Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions

Smith, Chery; Hill, Sarah; Amos, Amanda

doi:10.1136/tobaccocontrol-2020-055874

Cited by 79 publications

(60 citation statements)

References 84 publications

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“…Yet, supporting smokers in their efforts to quit has been one of the weakest points of the Finnish tobacco control policy [24]. Tax increases reduce inequalities in smoking by affecting the lower SEP smokers more (equity-positive impact) [25]. Several tobacco tax increases have been implemented in Finland since 2009.…”

Section: Discussionmentioning

confidence: 99%

Association between educational level and smoking cessation in an 11-year follow-up study of a national health survey

Ruokolainen

Härkänen

Lahti

et al. 2021

Scand J Public Health

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Aims: There is a lack of longitudinal, population-based studies on the association between education and smoking cessation. A more thorough examination of this association is needed to address inequalities in smoking. Methods: The longitudinal Health 2000 Survey and Health 2011 Survey, representing the Finnish population aged ⩾30 years, were analysed. Of the 1352 baseline daily smokers, 945 (70%) provided a smoking status at the follow-up. The analytic sample size was 884 (excluding the follow-up occasional smokers). Self-reported questionnaire data and measurements (e.g. plasma cotinine) from the baseline were utilised. The outcome variable was smoking cessation at the follow-up, and the main explanatory variable was education. Logistic regression was the main method for statistical analyses. All of the analyses accounted for the sampling design. Results: At the follow-up, 28% of the baseline daily smokers had quit smoking. An adjusted regression model showed that highly educated respondents had a higher likelihood of quitting smoking compared with those with basic education. Controlling for demographic and health-related variables had a modest effect on this association. Higher scores for plasma cotinine, symptoms of depression and heavy alcohol use were associated with a lower likelihood of quitting smoking. The association between education and smoking cessation was weaker for women than it was for men. Conclusions: High education is associated with smoking cessation among the general adult population, especially among men. A higher plasma cotinine level is strongly associated with continued smoking among both sexes. Background variables only modestly affected the association between education and smoking cessation.

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Section: Discussionmentioning

confidence: 99%

Association between educational level and smoking cessation in an 11-year follow-up study of a national health survey

Ruokolainen

Härkänen

Lahti

et al. 2021

Scand J Public Health

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“…This consideration is worthy of future investigation because previous studies have observed that population-level tobacco control policies could produce greater health benefits in low-income populations than in high-income populations. 15,69,70 To conclude, although the health burden associated with TSE has decreased over past decades around the world, there is still considerable scope to further reduce this preventable harm to children. 71 To achieve this goal, comprehensive smoke-free policies are needed and this systematic review and meta-analysis, albeit based on a small number of studies, suggests that including private and outdoor places in national tobacco control policies could produce additional benefits.…”

Section: Discussionmentioning

confidence: 99%

Effect of smoke-free policies in outdoor areas and private places on children's tobacco smoke exposure and respiratory health: a systematic review and meta-analysis

Radó

Mölenberg

Westenberg

et al. 2021

The Lancet Public Health

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Background Smoke-free policies in outdoor areas and semi-private and private places (eg, cars) might reduce the health harms caused by tobacco smoke exposure (TSE). We aimed to investigate the effect of smoke-free policies covering outdoor areas or semi-private and private places on TSE and respiratory health in children, to inform policy. MethodsIn this systematic review and meta-analysis, we searched 13 electronic databases from date of inception to Jan 29, 2021, for published studies that assessed the effects of smoke-free policies in outdoor areas or semi-private or private places on TSE, respiratory health outcomes, or both, in children. Non-randomised and randomised trials, interrupted time series, and controlled before-after studies, without restrictions to the observational period, publication date, or language, were eligible for the main analysis. Two reviewers independently extracted data, including adjusted test statistics from each study using a prespecified form, and assessed risk of bias for effect estimates from each study using the Risk of Bias in Non-Randomised Studies of Interventions tool. Primary outcomes were TSE in places covered by the policy, unplanned hospital attendance for wheezing or asthma, and unplanned hospital attendance for respiratory tract infections, in children younger than 17 years. Random-effects meta-analyses were done when at least two studies evaluated policies that regulated smoking in similar places and reported on the same outcome. This study is registered with PROSPERO, CRD42020190563. FindingsWe identified 5745 records and assessed 204 full-text articles for eligibility, of which 11 studies met the inclusion criteria and were included in the qualitative synthesis. Of these studies, seven fit prespecified robustness criteria as recommended by the Cochrane Effective Practice and Organization of Care group, assessing smoke-free cars (n=5), schools (n=1), and a comprehensive policy covering multiple areas (n=1). Risk of bias was low in three studies, moderate in three, and critical in one. In the meta-analysis of ten effect estimates from four studies, smoke-free car policies were associated with an immediate TSE reduction in cars (risk ratio 0•69, 95% CI 0•55-0•87; 161 466 participants); heterogeneity was substantial (I² 80•7%; p<0•0001). One additional study reported a gradual TSE decrease in cars annually. Individual studies found TSE reductions on school grounds, following a smoke-free school policy, and in hospital attendances for respiratory tract infection, following a comprehensive smoke-free policy. Interpretation Smoke-free car policies are associated with reductions in reported child TSE in cars, which could translate into respiratory health benefits. Few additional studies assessed the effect of policies regulating smoking in outdoor areas and semi-private and private places on children's TSE or health outcomes. On the basis of these findings, governments should consider including private cars in comprehensive smoke-free policies to protect child health.

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“…Third, further work should explore equity implications of our messaging approaches—especially given growing evidence regarding the proequity effect of pricing interventions. 54 …”

Section: Discussionmentioning

confidence: 99%

Message framing to inform cancer prevention pricing interventions in the UK and USA: a factorial experiment, 2019

et al. 2021

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ObjectivesTo advance understanding of how message framing can be used to maximise public support across different pricing policies for alcohol, tobacco and sugary drinks/foods that prevent consumption of cancer-causing products.DesignWe designed a 3×4×3 randomised factorial experiment to test responses to messages with three pricing policies, four message frames and three products.SettingOnline survey panel (Qualtrics) in 2019.ParticipantsAdults (N=1850) from the UK and USA.InterventionsParticipants randomly viewed one of 36 separate messages that varied by pricing policy (increasing taxes, getting rid of price discounts, getting rid of low-cost products), four frames and product (alcohol, tobacco, sugary drinks/foods).Primary and secondary outcome measuresWe assessed the relationship between the message characteristics and four dependent variables. Three were related to policy support: (1) increasing taxes on the product mentioned in the message, (2) getting rid of price discounts and special offers on the product mentioned in the message and (3) getting rid of low-cost versions of the product mentioned in the message. One was related to reactance, a psychological response to having one’s freedom limited.ResultsWe found no effect for pricing policy in the message. Frames regarding children and reducing cancer risk moderated some outcomes, showing promise for real-world use. We found differences in support by product and reactance with greatest support and least reactance for tobacco policies, less support and more reactance for alcohol policies, and the least support and most reactance for sugary drinks/foods policies.ConclusionsCancer prevention efforts using policy interventions can be informed by the message framing literature. Our results offer insights for cancer prevention advocacy efforts across the UK and USA and highlight that tax versus non-tax approaches to increasing the cost of cancer-causing products result in similar responses from consumers.

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Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions

Cited by 79 publications

References 84 publications

Association between educational level and smoking cessation in an 11-year follow-up study of a national health survey

Association between educational level and smoking cessation in an 11-year follow-up study of a national health survey

Effect of smoke-free policies in outdoor areas and private places on children's tobacco smoke exposure and respiratory health: a systematic review and meta-analysis

Message framing to inform cancer prevention pricing interventions in the UK and USA: a factorial experiment, 2019

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