Health-related effects of government tobacco control policies: What's the evidence?
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Welcome!Health-related effects of
government tobacco control policies: What's
the evidence?
You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the
line.
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What’s the evidence? Hoffman SJ, & Tan C. (2015). Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health, 15(744).
http://www.healthevidence.org/view-article.aspx?a=28889
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Poll Question #1What sector are you from?1. Public Health Practitioner2. Health Practitioner (Other)3. Education4. Research5. Provincial/Territorial/Government/Ministry6. Municipality7. Policy Analyst (NGO, etc.)8. Other
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A Model for Evidence-Informed Decision
Making
National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]
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Stages in the process of Evidence-Informed Public Health
National Collaborating Centre for Methods and Tools. Evidence-Informed Public Health. [http://www.nccmt.ca/eiph/index-eng.html]
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Poll Question #3
Have you heard of PICO(S) before?
1.Yes2.No
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Searchable Questions Think “PICOS”
1. Population (situation)
2. Intervention (exposure)
3. Comparison (other group)
4. Outcomes
5. Setting
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How often do you use Systematic Reviews to inform a program/services?
A.AlwaysB.OftenC.SometimesD.NeverE.I don’t know what a systematic review is
Poll Question #4
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Steven J. Hoffman
Director of Global Strategy Lab and Associate Professor of Law,
University of Ottawa
Charlie TanMD Candidate, Michael G.
DeGroote School of Medicine, McMaster University
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Government tobacco control policies improve health outcomes of the general populationA.Strongly agreeB.AgreeC.NeutralD.DisagreeE.Strongly disagree
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Poll Question #5
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ReviewHoffman SJ, & Tan C. (2015). Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health, 15(744).
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Importance of Review• The global tobacco epidemic is a major
public health problem that continues to deepen– Nearly one billion smokers worldwide in 2012– Leading cause of preventable death– More than 600 000 annual deaths due to
secondhand smoke (SHS) exposure
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Framework Convention on Tobacco Control (FCTC)• International treaty introduced by the
World Health Organization (WHO) in 2005• Aims to reduce tobacco consumption and
protect all people from tobacco exposure through provisions that direct countries to implement tobacco control programs
• 180 parties (as of December 2015)
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MPOWER
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Rationale of Review• To take stock of the global research
evidence base about the health effects of government tobacco control policies
• Provides policymakers with an evidence-based resource to help with deliberations and decision-making on setting priorities for national FCTC implementation
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Overview of Systematic Reviews• This overview includes systematic reviews
evaluating government tobacco control policies
• Overviews of systematic reviews build on the strengths of individual reviews and add breadth by integrating the findings of many reviews together
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Review Focus:• P Any individual who smokes and/or may be
affected by smoking (through SHS exposure)
• I Government tobacco control policies
• C Different interventions (e.g., clinical) or no intervention
• O Outcome measures relating to tobacco use, SHS exposure and primary health outcomes
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Literature Search• Relevant reviews were identified through:– Electronic databases
• Health Evidence (HE), Health Systems Evidence (HSE), Rx for Change (RC), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE)
– References of other overviews of systematic reviews
– Monthly updates• HE, HSE, Quebec Public Health Research Network
– Two tobacco control experts
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Study Selection
• Titles and abstracts screening• Full text review
• Two independent reviewers, with conflicts resolved through discussion
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Exclusion Criteria• Reviews that did not follow a systematic
methodology• Other overviews of systematic reviews• Reviews evaluating clinical interventions• Reviews evaluating multicomponent tobacco control
programs if effects of individual interventions were not independently studied or could not be differentiated
• Reviews evaluating recall of media campaigns and perceptions of smoking as outcome measures
• No exclusions on the basis of language
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Data Extraction• Following variables were extracted
from the reviews into a summary table:– Number of studies included– Year of last search– Key findings from review
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Risk of Bias• Quality ratings given to each review by their
source databases were extracted– HE
• Independent quality assessment tool specific for public health intervention literature
– HSE and RC• AMSTAR
– CDSR and DARE• No numerical quality rating; quality assessment was
independently performed using the AMSTAR tool
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Review Prioritization• In order to focus on most recent and
accurate evidence, we prioritized:– Strong and moderate quality reviews
(based on HE or AMSTAR tools); and– Reviews published since 2000
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Findings• MPOWER components were used as
organizing framework, with an additional FCTC provision (Restrict sales to minors)– No reviews found for Monitor tobacco use and
prevention policies
• Outcomes grouped into seven categories:– Tobacco consumption, smoking prevalence,
smoking cessation, smoking initiation, SHS exposure, medical conditions, hospitalization
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Findings
Protect people from tobacco smokeNumber of Reviews 12Quality 3 strong, 8 moderate, 1 moderate
(HE)/strong (HSE)Findings • 8 reviews on smoking behaviour; 6
reported beneficial effects• 3 reviews on SHS; all reported
reductions in SHS exposure• 6 reviews on health outcomes; all
reported reductions in adverse effects
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Findings
Offer help to quit tobacco useNumber of Reviews 12Quality 8 strong, 4 moderateFindings • 2 reviews on financial assistance for
smokers; both reported beneficial effects on smoking behaviour
• 8 reviews on incentives and competitions for smokers; 4 reported beneficial effects on smoking behaviour
• 3 reviews on provider-directed financial interventions; all reported no effect on smoking behaviour
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Findings
Warn about the dangers of tobaccoNumber of Reviews 9Quality 4 strong, 5 moderateFindings • 3 reviews on health warning labels or
plain packaging on tobacco products; 2 reported beneficial effects on smoking behaviour
• 7 reviews on mass media campaigns; 4 reported beneficial effects on smoking behaviour (as part of multicomponent tobacco control programs)
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Findings
Enforce bans on tobacco advertising, promotion and sponsorshipNumber of Reviews 4Quality 4 moderateFindings • No reviews reported beneficial effects
on smoking behaviour• Large amount of evidence linking
advertisements and tobacco use• Individual studies suggest scope
and enforcement are critical
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Findings
Raise taxes on tobaccoNumber of Reviews 6Quality 1 strong, 5 moderateFindings • 5 reported beneficial effects on
smoking behaviour• Negative price elasticities of
demand for increases in cigarette prices and smoking behaviour
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Findings
Restrict sales to minorsNumber of Reviews 5Quality 5 moderateFindings • Inconsistent evidence on effects on
smoking behaviour• If effective, appear to depend on
robust enforcement
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Principal Findings• Strongest evidence for smoking bans and price
increases of tobacco products • Positive results also found for mass media
campaigns (as part of multicomponent programs) and cigarette packaging interventions
• Financial assistance reducing the costs of smoking cessation interventions and financial incentives may be effective strategies
• Limited evidence found for advertising restrictions and youth access restrictions
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Strengths and Limitations• Strengths
– Synthesis of large number of studies (over 1150)– Systematic and transparent search protocol– Reviews prioritized by quality and publication date
• Limitations– Search did not include unpublished reviews– Reviews in other disciplines may have been
excluded or have low quality ratings– Loss of study intricacies and details– Reviews on multicomponent interventions
excluded
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Future Directions• Effectiveness of smoke-free policies and tobacco
price increases is well established• Further evaluations of the remaining interventions• Studies of the various factors that can influence
effectiveness and feasibility (cost, local context, political barriers and implementation strategies)
• Studies of the synergistic effects of multicomponent programs and which which combinations of policies are most effective and/or feasible
• “Endgame proposals” to eliminate tobacco use
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Overall Summary and Implications• Countries should ideally implement policies
concurrently to develop multicomponent programs
• Regulations that ban smoking and increase tobacco product prices should be prioritized if needed when resources are constrained
• Other FCTC provisions can further strengthen and work synergistically with these priority policies
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Government tobacco control policies improve health outcomes of the general populationA.Strongly agreeB.AgreeC.NeutralD.DisagreeE.Strongly disagree
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Poll Question #6
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Poll Question #7Do you agree with the findings of this review?A.Strongly agreeB.AgreeC.NeutralD.DisagreeE.Strongly disagree
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Questions?
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A Model for Evidence-Informed Decision
Making
National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]
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