{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:57:21Z","timestamp":1790791041924,"version":"4.1.0"},"reference-count":48,"publisher":"BMJ","funder":[{"DOI":"10.13039\/100015283","name":"Bloomberg Philanthropies","doi-asserted-by":"publisher","award":["KC085918"],"award-info":[{"award-number":["KC085918"]}],"id":[{"id":"10.13039\/100015283","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2026,8,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>North Macedonia consistently provides substantial direct subsidies for tobacco cultivation despite its commitments under the WHO Framework Convention on Tobacco Control and aspirations to align with the European Union\u2019s Common Agricultural Policy. This study examines tobacco subsidies and their implications on production trends, farmer behaviour and policy alignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study applies descriptive analysis to assess the economic significance of tobacco farming and subsidies and correlation analysis and Interrupted Time Series Analysis to estimate the relationship between production and financial incentives (price and subsidies). The study also draws on survey results to understand farmer attitudes towards tobacco growing and subsidies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Tobacco remains North Macedonia\u2019s most subsidised crop, receiving around 40% of crop-related support. While subsidies appear to sustain production and significantly supplement farmer income, cultivated area and farmer participation are declining. Survey results provide further support that subsidies influence farmer behaviour and that without them most farmers would quit tobacco farming.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>North Macedonia allocates substantial public funds to tobacco subsidies aimed to support rural households and promote its valuable agricultural export, but this may not be the most economically prudent use of national resources. A strategic transition plan is essential to align agricultural policy with international commitments and health and sustainability goals. This includes measures for diversification and transition towards viable alternatives along with phased decoupling of subsidies. Successful implementation of reforms would be facilitated with farmer support for alternative livelihoods, a clear timeline of measures, stronger institutional capacity and investment in sustainable rural development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tc-2025-059680","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:20:29Z","timestamp":1790788829000},"page":"tc-2025-059680","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Subsidising tobacco growing in North Macedonia: policy at a crossroads"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6198-9575","authenticated-orcid":false,"given":"Biljana","family":"Tashevska","sequence":"first","affiliation":[{"name":"Faculty of Economics - Skopje, Ss Cyril and Methodius University, Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8451-3383","authenticated-orcid":false,"given":"Tamara","family":"Mijovic Spasova","sequence":"additional","affiliation":[{"name":"Analytica Skopje, Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4375-8181","authenticated-orcid":false,"given":"Bojana","family":"Mijovic Hristovska","sequence":"additional","affiliation":[{"name":"Analytica Skopje, Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5748-2141","authenticated-orcid":false,"given":"Marija","family":"Trpkova-Nestorovska","sequence":"additional","affiliation":[{"name":"Faculty of Economics - Skopje, Ss Cyril and Methodius University, Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8182-1219","authenticated-orcid":false,"given":"Kristijan","family":"Kozheski","sequence":"additional","affiliation":[{"name":"Faculty of Economics - Skopje, Ss Cyril and Methodius University in Skopje Faculty of Economics, Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3630-9486","authenticated-orcid":false,"given":"Borce","family":"Trenovski","sequence":"additional","affiliation":[{"name":"Economics, Saints Cyril and Methodius University in Skopje Faculty of Economics, Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093010202351000_tc-2025-059680v1.1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.18332\/tpc\/132596","article-title":"How does tobacco growing impact advancement in demand reduction measures?","volume":"7","author":"Lencucha","year":"2021","journal-title":"Tob Prev Cessat"},{"key":"2026093010202351000_tc-2025-059680v1.2","doi-asserted-by":"crossref","first-page":"362","DOI":"10.2471\/BLT.16.175596","article-title":"Tobacco growing and the sustainable development goals, Malawi","volume":"95","author":"Kulik","year":"2017","journal-title":"Bull World Health Organ"},{"key":"2026093010202351000_tc-2025-059680v1.3","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2017-053773"},{"key":"2026093010202351000_tc-2025-059680v1.4","unstructured":"World Bank . 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The post-buyout experience: peanut and tobacco sectors adapt to policy reform. Economic Information Bulletin no.60. Washington, DC USDA Economic Research Service; 2009. Available: https:\/\/www.ers.usda.gov\/publications\/pub-details\/?pubid=44440","DOI":"10.2139\/ssrn.1547107"},{"key":"2026093010202351000_tc-2025-059680v1.8","unstructured":"Kirwan BE , White TK , Uchida S . Aggregate and farm-level productivity growth in US tobacco before and after the quota buyout (preliminary). University of Maryland & USDA Economic Research Service; 2010."},{"key":"2026093010202351000_tc-2025-059680v1.9","unstructured":"European Commission . Commission staff working document accompanying the proposal for a council directive on the structure and rates of excise duty applied to tobacco and related products. Brussels European Commission; 2025. Available: https:\/\/eur-lex.europa.eu\/legal-content\/GA\/ALL\/?uri=CELEX%3A52025SC0560"},{"key":"2026093010202351000_tc-2025-059680v1.10","unstructured":"FAO . FAOSTAT: production: crops and livestock products. 2024. Available: https:\/\/www.fao.org\/faostat\/en\/#data\/QCL [Accessed Oct 2025]."},{"key":"2026093010202351000_tc-2025-059680v1.11","doi-asserted-by":"crossref","unstructured":"World Health Organization . World no tobacco day 2023: grow food, not tobacco. Licence: CC BY-NC-SA 3.0 IGO. Geneva; 2023. doi:10.53127\/tblg-2023-A001","DOI":"10.53127\/tblg-2023-A001"},{"key":"2026093010202351000_tc-2025-059680v1.12","unstructured":"Drope J , Hamill S , Chaloupka F , et al . The Tobacco Atlas. Growing. New York Vital Strategies and Economics for Health; 2025. 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Available: https:\/\/www.tobacconomics.org\/files\/research\/289\/Arpad_Szabo_Chicago2016.pdf"},{"key":"2026093010202351000_tc-2025-059680v1.22","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18010343","article-title":"An Overview of the Policy and Market Landscape of Tobacco Production and Control in Mozambique","volume":"18","author":"Nguenha","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2026093010202351000_tc-2025-059680v1.23","doi-asserted-by":"crossref","DOI":"10.1002\/puh2.70008","article-title":"The Interplay of Tobacco Farming and Tobacco Control: Exploring Socioeconomic and Health Dynamics in Malawi","volume":"3","author":"Ngoma","year":"2024","journal-title":"Public Health Chall"},{"key":"2026093010202351000_tc-2025-059680v1.24","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1093\/ntr\/ntz173","article-title":"Explaining Why Farmers Grow Tobacco: Evidence From Malawi, Kenya, and Zambia","volume":"22","author":"Appau","year":"2020","journal-title":"Nicotine Tob Res"},{"key":"2026093010202351000_tc-2025-059680v1.25","unstructured":"Sahadewo GA , Drope J , Witoelar F , et al . The economics of tobacco farming in Indonesia: results from two waves of a farm-level survey. Tobacconomics; 2021. Available: https:\/\/www.tobacconomics.org\/files\/research\/654\/indonesia-economics-of-tobacco-farming.pdf"},{"key":"2026093010202351000_tc-2025-059680v1.26","doi-asserted-by":"crossref","unstructured":"Mijovic Hristovska B , Mijovic Spasova T , Trpkova-Nestorovska M , et al . The economics of tobacco farming in North Macedonia. Tob Prev Cessation 2023;9. doi:10.18332\/tpc\/172679","DOI":"10.18332\/tpc\/172679"},{"key":"2026093010202351000_tc-2025-059680v1.27","doi-asserted-by":"crossref","unstructured":"Pervez AKMK , Bhuiya RA , Amin MdR , et al . Farmers\u2019 Willingness to Stop Tobacco Cultivation and Perception of Alternate Food Crops to Replace It: Case of Major Tobacco Growing Areas in Bangladesh. 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Available: https:\/\/makstat.stat.gov.mk\/PXWeb\/pxweb\/en\/MakStat\/MakStat__Naselenie__ProcenkiNaselenie__ProcenkiPopis2021__Proceni31Dekemvri\/31122021_MKD_Za_PX.px\/table\/tableViewLayout2\/ [accessed Apr 2026]"},{"key":"2026093010202351000_tc-2025-059680v1.31","unstructured":"MAKSTAT database . Components of GDP by sections and divisions of NKD Rev.2, by years. State Statistical Office; 2025. Available: https:\/\/makstat.stat.gov.mk\/PXWeb\/pxweb\/en\/MakStat\/MakStat__BDP__BDPInvesGodisni__GodisniBDPsporedESS2010\/375_NacSmA_Mk_09p2a_01ml.px\/table\/tableViewLayout2\/?rxid=46ee0f64-2992-4b45-a2d9-cb4e5f7ec5ef [accessed Apr 2026]"},{"key":"2026093010202351000_tc-2025-059680v1.32","unstructured":"MAFWE . Annual agricultural report 2022. Ministry of Agriculture, Forestry and Water Economy; 2023."},{"key":"2026093010202351000_tc-2025-059680v1.33","unstructured":"Law on tobacco, tobacco products and related products, no.98. Official Gazette of the Republic of North Macedonia; 2019."},{"key":"2026093010202351000_tc-2025-059680v1.34","unstructured":"Government of the Republic of North Macedonia . National strategy on agriculture and rural development for the period 2021\u20132027. Official Gazette of the Republic of North Macedonia; 2021."},{"key":"2026093010202351000_tc-2025-059680v1.35","unstructured":"Geiss O , Kotzias D . Tobacco, cigarettes and cigarette smoke: an overview. Ispra, Italy: European Commission, Institute for Health and Consumer Protection, 2007."},{"key":"2026093010202351000_tc-2025-059680v1.36","doi-asserted-by":"crossref","DOI":"10.3390\/molecules25071734","article-title":"Carbohydrates-Key Players in Tobacco Aroma Formation and Quality Determination","volume":"25","author":"Bano\u017ei\u0107","year":"2020","journal-title":"Molecules"},{"key":"2026093010202351000_tc-2025-059680v1.37","doi-asserted-by":"crossref","unstructured":"Pashovska S , Kareska K . Analysis of the meaning and impact of subsidies on the development of tobacco production in Macedonia. Proceedings of the 1st International Symposium on Biotechnology; 2023:83\u201392. Available: https:\/\/doi.ub.kg.ac.rs\/10-46793-sbt28\/","DOI":"10.46793\/SBT28.083P"},{"key":"2026093010202351000_tc-2025-059680v1.38","unstructured":"SSO . MAKSTAT database. State Statistical Office. Available: https:\/\/makstat.stat.gov.mk\/PXWeb\/pxweb\/en\/MakStat\/MakStat__NadvoresnaTrgovija__KumulativniPod\/160_SMTK_godisni_ml.px\/?rxid=46ee0f64-2992-4b45-a2d9-cb4e5f7ec5ef [Accessed Oct 2025]."},{"key":"2026093010202351000_tc-2025-059680v1.39","unstructured":"State Statistical Office of the Republic of North Macedonia . Basic demographic indicators at the national level, (revised data based on the population census, 2021) from 2003 to 2022 by years and units. State Statistical Office; 2024. Available: https:\/\/makstat.stat.gov.mk\/PXWeb\/pxweb\/en\/MakStat\/MakStat__Naselenie__ProcenkiNaselenie__ProcenkiPopis2021__Proceni2003_2020Revidirani\/100_stapki_po_godini_ml.px\/ [accessed Feb 2026]"},{"key":"2026093010202351000_tc-2025-059680v1.40","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.3390\/agriculture13091711","article-title":"Characteristics of the Supply Chain of Tobacco and Tobacco Products: Evidence from Serbia","volume":"13","author":"Tica","year":"2023","journal-title":"Agriculture"},{"key":"2026093010202351000_tc-2025-059680v1.41","unstructured":"World Bank . North macedonia special focus note: agriculture. Washington, DC World Bank Group; 2018. Available: https:\/\/documents1.worldbank.org\/curated\/en\/540801560754049765\/pdf\/North-Macedonia-Special-Focus-Note-Agriculture.pdf"},{"key":"2026093010202351000_tc-2025-059680v1.42","unstructured":"Kotevska A , Martinovska Stojcheska A , Erjavec E , eds. 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