tobacco SP adoption; 2. To examine how barriers and facilitators became consequential through agenda control, constitutional filtering, bicameral sequencing, and venue gatekeeping across Brazil’s Congress; and 3. To analyze how competing coalitions, their beliefs, and their strategic resources shaped SP outcomes across Brazil’s legislative venues. Methods In the first paper, I conducted a global systematic review of peer-reviewed studies on barriers and facilitators to tobacco SP adoption. I searched PubMed, Embase, and Web of Science for studies published in English between January 2005 and October 2025, screened records using predefined inclusion criteria, and extracted data into a framework integrating the Policy Dystopia Model, Multiple Streams Theory, and Strategic Action Typologies. In the second paper, I conducted a single-case, theory-guided process-tracing study of Brazil’s SP trajectory across the Federal Senate and the Chamber of Deputies. First, I reconstructed the dated legislative chronology from official congr…
author: Correia Borges, Luciana
language: en_US
language: English
keywords: Coalitions, Gatekeeping, Health Policy, Influence, Standardized Packaging, Tobacco
date published: 2026
date modified: 2026-07-27T21:47:25Z
provider: University of Nevada - Reno
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Nevada - Reno