背景:无烟烟草,全球超过3亿人使用,导致大量的发病率和死亡率。对于无烟烟草控制,许多国家采取了超越世界卫生组织烟草控制框架公约的政策,这有助于降低吸烟率。这些政策(在《烟草控制框架公约》之内和之外)对无烟烟草使用的影响仍不清楚。我们旨在系统地审查与无烟烟草及其背景相关的政策,并调查其对无烟烟草使用的影响。
方法:在这篇系统综述中,我们在2005年1月1日至2021年9月20日之间以英语和南亚主要语言搜索了11个电子数据库和灰色文献,总结无烟烟草政策及其影响。纳入标准是对无烟烟草使用者的所有类型的研究,这些研究自2005年以来提到了任何无烟烟草相关政策,但系统评价除外。组织或私人机构发布的政策被排除在外,以及对电子烟和电子尼古丁输送系统的研究,除非减少危害或转换被评估为戒烟策略。两名审稿人独立筛选文章,标准化后提取数据。使用有效公共卫生实践项目的质量评估工具评估研究质量。影响评估的结果包括无烟烟草流行率,摄取,停止,和健康影响。由于对政策和结果的描述存在很大的异质性,数据是描述性和叙述性综合的。该系统评价在PROSPERO(CRD42020191946)中注册。
结果:确定了14317条记录,其中252项符合条件的研究被纳入描述无烟烟草政策的研究。57个国家有针对无烟烟草的政策,其中17家有无烟烟草控制框架公约之外的政策(例如,吐痰禁令)。18项研究评估了影响,质量可变(六个强,七个温和的,和五个弱),并主要报告无烟烟草使用的流行率。根据《烟草控制框架公约》评估政策举措的工作机构发现,这些举措与税收方面的无烟烟草流行率降低4·4%至30·3%以及多方面政策方面的22·2%和70·9%有关。两项评估非框架销售禁令政策的研究报告了无烟烟草销售(6·4%)和使用(性别17·6%)的显着减少;一项研究,然而,据报道,在全面禁止销售后,年轻人无烟烟草的使用有增加的趋势,可能是由于跨境走私。一项报告戒烟的研究发现,暴露于烟草控制政策框架公约的个人戒烟尝试增加了13·3%(47·5%):教育,通信,培训,和公众意识,与未暴露者相比(34·2%)。
结论:许多国家实施了无烟烟草控制政策,包括超出《烟草控制框架公约》的范围。现有证据表明,税收和多方面的政策举措与有效减少无烟烟草使用有关。
背景:英国国立卫生研究院。
Smokeless tobacco, used by more than 300 million people globally, results in substantial morbidity and mortality. For smokeless tobacco control, many countries have adopted policies beyond the WHO Framework Convention on Tobacco Control, which has been instrumental in reducing smoking prevalence. The impact of these policies (within and outside the Framework Convention on Tobacco Control) on smokeless tobacco use remains unclear. We aimed to systematically
review policies that are relevant to smokeless tobacco and its context and investigate their impact on smokeless tobacco use.
In this systematic
review, we searched 11 electronic databases and grey literature between Jan 1, 2005, and Sept 20, 2021, in English and key south Asian languages, to summarise smokeless tobacco policies and their impact. Inclusion criteria were all types of studies on smokeless tobacco users that mentioned any smokeless tobacco relevant policies since 2005, except systematic reviews. Policies issued by organisations or private institutions were excluded as well as studies on e-cigarettes and Electronic Nicotine Delivery System except where harm reduction or switching were evaluated as a tobacco cessation strategy. Two reviewers independently screened articles, and data were extracted after standardisation. Quality of studies was appraised using the Effective Public Health Practice Project\'s Quality Assessment Tool. Outcomes for impact assessment included smokeless tobacco prevalence, uptake, cessation, and health effects. Due to substantial heterogeneity in the descriptions of policies and outcomes, data were descriptively and narratively synthesised. This systematic
review was registered in PROSPERO (CRD42020191946).
14 317 records were identified, of which 252 eligible studies were included as describing smokeless tobacco policies. 57 countries had policies targeting smokeless tobacco, of which 17 had policies outside the Framework Convention on Tobacco Control for smokeless tobacco (eg, spitting bans). 18 studies evaluated the impact, which were of variable quality (six strong, seven moderate, and five weak) and reported mainly on prevalence of smokeless tobacco use. The body of work evaluating policy initiatives based on the Framework Convention on Tobacco Control found that these initiatives were associated with reductions in smokeless tobacco prevalence of between 4·4% and 30·3% for taxation and 22·2% and 70·9% for multifaceted policies. Two studies evaluating the non-Framework policy of sales bans reported significant reductions in smokeless tobacco sale (6·4%) and use (combined sex 17·6%); one study, however, reported an increased trend in smokeless tobacco use in the youth after a total sales ban, likely due to cross-border smuggling. The one study reporting on cessation found a 13·3% increase in quit attempts in individuals exposed (47·5%) to Framework Convention on Tobacco Control policy: education, communication, training, and public awareness, compared with non-exposed (34·2%).
Many countries have implemented smokeless tobacco control policies, including those that extend beyond the Framework Convention on Tobacco Control. The available evidence suggests that taxation and multifaceted policy initiatives are associated with meaningful reductions in smokeless tobacco use.
UK National Institute for Health Research.