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... For Sub-Saharan Africa (SSA), it has been estimated that tobacco use will increase up to 37% [8] by 2025 [8], the fastest expected growth among the six regions of the World Health Organization (WHO). The shift of the activities of transnational tobacco companies (TTCs) to LMICs [11][12][13][14][15], alongside general socioeconomic transformation [15][16][17][18] and lag in tobacco control [15,19] has made tobacco use a major public health concern in SSA. A key challenge to the efforts to address this public health issue in SSA has been sparse research, resulting from inadequate tobacco control research capacity [20][21][22]. ...
... Moreover, WHO reports [75][76][77][78][79] and other studies [15,80], suggest that countries in SSA generally lag behind those in other regions in terms of progress in tobacco control [77][78][79]81,82]. Although the smoking epidemic is yet to gain a strong foothold in the region [38,39,83], all the countries have experienced the shift in the TTCs' activities toward them [11][12][13][14][15]. The tobacco industry continues to exert influence in the region although only a few countries, including Democratic Republic of Congo (DRC), Kenya, South Africa, and Tanzania have domestic tobacco companies, with the British American Tobacco (BAT) as the dominant TTC in many countries [71][72][73]. ...
Over one billion of the world’s population are smokers, with increasing tobacco use in low- and middle-income countries. However, information about the methodology of studies on tobacco control is limited. We conducted a literature search to examine and evaluate the methodological designs of published tobacco research in Sub-Saharan Africa (SSA) over the past 50 years. The first phase was completed in 2015 using PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. An additional search was completed in February 2017 using PubMed. Only tobacco/smoking research in SSA countries with human subjects and published in English was selected. Out of 1796 articles, 447 met the inclusion criteria and were from 26 countries, 11 of which had one study each. Over half of the publications were from South Africa and Nigeria. The earliest publication was in 1968 and the highest number of publications was in 2014 (n = 46). The majority of publications used quantitative methods (91.28%) and were cross-sectional (80.98%). The commonest data collection methods were self-administered questionnaires (38.53%), interviews (32.57%), and observation (20.41%). Around half of the studies were among adults and in urban settings. We conclud that SSA remains a “research desert” and needs more investment in tobacco control research and training.
... Tobacco companies resist tobacco control at all levels of governance (Saloojee & Dagli, 2000;WHO, 2000), whether domestic, (Brandt, 2007;Landman et al., 2002;Mandel et al., 2006;Ong & Glantz, 2001;Tsoukalas & Glantz, 2003) regional, (Ashraf, 2002;Barnoya & Glantz, 2002;European Commission, 2004;Gilmore & McKee, 2004;Neuman et al., 2002), or global (Francey & Chapman, 2000;Landman et al., 2008;Muggli & Hurt, 2003;Ong & Glantz, 2000;Satcher, 2001;WHO, 2000;Yach & Bettcher, 2000). The industry worked directly and through surrogates to divert attention from the public health issues raised by tobacco consumption, attempting to reduce budgets for WHO's scientific and policy activities, pitting other UN agencies against WHO, distorting scientific studies, and trying to convince developing countries that tobacco control is a "First World" agenda The companies' activities can be understood as transnational corporations' behavior in the world political economy with the instrumental motive of maximizing profit (Charney, 1983;Gilpin, 2001;Keohane & Nye, 1972;Sikkink, 1986;Sklair, 2002). ...
... The major tobacco companies -Philip Morris (PM), British American Tobacco (BAT), and Japan Tobacco International (JTI), which together control over 41% of the worldwide tobacco market -are based in developed countries, but operate globally (Davis et al., 2007;Mackay et al., 2006;Sklair, 2002;Yach & Bettcher, 2000). This globalization of the industry, which makes it difficult for a single country to regulate it (Charney, 1983;Lowi, 2001) and the associated tobacco epidemic, stimulated the creation of the FCTC (Bettcher & Subramaniam, 2001;Satcher, 2001;WHO, 2003). ...
In 1999 the World Bank published a landmark study on the economics of tobacco control, Curbing the Epidemic: Governments and the Economics of Tobacco Control (CTE), which concluded that tobacco control brings unprecedented health benefits without harming economies, threatening the transnational tobacco companies' ability to use economic arguments to dissuade governments from enacting tobacco control policies and supporting the WHO Framework Convention on Tobacco Control (FCTC). We used tobacco industry documents to analyze how tobacco companies worked to discredit CTE. They hired public relations firms, had academics critique CTE, hired consultants to produce "independent" estimates of the importance of tobacco to national economies, and worked through front groups, particularly the International Tobacco Growers' Association, to question CTE's findings. These efforts failed, and the report remains an authoritative economic analysis of global tobacco control during the ongoing FCTC negotiations. The industry's failure suggests that the World Bank should continue their analytic work on the economics of tobacco control and make tobacco control part of its development agenda.
... Smoking is a major public health problem worldwide (World Health Organization 1997Satcher 2001;Gori 2002). A recent estimate suggested that 29 percent of the adult population were smokers globally in 1995 (Peto & Lopez 2000). ...
... The main challenge to address tobacco use in LMICs such as those in the WHO African region has been the shift of tobacco industry activities in such places. [36][37][38][39][40] Two key activities of tobacco companies were examined in this study-media messages and promotions. These activities have adverse effects for tobacco use and SHS exposure. ...
Introduction
Though Africa is in Stage 1 of the tobacco epidemic, lack of effective public smoking laws or political will implies that secondhand smoke (SHS) exposure may be high in youth. The study objective is to estimate prevalence and identify determinants of SHS exposure among never-smoker adolescents in Africa and make cross-country comparisons.
Methods
Pooled data from the Global Youth Tobacco Surveys conducted in 25 African countries during 2006–2011 were used. Based on the venue of exposure in past 7 days, SHS was categorized into exposure inside, outside, and overall exposure (either inside or outside of the home), respectively. Data were analyzed in 2015 using logistic regression models to identify factors related to SHS exposure in three venues.
Results
About 21% and 39% of adolescents were exposed to SHS inside or outside of the home, with overall exposure of 45%. In all 25 African countries, parental smoking was significantly associated with SHS exposure inside the home (ORs ranging from 3.02 [95% CI=2.0, 4.5] to 14.65 [95% CI=10.0, 21.5]). Peer smoking was associated with SHS exposure outside the home in 18 countries (ORs ranging from 1.45 [95% CI=1.0, 2.1] to 3.00 [95% CI=1.8, 5.1]). Parental smoking, peer smoking, and anti-smoking messages in media were identified as three major factors associated with SHS exposure.
Conclusions
A significant proportion of never-smoking adolescents in Africa are exposed to SHS, suggesting the need for countries to adopt policies to protect never smokers through the implementation of the WHO Framework Convention on Tobacco Control.
... Future studies should examine whether biomarkers associated with smoking, such as smoking-induced DNA adducts and genomic damage, are present within cervical tissue and whether such biomarkers are detectable before the development of CIN3 or cervical cancer. Although anti-smoking campaigns in the United States may reduce the impact of this secondary factor on the incidence of cervical precancer and cancer, we anticipate that smoking may be contributing to increasing rates of cervical cancer in resource-poor regions of the world where cigarette smoking is now on the rise (29) and where Pap smear screening programs are suboptimal (30). ...
Background: In case-control studies, smoking, parity, and oral contraceptive use have been associated with an increased risk of cervical intraepithelial neoplasia grade 3 (CIN3) and cervical cancer among women who are infected with oncogenic human papillomavirus (HPV). However, these potential risk factors have not been adequately studied in prospective studies. Methods: We studied 1812 women who were enrolled in a 10-year prospective study of cervical neoplasia at Kaiser Permanente in Portland, Oregon, and who at enrollment had tested positive for oncogenic HPV DNA and had responded to a questionnaire that included questions on smoking, oral contraceptive use, and parity. Absolute risks and crude relative risks (RRs) with 95% confidence intervals (CIs) for CIN3 or cervical cancer were computed for three time intervals (0-8, 9-68, and 69-122 months after enrollment) using the Kaplan-Meier method. Conditional logistic regression models were used to control for factors that may have influenced our risk estimates, specifically the cytologic interpretation of baseline Pap smear, number of Pap smears during follow-up, age at enrollment, age at prediagnosis visit, and age at diagnosis. All statistical tests were two-sided. Results: Oral contraceptive use and parity were not associated with risk of CIN3 or cervical cancer. Former smokers, women who smoked less than one pack of cigarettes per day, and women who smoked one or more packs per day had crude RRs for CIN3 or cervical cancer for the entire follow-up period of 2.1 (95% CI = 1.1 to 3.9), 2.2 (95% CI = 1.2 to 4.2), and 2.9 (95% CI = 1.5 to 5.6), respectively, compared with never smokers. In the multivariable model, former smokers, women who smoked less than one pack/day, and women who smoked one or more packs/day had RRs of 3.3 (95% CI = 1.6 to 6.7), 2.9 (95% CI = 1.4 to 6.1), and 4.3 (95% CI = 2.0 to 9.3), respectively, for CIN3 or cervical cancer compared with never smokers. Conclusions: Smoking is associated with an increased risk of invasive cervical cancer in women who are infected with oncogenic HPV. Subsequent studies should examine the role of smoking in the multistage pathogenesis of cervical cancer.
... Las consecuencias del tabaquismo en la población se evidencian luego de 30 años del pico de mayor consumo (6); además, dado que la edad media de inicio en consumo de tabaco en el mundo es de 15 años, la Organización Mundial de la Salud (OMS) considera al tabaquismo como una enfermedad pediátrica (7). El consumo de tabaco constituye actualmente la principal causa aislada de mortalidad evitable en los países desarrollados y por ello precisa un enfoque colectivo desde la salud pública (8)(9)(10)(11)(12)(13)(14). Esta realidad tiene el agravante de la promoción activa del consumo de tabaco por la industria tabacalera (conocida como efecto Boomerang (15,16). ...
Antecedentes. El tabaquismo puede considerarse como una pandemia. Material y métodos. Estudio descriptivo correlacional en el que participaron 237 estudiantes de los semestres I a X de todas las facultades de la Universidad de Manizales inscritos durante el primer período académico del año 2007. Todos respondieron una encuesta que incluyó además los cuestionarios de Glover Nilsson, Fagerström y de Richmond. Resultados. Según criterios de la Organización Mundial de la Salud se encontró que el 41 por ciento de los encuestados son fumadores (37.6% habituales y 3.4% esporádicos), con proporciones iguales por género; el 58.2 por ciento son no fumadores, el 0.8 por ciento son exfumadores y el 38.9 por ciento fuman de 1-3 cigarrillos por día. El 86.6 por ciento de los fumadores adquirió este hábito antes de ingresar a la Universidad, la mayoría de ellos (77.9%) entre los 12 y 17 años de edad. En todas las facultades predominaron los No fumadores, excepto en Comunicación Social, Educación y Medicina. El 46 por ciento cree que debería haber un área permanente de No fumadores en las cafeterías de la Universidad. La mayoría de fumadores de la UM tienen una baja o moderada motivación para abandonar este hábito. Conclusiones. Se requiere con urgencia la implementación de medidas que promuevan la prevención en la adquisición de este hábito y la promoción para su cesación.
... In spite of this contraction in their traditional markets, TTCs have enjoyed record sales and profits since the early 1990s mainly because of increasing sales in the developing world. (Satcher, 2001;Telegraph, 2006). As the WHO director general pointed out in 1994, "In the developed countries, per capita cigarette consumption has fallen by 10% since 1970. ...
The World Health Organization's (WHO's) Framework Convention on Tobacco Control (FCTC) is a major blow to the worldwide expansion strategies and marketing practices of transnational tobacco companies. As expected, the industry vehemently opposed the treaty, lobbying instead for voluntary agreements and regulation by the market. However, in spite of bitter and persistent opposition by the tobacco industry, the FCTC was adopted by WHO. If the tobacco industry “lost” its battle to prevent FCTC from being institutionalized, who “won” and how? Our research suggests that the efforts of the epistemic community—a like-minded network of professionals whose authoritative claim to consensual knowledge provides them with a unique source of power in public policy decision making—won the battle by being able to better convince the decision makers as to the needs of the FCTC by relying on, and successfully disseminating, its knowledge, expertise, and ideas. © 2009 Wiley Periodicals, Inc.
... Smoking is a major public health problem worldwide (World Health Organization 1997Satcher 2001;Gori 2002). A recent estimate suggested that 29 percent of the adult population were smokers globally in 1995 (Peto & Lopez 2000). ...
This paper examines the prevalence of smoking, the age pattern of initiation of smoking, and factors associated with current smoking status among 15–19 year olds in five Asian societies, using data from large-scale youth surveys. The life-table method is used to examine the age pattern of initiation of smoking and logistic regression is used to examine factors associated with current smoking status. Smoking prevalence is high among boys but very low among girls. Among boys, 82 percent in Indonesia, 73 percent in Thailand, 70 percent in the Philippines, and 35 percent in Nepal begin smoking by age 20. In all countries, smoking is much more prevalent among teens who have experienced some transitions to adulthood. In Indone-sia and Nepal, teen smoking is more prevalent in less developed regions. Among Filipino girls, residence in metro Manila is associated with high probability of smoking. In most countries, teens who have close relationships with parents are less likely to smoke.
... Growing smoking across the developing world obviously raises public health concerns (Satcher 2001;Sugarman 2001;Warner 2005). The global spread of cigarettes will limit the benefits for longevity of other forces of development, medicine, and public health Lopez 2003a, 2003b). ...
Declining tobacco use in high-income nations and rising tobacco use in low- and middle-income nations raises questions about
the sources of worldwide patterns of smoking. Theories posit a curvilinear influence of national income based on the balance
of affordability and health-cost effects. In addition, however, economic inequality, gender inequality and government policies
may moderate the rise and fall in smoking prevalence with national income. This study tests these arguments using aggregate
data for 145 nations and measures of smoking prevalence circa 2000. The results show nonlinear effects of national income
for males that take the form of an inverted U, but show linear effects for females. They also show non-additive effects of
economic inequality for males that moderate both the rise and decline of smoking with national income and non-additive effects
of gender equality for females that moderate the positive effect of national income.
... The development of tobacco control policies at the national and local levels through policy transfer, lesson drawing, and diffusion over the past 50 years provides an explanation for this collective action (Mamudu 2005). This cooperation was facilitated by the accumulation of scientific knowledge on the health, economic, and social consequences of tobacco use and exposure to tobacco smoke (Bettcher et al. 2001;Corrao et al. 2000;Jha and Chaloupka 1999) and transnational issues such as the worldwide extension of activities of the tobacco industry, cross-border advertising, global marketing, and smuggling (Satcher 2001;Taylor and Bettcher 2000;WHO 2003). ...
The Westphalian idea of sovereignty in international relations has undergone recent transformation. "Shared sovereignty" through multilevel governance describes the responsibility of the European Union (EU) and its Member States in tobacco control policy. We examine how this has occurred on the EU level through directives and recommendations, accession rules for new members, tobacco control campaigns, and financial support for antitobacco nongovernmental organizations. In particular, the negotiation and ratification of the Framework Convention on Tobacco Control (FCTC) and the participation in the FCTC Conference of the Parties illustrates shared sovereignty. The EU Commission was the lead negotiator for Member States on issues over which it had jurisdiction, while individual Member States, through the EU presidency, could negotiate on issues on which authority was divided or remained with them. Shared sovereignty through multilevel governance has become the norm in the tobacco control policy area for EU members, including having one international organization negotiate within the context of another.
... [13][14][15][16] This is despite World Health Organization predictions that by 2020 tobacco attributable deaths worldwide will correspond to 12.3% of all deathssurpassing diarrhoeal diseases, perinatal diseases, and tuberculosis-and that by 2030 70% of tobacco related deaths will occur in the developing world. 17 As for "reproductive health", the text suggests that there may be some substances in "complex mixtures such as tobacco smoke [which] have been implicated in the causation of reproductive and developmental health eVects such as low birth weight". This may be taken to suggest that some components in the complex mixture are the actual cause of low birth weight and, if removed, could conceivably allow pregnant women to continue smoking without placing their fetuses at risk, congruent with the industry's research on product modification. ...
In the fall of 2000, Philip Morris re-initiated an external research grants programme ("Philip Morris External Research Program", or PMERP), the first since the dissolution of the Council for Tobacco Research (CTR) and the Center for Indoor Air Research (CIAR). The ostensible purpose of the programme is to help develop cigarette designs "that might reduce the health risk of smoking". Internal company documents also indicate that Philip Morris urgently seeks to restore its scientific "credibility", as part of a "new openness" in relation to the external community. The structure of the review panel--a cohort of external peer reviewers, a science advisory board, and an internal, anonymous review and approvals committee--is nearly identical to that of the CIAR. The majority of the named reviewers have had previous affiliation with the tobacco industry either as reviewers or grantees, but only a minority have done research directly on tobacco or smoking. The programmatic substance of the PMERP could be interpreted as soliciting exculpatory evidence with respect to smoking and exposure to smoke. We remain sceptical about the scientific integrity of PMERP.
... It is well known that smoking is the single most preventable cause of disease morbidity and mortality worldwide [1][2][3][4]. Young adolescence is the age at which young people begin to experiment with tobacco products [5]. Epidemiological studies indicate that smoking prevalences among youth underwent a sustained and substantial decline in the 1970s and 1980s, but during the 1990s, smoking prevalence increased among adolescents in Canada and the United States [6], in Europe [7], and also in Germany [8]. ...
This paper examines the effectiveness of the "Smoke-Free Class Competition" in delaying the onset of smoking in adolescence. Each participating class must decide if they want to be a "smoke-free class" for the 6-month period from fall to spring. Classes monitor their (non-)smoking behavior and report it to the teacher regularly. Classes in which pupils refrain from smoking for this period of time participate in a prize draw, in which they can win a number of attractive prizes.
To evaluate the effectiveness of the competition, a sample of 131 participating and nonparticipating classes (number of pupils 2,142; mean age 12.9 years, SD = 0.98) was compared with regard to their smoking behavior. Smoking status was determined by self-assessment on three occasions: (a) prior to the beginning of the competition, (b) 1 month after the competition, and (c) 1 year after the start of the competition.
From pretest to posttest smoking increased by 7.5% in the comparison group, while it decreased by 0.2% in the intervention group (OR = 2.19; P < 0.001). In the follow-up measurement, a clear increase in smoking prevalence occurs in all groups; however, the pupils in the intervention condition still have a significant lower increase of smoking (OR = 1.45; P < 0.01). Moreover, with regard to the nonsmokers at baseline, pupils in the comparison group showed significantly higher prevalences in smoking than the intervention group in the postmeasurement, 7.8 versus 13.9% (OR = 1.98; P < 0.001), as well as in the in the follow-up-measurement, 17 versus 21.3% (OR = 1.36; P < 0.05).
The results suggest that the participation in the competition could delay the onset of smoking in adolescence.
... Smoking remains the leading preventable cause of premature disease and death worldwide (WHO, 1997). It is estimated that in the next 20±30 years, 10 million people per year will die from tobaccorelated diseases such as cancer, cardiovascular disease, chronic obstructive pulmonary disease and others (Satcher, 2001). Epidemiological studies indicate that smoking prevalence among youth underwent a sustained and substantial decline in the 1970s and 1980s, but during the 1990s smoking prevalence increased among adolescents in the US (Ferrence et al., 2000) and also inEurope (WHO, 2000). ...
... [36][37][38][39] Most significant, in May 2003, the World Health Assembly adopted the Framework Convention on Tobacco Control, an international treaty that will require participating countries to implement, among other provisions, comprehensive bans on tobacco advertising and promotion. 19,[40][41][42][43][44] Currently, the process of achieving treaty ratification by the requisite 40 World Health Organization member nations is underway. ...
We examined the extent to which adolescents in Norway have been exposed to tobacco marketing despite an existing ban, and whether exposure is related to their current smoking or expectations they will smoke in the future.
Questionnaires were administered to nationally representative systematic samples of Norwegian youths aged 13 to 15 years in 1990 (n = 4282) and 1995 (n = 4065).
About half in each cohort reported exposure to marketing. Youths reporting exposure were significantly more likely to be current smokers and to expect to be smokers at 20 years of age, after control for important social influence predictors.
Adolescents' current smoking and future smoking expectations are linked to marketing exposure even in limited settings, suggesting the need for comprehensive controls to eliminate the function of marketing in promoting adolescent smoking.
... The experience gained over recent decades by the tobacco industry in global marketing and the development of new markets has contributed to the worldwide expansion of tobacco consumption (Warner, 2000). In response, global public health efforts aim to provide consistent anti-smoking policies across the world (Satcher, 2001; Sugarman, 2001). One promising strategy, the creation of an international treaty, has moved forward with the WHO Framework Convention on Tobacco Control (WHO, 2005). ...
Despite the growing problem of global tobacco use, accurate information on the prevalence and patterns in the world's poorest nations remains sparse. For sub-Sahara Africa, in particular, a weak knowledge base limits the targeting of strategies to combat the potential growth of tobacco use and its harmful effect on future mortality. To describe the prevalence and social patterns of the use of cigarettes and other tobacco in Africa, this study examines population-based data from 16 Demographic Health Surveys (DHS) of men aged 15-54 years and women aged 15-49 years in 14 nations. Descriptive statistics show the highest cigarette use among men in several nations of east central Africa and Madagascar, lowest use in nations of west central Africa, and medium use in nations of southern Africa. Multinomial logistic regression results for men show highest cigarette use among urban, less educated, and lower status workers. Results for women show much lower prevalence than men but similar social patterns of use. The DHS results thus give new and comparable information about tobacco use in low-income nations, disadvantaged social groups, and an understudied region of the world.
... [49][50][51] As use has declined in the developed world, tobacco companies have increased their promotional efforts in the developing world. 52,53 Today, a key challenge is to contain women's tobacco use in low-and middle-income nations as women's status improves and traditional barriers to their tobacco use erode. ...
We examined pregnant women's use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa.
Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005.
At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% [Uruguay] to 35.0% [Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home.
Pregnant women's tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.
This paper investigates why India actively negotiated and ratified the Framework Convention on Tobacco Control (FCTC), the first global health treaty to curb tobacco use worldwide. The World Health Organization’s (WHO) decision to conduct FCTC negotiations aligned with India’s shifting disease burden that was pivoting from infectious to non-communicable diseases, particularly cancer, which shot up due to surging tobacco use. The WHO’s decision to frame the agreement around constraining global tobacco commerce, particularly the might of multinational tobacco companies, meshed with the interests of New Delhi, which was concurrently seeking to curb surging tobacco consumption. This triggered a positive approach and attitude to FCTC negotiations, leading to India’s ratification. India’s negotiation and ratification of the FCTC shows that the literature(s) on rising powers and international organizations must consider how factors like the WHO’s institutional politics, specifically the intent to negotiate a focused global agreement to curb tobacco production and distribution worldwide, affects how countries perceive and seek to use that agreement to bolster domestic policy concerns like tobacco control.
Introduzione
Il fumo di tabacco è un agente etiologico trasversale e multiorgano responsabile di quella che l'OMS chiama Epidemia da Tabacco. Il fumo di sigaretta e il consumo di tutti i prodotti a base di tabacco rappresentano oggi la principale causa di morbilità e mortalità prevenibile (Satcher D, Am J Pub Health 2001), soprattutto nei Paesi occidentali, provocando ogni anno, in tutto il mondo, circa 5,4 milioni di morti premature a fronte di 1,3 miliardo di fumatori (US Department of Health and Human Services, 2004). In Italia, l'indagine DOXA-ISS del 2010 rileva una incidenza di fumatori pari al 21,7% nella popolazione generale sopra i 14 anni (11,1 milioni) e del 21,9% nella fascia d'età fra 15 e 24 anni. Il 55,5% degli attuali fumatori dichiara di avere iniziato a fumare prima dei 17 anni (DOXA, ISS, OSSFAD, 2010). Si calcola che in Italia muoiano, complessivamente, ogni anno, 85.000 persone per cause legate al fumo, e che uno ogni sei/sette decessi sia dovuto ad una patologia fumo-correlata. Nei Paesi industrializzati, dove il numero dei fumatori negli ultimi decenni sembra in declino, la prevalenza del fumo negli adolescenti non accenna a diminuire (Warren CW et al, Lancet 2006). I fumatori che iniziano a fumare in giovane età e continuano a farlo regolarmente hanno il 50% di probabilità di morire a causa di una patologia fumo-correlata (CDC, MMWR 1998). Le stime dell'OMS prevedono che, per l'anno 2030, se non cambierà il trend del tabagismo, il tabacco ucciderà oltre 10 milioni di persone, molte di più delle vittime dell'HIV, della tubercolosi, degli incidenti stradali, dei suicidi e degli omicidi messi insieme. Lo sport invece, da sempre, è sinonimo di vita e benessere. Lo sport fa bene alla salute, aiuta a raggiungere un migliore stato di benessere psico-fisico, ispira libertà, bellezza e divertimento, ed è sinonimo di prestanza fisica, di determinazione, di sfida ai propri limiti personali. Lo sport insegna il rispetto. Viceversa il tabagismo è esattamente l'opposto: nega il rispetto per il prossimo, è dipendenza, è non libertà, è non pulizia (dentro e fuori), è sfida ai limiti imposti dall'esterno, porta a conquiste fasulle e ad una effimera immagine positiva di sé che si basa su un oggetto chiamato sigaretta e si esaurisce nell'arco di pochi minuti, dà una minore prestanza fisica, danneggia la salute e compromette una ottimale performance sportiva (Fornaro A, Tabaccologia 2004). In sostanza, un connubio impossibile fra fumo e sport.
When people speak of the globalisation of industry, they usually mean worldwide networking between firms, in many cases involving the merger of complete sectors of industry. The consequences of these economic processes are not always beneficial. Some typical examples of globalisation are brand names such as Coca-Cola® or McDonald’s®, and the cigarette industry can also be added to this list, being led by a small number of worldwide tobacco groups (e.g. Philip Morris, British American Tobacco (BAT), RJ Reynolds, Brown & Williamson). Especially in the case of the cigarette industry, globalisation is seen by many as a double-edged sword; for instance, causing Gro Harlem Brundtland, the Director General of the WHO, speaking in February 1999 in Davos, to describe the “operations” of the tobacco industry as a serious threat to the health of nations [1].
Over the past century, the tobacco industry has consistently been successful in advertising its products – a fact testified to ultimately by annual turnover figures of US $400 billion and annual profits of thousands of millions [1]. A slight dip in the normally stable share prices was recorded on 22 August 1997 when Geoffrey Bible, the CEO of Philip Morris, stated in a case for damages before a US court that he would halt cigarette production if a link could be proved between smoking and cancer [2]. The link is incontrovertible and yet cigarettes continue to be produced and aggressively advertised, even with apparently warning slogans [3]. It might be thought that the tobacco industry enjoys special favour with politicians in numerous countries [4]. The phenomenon of economic globalisation is a fait accompli in the tobacco industry and its globalised marketing and promotion of tobacco represents a threat to public health in all countries: in 1986, a total of 61% of the world’s tobacco consumption was in developing countries, and by the year 2000, this figure had risen to 71% [1, 5]. By 2020, 70% of the expected 8.4 million deaths caused by tobacco will be in developing countries [6]. At present, since 70% of tobacco is grown in developing countries [5], tobacco control programmes need to be the highest priority.
The question arises if the death toll from tobacco does not constitute a crime against humanity, susceptible to prosecution in the international criminal court of the United Nations.
By 2020 the burden of disease due to tobacco is expected to outweigh that caused by any single disease. From its 1990 level of being responsible for 2.6% of all disease burden worldwide, tobacco is expected to increase its share to close to 10%.
Objectives: Preventing adolescent smoking is an important heath issue. Statistics from 1990 to 2001 show that the prevalence rate of smoking amongst teenagers aged 15 to 18 in Taiwan has remained the same. However, the consumption of imported cigarettes has replaced that of domestic cigarettes. The reason accounting for such switch is worth further investigation. The main purpose of this study was to understand how teenagers identify their cigarette consumption behavior by the process of selecting special cigarette brand. Method: Focus group discussion and individual interviews were conducted to explore the cigarette consumption behavior of 44 student smokers purposively selected from two vocational high schools in Taipei area. These interviews were tape-recorded, transcribed, and coded. Matrices were constructed to identify themes and evolving concepts. Results: Most of the student subjects smoked Mildseven brand and followed the choice of their peer groups or family when selecting cigarette brand. Only a few students were influenced by adolescent cigarette subculture, considering cigarette price and taste. Students switching to other cigarette brands were mainly affected mostly by symbolized advertisements and adolescent cigarette subculture. Conclusion: The results show that adolescent cigarette consumption behavior was significantly related to youth cigarette subculture and the image of cigarette advertisements. From the health promotion perspective, using anti-smoking marketing strategies in schools to decrease the myth of cigarette consumption was an important strategy to prevent adolescent smoking.
Background. Smoking may be viewed as a pandemic. Materials and methods. Descriptive study with a sample of 237 students enrolled from I to X semester of all schools in Universidad de Manizales during the first academic period of the year 2007. All of them were randomly assigned to answer a questionnaire which included Glover Nilsson, Fargerström and Richmond tests. Results. According to WHO criteria, 41 percent of the students are smokers (37.6% regular and 3.4% sporadic) with equal proportions between sexes, 58.2 percent were non-smokers, 0.8 percent ex-smokers and 38.9 percent smoke 1-3 cigarettes a day. 86.6 percent of smokers started his habit before getting into the University; most of them (77.9%) between 12 and 17 years of age. In most of the schools non-smokers are majority, with exception of social Communications, education and medicine. 46 percent believes that hould exist a permanent non smoking area in the University cafeterias. The majority of the smokers has low or moderate motivation to quit smoking. Conclusions. Is urgent to establish preventive actions to in the acquisition of smoki habit and to promote its cessation in every one students.
This book presents a summary of the consequences that tobacco smoking has on health, taking into account all organ systems affected, such as the respiratory tract, cardiovascular system, central nervous system, and urinary tract, including mineral metabolism, the pregnant woman, etc. It also describes primary prevention measures as well as possible intervention modalities, established on evidence-based medicine, to help individuals stop smoking. The book is of a high scientific standard and thus differs from many popular-science treatises. It helps inform the reader of all smoking-related problems.
In case-control studies, smoking, parity, and oral contraceptive use have been associated with an increased risk of cervical intraepithelial neoplasia grade 3 (CIN3) and cervical cancer among women who are infected with oncogenic human papillomavirus (HPV). However, these potential risk factors have not been adequately studied in prospective studies.
We studied 1812 women who were enrolled in a 10-year prospective study of cervical neoplasia at Kaiser Permanente in Portland, Oregon, and who at enrollment had tested positive for oncogenic HPV DNA and had responded to a questionnaire that included questions on smoking, oral contraceptive use, and parity. Absolute risks and crude relative risks (RRs) with 95% confidence intervals (CIs) for CIN3 or cervical cancer were computed for three time intervals (0-8, 9-68, and 69-122 months after enrollment) using the Kaplan-Meier method. Conditional logistic regression models were used to control for factors that may have influenced our risk estimates, specifically the cytologic interpretation of baseline Pap smear, number of Pap smears during follow-up, age at enrollment, age at prediagnosis visit, and age at diagnosis. All statistical tests were two-sided.
Oral contraceptive use and parity were not associated with risk of CIN3 or cervical cancer. Former smokers, women who smoked less than one pack of cigarettes per day, and women who smoked one or more packs per day had crude RRs for CIN3 or cervical cancer for the entire follow-up period of 2.1 (95% CI = 1.1 to 3.9), 2.2 (95% CI = 1.2 to 4.2), and 2.9 (95% CI = 1.5 to 5.6), respectively, compared with never smokers. In the multivariable model, former smokers, women who smoked less than one pack/day, and women who smoked one or more packs/day had RRs of 3.3 (95% CI = 1.6 to 6.7), 2.9 (95% CI = 1.4 to 6.1), and 4.3 (95% CI = 2.0 to 9.3), respectively, for CIN3 or cervical cancer compared with never smokers.
Smoking is associated with an increased risk of invasive cervical cancer in women who are infected with oncogenic HPV. Subsequent studies should examine the role of smoking in the multistage pathogenesis of cervical cancer.
Youth smoking continues to be an important public health problem. Many policy tools designed to reduce youth smoking are based on economic principles. This paper describes the economic and policy context of tobacco use aiming at reducing youth smoking and explains the economic rationale for tobacco control tools such as excise tax and price, clean indoor air laws, youth access laws and the broad provision of health information to the public. An overview of economic models of addiction provides the framework for empirical analysis of the impact of these policies. This is followed by a summary of the empirical evidence of the effectiveness of various tobacco control tools that are primarily economic in nature. The most consistent finding in this literature is that higher cigarette prices discourage youth smoking. Compared to the effects of cigarette taxation and price on youth smoking, the evidence on the effectiveness of the youth access laws and clean indoor air laws are still mixed and inconclusive. More research is needed to address issues such as: (1) the effects of gender, age, race and socio-economic status on the relationship between tobacco control policies and youth smoking; (2) better measurement of the outcome variables to account for the multi-dimensional nature of dependence; and (3) the effects of excise taxes and other tobacco control policies with regard to a host of dimensions of smoking such as initiation, cessation, and more generally the trajectories of tobacco use that would include patterns of progression, maintenance, regression, cessation, and relapse. More frequently collected longitudinal data than those currently available are needed to address the above issues. Understanding smoking behavior cannot be achieved without incorporating familial and other social contexts.
This study estimated smoking prevalence and identified factors associated with initiation among preteens in Nashville, TN. An anonymous, self-administrated questionnaire was given to 238 fifth- and sixth-graders in a middle-class neighborhood school. The mean age at initiation was 8.5 years (range 6-11 years). Overall, 10.5% of students had ever smoked; 16.1% of blacks and 9.3% of whites. Eighty-six percent continued to smoke. Black sixth-graders smoked (26.9%) four times the rate of black fifth-graders and 2.5 times that of white sixth-graders. Relatives initiated 78% of blacks while friends initiated 68% of whites. One-quarter of smokers got their cigarettes at home. Regular attendees of religious services had a lower smoking rate (6.9% versus 16.4%; p=0.01). Smoking rates decreased with increased knowledge of risks (p=0.00001). Among smokers, none believed that smoking is a risk factor for heart disease, 96% did not believe that smoking has any short-term health effects or is a risk factor for stroke. Few ever-smokers had a complete understanding of the health risks. Targeted messages and curriculum should be developed to teach preteens about the short- and long-term dangers of smoking. Clinicians can play a major role in educating their clients about the risks of smoking.
The morbidity and mortality associated with cigarette smoking is shifting from the developed world to developing countries, especially developing Arab countries. One such country is Egypt, which has the highest rate of tobacco consumption in the Arab world. To curb the rising smoking epidemic in Egypt, appropriate adolescent smoking prevention programs need to be developed. Most of the effective adolescent smoking prevention programs are based on the social influence approach, which targets the proximal psychosocial variables believed to promote adolescent smoking. However, most of our understanding of adolescents' psychosocial smoking risk factors is based mainly on Western studies. Whether these factors have the same influence on Egyptian adolescents' smoking behavior has not been investigated to date. An understanding of the psychosocial correlates of smoking behavior among Egyptian adolescents may help in designing the appropriate smoking prevention program aimed at this population. This study reports the results of a cross-sectional survey administered to a random sample of 1930 students in grades 7, 9 and 12 in the city of Alexandria, Egypt, in May 2003. Adolescent smoking behavior was positively associated with positive beliefs about smoking, sibling, parent and peer smoking, and social smoking norms, with sibling smoking and perceived adult smoking norms having a stronger influence on adolescents' smoking behavior than peer smoking and perceived peer smoking norms. Refusal self-efficacy was protective against smoking behavior, while knowledge of the short-term negative consequences of smoking was protective against susceptibility to future smoking among females only. The results suggest that adolescents from collective cultures, like Egypt, are more influenced by their family's smoking behavior and perceived adult smoking norms than their peers' smoking behavior and perceived peer smoking norms. Smoking prevention programs aimed at Egyptian adolescents should be accompanied by smoking cessation programs for the family and adult community members.
I examined demographic and socioeconomic patterns of tobacco use in 2 African nations in the early stages of epidemic.
I used population-based data from the Demographic Health Surveys of men aged 15-59 years (N=5111) and women aged 15-49 years (N=20809) in Malawi (2000) and Zambia (2001/2002) and multinomial logistic regression models to examine tobacco use (nonsmoker, light cigarette smoker, heavy cigarette smoker, and user of other tobacco) as a function of age, residence, education, occupation, marital status, and religion.
Male tobacco users tend to be less educated, urban, household service or manual workers, formerly married, and non-Christian and non-Muslim. Although tobacco use is less common among women, it relates inversely to their education and occupational status. Tobacco users more often reported drinking, getting drunk, and, among men, paying for sex.
Tobacco use patterns in 2 African nations at the early stages of epidemic suggest the need for public health officials to focus on disadvantaged groups to prevent the worldwide spread of tobacco.
The North Karelia Project, a major demonstration programme for coronary heart disease (CHD) prevention, began in the eastern province of North Karelia in Finland in 1972. A number of other national CHD prevention activities have also been undertaken particularly since 1977. In the 1980s, a national strategy was developed for CHD prevention. This paper reports the 20-year changes in risk factors in North Karelia and in the original reference area of the project and the 10-year changes in a third area in southwestern Finland.
The results are based on comparable surveys of cross-sectional population samples, aged 30-59 years, every fifth year since 1972.
During the first 5 years total cholesterol and blood pressure fell more in North Karelia than in the reference area, but subsequently changes have been about the same in both areas. The decline levelled off between the 1982 and 1987 surveys. This resulted in new nationwide preventive activities and during the last 5 years major declines in both serum total cholesterol and blood pressure have been observed. Smoking reduced more during the first 10 years in North Karelia than in Kuopio province. During the last 10 years a small decline has been observed in both areas. No change in smoking has occurred in southwestern Finland in the last 10 years.
A major decline in cardiovascular disease risk factors has been observed in the last 20 years in Finland. This decline was associated with the launch of the national demonstration project in North Karelia in the 1970s and with subsequent major national activities thereafter.
To identify and quantify the major external (nongenetic) factors that contribute to death in the United States.
Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and complications of vital statistics and surveillance data were also obtained.
Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity.
Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates.
The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations.
Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.
To examine how deeply foreign cigarette advertising had penetrated the Chinese market when a new ban on cigarette advertising was enacted in February 1995.
A survey using self-completion questionnaires administered in college classrooms from November 1994 to March 1995.
Eight universities and four medical schools in three Chinese cities: Beijing, Wenzhou, and Hangzhou.
1896 college students who agreed to complete a written questionnaire. The mean age was 21.2 years; 39.5% of respondents were female.
Four of the top eight cigarette brands most familiar to the respondents were foreign: Marlboro, 555, Kent, and Hilton. Advertisements for the foreign brands were much more likely to be seen than those for the domestic brands; those for Marlboro were reported most often (29.7%), followed by 555 (21.8%) and Kent (18.1%). Among smokers, Marlboro was the most preferred foreign brand, by 44.2%. The preference for Marlboro was also correlated with smokers having seen its advertisements. Most respondents, 71.8%, believed that cigarette advertising should be banned.
The previous restrictions on cigarette advertising in China failed to prevent a large portion of the population from seeing and understanding the advertisements. Before the 1995 advertising ban took effect, strict limitations on imports of foreign cigarettes notwithstanding, certain highly advertised brands such as Marlboro achieved wide recognition and even consumer preference. Stricter restrictions are suggested as previous ones have failed to achieve their intended effects.
Objective.
—To evaluate whether tobacco advertising encourages teenagers younger than 18 years to start smoking.Design.
—Comparison of 1990 California telephone survey data with data from a 1986 national telephone survey (both used a random-digit dialing system); 95% confidence intervals were calculated. To test our hypothesis, we considered whether the perception of advertising was related to age, whether the pattern of market share across age and sex groups followed the pattern of perceived advertising, and whether changes in market share paralleled changes in advertising as perceived by the youngest age group.Participants.
—There were 24296 adults and 5040 teenagers.Results.
—The most advertised brands of cigarettes were Marlboro, according to 33.6% of adults and 41.8% of teenagers, and Camel, according to 13.7% of adults and 28.5% of teenagers—named most often by 12- to 13-year-olds (34.2%). The brands that were purchased most often were Marlboro and Camel. Together these were the brands of choice of 79.9% of males and 85% of females aged 12 through 17 years. Marlboro's market share increased in youths and young adults up to age 24 years and then decreased gradually with age; Camel's market share decreased abruptly with age: it was the brand of choice of 24.5%±5.8% of males aged 12 through 17 years but was chosen by only 12.7%±3.6% of males aged 18 through 24 years; for females, 21.7%±13.7% aged 12 through 17 years chose Camels, while only 5.5%±3.2% aged 18 through 24 years preferred this brand. Both Marlboro and Camel brands had a higher market share in California in 1990 compared with that for the United States in 1986. Of interest is that the market share for Camel increased among the younger smokers but was more evenly distributed for Marlboro.Conclusions.
—Perception of advertising is higher among young smokers; market-share patterns across age and sex groups follow the perceived advertising patterns; and changes in market share resulting from advertising occur mainly in younger smokers. Cigarette advertising encourages youth to smoke and should be banned.(JAMA. 1991;266:3154-3158)
Objective.
—To identify and quantify the major external (nongenetic) factors that contribute to death in the United States.Data Sources.
—Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and compilations of vital statistics and surveillance data were also obtained.Study Selection.
—Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity.Data Extraction.
—Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates.Data Synthesis.
—The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400000 deaths), diet and activity patterns (300 000), alcohol (100 000), microbial agents (90 000), toxic agents (60 000), firearms (35 000), sexual behavior (30 000), motor vehicles (25 000), and illicit use of drugs (20 000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations.Conclusions.
—Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.(JAMA. 1993;270:2207-2212)
Cigarettes have particular appeal to potential smugglers because taxes often account for a large share of their price, making them a highly profitable product to smuggle. Economic models of smuggling are used to develop techniques for measuring the extent and nature of the worldwide cigarette smuggling problem. We conduct three separate empirical analyses. Our estimates indicate that between 6% and 8.5% of global cigarette consumption is smuggled. The perceived level of cor- ruption, as measured on a published 'transparency index' ranging from 0 (highly corrupt) to 10 (highly clean), statistically explains more of the variance in experts' esti- mates of cigarette smuggling than do cigarette prices. Using data on relative cigarette prices and travel between European countries, we estimate the extent of bootlegging (the legal purchase of cigarettes in one country for consumption or resale in another country without paying applicable taxes or duties) in Europe. Simulations show that even when the potential for increased smuggling is taken into account, increases in cig- arette tax rates result in increased tax revenue. Coordinated multilateral increases in cigarette taxes would result in significantly more tax revenue and less smuggling than unilateral tax increases. Smuggling is sometimes perceived to be an insurmountable obstacle to higher ciga- rette tax rates. Our results suggest that countries need not make a choice between higher cigarette tax revenues and lower cigarette consumption. Higher tax rates will achieve both objectives.
The BJC is owned by Cancer Research UK, a charity dedicated to understanding the causes, prevention and treatment of cancer and to making sure that the best new treatments reach patients in the clinic as quickly as possible. The journal reflects these aims. It was founded more than fifty years ago and, from the start, its far-sighted mission was to encourage communication of the very best cancer research from laboratories and clinics in all countries. The breadth of its coverage, its editorial independence and it consistent high standards, have made BJC one of the world's premier general cancer journals. Its increasing popularity is reflected by a steadily rising impact factor.
To evaluate whether tobacco advertising encourages teenagers younger than 18 years to start smoking.
Comparison of 1990 California telephone survey data with data from a 1986 national telephone survey (both used a random-digit dialing system); 95% confidence intervals were calculated. To test our hypothesis, we considered whether the perception of advertising was related to age, whether the pattern of market share across age and sex groups followed the pattern of perceived advertising, and whether changes in market share paralleled changes in advertising as perceived by the youngest age group.
There were 24,296 adults and 5040 teenagers.
The most advertised brands of cigarettes were Marlboro, according to 33.6% of adults and 41.8% of teenagers, and Camel, according to 13.7% of adults and 28.5% of teenagers--named most often by 12- to 13-year-olds (34.2%). The brands that were purchased most often were Marlboro and Camel. Together these were the brands of choice of 79.9% of males and 85% of females aged 12 through 17 years. Marlboro's market share increased in youths and young adults up to age 24 years and then decreased gradually with age; Camel's market share decreased abruptly with age: it was the brand of choice of 24.5% +/- 5.8% of males aged 12 through 17 years but was chosen by only 12.7% +/- 3.6% of males aged 18 through 24 years; for females, 21.7% +/- 13.7% aged 12 through 17 years chose Camels, while only 5.5% +/- 3.2% aged 18 through 24 years preferred this brand. Both Marlboro and Camel brands had a higher market share in California in 1990 compared with that for the United States in 1986. Of interest is that the market share for Camel increased among the younger smokers but was more evenly distributed for Marlboro.
Perception of advertising is higher among young smokers; market-share patterns across age and sex groups follow the perceived advertising patterns; and changes in market share resulting from advertising occur mainly in younger smokers. Cigarette advertising encourages youth to smoke and should be banned.
Fifty years ago, THE JOURNAL published 2 articles1,2
that were among the first of what was to become a deluge of epidemiological
studies linking tobacco use to adverse health outcomes. These early studies
on tobacco and disease established the basis for assessing disease causality
and led to the conclusion that tobacco use is directly responsible for more
than 25 causes of death.3 In the last 2 decades,
this epidemiological evidence for disease causation has been complemented
by evidence of economic harm.
Faced with a difficult business environment in the United States and the falling demand for cigarettes in industrialized countries, multinational tobacco companies have been competing fiercely to expand their sales in developing countries. Because of the worldwide threat posed by smoking to health and the emphasis being placed by international tobacco companies on marketing in developing countries, an international regulatory strategy, such as the WHO proposed Framework Convention on Tobacco Control, is needed. This review describes from a public health perspective the possible scope and key considerations of protocols that should be included in the convention. The key international areas that should be considered in tobacco control are: prices, smuggling; tax-free tobacco products; advertising and sponsorship; the Internet; testing methods; package design and labelling; agriculture; and information sharing.
Treating Tobacco Use and Dependence, a Public Health Service-sponsored Clinical Practice Guideline, is a product of the Tobacco Use and Dependence Guideline Panel ("the panel"), consortium representatives, consultants, and staff. These 30 individuals were charged with the responsibility of identifying effective, experimentally validated tobacco dependence treatments and practices. The updated guideline was sponsored by a consortium of seven Federal Government and nonprofit organizations: the Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, Robert Wood Johnson Foundation, and University of Wisconsin Medical School's Center for Tobacco Research and Intervention. This guideline is an updated version of the 1996 Smoking Cessation Clinical Practice Guideline No. 18 that was sponsored by the Agency for Health Care Policy and Research (now the AHRQ), United States Department of Health and Human Services. The original guideline reflected the extant scientific research literature published between 1975 and 1994. The updated guideline was written because new, effective clinical treatments for tobacco dependence have been identified since 1994. The accelerating pace of tobacco research that prompted the update is reflected in the fact that 3,000 articles on tobacco were identified as published between 1975 and 1994, contributing to the original guideline. Another 3,000 were published between 1995 and 1999 and contributed to the updated guideline. These 6,000 articles were screened and reviewed to identify a much smaller group of articles that served as the basis for guideline data analyses and panel opinion. This guideline contains strategies and recommendations designed to assist clinicians, tobacco dependence treatment specialists, and health care administrators, insurers, and purchasers in delivering and supporting effective treatments for tobacco use and dependence. The recommendations were made as a result of a systematic review and analysis of the extant scientific literature, using meta-analysis as the primary analytic technique. The strength of evidence that served as the basis for each recommendation is clearly indicated in the guideline. A draft of the guideline was peer-reviewed prior to publication, and the comments of 70 external reviewers were incorporated into the final document. The key recommendations of the updated guideline, Treating Tobacco Use and Dependence, based on the literature review and expert panel opinion, are as follows: 1. Tobacco dependence is a chronic condition that often requires repeated intervention. However, effective treatments exist that can produce long-term or even permanent abstinence. 2. Because effective tobacco dependence treatments are available, every patient who uses tobacco should be offered at least one of these treatments: Patients willing to try to quit tobacco use should be provided with treatments identified as effective in this guideline. Patients unwilling to try to quit tobacco use should be provided with a brief intervention designed to increase their motivation to quit. 3. It is essential that clinicians and health care delivery systems (including administrators, insurers, and purchasers) institutionalize the consistent identification, documentation, and treatment of every tobacco user seen in a health care setting. 4. Brief tobacco dependence treatment is effective, and every patient who uses tobacco should be offered at least brief treatment. 5. There is a strong dose-response relation between the intensity of tobacco dependence counseling and its effectiveness. Treatments involving person-to-person contact (via individual, group, or proactive telephone counseling) are consistently effective, and their effectiveness increases with treatment intensity (eg, minutes of contact). 6. (ABSTRACT TRUNCATED)
In this paper, we develop an econometric model to estimate the impacts of Electronic Vehicle Management Systems (EVMS) on the load factor (LF) of heavy trucks using data at the operational level. This technology is supposed to improve capacity utilization by reducing coordination costs between demand and supply. The model is estimated on a subsample of the 1999 National Roadside Survey, covering heavy trucks travelling in the province of Quebec. The LF is explained as a function of truck, trip and carrier characteristics. We show that the use of EVMS results in a 16 percentage points increase of LF on backhaul trips. However, we also find that the LF of equipped trucks is reduced by about 7.6 percentage points on fronthaul movements. This last effect could be explained by a rebound effect: higher expected LF on the returns lead carriers to accept shipments with lower fronthaul LF. Overall, we find that this technology has increased the tonne-kilometers transported of equipped trucks by 6.3% and their fuel efficiency by 5%.
Updating the global predictions for 2020: the impact of current policies
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Helene D. Gayle, MD, MPH (2002)
Lawrence W. Green, DrPH, MPH (2001)
Marsha D. Lillie-Blanton, DrPH (2003)
Marvin Marcus, DDS (2001)
Kenneth R. McLeroy, PhD (2001)
Marla E. Salmon, ScD, RN (2002)
Susan C. Scrimshaw, PhD (2002)
Marcia Stanhope, DSN, RN, FAAN (2002)
Lorna Wilson, RN, MSPH (2003)
Ruth E. Zambrana, PhD (2002)
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