Population tobacco control interventions and their effects on social inequalities in smoking
Debra Fayter1; Caroline Main1; Kate Misso1; David Ogilvie2; Mark Petticrew3; Amanda Sowden1
Lisa Stirk1;
1 Centre for Reviews and Dissemination (CRD),
2 MRC Social and Public Health Sciences Unit (MRC SPHSU),
3 Public and Environmental Health Research Unit,
4 Department of Public Health,
Centre for Reviews and Dissemination, CRD Report 39.
Available online as PDF file [322p.] at: http://www.york.ac.uk/inst/crd/CRD_Reports/crdreport39.pdf
Reducing social inequalities in smoking and its health consequences is a public-health and political priority: the Department of Health has a specific target to reduce the prevalence of smoking in „manual groups‟ from 32% to 26% by 2015. Although the extent and causes of health inequalities have been extensively researched, we know remarkably little about the actual effects of measures to reduce such inequalities in general or about the differential impacts of tobacco control measures in particular. It is possible that a strategy which successfully reduces smoking in the population overall might widen inequalities if its benefits
are concentrated among the better-off.
The overall aims of this project were:
To synthesise the best available evidence about the differential effects of population tobacco control interventions on groups with different sociodemographic characteristics
To assess which interventions are likely to be effective in reducing smoking related health inequalities and to identify reasons why other interventions may be ineffective, attempting to answer the questions: What works? What might work? For whom? In what contexts?
To extend systematic review methods by integrating existing, related systematic reviews and the primary studies included in those reviews into a new systematic review, taking a broad view of the types of evidence which are available in seeking to answer a policy-relevant question, and To identify where evidence is lacking and to suggest areas where further primary or secondary research is required.
The project comprised two parts. Part 1 is a review of existing systematic reviews and Part 2 is a new systematic review of primary studies.
Content:
EXECUTIVE SUMMARY
BACKGROUND
PART 1 : A REVIEW OF SYSTEMATIC REVIEWS
TABLES & FIGURES
Figure 1 Quality assessment of included reviews
Table 1 Selected characteristics of included reviews
APPENDICES
Appendix 1 Search strategy and terms
Appendix 2 Quality assessment of the nineteen reviews included in the review of reviews
Appendix 3 Primary studies included in the nineteen systematic reviews
Appendix 4 Map of primary studies included in more than one systematic review
Appendix 5 Data extraction tables
PART 2: A SYSTEMATIC REVIEW
1. Introduction
2. Methods
2.1 Search methods
2.2 Inclusion/exclusion criteria
2.3 Data extraction and quality assessment
2.4 Data synthesis
2.5 Additional data
2.6 Advisory panel
3. Results
3.1 Effects of restrictions on smoking in workplaces and public places
3.2 Effects of restrictions on smoking in schools
3.3 Effects of restrictions on sales to minors
3.4 Effects of health warnings on tobacco products
3.5 Effects of restrictions on advertising of tobacco products
3.6 Effects of price of tobacco products on adults
3.7 Effects of price on young people
3.8 Effects of multi-faceted interventions
3.9. Overall Matrix for all included interventions
4. Discussion and conclusions
4.1 Findings and implications
4.2 Strengths and weaknesses of the review
4.3 Limitations of the evidence
4.4 Unanswered questions and future research
References
FIGURES
APPENDICES
Appendix A Search strategy
Appendix B List of included studies by intervention category
Appendix C List of studies excluded from the systematic review
Appendix D Data extraction tables
Appendix E Table of study suitability and quality
Appendix F Table indicating evidence for social gradient in effectiveness
Appendix G Advisory panel
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