Tobacco Control Research Research Articles

Critical realism: a practical ontology to explain the complexities of smoking and tobacco control in different resource settings

BackgroundThis paper presents critical realism (CR) as an innovative system for research in tobacco prevention and control. CR argues that underlying mechanisms are considered and explored to ensure effective implementation of any program/policy or intervention. Any intervention or program/policy that is transposed from one country to another or one setting to another is complex.MethodsThe research was undertaken and analyzed through a critical ethnography lens using CR as a philosophical underpinning. The study relied upon the following components: original fieldwork in Nigeria including participant observation of smokers, in-depth interviews and focus groups with smokers, and in-depth interviews with health professionals working in the area of tobacco control in Nigeria.ResultsFindings from this small ethnographic study in Nigeria, suggest that Critical Realism holds promise for addressing underlying mechanism that links complex influences on smoking.ConclusionThis paper argues that understanding the underlying mechanisms associated with smoking in different societies will enable a platform for effective implementation of tobacco control policies that work in various settings.

After the Smoke Has Cleared: Reflections from a Former Smoker and Tobacco Researcher

I grew up in a home where both parents smoked and I had my first cigarette at about age 13. I became a regular smoker sometime in my late teens, and at age 27 began working towards a doctoral degree in public health sciences on the topic of young women and smoking. As an active smoker entering into academic tobacco research circles, I felt very much like a stigmatized outsider and the antismoking sentiments of tobacco researchers and health advocates often felt to me like exclusionary “antismoker” views. In the tradition of autoethnographic writing, in this reflective piece I narrate my experiences as a smoker and my process of quitting in an effort to be critical and reflexive about my research, and also about the absence of the perspectives and active contributions of people who smoke to tobacco control research, programming, and practice.

Growth in Tobacco Control publications by authors from low- and middle-income countries

BackgroundResearch has contributed significantly to tobacco control in high-income nations, but has not yet played a comparable role in low- and middle-income countries (LMIC). In recent years, efforts have been...

From tobacco control research to policy: the example of smoke-free legislation in England

BackgroundTobacco control policies, such as legislation to make all enclosed public places and workplaces smoke free, are often highly contested. Despite growing evidence that smoke-free laws are effective in reducing secondhand smoke exposure and provide early health benefits, efforts to contest evidence for secondhand smoke and the effects of legislation are widespread. The Tobacco Control Research Group at Bath, UK, has produced a wide range of work assessing various effects of smoke-free legislation introduced on July 1, 2007, in England. We use our assessment of whether the legislation reduced hospital admissions for heart attacks as an example of our research. When this assessment was published in the British Medical Journal in 2010, several studies showing a decrease in admissions for heart attack after the introduction of smoke-free laws in other countries had already been published. In view of efforts to contest these findings by pro-tobacco bloggers, media articles questioning the credibility of tobacco control research, and spurious coverage of our work in national newspapers before it was published, we had two aims: to build on existing research by taking into account long-term trends; and to ensure the findings, when published, were accurately reported in the media and to policy makers. MethodsWe investigated the short-term effect of the English smoke-free legislation with numbers of emergency hospital admissions per week coded with a primary diagnosis of a myocardial infarction from July 1, 2002, to Sept 30, 2008, in all patients aged 18 years and older. The analysis was done with a segmented Poisson regression analysis that adjusted for long-term trends and other potential confounders. Cost savings to the NHS were calculated in collaboration with the London Health Observatory. For the media strategy, we prepared simple but accurate media briefings, which we disseminated to ten key parties that were likely to be contacted by the media. We held a press briefing at the Science Media Centre (London), and worked closely with them, Bath University press office, and the British Medical Journal. FindingsSmoke-free legislation was association with a 2·4% (95% CI −4·06 to −0·66) reduction in the number of emergency admissions for myocardial infarction. This reduction equates to 1200 fewer emergency admissions for myocardial infarction in the first year after legislation. The London Health Observatory estimated that £8·4 million has been saved in emergency hospital care for heart attacks in the first year since smoke-free legislation was introduced. The research received wide reaching, positive coverage in both print and broadcast media, featuring on the BBC, BBC Radio 4's Today programme, BBC Radio 5 Live, and local BBC radio stations. National newspapers that featured the story included The Times, Financial Times, Independent, and Daily Mail. Internationally, the research was reported by media in several countries, including the USA, Canada, and New Zealand. Our efforts to ensure that coverage was accurate were successful, despite later efforts by pro-tobacco bloggers to undermine it. InterpretationThis study adds to the growing evidence that smoke-free legislation leads to reductions in myocardial infarctions and builds on previous work by showing that such decreases are noted even when underlying reductions in admissions and other potential confounders are controlled for. With careful planning and communication, public health research in a contested field can be effectively and accurately disseminated. The research has subsequently contributed to the present government's tobacco control strategy. FundingDepartment of Health's Policy Research Programme.

A transdisciplinary approach to protocol development for tobacco control research: a case study

The increasing complexity of scientific problems related to lifestyle risk factors has prompted substantial investments in transdisciplinary or team science initiatives at the biological, psychosocial, and population levels of analysis. To date, the actual process of conducting team science from the perspectives of investigators engaged in it has not been well documented. We describe the experience of developing and implementing data collection protocols using the principles of transdisciplinary science. The New England Family Study Transdisciplinary Tobacco Use Research Center was a 10-year collaboration involving more than 85 investigators and consultants from more than 20 disciplines as well as more than 50 research staff. We used a two-phase process in which all the study personnel participated in the developing and testing of 160 instruments. These instruments were used in 4,378 assessments with 3,501 participants. With substantial effort, it is possible to build a team of scientists from diverse backgrounds that can develop a set of instruments using a shared conceptual approach, despite limited or no experience working together previously.

Priorities for tobacco control research in India

Priorities for tobacco control research in <scp>I</scp>ndia

The balancing act: Experts' opinions about the relative resourcing of tobacco control efforts for the general population versus disadvantaged populations

Despite the persistent socioeconomic gradient associated with smoking, little is known about how to 'close the gap'. There is a debate regarding the implications of directing resources away from general population efforts towards disadvantaged groups. The study explored views of those with expertise in tobacco control about the appropriate balance of tobacco control resourcing between the general population and disadvantaged groups. A Web-based survey of 192 respondents (response rate 65%) working in tobacco control in Australia and New Zealand was completed. Respondents were sampled from the Australian and New Zealand Tobacco Control Contact List and a literature search. Respondents were asked to allocate a hypothetical budget for: (a) anti-tobacco mass media campaigns; and (b) tobacco control research. The vast majority (93%) of respondents believed that some tobacco control resources should be specifically directed towards disadvantaged groups. Respondents believed up to half of mass media resources should be directed towards disadvantaged groups. In the case of tobacco control research, the median allocation to the general population was approximately one-third of a hypothetical research budget. It appears there is a desire among the Australian and New Zealand tobacco control community for substantial effort to be directed towards disadvantaged groups. It is important to develop an evidence base to ensure an efficient and equitable approach to balancing the potentially competing demands of general population versus disadvantaged group activities in relation to tobacco control.

Building tobacco control research in Thailand: meeting the need for innovative change in Asia.

IntroductionIn low- and middle-income countries (LMICs) over the past two decades locally relevant tobacco control research has been scant. Experience shows that tobacco control measures should be based on sound research findings to ensure that measures are appropriate for local conditions and that they are likely to have an impact. Research should also be integrated within tobacco control measures to ensure ongoing learning and the production of knowledge. Thailand, a middle-income country, has a public health community with a record of successful tobacco control and a longstanding commitment to research. Thailand's comprehensive approach includes taxation; bans on tobacco advertising, sponsorship and promotion; smoke-free areas; graphic cigarette pack warnings; social marketing campaigns; cessation counseling; and an established tobacco control research program. The purpose of this study was to document and analyze the development of tobacco control research capacity in Thailand and the impact of research on Thai tobacco control measures.MethodWe used mixed methods including review of historical documentation and policy reports, qualitative interviews with key members of Thailand's tobacco control community, and an analysis of research productivity.FindingsIn Thailand, tobacco control research has evolved through three phases: (1) discovery of the value of research in the policymaking arena, (2) development of a structure to support research capacity building through international collaborations supported by foreign funding agencies, and (3) delivery of locally relevant research made possible largely through substantial stable funding from a domestic health promotion foundation. Over two decades, Thai tobacco control advocates have constructed five steppingstones to success: (1) adapting foreign research to inform policymaking and lobbying for more support for domestic research; (2) attracting foreign funding agencies to support small-scale research and capacity building; (3) participating in multi-country research and capacity building programs; (4) using collaborative experiences to demonstrate the need for domestic support of locally relevant research; and (5) maintaining an unwavering commitment to research while being vigilant to ensure continued research support.ConclusionThe evolution of tobacco control research in Thailand provides examples of steppingstones that LMICs may be able to use to construct their own tobacco control research pathways.

Tobacco control in Europe: A deadly lack of progress

igarettes are uniquely dangerous, killing half of all those who regularly use them and damaging the health of those who breathe in users’ smoke, particularly children. Just under a third of European adults currently smoke, and smoking has become increasingly associated with poverty, contributing significantly to widening health inequalities across the EU. In 2004, the ASPECT report, a comprehensive review of tobacco use and tobacco control policies in the EU, found that tobacco use caused well over half a million deaths in Europe annually and on top of that constituted a huge economic burden, estimated conservatively at E98-130 billion a year. 1 This review also identified that whilst some European countries were observing declines in tobacco use and mortality, in other countries tobacco use was still increasing, particularly among women. The ASPECT report identified 43 recommendations to combat the epidemic, covering tobacco control policy, interventions and research. Yet to date, few of these recommendations have been implemented, and as a result, future prospects for curbing the smoking epidemic across Europe are currently very bleak. On the optimistic side, in 2003, the world’s first public health treaty, the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) came into force in recognition of the smoking pandemic and the power of the major transnational tobacco companies to push their deadly products. 2 The FCTC sets out supply and demand strategies to reduce tobacco use and has since been ratified by all EU countries (except the Czech Republic) and the European Union. The FCTC represents a unique and historic opportunity to fight the pandemic and collectively reduce the public health burden caused by tobacco and should therefore herald the way to faster progress in reducing smoking. However, the FCTC will only fulfil its potential if it is implemented in the most effective way and there is strong evidence that this is currently not the case. The Tobacco Control Scale (TCS) was developed by Joossens and Raw 3 to monitor the implementation of tobacco control

Tobacco Use Patterns

Tobacco Use Patterns

Four Arguments against the Adult-Rating of Movies with Smoking Scenes

SC has over 30 years experience in tobacco control research and advocacy and has won several international and national awards, including the American Cancer Society's Luther Terry medal for outstanding international leadership. He was deputy editor then editor of Tobacco Control for 17 years and is now Editor Emeritus. He is committed to exposing tobacco industry marketing practices and supporting the WHO's Framework Convention on Tobacco Control's provisions on banning tobacco advertising. MCF has dedicated his 17-year research career to conducting objective research and evaluation of major tobacco control programs such as the American Legacy Foundation's truth® campaign and key policy interventions such as cigarette excise taxes and smoke-free air laws. No specific funding was received for writing this article. Provenance: Not commissioned; externally peer reviewed.

INDIVIDUALIZED VERSUS POPULATION-BASED APPROACHES TO TOBACCO CONTROL - A FALSE DICHOTOMY

INDIVIDUALIZED VERSUS POPULATION-BASED APPROACHES TO TOBACCO CONTROL - A FALSE DICHOTOMY

O5-1 Smoke-free legislation: global reach, impact and remaining challenges

In recent years, legislation prohibiting or restricting smoking in public places (smoke-free legislation) has been enacted in an increasing number of countries. Where the effects of the legislation have been...

Smoking, Stigma and Social Class

AbstractThe decline in cigarette smoking in high-income countries is attributed to the increasing social unacceptability of smoking, a cultural shift in which tobacco control policies are identified as playing a major part. While seen as essential to protect public health, there is a growing appreciation that these polices may have contributed to a social climate in which smoking is stigmatised. The paper reviews this debate on smoking and stigma. It notes that individuals are represented by their smoking status; other social differences are typically treated as secondary. Thus, while the links between disadvantage and smoking are acknowledged, social class remains on the margins of the debate. The paper argues instead that class provides an essential analytic lens through which to understand the stigma of smoking and the stigmatising impacts of tobacco control policies. In support of its argument, it discusses how the stigmatisation of smoking has occurred against a backdrop of widening socioeconomic differentials in smoking and the increasing importance of the body and behaviour in public discourses about social class and moral worth. The paper concludes by underlining the importance of embedding tobacco control research and policy in an appreciation of social class, and social inequalities more broadly.

Publications as an Indicator of Increased Tobacco Control Research Productivity (Quantity and Quality) in New Zealand

Tobacco control (TC) research capacity and productivity are critical for developing evidence-informed interventions that will reduce the harmful effects of smoking. The aim of this paper was to investigate New Zealand's (NZ) TC research capacity along with the quantity and quality of publications, following two government initiatives aimed, in part, at improving the quantity and quality of NZ TC research. Scopus was searched for articles with at least one NZ author and where the topic was of primary relevance to TC. Publications were organized into two time periods, following the government initiatives, 1993-2003 and 2004-2009. We analyzed the number of publications, publication journals, type of publications, impact (using the impact factor), and authorship. There has been an increase in number and impact of publications and number of authors. The number of publications has increased from an average of 14 (1994-2003) to 38 per year (2004-2009). The number of journals published increased from 64 to 86. The impact during 2004-2009 was almost threefold than in 1993-2003. The number of authors increased from 212 to 345, and the number of authors who had at least one first-authored publication increased from 80 to 124. These results show an encouraging trend in NZ TC research, with an increase in research productivity, quality, and in research capacity. It is possible that government-initiated and -funded infrastructural support contributed to increasing needed TC research, which supports the worth of such initiatives.

Conceptual challenges in the translation of research into practice: it's not just a matter of "communication".

This paper identifies key barriers to the translation of science into practice and policy and makes recommendations for addressing them. It focuses on the challenges of translation within the field of tobacco control, but we argue that the insights are widely generalisable. Actor-Network Theory is used to frame an analysis, supplemented by focussed discussions with international tobacco control practitioners (service delivery and advocacy) and researchers. The central challenge to translation is that researchers and practitioners have different "practical ontologies". Researchers use findings from specific contexts to generalise to universal principles, while practitioners try to use these generalisations to inform their work in what are typically a somewhat different set of specific contexts. Neglecting the need to translate back from the general to the particular means research syntheses are not framed to meet practitioners' needs. Traditional knowledge broking roles need to be extended to better align the needs of researchers and practitioners. This may be facilitated by more creative use of "social computing" to enable real-time input into research syntheses from all interested parties, including input to the questions that research addresses. To do this systematically requires that we construct "generalisation gradients" to help practitioners apply general research conclusions to their particular situation and researchers to identify the relevance of their work. Disadvantaged communities in particular need help, since there is typically less research directly applicable to their contexts; thus, they need to generalise more.

One Size Does Not Fit All When it Comes to Smoking Cessation: Observations from the International Tobacco Control Policy Evaluation Project

The global community, through the World Health Organization’s Framework Convention on Tobacco Control (FCTC), is seeking to develop Guidelines for the implementation of Article 14 of the Convention, which deals with support for smoking cessation. This development requires models of how best to develop infrastructure and measures to promote and support cessation around the world. This special issue of Nicotine & Tobacco Research provides some evidence from the International Tobacco Control (ITC) Policy Evaluation Project that is contributing to an increased understanding of the challenges associated with encouraging and supporting smoking cessation. The ITC project (of which we are all leaders) is a research collaborative of more than 80 tobacco control researchers across 20 countries of which data from 7 countries are featured in this supplement. This commentary discusses three areas where the research reported here makes a contribution: our understanding of dependence; the effects of socioeconomic factors on cessation; and the potential utility of support programs. But first, we describe the context for this research.

Smoking and Aboriginal and Torres Strait Islander and Māori children

Smoking and the deaths and suffering it causes are more common among Aboriginal and Torres Strait Islander peoples and Māori than other Australians and New Zealanders. While, many tobacco control activities that are not specifically targeted at children will have a positive impact on child health, this review concentrates on recent tobacco control research on pregnant women and children. The important tasks are to reduce smoking by pregnant Māori and Aboriginal and Torres Strait Islander women to reduce infant and child exposure to second-hand smoke and to reduce smoking initiation of children and adolescents. Health professionals who want to reduce the suffering caused by smoking among Māori and Aboriginal and Torres Strait Islander children can be guided by much new relevant research evidence and clear frameworks about how to approach tobacco control in these communities.

Training Physicians to Do Office-based Smoking Cessation Increases Adherence to PHS Guidelines

Cigarette smoking is the leading cause of preventable mortality and morbidity in the United States. Healthcare providers can contribute significantly to the war against tobacco use; patients advised to quit smoking by their physicians are 1.6 times more likely to quit than patients not receiving physician advice. However, most smokers do not receive this advice when visiting their physicians. The Morehouse School of Medicine Tobacco Control Research Program was undertaken to develop best practices for implementing the "2000 Public Health Services Clinical Practice Guidelines on Treating Tobacco Use and Dependence" and the "Pathways to Freedom" tobacco cessation program among African American physicians in private practice and healthcare providers at community health centers. Ten focus groups were conducted; 82 healthcare professionals participated. Six major themes were identified as barriers to the provision of smoking cessation services. An intervention was developed based on these results and tested among Georgia community-based physicians. A total of 308 charts were abstracted both pre- and post-intervention. Charts were scored using a system awarding one point for each of the five "A's" recommended by the PHS guidelines (Ask, Advise, Assess, Assist, Arrange) employed during the patient visit. The mean pre-intervention five "A's" score was 1.29 compared to 1.90 post-intervention (P < 0.001). All charts had evidence of the first "A" ("asked") both pre- and post-intervention, and the other four "A's" all had statistically significant increases pre-to post-intervention. The results demonstrate that, with training of physicians, compliance with the PHS tobacco guidelines can be greatly improved.

Lessons Learned From the Application of Systems Science to Tobacco Control at the National Cancer Institute

Nearly 10 years ago, the Tobacco Control Research Branch of the National Cancer Institute (NCI) at the National Institutes of Health (NIH) developed a transdisciplinary initiative to explore the application of systems thinking approaches and methods to research, practice, and policy in tobacco prevention and control. The Initiative on the Study and Implementation of Systems (ISIS)1,2 was relatively new for NIH and resulted in much discourse among some scientists because of its sheer breadth and the scope of what it hoped to achieve: answers to the questions “Is it possible to understand the interplay of factors that both sustain and potentially disrupt tobacco use?” and “What structures and functions are essential for both understanding that complexity and improving our efforts in tobacco control?” We chose tobacco as an exemplar proof of concept for applying complexity theory and systems science to a wide range of behavioral and public health challenges.