Supplemental Material 2: Framework index.

Theme: Adoption of TAPS provisions due to international commitments
Sub-theme	Category	Coded Text	Source	
Response to Synar’s Amendment & WHO’s Regional Action Plan	First national tobacco advertising regulation 	Tobacco sales to minors are prohibited. In 1992, former US Representative Mike Synar of Oklahoma authored an amendment to the US Public Health Service Act (known as the Synar Amendment) which became law in 1993. Among other provisions, this amendment required all states to pass and enforce laws that barred the sale of tobacco products to anyone under the age of 18 years, and provided for random unannounced inspection of stores to assure compliance. The FSM is treated as if it were a state for US federal grant application purposes, and is thus bound by the Synar Amendment if it seeks such funds. In 1994, the US Center for Substance Abuse Prevention (CSAP) threatened to withhold the grant funds used to support the FSM's ment~ health, drug and alcohol abuse programmes until each FSM state came into compliance with the Synar Amendment. In response to this pressure, all four states of the FSM enacted relevant laws. Kosrae State already had made it illegal to seU tobacco to a minor in April 1992, and so they only had to add legislation concerning the inspection of retail premises in August 1994. The other three states all passed laws in conformity with the Synar Amendment between June and August 1994.

Tobacco advertising is prohibited. Although these laws were stimulated by outside funding pressure, the state legislators took the opportunity to add various other tobacco control measures not specifically required by the Synar Amendment. For example, Chuuk, Pohnpei and Yap States banned the advertising of any tobacco product

Thus the potential funding crisis produced by the Synar Amendment led to an abundance of progressive public health legislation concerning tobacco (and alcohol) control in the FSM states.

Section 1. Title 41 of the Code of the Federated States of the Federated States of Micronesia is hereby further amended by adding a new section 801 of chapter 8 to read as follows:
“Section 801. Smoking of tobacco prohibited in National Government offices; Signs.”

Section 803. Providing tobacco to minors.
No person shall sell, give or otherwise provide cigarettes, cigars, pipe tobacco, chewing tobacco, snuff or other tobacco products to a person 17 years of age or younger

"Section 802.	Advertising of harmful products.
(1)	No manufacturer, retailer, distributor of tobacco products or other person shall advertise or promote by billboard, radio, television, public broadcast, handout, device or otherwise for commercial purposes:
	(a) cigarettes, cigars, pipe tobacco, chewing tobacco, snuff or other tobacco products;

(1)	Notwithstanding the prohibitions of subsection (1) of this section, nothing herein shall prohibit a commercial vendor from advertising prices of legal products by hand-drafted signs; PROVIDED, however, that such signs are inside of the vendor's premises and not visible to the public from outside of the vendor's premises.

Any person who violates the provisions of this section shall be guilty of a misdemeanor, and upon conviction thereof shall be fined not more than $5,000 per offense, or imprisoned not more than 30 days per offense, or both."

Future action by WHO Through the Regional Director, WHO will be advocating a "Tobacco advertising-free 
Western Pacific Region by the year 2000" as an important feature of tobacco-or-health policy.

•	a call for a ''Tobacco-advertising free Region by the Year 2000" as part of comprehensive legislation on tobacco or health; 
•	the recommendation that a percentage of tobacco tax should be used to fund sports, arts and health promotion, so that sports and arts organizations do not suffer from the ban on tobacco sponsorship; 

•	involvement of religious and other community groups in tobacco-or health activities;

The first Western Pacific Regional Working Group on Tobacco or Health was convened In Tokyo, Japan, In November 1987. The second Regional Working Group met in Perth, Australia, m March 1990. The Group produced an Action Plan on Tobacco or Health, which was endorsed by the Regional Committee in September 1990.2 The Action Plan contained practical and realistic objectives and goals to be achieved within specific time periods. 
The third Regional Working Group was convened in Manila, Philippines, in April 1994, to assess progress on the 1990-1994 Action Plan, and to devise a further Action Plan on Tobacco or Health for 1995-1999.

Specifically, legislation should: 
• ban all advertising and promotion of tobacco products, trademarks, brand names, logos; 
• create and expand smoke-free environments in enclosed public places, including health premises, restaurants, cinemas, theatres, public transport and indoor places of work; and especially all areas frequented by young people; 
• ban the importation, manufacture and sale of smokeless tobacco; 
• prohibit sale of tobacco products to minors; 
• prohibit cigarette-vending machines in public places; 
• reduce the level of harmful substances in tobacco products;
• ensure that all tobacco products and packages (and any advertisements) are labelled with strong, factual and varied warnings: in large, visible lettering; covering at least 25% of the front and back surface areas, or 25% of the total area of an advertisement; in black and white; in the principal languages; and in pictures. particularly in countries with low literacy rates.

"Several countries in the Region have already banned tobacco advertising. We are now urging other countries in the Region to follow our example and ban all tobacco promotion in the Western Pacific by the end of the decade." 
Message of the Regional Director, WHO Western Pacific Region on World No-Tobacco Day 1994

International and national sporting organizations and arts and cultural organizations should reject tobacco sponsorship. Committees for the Olympic Games, Asian Games and other major sporting events should make their games smoke-free, including a complete ban on advertising and promotion of all tobacco products.

1995 
The 1995-1999 Action Plan will have been received by all countries and areas and widely distributed to the priority target audiences. 
The priority recommendation of "A Tobacco Advertising-Free Western Pacific" will have been communicated throughout the Region.

1996 
Most countries and areas will develop 
draft legislation.

1997 
All countries and areas will report progress on comprehensive tobacco control legislation, especially on promotional bans and the establishment of major smoke-free areas. 
Policies on smoke-free workplaces will be incorporated into industrial and other workplace legislation. 
A regional meeting to monitor progress in the implemental10n of the Action Plan will be held.

1998 
Comprehensive legislation on tobacco 
or health will have been adopted.

1999 
Comprehensive national tobacco-control policies will be Implemented In all countries and areas which do not yet have such policies

The fourth meeting of the Working Group on Tobacco or Health will be convened to evaluate proper 
implementation of the Action Plan on Tobacco or Health for 1995-1999 and develop an Action Plan for 2000-2004.	1

1

1

2

3

4

4

5

5

5

5

5

5

5

5

5

5

5

5

5

	
	Chuuk’s first TAPS bans	(c) No manufacturer, retailer or distributor of alcoholic beverages, tobacco, including but not limited to	snuff, cigarettes and/or controlled substances, as defined in subsection (a) above, or other person, shall advertise or promote, by billboard, radio, television, public broadcast, handout, device or otherwise for commercial purposes, other than by radio or cable television where the operator does not control the content of the programming:
(1)	any tobacco product, including but not limited to snuff;
	(2) any alcoholic beverage, including but not limited to beer, wine, and liquor;
	(3) any controlled substances, as defined	in subsection (a) above.
Any person who violates the provisions of this subsection (c) shall be guilty of a misdemeanour, and upon conviction therein, shall be fined not less than $100 per offense, or imprisoned not less than 30 days per offense, or both.

(d) Notwithstanding the prohibitions of subsection (c) of this section, nothing herein shall prohibit a commercial vendor from displaying prices of leg products by signs.	6	
	Pohnpei’s bans on event sponsorships 	Pohnpei's legislature further banned all contests, raffles, lotteries: 
“or any other promotional event that awards prizes of any kind which is based in whole or in part on the element of chance and that is premised in any way upon the obtaining or consumption of any tobacco product” (Third Pohnpei Legislature L.B. No. 357-94).

Advertising and promotion is prohibited except for displays of prices of tobacco products
Exemption: Advertising from outside the state incidental to the main topic of the print, radio or television provided there is no financial gain from the placement.	1

7

	
	Yap’s ban on tobacco advertising	In 1994, Yap State enacted Yap State Law No. 3-80 (1994) – An Act to amend Title 11 of the Yap State Code by adding sections 1301, 1302, and 1303 to prohibit the advertisement of harmful products and sale to minors of tobacco products.

§1301.  Advertising of harmful products.
     (a)  No manufacturer, retailer, distributor of tobacco products or other person shall advertise or promote by billboard, radio, television, public broadcast, handout, device or otherwise for commercial purposes:
     (1)  cigarettes, cigars, pipe tobacco, chewing tobacco, snuff or other tobacco products;

     (b)  Notwithstanding the prohibitions of subsection (a) of this section, nothing herein shall prohibit a commercial vendor from advertising prices of legal products by hand-drafted signs; PROVIDED, however, that such signs are inside of the vendor's premises and not visible to the public from outside of the vendor's premises.
     (c)  Any person who violates the provisions of this section shall be guilty of a misdemeanor, and upon conviction thereof shall be fined not more than $5,000 per offense, or imprisoned not more than 30 days per offense, or both.	8

9

9	
	Kosrae	No legislation on tobacco advertising, promotion and sponsorship	7	
WHO FCTC ratification delayed impact	National legislation on tobacco packaging and labelling 	Section 1. Chapter 8 of title 41 of the Code of the Federated States of Micronesia, is hereby amended by adding a 3 new section 802 to read as follows: “Section 802. Prohibition on tobacco packaging and labeling. No person shall distribute, import, purchase for commercial purposes, or display tobacco: 
(1) which contains on each unit packet and package of tobacco products, and any outside packaging and labeling any false, misleading, deceptive or likely to create an erroneous impression about the product’s characteristics, health effects, and hazards or emissions, including any term, descriptor, trademark, figurative, or any other sign that directly or indirectly creates the false impression that a particular tobacco product is less harmful than other tobacco products. These may include, but are not limited to words or descriptors such as “light”, “mild”, “ultra-light”, “less tar”, “slim”, or similar descriptors, or graphics associated with such descriptors; (2) unless the outside packaging and labeling of each unit packet and package of tobacco products, or wrapper in the case of cigars, contains permanently affixed health warnings describing the harmful effects of tobacco use, and may include other appropriate messages as described in relevant regulations. These warnings and messages: 
(a) shall be approved by the Secretary of 
the FSM Department of Health and Social Affairs or his/her designee; 
(b) shall be rotating; (c) shall be in English and/or the respective state’s local vernacular; (d) shall be large, clear, visible and legible; (e) should be up 50 percent or more of the principle display area; and (f) may be in the form of or include pictures or pictograms.	10	
	Chuuk’s Act on tobacco industry sponsorship 	To repeal CSL No. 191-08, otherwise known as the "Smoking Act of 2011," in its entirety, and to establish the Chuuk State "Indoor Clean Air Act of 2011"0 and for other purposes.

Section 5. Definitions: 
(1) "Smoking" means the activity of inhaling and exhaling smoke from tobacco and other substances that are lit in cigars, cigarettes, pipes and smoking articles while lit-; (2) "Chewing" means placing tobacco and other substances that are chewed including cigars, cigarettes, chewed alone or chewed together with other chewing stuffs;

Section 7' Ban of tobacco. There shall be no tobacco advertisement;, promotion and 
sponsorship of sports eve fit by tobacco companies or local businesses involving tobacco in the State of Chuuk.

Selling of loose/per stick of cigarettes 
is prohibited by this Act.

Section 9. Civil penalty and Fine: a) The owner 4f a public place or place of employment who fails to enforce the Act, shall be punished by a fine of $500 for the first violation, and a fine of $ 1000 for each individual subsequent violation, including a temporary suspension or permanent suspension or revocation of the owner's license or permit or an imprisonment of not less than 30 days but not more than 60 days as the court may deems fit.	11

11

11

11

11

	
	Pohnpei’s prohibition on TAPS	§1-102. Definitions. As used in this chapter and §3-101, unless the context clearly requires otherwise:
(1) “Advertise,” “advertising” or “advertisement” means to intentionally call the attention of the general public to a commodity by any physical, mechanical or electronic means, including, but not limited to, billboards, establishment signs, display cases, radio broadcasts, television broadcasts, telephone surveys, cable transmissions, handouts or any other devices, or by praising a commodity publicly so as to induce or encourage a person to want to purchase, obtain, consume or otherwise use it. Advertising includes any use of the name of the commodity which is the subject of the advertisement or any image, song, signal, statement or emblem which, by its use, is designed to call attention to the commodity, and also includes any gift of the commodity or any gift or promotional item which is provided along with the obtaining of the commodity, such as tee shirts, sports hats or cigarette lighters which bear the name of the commodity or any other image or symbol which calls attention to the commodity. Advertising includes all activities of the person seeking to call attention to the product and any aspect of the commodity or paraphernalia provided in or along with the commodity which constitutes an advertisement as defined by this subsection and which is offered by or through that person, whether or not that person or the business he represents is the source of such advertisement. For purposes of this chapter and §3-101, advertisement shall not include the use of the trademark, brand name or symbol of a commodity in respect to the sponsorship of a sporting event or of a participant therein, or for a donation to, or sponsorship of a charitable activity or event; PROVIDED that there is no requirement for the purchase, obtainment, use or consumption of the commodity to obtain the sponsorship or donation or to attend or participate in the event or activity. (2) “Alcoholic beverages” means any and all alcoholic beverages as defined by §2-101(1). (3) “Minor” means any natural person below the age of 18 years. (4) “Narcotic drugs” means any and all controlled substances as defined by §4-101(15). (5) “Tobacco products” means any and all of the commodities produced from the tobacco plant, including cigarettes, cigars, pipe tobacco, chewing tobacco, and other tobacco products.
§1-103. Advertising prohibited. (1) No person who conducts any business within this state which offers for distribution, wholesale sale, retail sale, use or consumption any tobacco product, alcoholic beverage or narcotic drug as defined by this chapter may undertake or allow to be undertaken through his offering of such commodity for transfer to another, any activity which constitutes the advertisement of such commodity; PROVIDED, HOWEVER, that persons who have signs and other physical indices of advertisement which were posted or otherwise emplaced prior to the effective date of this chapter [August 15, 1994] shall have 45 days following the effective date of this chapter to remove such signs and other indices of advertisement from public view and to cease to use them in any manner which would constitute a violation of this chapter. (2) No person may provide services or act as the agent of another party for profit or any other valuable consideration for the purpose of advertising any tobacco product, alcoholic beverage or narcotic drug as defined by this chapter within the state of Pohnpei; PROVIDED, HOWEVER, that persons holding valid contracts or other legal obligations for service or agency on the effective date of this chapter [August 15, 1994] for the purpose of advertising any such commodity shall, within 45 days following the effective date of this chapter, cease any activity prohibited by this subsection. (3) Notwithstanding the prohibitions of Subsection (1) of this section, nothing therein shall prohibit a commercial vendor from advertising the prices of legal products by hand-drafted or electronically or mechanically produced signs of a size substantially equivalent to those used generally for other products offered for sale or transfer by the vendor; PROVIDED, HOWEVER, that such signs are posted inside the vendor’s premises and are not readily visible to the public from outside the vendor’s premises. (4) Notwithstanding the prohibitions of Subsection (1) of this section, nothing therein shall prohibit a person who conducts a business lawfully dealing in any tobacco product, alcoholic beverage or narcotic drug to indicate in the name of the business and in references to the name of the business that the business deals in such commodities; PROVIDED, HOWEVER, that such name and/or references may not contain any reference by word or symbol to any particular trademark, brand name or producer of a commodity for which advertisement is prohibited by Subsection (1) of this section. (5) Notwithstanding the prohibitions of Subsection (2) of this section, nothing therein shall prohibit a broadcaster of audio or video signals by air or cable transmission or vendor of printed materials, audio recordings or video recordings for purchase or rent from transmitting or offering for sale or rent pre-printed or pre-recorded material obtained from outside the state which contain advertisements prohibited by this chapter, but which are incidental to the main topic of the printing or prerecording; PROVIDED that the transmitter or vendor neither has requested such advertisements nor gains any specific royalties or any other specific fees or valuable consideration for the transmission, sale or rental of such advertisements.
§1-104. Prohibition on promotional activities. No person or business entity, by itself or in conjunction with any other person or business entity, may initiate, advertise for, coordinate, facilitate, manage, broker, serve as an agent or in any other manner participate in sponsoring or operating any contest, raffle, lottery or any other promotional event that awards prizes of any kind which is based in whole or in part on the element of chance and that is premised in any way upon the obtaining or consumption of any tobacco product, alcoholic beverage or narcotic drug as defined by this chapter or the display or surrender of any indices of the obtaining or use of that commodity or of any packaging, coupon or other item which can be identified with that commodity; PROVIDED, HOWEVER, that the prohibition of this section shall not apply to the awarding of prizes with respect to a promotional event which has already been initiated prior to the effective date of this chapter [August 15, 1994]; PROVIDED FURTHER that the award of such prizes is made within 60 days following the effective date of this chapter. It shall be the burden of the person or business seeking the exemption provided herein to show to the satisfaction of the court that the exemption applies to the activity in question.

Any person or business entity who shall knowingly and willfully violate any provision of §§1-103, 1-104, 1-105 or 3-101, shall be guilty of an offense against this state, and upon conviction thereof, shall be fined not more than $1,000, or imprisoned not more than 30 days, or both such fine and imprisonment. Each day that such a violation occurs shall constitute a separate offense. A criminal action against a business entity which violates any such provision may be joined with a criminal action against the owners and operators thereof, as well as other violators, or may be prosecuted separately; and a conviction against one of the parties shall not bar the prosecution of other culpable persons or business entities.	12

12	
Progress followed WHO FCTC Secretariat’s assessment	FCTC implementation and policy gaps assessment	A needs assessment exercise concerning implementation of the WHO FCTC was conducted jointly by the Government of FSM and the Convention Secretariat from April to November 2012, including an initial analysis of the status, challenges and potential needs deriving from the country’s most recent implementation report and other sources of information, and the mission of an international team from the Convention Secretariat and the WHO Country Liaison Office for Northern Micronesia to FSM from 21 to 29 November 2012.

This report contains a detailed overview of the status of implementation of substantive articles of the treaty. The report identifies gaps and areas where further actions are needed to ensure full compliance with the requirements of the treaty, taking into account the guidance provided by implementation guidelines adopted by the COP where relevant. Specific recommendations are then made concerning each particular area.

Article 5.3 stipulates that in setting “public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry”. 
The guidelines for implementation of Article 5.3 recommend that “all branches of government ... should not endorse, support, form partnerships with or participate in activities of the tobacco industry described as socially responsible”. 
There is some evidence that tobacco importers do undertake programmes that are aimed at providing an image of corporate social responsibility. FSM has not implemented a code of conduct for civil servants that would provide protection from commercial or other vested interests of the tobacco importers. The Department of Health and Social Affairs is working with the Office of the Attorney General to develop legislation to implement Article 5.3 and its guidelines. 
Gaps – 
1. There is a lack of awareness of Article 5.3 of the Convention and its guidelines among public officials. 
2. There is no regulation to ban those activities described as “socially responsible” by the tobacco industry. 
It is therefore recommended that FSM develop policy and disseminate information in line with Article 5.3 and its guidelines and link this to the general requirements under a code of conduct for all public officials including elected officials. It is also recommended that the legislation process on Article 5.3 be expedited.

Current legislation at the national and state levels does not completely ban tobacco advertising, promotion and sponsorship. Addressing the treaty provisions and guidelines with implementation deadlines (Articles 8, 11 and 13 and corresponding implementation guidelines) will make a substantial contribution to meeting the obligations under the WHO FCTC and to improving health status and quality of life in FSM.

Eighth, the Conference of the Parties has adopted seven guidelines, on implementation of Articles 5.3, 8, 9 and 10, 11, 12, 13, and 14, and a set of guiding principles and recommendations for implementation of Article 6 of the WHO FCTC (Price and tax measures to reduce the demand for tobacco). The aim of these guidelines and recommendations is to assist Parties in meeting their legal obligations under the respective articles of the Convention. The guidelines draw on the best available scientific evidence and the experience of Parties. FSM is strongly encouraged to follow these guidelines in order to fully implement the Convention.

Tobacco advertising, promotion and sponsorship (Article 13) 
Article 13.1 of the Convention notes that the Parties “recognize that a comprehensive ban on advertising, promoting and sponsorship would reduce the consumption of tobacco products”. 
Article 13.2 of the Convention requires each Party to: “in accordance with its constitution or constitutional principles, undertake a comprehensive ban of all tobacco advertising, promotion and sponsorship. This shall include, subject to the legal environment and technical means available to that Party, a comprehensive ban on crossborder advertising, promotion and sponsorship originating from its territory. In this respect, within the period of five years after entry into force of this Convention for that Party, each Party shall undertake appropriate legislative, executive, administrative and/or other measures and report accordingly in conformity with Article 21”. 
FSM has no national legislation but is largely covered by state-based legislation that bans advertising, promotion and sponsorship. A matrix of that legislation is provided in Annex 2. Chuuk, Pohnpei and Yap States have broad bans on advertising and promotion, while Kosrae State does not. The existing legislation does not ban sponsorship. It would be important to broaden and revise the policy and legislation in order to exclude this loophole.

There is no legislation or regulation that bans display of tobacco products at points of sale.
Gaps – 
1. Point-of-sale displays of tobacco products are still allowed. 2. Sponsorship and corporate “socially responsible” activities are not banned in all states. 
3. Internet sales, which inherently involve advertising and promotion, are allowed; 
It is recommended that FSM adopt and implement legislation that will completely ban all advertising, promotion and sponsorship, including point-of-sale tobacco displays, Internet tobacco sales, and contributions from the tobacco industry and importers in the form of “socially responsible” activities in line with Article 13 and its guidelines.

Article 13.5 encourages Parties to “implement measures beyond the obligations set out in paragraph 4”. 
Currently FSM has not implemented any measures beyond the obligations set out in paragraph 4. 
Article 13.7 reaffirms Parties’ “sovereign right to ban those forms of cross-border tobacco advertising, promotion and sponsorship entering their territory and to impose equal penalties as those applicable to domestic advertising, promotion and sponsorship originating from their territory in accordance with their national law”. 
FSM has not yet implemented any measures to ban cross-border tobacco advertising, promotion and sponsorship entering into its territory. 
It is therefore recommended that FSM collaborate to adopt and implement legislation and regulations to ensure a complete ban on cross-border tobacco advertising, promotion and sponsorship entering into and originating from its territory. It is further recommended that national legislation address the banning of cross-border tobacco advertising, promotion and sponsorship in consultation with the states.

Chuuk legislation: Some question as to whether the sponsorship applies only to sports	7

7

7

7

7

7

7

7

7

	Adoption of National Cancer Plan 	Objective 1 table

Related to Article 5.3: Relating to Industry Interference: Review the WHO Guidelines for Implementation of Article 5.3 and determine processes for FSM National and all States to implement the recommendations in the guidelines 
    
· Revisit and resurrect packaging & labeling legislation, making revisions where appropriate, i.e. graphics. ·Revisit legislation banning single/partial sales of tobacco, and move it through to enactment · Revisit advertising and sponsorship legislation and close loopholes · In Chuuk, advertising/sponsorship legislation has been introduced and passed in one house, but hasn’t been enacted. Work to mobilize to move the legislation through to enactment.	13(p1)

13(p1)
	
	Adoption of Tobacco Control Act 	This chapter is known and may be cited as the “Federated States of Micronesia Tobacco Control Act.”

(1) ‘Advertisement’ means any commercial communication through any media or means, that is intended to have, or is likely to have, the direct, indirect, or incidental effect of the following: 
(a) creating an awareness of a tobacco product, brand manufacturer, or seller; (b) promoting the purchase or use of a tobacco product or brand of a tobacco 
advertisement includes, but is not limited to, words, names, messages, mottos, slogans, letters, numbers, pictures, images, colors and other graphics, sounds, and any other auditory, visual, or sensory matter, in whole or part, that is or are: 
(i) commonly identified or associated with a tobacco product, brand, manufacturer, or seller; 
(ii) otherwise an indicia of product, brand, manufacturer, or seller identification; 
(2) ‘Brand’ means a brand of tobacco product; (3) ‘Brand variant’ means a tobacco product distinguishable from another tobacco product by any means, including the following: (a) the tobacco product is sold under different brand names; (b) the tobacco is sold under the same 
brand name, but differs in one or more of the following ways: (i) containing or not containing menthol; (ii) being otherwise different flavored; (iii) producing different quantities of tar, nicotine, carbon-monoxide or other constituents; (iv) allegedly differing in mildness; (v) having or not having filter tips 
or cork tips; (vi) being sold in retail packages containing number of pieces; (vii)being of different length or mass; (4) ‘Body corporate’ means an association, corporation, corporate body, corporate identity company, person, government agency or 
institution identified by a particular name; (5) ‘Class’ in relation to tobacco product, means a class of tobacco product, and includes
manufactured cigarettes, cigarettes tobacco, pipe tobacco, cigars, cigarillos, bidis or anything containing tobacco products. 

(23) ‘Tobacco product’ means any product containing tobacco in any form that is intended for human use. A tobacco product includes all parts and materials inter alia, such as papers, filters and filter wrappers, over-wrappers, rods, portion pouches, cigars, cigarettes, smokeless tobacco, pipe tobacco and roll your own tobacco, and similar matter, as applicable, even if sold separately. 
(24) ‘Tobacco use’ means any form of 
consuming tobacco including smoking, chewing, or otherwise inhaling or ingesting.

Prohibition of Tobacco Product Promotion, Advertisement, Sponsorship and Sale. (1) No person shall promote or cause to promote by any other person, a tobacco product or a tobacco product-related brand element through direct or indirect means, including through sponsorship of an organization, service, physical establishment or vehicle of any kind, or event. 
(2) No person shall sell, promote, 
distribute or cause to be sold, promoted or distributed, any item other than a tobacco product which bears the brand name (alone or in conjunction with any other word), trade-mark, trade-name, distinguishing guise, logo, graphic arrangement, design, slogan, symbol, motto, selling message, recognizable color or pattern of colors, or any other indicia of product identification identical or similar to, or identifiable with, those used for any brand of tobacco product. 
(3) No person shall promote or cause to promote by any other person, a tobacco product or a tobacco product-related brand element, except as prescribed by this Act or its regulation. 
(4) Notwithstanding any regulation made under this Act, no person shall promote or cause to promote tobacco products or brand elements: 
(a) in a manner that allows a consumer or purchaser of tobacco products to be deceived or misled concerning its character, properties, toxicity, composition, merit or safety; (b) that does not display, in the 
prescribed form and manner, the information required in accordance with this Act or any regulations about the product and its 
emissions, health hazards and effects arising from the use of the product or from its emissions and other health-related messages such as advice on how to quit smoking; 
(c) through means of promotion that can be viewed from outdoors; (d) utilizing any item other than a 
tobacco product, or a physical establishment or vehicle of any kind, which bears the brand name (alone or in conjunction with any other word), trade-mark, trade-name, distinguishing guise, logo, graphic arrangement, design, slogan, symbol, motto, selling messages, recognizable color or pattern of colors, or any other indicia of product identification identical or similar to, or identifiable with, those used for any brand of tobacco product; 
(e) utilizing any athletic, musical, artistic or any other social or cultural event, or any entry or team in any event, in the brand name (alone or in conjunction with any other word), trade-mark, trade-name, distinguishing guise, logo, graphic arrangement, design, slogan, symbol, motto, selling message, 
recognizable color or pattern of colors, or any other indicia of product identification 
identical or similar to, or identifiable with, those used for any brand of tobacco product; (5) No person or entity shall offer or 
provide any consideration, direct or indirect, for the purchase of a tobacco product, 
including a gift to a retailer, purchaser or a third party, bonus, premium, cash rebate or right to participate in a game, lottery or contest, or distribute a tobacco product without monetary consideration, or in 
consideration of the purchase of a product or service or the performance of a service, whether requiring the purchase of a tobacco product or not. 
(6) No person or entity shall directly 
target individuals with promotional, including informational material, such as direct mail, telemarketing, “consumer survey”, or “research” or person- to- person conversation by a business in the tobacco industry or person acting to further its interests. 
(7) No person shall advertise, arrange for, or participate in the advertising of any tobacco product, brand, manufacturer or seller, directly or indirectly. This prohibition shall apply to advertising in, as well as to advertising transmitted into or out of the Federated States of Micronesia; (8) No person shall: 
(a) display, exhibit, announce, 
broadcast or telecast, or cause or permit to be displayed, exhibited, announced, broadcast or telecast, or authorize the display, exhibition, announcement, broadcast or telecast to the public of a tobacco product advertisement; (b) whether or not for payment or other 
consideration, publish, broadcast or disseminate on behalf of another person a tobacco product advertisement or arrange for a tobacco product advertisement to be published, broadcast, or disseminated; 
(c) print or publish, or cause or permits to be printed or published, or authorize the printing or publication of a tobacco product advertisement in any printed publication, book, magazine, leaflet, handbill, newspaper or other printed matter intended for the public. 
(9) Subsections(1),(2),(3),(4),(5),(6), (7), and (8)does not apply to the following: (a) a tobacco product advertisement that is an accidental or incidental accompaniment to a film or video; 
(b) any tobacco product advertisement 
included in any book, magazine, or newspaper printed outside FSM, or in any radio or television transmission originating outside FSM, or any film, video recording or visual disk originating outside FSM, unless: 
(i) the principal purpose of the 
book, magazine, newspaper, broadcast, telecast, film, video recording or visual disk is the promotion of the use of a tobacco product or smoking; or 
(ii) the book, magazine, newspaper, 
broadcast, telecast, film, video recording or visual disk is intended for sale, distribution, or exhibition in the FSM; or (iii) in the case of, a tobacco 
product advertisement in any radio, television, electronic transmission or data message, the advertisement is targeted primarily at an audience in the FSM. 
(10) For the purpose of monitoring compliance with this Section, tobacco manufacturers, wholesale distributors, and importers, and any other sellers as may be prescribed in regulations, shall provide reports as required by this sub-section to the Department of Health and Social Affairs on a periodic basis, which shall be at least 
annually, and upon request, as prescribed as to content, format, periodicity, and all other details specified in regulations. Reports shall contain information in total and by brand on any tobacco advertising, promotion, or sponsorship including any donations, whether publicly acknowledged or not, undertaken during the reporting period, including, but not limited to: 
(a) the kind of advertising, promotion or sponsorship, including its content, form, and the medium used; 
(b) the placement and extent or 
frequency of the advertising, promotion, or sponsorship; 
(c) the identity of all persons and 
entities involved in the advertising, promotion or sponsorship, including advertising and production companies; 
(d) the amount of financial and/or other 
resources used for the tobacco advertising, promotion or sponsorship; and 
(e) other information as may be required by the Department of Health and Social Affairs. (11) The Department shall make information from the reports required in this Article readily available to the public, subject to any precautions necessary for preventing misleading or promotional information, if any, from becoming public. 
(12) Government shall not participate in, support, endorse, or accept: 
(a) any legal or policy measure drafted 
by or in collaboration with the tobacco industry, or any offer of assistance with drafting such measures from the tobacco industry; 
(b) any education, instruction, or 
training on any tobacco control policy matter provided by or with any kind of contribution from the tobacco industry; 
(c) any partnership of any kind with the tobacco industry; 
(d) any non-binding or non-enforceable agreement or tobacco industry code of conduct in the place of legally enforceable tobacco control measures; or 
(e) any tobacco industry involvement in 
any manner in any initiative, campaign, program, or activity directly or indirectly related to tobacco control or public health, including but not limited to, any youth access or education program, public education campaign, or other tobacco control or public health initiative.”

Section 6. Title 41 of the Code of the Federated 
21 States of Micronesia (Annotated), as amended, is hereby 22 further amended by inserting a new section 1205 under 23 chapter 12 to read as follows: “Section 1205. Restrictions or Limitations on Distribution and Sale of Tobacco Products.
(1) No person shall sell or offer to sell tobacco to a person who is less than eighteen years of age. 
(2) No person shall purchase a tobacco 
product for the use of a person under the age of eighteen years of age. 
(3) No person shall allow a person under the age of eighteen to purchase or sell a tobacco product on premises occupied by the aforementioned person. 
(4) It shall not be a defense to section 5 of this chapter that the person appeared to be eighteen years old or older. 
(5) No person shall, for the purpose of political gain, offer, give, or distribute to any person a tobacco product. 
(6) No person shall, for the purpose of inducing or promoting the sale of any tobacco product, offer, give or distribute to any person a free sample of the tobacco product. (7) A retailer of tobacco products shall display clearly for the public a notice to the effect that the sale of any tobacco product to a minor is prohibited. 
(8) It is not a defense for a person charged under subsection (6) that the person believed that the person to whom the tobacco product was sold, given or provided was over the age of eighteen years at the time of the offense is alleged to have been committed, unless the accused took all reasonable steps to ascertain the age of the person to whom the tobacco product was sold, given, or provided. (9) A person who contravenes subsections (1),(2),(3),(4),(5), (6), and (7), commits an offense. 
(10) It is a defense to a prosecution under this section if a person proves that he/she: (a) had reasonable cause to believe that 
the person purchasing the tobacco product, or for whom the tobacco product was purchased, or to whom the tobacco product was supplied, was not under the age of eighteenth years; or 
(b) had taken all reasonable precautions 
to ensure that the purchaser presented a prescribed form of identification showing his or her age and that there was no apparent reason to doubt the authenticity of the document or that it was issued to the person producing it.
(11) No person shall sell or offer to sell tobacco products: 
(a) by means of a display that permits a 
person to handle the tobacco product before paying for it; 
(b) through a vending machine; 
(c) through the mail or the internet; (d) at a retail store unless signs 
bearing health warnings and other information are posted at the place in accordance with this Act and its regulations. 
(12) No person shall offer tobacco products for sale (whether by retail or wholesale) and allow any part of a tobacco product, tobacco package, or tobacco carton to be visible from: (a) outside the place; or 
(b) an area inside the place visible to the public.”

Section 7. Title 41 of the Code of the Federated 
20 States of Micronesia (Annotated), as amended, is hereby 21 further amended by inserting a new section 1206 under 22 chapter 12 to read as follows: “Section 1206. Restrictions or Limitations on Packaging and labeling of Tobacco Products (1) No person shall sell or offer to sell tobacco products in any of the following manners: 
(a) loose cigarette sticks or cigarette roll; or (b) loose tobacco in an unopened 
package that contains less than thirty-four point two (34.2) grams of tobacco; or 
(c) cigarettes in an unopened package 
that contains fewer than 20 cigarettes being no less than 84mm in length and weighing no less than 0.8grams. 
(2) No person shall sell tobacco products except in a package containing the quantities or number of units prescribed by this Act or regulations under this Act. 
(3) No person shall sell, distribute, or display for sale or distribution, import, or export any tobacco products in a package, or with a label in a manner that allows a consumer 
or purchaser of tobacco products to be deceived or misled concerning its characteristics, properties, toxicity, composition, merit or safety. 
(4) No person shall sell or offer to sell tobacco products in a place other than those prescribed by regulations under this Act. (5) No person shall sell or offer for sale a tobacco product unless: 
(a) the package containing the product conforms with prescribed requirements; (b) the package containing the product 
displays in accordance with this Act and its regulations with the following: 
(i) a graphical health message; (ii) a list of the harmful 
constituents of the product; (iii) the emissions of the product (if any); and (iv) in the case of a tobacco 
product intended for smoking, a list of the harmful constituents and their respective quantities present in the smoke. 
(6) Prescribed regulations under this Act may provide that every unit packet and package of tobacco sold in FSM must carry messages that are in the form of, or include, pictures or pictograms. 
(7) All tobacco products imported for sale or sold in FSM must carry a clear statement that the product is intended or made for sale in FSM. 
(8) No manufacturer, distributor, importer, or retailer of a tobacco product shall distribute or supply any tobacco product in contravention of subsection 2 and 3 of this section. 
(9) Any requirements arising from subsections 6 and 7 do not relieve a 
manufacturer, importer, or retailer of tobacco products of other obligations or liabilities arising from other requirements to warn consumers of the risks of using tobacco products.”

Section 11. Title 41 of the Code of the Federated 
2 States of Micronesia (Annotated), as amended, is hereby 3 further amended by inserting a new section 1210 under 4 chapter 12 to read as follows: “Section 1210. Inspection 
(1) For the purpose of this Act, the FSM Secretary of Health and Social Affairs may appoint any qualified person or designate any class of persons to perform the duties of inspector or analyst at the FSM National Government. The responsibilities of an inspector shall be specified in the act of appointment. 
(2) No tobacco control inspector may be assigned to duties involving any business or operation or articles in which he or she, or his or her parents, children or siblings, has any pecuniary interest whatsoever. 
(3) Every person authorized as an inspector or analyst under subsection 1 of this section, may, at any reasonable time, to ascertain compliance with this Act and the regulation under it, enter and inspect any of the following places: 
(a) referred to in section 7 subsection 2; 
(b) where tobacco is tested, stored, packaged, labeled or sold; 
(c) where anything used in the manufacture, storage, packing, promotion, sale or testing of tobacco is to be found; 
(d) where information relating to the 
manufacture, storage, packaging, labeling, promotion, sale or testing of tobacco is to be found. 
(4) Authorized inspectors and analysts shall have the following powers, which no person shall deny, obstruct, or hinder: (a) Enter any port of entry where 
articles subject to this chapter are being received, shipped or prepared for export, and examine and take samples of articles, and examine anything which appears capable of being used for such preparation, packaging, storage, sale or conveyance; 
(b) Detain and search any vehicle at 
any port of entry which is conveying any article subject to this chapter, and examine and take samples of any such article; 
(c) Open and inspect any package which contains any article subject to this chapter; 
(d) Examine any books, accounts, 
documents, or other records that could contain any relevant information about articles subject to this chapter and make copies of them;
(e) Destroy or dispose of tobacco products, which has been imported which is decayed or putrefied or otherwise a danger to the public health, with prior notice to the owner; 
(f) Call a member of the local or national police force for necessary assistance. Any member of the national police force shall aid the inspector as required; (g) Question any person to determine compliance with this chapter. (5) After any inspection, the tobacco control inspector shall give to the owner or person in charge a written report noting any violation of this chapter or the regulations. A copy of this report shall be given to the Secretary of Health. 
(6) Any person aggrieved by any of these actions has a right to a heard in front of a panel which shall be conducted according to regulations promulgated by the Secretary of Health and Social Affairs.”

Section 12. Title 41 of the Code of the Federated 
4 States of Micronesia (Annotated), as amended, is hereby 5 further amended by inserting a new section 1211 under 6 chapter 12 to read as follows: “Section 1211. Enforcement, Offences, and Penalties. 
(1) Any person found guilty of violating any provision under section 1103 of this Act shall be liable for a fine of: 
(a) in the case of an individual, not 
less than $500 and not more than $5,000 for the first offense, and of not less than $1,000 and not more than $10,000 for subsequent offences; and 
(b) in the case of a manufacturer, not 
less than $1,000 and not more than $10,000 for the first offense, and of not less than $2,000 and not more than $20,000 for subsequent offences. 
(2) Any person found guilty of violating any provision under section 1104 of this Act shall be liable for a fine of: 
(a) in the case of an individual, not less than $500 and not more than $5,000 for the first offence, and of not less than $1,000 and not more than $10,000 for subsequent offences; and 
(b) in the case of a manufacturer, not 
less than $1,000 and not more than $10,000 for the first offence, and of not less than $2,000 and not more than $20,000 for subsequent offences. 
(3) Any person found guilty of violating any provision under section 1105 of this Act shall be liable for a fine of: 
(a) in the case of an individual, not 
less than $500 and not more than $5,000 for the first offence, and of not less than $1,000 and not more than $10,000 for subsequent offences; and 
(b) in the case of a manufacturer, not 
less than $1,000 and not more than $10,000 for the first offence, and of not less than $2,000 and not more than $20,000 for subsequent offences. 
(4) Any person found guilty of violating any provision under section 1106 of this Act shall be liable for a fine of:
(a) in the case of an individual, not 
less than $500 and not more than $5,000 for the first offence, and of not less than $1,000 and not more than $10,000 for subsequent offences; (b) in the case of the proprietor of a 
retail establishment, not less than $1,000 and not more than $10,000 for the first offence, and of not less than $2,000 and nor more than $20,000 for subsequent offences; and 
(c) in the case of a manufacturer, not 
less than $1,500 and not more than $10,000 for the first offence, and of not less than $2,500 and not more than $20,000 for subsequent offences. 
(5) Any proprietor, owner or manager of any premises listed under section 1106 of this Act found guilty of failing to enforce the smokefree policy applicable to the facility under his or her responsibility, including the posting of prescribed signs and ensuring that any designated smoking areas meet the requirements of the Act and its regulations, shall be liable for a fine of not less than $500 and not more than $5,000 for the first offence, and of not less than $1,000 and not more than $10,000 for subsequent offences. (6) Any person found guilty of smoking in a place or area where smoking is prohibited under section 1106 of this Act and Title 41, Section 801 shall be liable for a fine of not less than $500 and not more than $1,000 for the first offence, and of not less than $1,000 and not more than $2,500 for subsequent offences. (7) Any person found guilty of violating any provision under section 1107 and 1108 of this Act shall be liable for a fine of: 
(a) in the case of an individual, not 
less than $2,500 and not more than $10,000 for the first offence, and of not less than $5,000 and not more than $20,000 for the subsequent offences; 
(b) in the case of a proprietor of a 
retail establishment, not less than $3,000 and not more than $10,000 for the first offence, and of not less than $6,000 and not more than $20,000 for the subsequent offences; (c) in the case of a wholesale 
distributor, not less than $3,500 and not more than $10,000 for the first offence, and of not less than $7,000 and not more than $20,000 for subsequent offences; (d) in the case of a manufacturer, not 
less than $4,000 and not more than $10,000 for the first offence, and of not less than $8,000 and not more than $20,000 for subsequent offences; 
(8) In addition to any fines imposed, any person found guilty of violating any provision under section 1709 of this Act shall be liable for a penalty equivalent to the proceeds from the distribution of illegal tobacco products as well as taxes and duties owed on those 
products. 
(9) Nothing in this Act shall preclude the criminal enforcement of its provisions in a Court of competent jurisdiction. 
(10) Where a person is found guilty of an offence under any section of this Act other than section 1709, the Court may impose an additional fine in addition to any other penalty, following an application by the prosecuting party appended to the statement of offence, equal to the amount of monetary benefit gained by the person as a result of the offence, even if the maximum fine is imposed under another provision. 
(11) A person who commits or continues an offence under this Act on more than one day is liable to be convicted for a separate offence for each day on which the offence is committed or continued. 
(12) Any person found to have violated any requirement under this Act or implementing regulations may be ordered to pay the reasonable costs associated with any inspection, investigation, and enforcement action brought about by the non-compliance.”	14	
	Strengthened legislation in Pohnpei	Are you aware that it is against the law for businesses to sell cigarettes to minors and also prohibits businesses and stores that sell tobacco products to keep the products out of sight of customers, under the counter, or in special cabinets?
Are you also aware that the same law calls on the State public safety to enforce this law and fine anyone or business in violation of up to $100 and/or put in jail for 30 days or a combination of both?	15	

Theme: Limited involvement of local stakeholders
Sub-theme	Category	Coded Text	Source	
Impact from international and local actors	WHO Country Office’s involvement	In 2005, a national workshop was held in Palikir, Pohnpei to revise and endorse outline an approach for the development of the FSM National Strategy to Prevention and Control of NCDs. Participants included a wide cross section of agencies including government departments and offices, the College of Micronesia (COM) and NGOs representing the four states of the FSM, and the WHO. Outcomes of the workshop included key recommendations for objectives and activities targeting each NCD focus area (i.e. harmful use of alcohol and tobacco use, betel nut chewing, unhealthy diet and physical inactivity). The workshop documents were also circulated to key FSM government and NGO agencies for further review and comment. During the workshop, participants worked in groups to develop key recommendations for activities and objectives in each of the focus areas, and subsequently circulated it to all the key agencies (those who attended and those who were unable to do so) for further comment and refinement. 
In view of the FSM’s unique structure – with the National Government and four States, it was agreed that the National Strategic Plan would serve as a guiding document for the development of State‐level strategies. All of the four FSM states will update their state level NCD Strategic Plan and will be aligned with the FSM NCD Strategic Plan of Action. In February 2012, the second FSM NCD Chronic Disease Conference was held in Yap and in this meeting the 2005 FSM NCD Strategy was again reviewed and commented with assistance from PIHOA. A steering committee was then formed within the FSM Department of Health and Social Affairs to complete the work already started. This document is the product of that steering committee recommendation. 
In December of 2017, the NCD Plan stakeholders and partners met in Yap to start the update process of the Plan. The technical team met again during the mid‐year meeting in Pohnpei and finalized the draft Plan. WHO provided technical and financial assistance to the renewal of the Plan which covers 20192024. The monitoring piece of this strategic plan was also done during the last NCD summit.

Objective 10: Control and influence the information concerning tobacco - Young people in particular are influenced by information concerning tobacco.

Tables: 
-Reducing prevalence of common risk factors: Tobacco use [p.12-14]
-Objective 10: Control and influence the information concerning tobacco [p.35]
-Objective 11: To amend existing tobacco laws to increase the tax on sales and licensures [p.36-37]

Annex D tables: PLAN OF ACTION FOR TOBACCO: REDUCE TOBACCO USE TO REDUCE CANCER [p.36-41]	16

17

17

16
	
	FCTC Secretariat’s impact 	The workshop followed a needs-assessment assistance supported by the World Health Organization Convention Secretariat for the international Framework Convention on Tobacco Control. FSM jointly conducted the joint needs assessment with the convention secretariat in November 2012. The needs-assessment report was used as a reference during the workshop. 
The FSM national government participants at the workshop came from the Department of Health & Social Affairs; the Department of Resources and Development; the Department of Finance and Administration; Department of Transportation, Communication and Infrastructure, Office of Environment and Emergency Management; the Office of Statistic, Budget and Economic Management, Overseas Development Assistance and Compact Management; the Department of Education; and the Department of Foreign Affairs. 
Participants form the state governments came from the attorney general's offices and staff members from both the legislative and judiciary branches. 
Various civil society representatives were in attendance in their various capacities, including memberships on the tobacco control coalitions from both the national and states levels. Secretary of Health and Social Affairs Dr. Vita Skilling and Assistant Secretary Marcus Samo took time to also witness the meeting.

FSM President Manny Mori has approved the establishment of a Tobacco Control Advisory Council as a multisectoral national coordination mechanism to implement the WHO Framework Convention. 
As its main outcomes, the workshop resulted in the creation of the following : (1) a draft FSM national action plan to implement the framework convention with four modified Action Plan developed by the States participants included as annexes; (2) one resolution endorsed and signed by the heads of delegations, participating states senators, government agencies, NGOs and attorney generals' offices calling for an increase on tobacco import tax and the allocation of 5 percent of collected tax to support the tobacco control program; (3) one tobacco control advisory council; (4) strengthening of the stakeholders knowledge of the Framework Convention on Tobacco Control and the ways to put in action its various objectives...	18

18

	
	Community health coalitions	Community Coalitions 
Public health professionals engage the active participation of community representatives through community coalitions to achieve primary prevention and health promotion objectives. Coalitions are “groups of individuals, factions, and constituencies who agree to work together to achieve a common goal.”11 Coalition members and partnering organizations collaborate in formal, organized ways to address issues of shared concern by implementing interventions aimed at changing individuals and environments.12 changes in
the ability of a community to identify, mobilize, and community health, coalitions aim to foster community capacity,13-16 the ability of a community to identify, mobilize, and address public health problems.17
The ability of a coalition to function depends on the participation of coalition members. Coalitions share existing and potential resources available from its members and partners.18,19 Coalition members work together and provide their commitment, expertise, and other assets to reach their community health promotion goals.18 

Coalition assessments help a coalition determine its progress according to its objectives and whether the coalition remains on track and may be sustained in the future to address the community’s health priorities. A coalition assessment is a type of evaluation because systematic information is provided to strengthen the partnership during implementation. The collection of outcome data may also be included to assess the extent of change among participants or within systems. The development of community coalitions generally takes place over time according to phases that are conducive to measurement, for example: (1) processes that maintain the partnership infra structure and function, (2) the implementation of activities and programs intended to accomplish a partnership’s goals, and (3) changes in health status or the community directly attributable to the work of a community coalition. Data to be collected to evaluate each phase of a coalition would involve: (1) conducting a member survey to assess satisfaction with how a coalition functions, (2) evaluating a program or activity that the partnership conducts, and (3) collecting community data on key health indicators. Such data would inform the extent of a coalition’s effect on the priority health problem.18

Because of the unique situation in Kosrae (single island state and relatively small population), when community-based outreach, awareness, and educational activities are planned, the appropriate public health programs work together to share resources, coordinate activities, and minimize confusion in the community.
Because Kosrae is a single-island state with a relatively small population and limited resources, the staff of the diabetes, tuberculosis, tobacco, and cancer programs collaborate to provide outreach, awareness, and education services in the schools and communities. During 2010, the Department of Health Services initiated two major community-based programs that encourage proper nutrition, physical activity, healthy lifestyles, and fitness — the Worksite Wellness Program and the Community Health Clubs.

The Kosrae Women’s Association sponsors cancer awareness activities in partnership with the Department of Health.

The following information was released by the National Government of the Federated States of Micronesia: A chronic disease risk reduction conference will be held on December 6-10, 2010, at the High Tide Hotel and Restaurant in Chuuk, FSM. 
This conference is sponsored by the National Cancer, Diabetes and Tobacco Programs. This is the first combined meeting of the 3 programs that deal with the prevention and control of chronic non-communicable diseases in the FSM. The combined efforts shows a very positive collaboration in dealing with the diseases that are contributing to high rates of mortality, heavy burdens on the lives of the people, negative impacts productivity of the work force, and the increasing cost of health care, among many things. 
This conference will bring together service providers, community supporters, policy and law makers, educators, NGO members and young people to review: the status of the chronic diseases, the current approaches to the prevention and control of these diseases, and the potential means of moving forward for a healthier FSM.

Apart from the usual hospital-based health care, community participation in health promotion and disease prevention is critical to successful partnership in the Federated States of Micronesia. Local civil societies, nongovernment organizations and church groups have all played key roles in increasing public awareness on important health issues.

Kosrae WNTD Policy Makers Advocacy Meeting was a huge success. We discussed Article 13 and have developed a plan to push for passage of a Comprehensive Ban on TAPS. Participants are pictured in our N photo. In the front is our Director of Health and the Lt. Governor. Others on the photo included pastors, women leaders, Mayors, Council Members, Youth representatives, etc.

In implementing this strategy, WHO and the Department of Health and Social Affairs will work with other government departments, other sectors, academia, civil society, other United Nations agencies, bilateral development partners, regional and global health initiatives, philanthropic foundations and others in support of planned national health priorities.	19

19

8

20

21

22

23

24

	

Theme: Problematic tobacco control program funding and administration
Sub-theme	Category	Coded Text	Source	
Grant hearings criticism	Tobacco control administration	Regarding the need for specific programs on tobacco and diabetes control and prevention the Committee inquired as to how prevalent these problems were in our Nation. The Department responded that more than 60% of our entire population is affected by one or both of these problems, and there has yet to be seen an indication of a reduction in these NCD type diseases. The Secretary stated that 20-30 years ago the kind of awareness and intervention programs were not as effective and well-known. People were somewhat aware at that time but the serious nature of these problems was not widely discussed. As a result of people’s attitudes all those years ago decades have gone by that has allowed these diseases to reach epidemic proportions. It will take several years for the current campaigns to have the desired effects of reduced disease numbers.

It was explained to your Committee that the Department is not seeing a reduction in the use of tobacco. The changes in tobacco use have been in type and the age groups using tobacco, but the Department is yet to see an overall reduction, unfortunately. There has been work with further legislation at the state level to restrict smoking areas. Also, your Committee was advised that a multi-year survey regarding smoking would shortly be finalized.

While the Committee believes that the problems of tobacco use, and the control and prevention of diabetes it would like to see more done with this program. Specifically it questioned what type of activities are being done to reach out to the communities. The Secretary stated that there are quarterly outreach activities being done but this was something that was just being started and the program was struggling to consistently reach all our citizens.

The Division of Health of the Department of Health and Social Affairs provides health planning, donor coordination, and technical and training assistance. It also coordinates and manages the preventative medicine and public health programmes funded by the United States Department of Health and Human Services. While the Division of Health does not have a direct role in the provision of health services, it has significant influence in the provision of health services as a result of its managerial responsibilities. Most state Departments of Health Services have very limited planning and programming capabilities. This area needs support and improvement.

The national Department of Health and Social Affairs is working in partnership with the four state Departments of Health Services on policy direction, coordination, monitoring and technical assistance.

The national Department of Health and Social Affairs oversees health programmes and ensures compliance with all laws and executive directives. The Department of Health Services in each state provides medical and public health services through a hospital, community health centres and dispensaries. Each state system is autonomous. Health services are highly subsidized by the state governments, except in private clinics.

The Division of Health in the Department of Health and Social Affairs conducts health planning, donor coordination, and technical and training assistance. It is also responsible for public health programmes funded by the United States Department of Health and Human Services. Access to and provision of quality health services greatly depend on governance and management of the Division of Health.

The Division of Health in the Department of Health and Social Affairs conducts health planning, donor coordination, and technical and training assistance. It is also responsible for public health programmes funded by the United States Department of Health and Human Services. Access to and provision of quality health services greatly depend on governance and management of the Division of Health.

The public health care system consists of the overarching, FSM National Department of Health and Social Affairs and the four state governments; Chuuk State Department of Health Services, Kosrae State Department of Health Services, Pohnpei State Department of Health Services and Yap State Department of Health Services.  The present health care system in the FSM has three levels; the community dispensaries, the state hospitals and referral to hospitals outside of the FSM.  

Each state government maintains its own health services. Although similar in many aspects, each system is also unique autonomously. Each state maintains a centrally located hospital that provides a minimum range of primary- and secondary-level services, both preventive and curative.

The state-based delivery system is an effective way of administering health. Given the geographical dispersal, remote nature and cultural diversity of the many island communities, the system has the best chance of developing more responsive and effective services to meet the needs of the community. In the environment of politically independent states, however, there are constraints on implementation of national policies.	25

26

25

22

22

24

24

27

28

22

22	
	Funding and sustainability	The summary for this grant award for March 29, 2014 to March 28, 2015 is as follows: Personnel: $247,439 Supplies: $ 16,523 Travel: $ 66,200 Contracts: $ 30,000 Other Costs: $ 34,000 Total: $394,192

The majority of the funding is to be used throughout the four States for the diabetes control and prevention ($164,192) and the Office of Smoking ($201,913).

The Department of H&SA stated that this grant was to help prevent and control the non-communicable diseases (NCDs) in our Nation. These combined NCDs are the number one killer in the Federated States of Micronesia. This grant proposed would support prevention and awareness goals. These goals would be in the areas of: 1) attempting to positively influence the environment; 2) work with the health system model in the hospitals; 3) treat patients at hospital and clinic with a whole patient “one stop shop” approach to address all of that person’s medical needs; and 4) strengthen the community and clinical linkage.	

The Department of Health and Social Affairs stated that this grant has been very successful in raising awareness regarding the dangers of tobacco use and an unhealthy diet. The Department stated that there has been a reduction in tobacco use, particularly in young people, since the first survey in 2007.

Your Committee notes that the budget, activities and goals for this program remain largely the same as in years past and it is satisfied with the Department’s progress in its endeavors regarding disease control and prevention in these areas.

The first item discussed during the hearing was the Department’s need to promptly submit the correct substance and form of resolutions for its grant applications and awards. Initially a resolution (C.R. No. 18-142), was submitted in March 2014 regarding a grant application for the Tobacco Program, however, during the hearing in March 2014 it was determined that the grant application had already been submitted to the donor agency, and a grant award had already been made. One again, your Committee voices its strong disapproval of the actions by the Department. By submitting the grant application without its legally required Congress approval the Executive branch makes a mockery of our laws. It was only on May 19, 2014 that the proper resolution in this matter was transmitted to Congress for its review. Once again, the Committee reminds the Department that the resolutions transmitted for action should be correctly drafted and include the budgets, application information or grant award and detailed breakdown of the proposed project. Finally, the Committee has stated in the past that the grant managers in these programs must begin their work immediately when a grant is posted so the various Executive departments and the State Departments of Health can provide their input in a timely manner.
During your Committee’s trip through the four States it heard many concerns from the State Departments of Health regarding their input during the grant application process. Members of your Committee asked the Secretary to outline the grant application process for them. The Secretary stated that the State programs were very involved in the budget and program project planning. The Secretary stated that the State budgets were submitted to the donors without any revisions at the National level. It was only if the donor decreased from the amount requested did the National Department of Health and Social Affairs unilaterally adjust the States budgets for U.S. federally funded programs. The States stated differently to the Committee during its April/May 2014 trip. The States advised your Committee that the Department made adjustments without consulting them and that, in their opinion, too much of the program funds rested at the National level where few activities took place.

Turning to the grant award and its use during this coming year the Secretary was asked what the proportion of money remaining at the National level verses the States. The Secretary stated that 6 employees were at the National level while 12 were in the States. The majority of the program cost is salaries at 56%. Not quite one third of the budget for this grant award will remain at the National level. The Committee emphasized to the Department that it felt this was too large a portion of the program grant to remain at the National level, and in the future it should work to transition a higher percentage of the funding and jobs to the State level.

As stated regarding the other grants reviewed during this hearing, your Committee reiterates it was troubled by the budget as presented as a large portion still rests with the National Department of Health and Social Affairs. The Department stated that training and travel rested with it as they were in the best position to target where training was needed and provide that. It also stated that in the past the State Governments did not file the necessary vouchers and paperwork after travel so some funding had been lost. The Committee stated that the States and individuals needed to adhere to the guidelines and should be responsible for these aspects of the grant.

It is clear that our Nation must work hard to prevent tobacco use and diabetes, and that this should be done primarily at the State level.

Your Committee agrees that additional funding is needed to continue the FSM Tobacco Control and Diabetes Control and Prevention Programs.

During the hearing the Committee inquired as to the status of future funding for this program. The Department advised that has been in contact with its counterparts in the U.S., and has received information that all the U.S. federally funded grants can expect approximately 15-20% across the board reduction in funding in the next year. Some programs may have even deeper cuts, but there will be no certainty until the U.S. budget is passed for the coming year. Given these comments your Committee is even more concerned about the future of our public health programs for the Nation. The Committee strongly urges the Department to effectively administer the program and take all measures necessary to ensure that our funding agencies have no reason to decrease their grant awards.	25

26

23

29

29

25

25

29

25

25

30

Theme: Incomplete documentation of TAPS
Sub-theme	Category	Coded Text	Source	
Documentation of marketing examples	Tobacco industry’s promotional activities	Today, the distributors of tobacco products throughout the FSM are located on Guam, from whence they push the products of “the Carolina Three”: Philip Morris, RJR Nabisco, and Brown and Williamson/British American Tobacco.

Most tobacco consumed today in the FSM is imported in the form of commercially manufactured cigarettes made either in the United States or the Philippines. These cigarettes are advertised and distributed by large transnational tobacco companies as part of a global strategy to "hook" people in the developing countries so as to assure a continued market for their deadly products. The distributors of tobacco products in the FSM are located on Guam, from which they market aggressively the products of some of the largest and wealthiest transnational corporations on the planet [6].

Philip Morris does not have an office in Guam. Distribution of products is through our sole distributor, Mid-Pacific Liquor Distributing Corporation (Mid-Pac), which is situated in Guam. The Asia Duty Free Division of Philip Morris Asia Inc. (PMAI) supports sales and marketing activities for Guam, which include placing orders for Mid-Pac at Philip Morris Products Inc_ (PMPI). Products are shipped directly by PMPI to Mid-Pac. PMPI issues invoices to Mid-Pac, and Mtd-Pac settles all payments directly with PMPI. 
Since Guam is one of the countries under the administration of Micronesia, it also acts as a major distribution channel of cigarettes from the U_S- to the rest of the neighbouring countries. In this connection, certain brands are available in both the domestic market and duty-free shops in Guam; others are not available in Guam's domestic market but are available in duty free shops in Guam and are exported from Guam to the Northern Mariana Islands, the Marshall Islands, Palau and the Federated States of Micronesia.

PM Micronesia Markets is scheduled to launch the MARLBORO Consumer Promotion in the Republic of Palau ("ROP") and the Federated States of Micronesia ("FSM") during the month of September 1999. A set of 2 lighters is selected as promotional item. Enclosed please find a colour copy of the item together with its specifications for your review. 
Purchase order will be placed with Tokai Seiki Co. (1-IIC) Ltd. at Flat 1-6, 3/F., Blk.3, Nan Fung Industrial City, 18 Tain Hau Road, Tuen Mun, Hong Kong for 6,000 pieces at unit price of approximately US$2.00. Please note that Tokai claims to be the sole supplier of this lighter in Micronesia.

PM Micronesia Markets is scheduled to launch the BENSON & HEDGES Consumer Promotion in the Republic of Palau ("ROP") and the Federated States of Micronesia ("FSM") during the month of July 1999. A Vivitar camera is selected as promotional item.  Enclosed please find a colour copy of the item together with its specifications for your review. 
Purchase order will be placed with Vivitar (Asia) Ltd- at Unit 1004-1005, 1& Floor, Conic Investment Building, 13 Hok Yuen Street, Hunghom, Hong Kong for 6,000 pieces at unit price of approximately US$2.00. 
The BENSON & HEDGES trademark will not be placed on the camera and that there is no proposed name for the item. 
We are currently trying to obtain a confirmation from Vivitar that the Company has no objection to the use of their trademark and the picture of their products in our catalogues and promotional materials. Once the letter is available, I will forward a copy for your reference. 
Should you need any additional information, please let me know.

PM Micronesia market is planning a MARLBORO Promotion in certain islands within the Micronesia. While particulars of the program, such as nature of the promotion, duration, location and how many items available aro yet to confirm, a compass watch is selected. 
I am informed that this compass watch appeared in the 1996 EMMA Premium Cataloguc, copy of which is enclosed. During that time, EEMA has instructed a Hong Kong company called Wainon Company Ltd. ("Wainon'") to manufacture the products. Our Regional Procurement has checked with Wainon who claimed that the watch is not patented and that they developed the mould of the watch. A copy of a letter from Wainon dated August 18, 1998 is enclosed for your reference. 
Our Regional Procurement, however, has engaged another company called Sweda Ltd. to develop a compass watch, design of which is similar to the one above. You will note from the enclosed specification of the item and quotation that the market intends to place an order for 15,000 pieces at unit price of approximately, USS4 .00. I would appreciate it if you could review the sample and anange for patent search you deem necessary at the Micronesia jurisdiction. 
The trademark MARLBORO will be depicted on the watch. 
Thank you for your attention. Once I have received further information regarding this Promotion, I will let you know.

Prevention efforts also are thwarted by tobacco companies that sponsor contests and give prizes (including free t-shirts and hats) to attract youth and adults to smoking.

Tobacco advertising is resource rich, aggressive, and uses established cultural norms (linking tobacco to betel nut use). Recent cigarette advertising campaigns have included free tee-shirts in exchange for 15 empty cigarette packs, cash sweepstakes with a grand prize of $1,000 in Truk and FSM

There were indications from the participants in the joint needs assessment that the tobacco industry had recently been running promotions and incentives involving prizes or benefits from the returning of empty packs.

While a resident in the State of Pohnpei, Federated States of Micronesia, I recall and have participated in numerous Sweepstakes, which were sponsored by your Winston's Company. 
Here in Kosrae State, which is also part of The Federated States of Micronesia, no such event has been taken place....would be good for your product as well as for a fund-raising project for an association. 
If such can be possible here, please advise as to Source for soliciting. 
Appreciate for your understanding and assistance. 
Enclosed retained from our recent received Sports Illustrated magazine.	31

1

32

33

34

35

20

36

7

37

	
Single source of population exposure to TAPS	National youth survey	[Tables: “Access & Availability” and “Media: Tobacco Advertising”]

Over 6 in ten of all students (69.6%) have seen advertisements or promotions for cigarettes during the past 30 days. In the past 30 days, 63.2% have seen cigarette advertisements in newspapers or magazines. One-fourth of all students have an object with a cigarette brand logo on it (such as a t-shirt, pen, backpack, etc.). There were no significant differences by gender

[Tables 5 & 7]

Seven out of ten students have stated that he or she has seen or heard anti-smoking media messages via the television, radio, billboards, posters, newspaper, magazines, and/or movies during the past 30 days. However, these anti-smoking media attempts are being diluted by pro-smoking advertisements, 69.6% of the students have seen or heard tobacco advertisements in the FSM. Therefore, anti-smoking media efforts must be enhanced to decrease to the amount of tobacco advertisement in the FSM.	38

39

39

39

References
1. 	Marshall M. Tobacco prevention in the Federated States of Micronesia. Drug and Alcohol Review. 1997;16(4):411-419. doi:10.1080/09595239700186811
2. 	Congress of the Federated States of Micronesia. Congress Bill No. 6-53.; 1989:1-2. https://cfsm.gov.fm/ifile/6th%20Congress/Bills/CFSM_CB_1R6_53.pdf. Accessed March 15, 2021.
3. 	Congress of the Federated States of Micronesia. Congress Bill No. 8-39.; 1993:1. https://www.cfsm.gov.fm/ifile/8th%20Congress/Bills/CFSMCB_1R8_39.pdf. Accessed March 15, 2021.
4. 	Congress of the Federated States of Micronesia. Congress Bill No. 8-115.; 1993:1-3. https://www.cfsm.gov.fm/ifile/8th%20Congress/Bills/CFSMCB_2R8_115.pdf. Accessed March 15, 2021.
5. 	WHO Regional Office for the Western Pacific. Regional Action Plan on Tobacco or Health for 1990-1994. Kuala Lumpur; 1994:1-31. https://apps.who.int/iris/bitstream/handle/10665/141130/WPR_RC045_13_Tobacco_1994_en.pdf?sequence=1&isAllowed=y. Accessed March 15, 2021.
6. 	Chuuk State. Chuuk State Law 2-94-08.; 1994:1-4. http://fsmlaw.org/chuuk/pdf/csl_a/CSL%202-94-08%20EV.pdf. Accessed March 15, 2021.
7. 	WHO Framework Convention on Tobacco Control, Convention Secretariat. Needs Assessment for Implementation of the WHO Framework Convention on Tobacco Control in the Federated States of Micronesia.; 2013:1-41.
8. 	Ichiho HM, Bs JY, Mcn KL, Aitaoto N. An Assessment of Non-Communicable Diseases, Diabetes, and Related Risk Factors in the Federated States of Micronesia, State of Yap: A Systems Perspective. PUBLIC HEALTH. 2013;72(5):11.
9. 	Yap State. Yap State Code No. 3-80.; 1994:1. http://fsmlaw.org/yap/code/title11/T11_Ch13.htm. Accessed March 15, 2021.
10. 	Congress of the Federated States of Micronesia. Congress Bill No. 16-118.; 2010:1-4. https://www.cfsm.gov.fm/ifile/16th%20Congress/Bills/C.B%2016-118.pdf. Accessed March 15, 2021.
11. 	Chuuk State. Chuuk State Law 11-12-17.; 2012:1-11. http://fsmlaw.org/chuuk/pdf/csl_b/CSL%2011-12-17%20EV.pdf. Accessed March 15, 2021.
12. 	Pohnpei State. Pohnpei State Code.; 2012:1-1380. http://fsmlaw.org/pohnpei/code/pdf/pohnpei%20state%202012%20code.pdf. Accessed March 15, 2021.
13. 	FSM Department of Health and Social Affairs. Comprehensive Cancer Control Plan: 2013-2018. Pohnpei; 2012:1-53. https://extranet.who.int/nutrition/gina/sites/default/filesstore/FSM_2013_CCC.pdf. Accessed March 15, 2021.
14. 	Congress of the Federated States of Micronesia. Congress Bill No. 19-132.; 2016:1-38. http://cfsm.gov.fm/ifile/19th%20Congress/BILLS/CB%2019-132.pdf. Accessed March 15, 2021.
15. 	Kaselehlie Press. Public Health Announcement. http://www.kpress.info/index.php?option=com_content&view=article&id=240:public-health-announcement&catid=8&Itemid=103. Published 2016. Accessed March 15, 2021.
16. 	Government of Federated States of Micronesia. National Strategic Plan of Action for the Prevention and Control of Non-Communicable Diseases in the Federated States of Micronesia (FSM): 2019-2024. Pohnpei; 2019:1-52. https://extranet.who.int/nutrition/gina/en/node/40321. Accessed March 15, 2021.
17. 	Government of Federated States of Micronesia. National Strategic Plan for the Prevention and Control of Non-Communicable Diseases in the Federated States of Micronesia: 2013-2017. Pohnpei; 2013:1-44. https://extranet.who.int/nutrition/gina/en/node/25918. Accessed March 15, 2021.
18. 	Pacnews. Pohnpei hosts FSM tobacco control action plan meeting.2013.
19. 	Sy AU, Heckert KA, Buenconsejo-Lum L, Mbbs JH, Tamang S, Palafox N. An Assessment of the Paciﬁc Regional Cancer Coalition: Outcomes and Implications of a Regional Coalition Internal and External Assessment. 2011;70(11):7.
20. 	Shehata C, Kroon E, Skilling VA, Taulung L. Cancer in Kosrae State, Federated States of Micronesia. Pacific Health Dialog. 2004;11(2):37-43.
21. 	States News Service. Chronic disease risk reduction conference to be held in Chuuk.2010.
22. 	World Health Organization, Regional Office for the Western Pacific. Western Pacific Country Health Information Profiles: 2011 Revision. Manila, Philippines; 2011. https://iris.wpro.who.int/handle/10665.1/10522. Accessed March 15, 2021.
23. 	BMJ Blogs Tobacco Control. Pacific Island Countries: World No Tobacco Day: A Brief Summary of Activities in Words and Pictures.; 2013:1-16. https://blogs.bmj.com/tc/files/2013/06/WNTD-booklet-pacific.pdf. Accessed March 15, 2021.
24. 	WHO Regional Office for the Western Pacific. WHO Country Cooperation Strategy 2018-2022: Federated States of Micronesia. Manila, Philippines; 2017:1-6. https://iris.wpro.who.int/bitstream/handle/10665.1/13947/WPRO-2017-DPM-013-fsm-eng.pdf. Accessed March 15, 2021.
25. 	Congress of the Federated States of Micronesia. Standing Committee Report No. 18-152. Pohnpei; 2014:1-5. http://www.cfsm.gov.fm/ifile/18th%20Congress/Committee%20Reports/SCR%20No.%2018-152.pdf. Accessed March 15, 2021.
26. 	Congress of the Federated States of Micronesia. Standing Committee Report No. 19-126. Pohnpei; 2016:1-3. http://www.cfsm.gov.fm/ifile/19th%20Congress/REPORTS/SCR%20No.%2019-126.pdf. Accessed March 15, 2021.
27. 	World Health Organization. Our work in the Federated States of Micronesia. https://www.who.int/micronesia/our-work. Published 2020. Accessed March 15, 2021.
28. 	Pacific Island Health Officers Association (PIHOA). Federated States of Micronesia (FSM). https://www.pihoa.org/fsm/. Published 2020. Accessed March 15, 2021.
29. 	Congress of the Federated States of Micronesia. Standing Committee Report No. 18-289. Pohnpei; 2015:1-3. http://www.cfsm.gov.fm/ifile/18th%20Congress/Committee%20Reports/SCR%20No.%2018-289.pdf. Accessed March 15, 2021.
30. 	Congress of the Federated States of Micronesia. Standing Committee Report No. 19-225. Pohnpei; 2017:1-3. https://www.cfsm.gov.fm/ifile/19th%20Congress/REPORTS/SCR_No__19-225.pdf. Accessed March 15, 2021.
31. 	Marshall M. Carolina in the Carolines: A Survey of Patterns and Meanings of Smoking on a Micronesian Island. maq. 2005;19(4):365-382. doi:10.1525/maq.2005.19.4.365
32. 	Friedman M. Proposed resolution/structural issues for PMI. 1997. https://www.industrydocuments.ucsf.edu/docs/#id=jlyg0053. Accessed March 15, 2021.
33. 	Industry Documents Library. Micronesia - 990000 Marlboro Consumer Promotion. 1999. https://www.industrydocuments.ucsf.edu/docs/#id=kpjb0076. Accessed March 15, 2021.
34. 	Industry Documents Library. Micronesia - 990000 Benson & Hedges Promotion. 1999. https://www.industrydocuments.ucsf.edu/docs/#id=spjb0076. Accessed March 15, 2021.
35. 	Industry Documents Library. Micronesia - Marlboro Promotion. 1998. https://www.industrydocuments.ucsf.edu/docs/#id=rkgb0076. Accessed March 15, 2021.
36. 	Palafox NA, Kaanoi M. Health Disparities Among Pacific Islanders. United States: Office of Minority Health; 2000:1. https://www.minorityhealth.hhs.gov/assets/pdf/checked/Health%20Disparities%20Among%20Pacific%20Islanders.pdf. Accessed March 15, 2021.
37. 	Industry Documents Library. While a resident in the State of Pohnpei Federated States of Micronesia I recall and have participated in numerous Sweepstakes which were sponsored by your Winston’s Company. 1993. https://www.industrydocuments.ucsf.edu/docs/#id=xpmn0227. Accessed March 15, 2021.
38. 	World Health Organization. Global Youth Survey (GYTS): Federated States of Micronesia 2013. Geneva; 2013:1-2. https://extranet.who.int/ncdsmicrodata/index.php/catalog/697. Accessed March 15, 2021.
39. 	World Health Organization. Global Youth Survey (GYTS): Federated States of Micronesia, Annex 3. Geneva; 2007:1-10. https://untobaccocontrol.org/impldb/wp-content/uploads/reports/Micronesia_annex3_GYTS.pdf. Accessed March 15, 2021.