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Overview of systematic reviews on the health-related effects of government tobacco control policies.

Hoffman SJ, Tan C - BMC Public Health (2015)

Bottom Line: Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well.Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention.Additional studies are needed on the various factors that can influence a policy's effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.

View Article: PubMed Central - PubMed

Affiliation: Global Strategy Lab, Faculty of Law, University of Ottawa, 57 Louis Pasteur Street, Ottawa, K1N 6N5, ON, Canada. steven.hoffman@uottawa.ca.

ABSTRACT

Background: Government interventions are critical to addressing the global tobacco epidemic, a major public health problem that continues to deepen. We systematically synthesize research evidence on the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force.

Methods: An overview of systematic reviews was prepared through systematic searches of five electronic databases, published up to March 2014. Additional reviews were retrieved from monthly updates until August 2014, consultations with tobacco control experts and a targeted search for reviews on mass media interventions. Reviews were assessed according to predefined inclusion criteria, and ratings of methodological quality were either extracted from source databases or independently scored.

Results: Of 612 reviews retrieved, 45 reviews met the inclusion criteria and 14 more were identified from monthly updates, expert consultations and a targeted search, resulting in 59 included reviews summarizing over 1150 primary studies. The 38 strong and moderate quality reviews published since 2000 were prioritized in the qualitative synthesis. Protecting people from tobacco smoke was the most strongly supported government intervention, with smoke-free policies associated with decreased smoking behaviour, secondhand smoke exposure and adverse health outcomes. Raising taxes on tobacco products also consistently demonstrated reductions in smoking behaviour. Tobacco product packaging interventions and anti-tobacco mass media campaigns may decrease smoking behaviour, with the latter likely an important part of larger multicomponent programs. Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well. Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention.

Conclusion: When designing and implementing tobacco control programs, governments should prioritize smoking bans and price increases of tobacco products followed by other interventions. Additional studies are needed on the various factors that can influence a policy's effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.

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Related in: MedlinePlus

Overview of results from strong and moderate quality systematic reviews published since 2000. A green square indicates the review found the intervention had a beneficial effect on the outcome measure. A yellow square indicates the review found an unclear or conditional effect. A red square indicates the review found the intervention had no effect. Thomas et al. 2008 could not be included in this table under “Protect people from tobacco smoke” since it looked at the effect of smoking bans on social inequalities in smoking; it did not evaluate their overall impact or the conditions under which they are effective. Kohler & Minkner 2014 conducted a review of state smoke-free laws and petitions, initiatives and referendums to protect non-smokers in Germany, finding 56 laws and amendments and 15 initiatives. HE = Health Evidence; HSE = Health Systems Evidence; RC = Rx for Change
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Fig2: Overview of results from strong and moderate quality systematic reviews published since 2000. A green square indicates the review found the intervention had a beneficial effect on the outcome measure. A yellow square indicates the review found an unclear or conditional effect. A red square indicates the review found the intervention had no effect. Thomas et al. 2008 could not be included in this table under “Protect people from tobacco smoke” since it looked at the effect of smoking bans on social inequalities in smoking; it did not evaluate their overall impact or the conditions under which they are effective. Kohler & Minkner 2014 conducted a review of state smoke-free laws and petitions, initiatives and referendums to protect non-smokers in Germany, finding 56 laws and amendments and 15 initiatives. HE = Health Evidence; HSE = Health Systems Evidence; RC = Rx for Change

Mentions: Six hundred and twelve reviews were identified through the search strategy. Screening titles and abstracts yielded 67 reviews that possibly met the inclusion criteria. Two reviewers screened the full-text of reviews and confirmed 45 met the inclusion criteria. Any conflicts were resolved by discussion between the two reviewers and a third reviewer was consulted when required. Four additional reviews for inclusion were identified from monthly updates, nine were identified by tobacco control experts and one was identified from the targeted search for reviews on mass media campaigns. In total, 59 reviews were included that together summarized over 1150 primary studies (see Fig. 1) [14–72].1 The 22 reviews excluded after full-text screening either evaluated excluded outcome measures (n = 1) [73], were overviews of systematic reviews (n = 3) [74–76], did not follow a systematic methodology (n = 1) [77], only reported results of multicomponent programs (n = 4) [78–81], did not adequately describe what interventions were evaluated (n = 2) [82, 83], or were not relevant for assessing government tobacco control policies (n = 11) [84–94]. Findings from the 38 reviews that were either strong or moderate quality and published since 2000 are presented here (see Fig. 2) [14–51]. A Web Appendix contains individualized summaries of these reviews as well as the lower quality and older reviews (see Additional file 1) [52–72].Fig. 1


Overview of systematic reviews on the health-related effects of government tobacco control policies.

Hoffman SJ, Tan C - BMC Public Health (2015)

Overview of results from strong and moderate quality systematic reviews published since 2000. A green square indicates the review found the intervention had a beneficial effect on the outcome measure. A yellow square indicates the review found an unclear or conditional effect. A red square indicates the review found the intervention had no effect. Thomas et al. 2008 could not be included in this table under “Protect people from tobacco smoke” since it looked at the effect of smoking bans on social inequalities in smoking; it did not evaluate their overall impact or the conditions under which they are effective. Kohler & Minkner 2014 conducted a review of state smoke-free laws and petitions, initiatives and referendums to protect non-smokers in Germany, finding 56 laws and amendments and 15 initiatives. HE = Health Evidence; HSE = Health Systems Evidence; RC = Rx for Change
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526291&req=5

Fig2: Overview of results from strong and moderate quality systematic reviews published since 2000. A green square indicates the review found the intervention had a beneficial effect on the outcome measure. A yellow square indicates the review found an unclear or conditional effect. A red square indicates the review found the intervention had no effect. Thomas et al. 2008 could not be included in this table under “Protect people from tobacco smoke” since it looked at the effect of smoking bans on social inequalities in smoking; it did not evaluate their overall impact or the conditions under which they are effective. Kohler & Minkner 2014 conducted a review of state smoke-free laws and petitions, initiatives and referendums to protect non-smokers in Germany, finding 56 laws and amendments and 15 initiatives. HE = Health Evidence; HSE = Health Systems Evidence; RC = Rx for Change
Mentions: Six hundred and twelve reviews were identified through the search strategy. Screening titles and abstracts yielded 67 reviews that possibly met the inclusion criteria. Two reviewers screened the full-text of reviews and confirmed 45 met the inclusion criteria. Any conflicts were resolved by discussion between the two reviewers and a third reviewer was consulted when required. Four additional reviews for inclusion were identified from monthly updates, nine were identified by tobacco control experts and one was identified from the targeted search for reviews on mass media campaigns. In total, 59 reviews were included that together summarized over 1150 primary studies (see Fig. 1) [14–72].1 The 22 reviews excluded after full-text screening either evaluated excluded outcome measures (n = 1) [73], were overviews of systematic reviews (n = 3) [74–76], did not follow a systematic methodology (n = 1) [77], only reported results of multicomponent programs (n = 4) [78–81], did not adequately describe what interventions were evaluated (n = 2) [82, 83], or were not relevant for assessing government tobacco control policies (n = 11) [84–94]. Findings from the 38 reviews that were either strong or moderate quality and published since 2000 are presented here (see Fig. 2) [14–51]. A Web Appendix contains individualized summaries of these reviews as well as the lower quality and older reviews (see Additional file 1) [52–72].Fig. 1

Bottom Line: Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well.Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention.Additional studies are needed on the various factors that can influence a policy's effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.

View Article: PubMed Central - PubMed

Affiliation: Global Strategy Lab, Faculty of Law, University of Ottawa, 57 Louis Pasteur Street, Ottawa, K1N 6N5, ON, Canada. steven.hoffman@uottawa.ca.

ABSTRACT

Background: Government interventions are critical to addressing the global tobacco epidemic, a major public health problem that continues to deepen. We systematically synthesize research evidence on the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force.

Methods: An overview of systematic reviews was prepared through systematic searches of five electronic databases, published up to March 2014. Additional reviews were retrieved from monthly updates until August 2014, consultations with tobacco control experts and a targeted search for reviews on mass media interventions. Reviews were assessed according to predefined inclusion criteria, and ratings of methodological quality were either extracted from source databases or independently scored.

Results: Of 612 reviews retrieved, 45 reviews met the inclusion criteria and 14 more were identified from monthly updates, expert consultations and a targeted search, resulting in 59 included reviews summarizing over 1150 primary studies. The 38 strong and moderate quality reviews published since 2000 were prioritized in the qualitative synthesis. Protecting people from tobacco smoke was the most strongly supported government intervention, with smoke-free policies associated with decreased smoking behaviour, secondhand smoke exposure and adverse health outcomes. Raising taxes on tobacco products also consistently demonstrated reductions in smoking behaviour. Tobacco product packaging interventions and anti-tobacco mass media campaigns may decrease smoking behaviour, with the latter likely an important part of larger multicomponent programs. Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well. Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention.

Conclusion: When designing and implementing tobacco control programs, governments should prioritize smoking bans and price increases of tobacco products followed by other interventions. Additional studies are needed on the various factors that can influence a policy's effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.

Show MeSH
Related in: MedlinePlus