To estimate tobacco use prevalence in healthcare workers (HCW) by country income level, occupation and sex, and compare the estimates with the prevalence in the general population.
We systematically ...searched five databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 2000 and March 2016 without language restriction. All primary studies that reported tobacco use in any category of HCW were included. Study extraction and quality assessment were conducted independently by three reviewers, using a standardised data extraction and quality appraisal form. We performed random effect meta-analyses to obtain prevalence estimates by World Bank (WB) country income level, sex, and occupation. Data on prevalence of tobacco use in the general population were obtained from the World Health Organisation (WHO) Global Health Observatory website. The review protocol registration number on PROSPERO is CRD42016041231.
229 studies met our inclusion criteria, representing 457,415 HCW and 63 countries: 29 high-income countries (HIC), 21 upper-middle-income countries (UMIC), and 13 lower-middle-and-low-income countries (LMLIC). The overall pooled prevalence of tobacco use in HCW was 21%, 31% in males and 17% in females. Highest estimates were in male doctors in UMIC and LMLIC, 35% and 45%, and female nurses in HIC and UMIC, 21% and 25%. Heterogeneity was high (I2 > 90%). Country level comparison suggest that in HIC male HCW tend to have lower prevalence compared with males in the general population while in females the estimates were similar. Male and female HCW in UMIC and LMLIC tend to have similar or higher prevalence rates relative to their counterparts in the general population.
HCW continue to use tobacco at high rates. Tackling HCW tobacco use requires urgent action as they are at the front line for tackling tobacco use in their patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aims
This paper provides a concise review of the efficacy, effectiveness and affordability of health‐care interventions to promote and assist tobacco cessation, in order to inform national guideline ...development and assist countries in planning their provision of tobacco cessation support.
Methods
Cochrane reviews of randomized controlled trials (RCTs) of major health‐care tobacco cessation interventions were used to derive efficacy estimates in terms of percentage‐point increases relative to comparison conditions in 6–12‐month continuous abstinence rates. This was combined with analysis and evidence from ‘real world’ studies to form a judgement on the probable effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on World Health Organization (WHO) criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of saving a life‐year was less than or equal to the per‐capita gross domestic product for that category of country.
Results
Brief advice from a health‐care worker given opportunistically to smokers attending health‐care services can promote smoking cessation, and is affordable for countries in all World Bank income categories (i.e. globally). Proactive telephone support, automated text messaging programmes and printed self‐help materials can assist smokers wanting help with a quit attempt and are affordable globally. Multi‐session, face‐to‐face behavioural support can increase quit success for cigarettes and smokeless tobacco and is affordable in middle‐ and high‐income countries. Nicotine replacement therapy, bupropion, nortriptyline, varenicline and cytisine can all aid quitting smoking when given with at least some behavioural support; of these, cytisine and nortriptyline are affordable globally.
Conclusions
Brief advice from a health‐care worker, telephone helplines, automated text messaging, printed self‐help materials, cytisine and nortriptyline are globally affordable health‐care interventions to promote and assist smoking cessation. Evidence on smokeless tobacco cessation suggests that face‐to‐face behavioural support and varenicline can promote cessation.
Aims
To (1) estimate the number of Parties to the Framework Convention on Tobacco Control (FCTC) providing tobacco dependence treatment in accordance with the recommendations of Article 14 and its ...guidelines; (2) assess association between provision and countries’ income level; and (3) assess progress over time.
Design
Cross‐sectional study.
Setting
Online survey from December 2014 to July 2015.
Participants
Contacts in 172 countries were surveyed, representing 169 of the 180 FCTC Parties at the time of the survey.
Measurements
A 26‐item questionnaire based on the Article 14 recommendations including tobacco treatment infrastructure and cessation support systems. Progress over time was assessed for those countries that also participated in our 2012 survey and did not change country income level classification.
Findings
We received responses from contacts in 142 countries, an 83% response rate. Overall, 54% of respondents reported that their country had an officially identified person responsible for tobacco dependence treatment, 32% an official national treatment strategy, 40% official national treatment guidelines, 25% a clearly identified budget for treatment, 17% text messaging, 23% free national quitlines and 26% specialized treatment services. Most measures were associated positively and significantly with countries’ income level (P < 0.001). Measures not associated significantly with income level included mandatory recording of tobacco use (30% of countries), offering help to health‐care workers (HCW) to stop using tobacco (44%), brief advice integrated into existing services (44%), and training HCW to give brief advice (81%). Reporting having an officially identified person responsible for tobacco cessation was the only measure with a statistically significant improvement over time (P = 0.0351).
Conclusion
Fewer than half of countries that are Parties to the Framework Convention on Tobacco Control have implemented the recommendations of Article 14 and its guidelines, and for most measures, provision was greater the higher the country's income. There was little improvement in treatment provision between 2012 and 2015 in all countries.
Background Tax policy is considered the most effective strategy to reduce tobacco consumption and prevalence. Tax avoidance and tax evasion therefore undermine the effectiveness of tax policies and ...result in less revenue for governments, cheaper prices for smokers and increased tobacco use. Tobacco smuggling and illicit tobacco trade have probably always existed, since tobacco's introduction as a valuable product from the New World, but the nature of the trade has changed. Methods This article clarifies definitions, reviews the key issues related to illicit trade, describes the different ways taxes are circumvented and looks at the size of the problem, its changing nature and its causes. The difficulties of data collection and research are discussed. Finally, we look at the policy options to combat illicit trade and the negotiations for a WHO Framework Convention on Tobacco Control (FCTC) protocol on illicit tobacco trade. Results Twenty years ago the main type of illicit trade was large-scale cigarette smuggling of well known cigarette brands. A change occurred as some major international tobacco companies in Europe and the Americas reviewed their export practices due to tax regulations, investigations and lawsuits by the authorities. Other types of illicit trade emerged such as illegal manufacturing, including counterfeiting and the emergence of new cigarette brands, produced in a rather open manner at well known locations, which are only or mainly intended for the illegal market of another country. Conclusions The global scope and multifaceted nature of the illicit tobacco trade requires a coordinated international response, so a strong protocol to the FCTC is essential. The illicit tobacco trade is a global problem which needs a global solution.
'In the absence of the COVID-19 pandemic, many people in tobacco control worldwide would have been at the Hague, Netherlands, from 9-14 November for the 9th Conference of the Parties (COP9) of the ...WHO Framework Convention on Tobacco Control (WHO FCTC), advocating for even stronger policies against the tobacco epidemic. The COP has been postponed to 2021, but the pandemic did not stop the global civil society from "virtually" gathering to talk about the WHO FCTC, where it is and where it is going.'
The guidelines outline what countries should be doing regarding tobacco dependence treatment; yet only 15% of the world's population has access to appropriate cessation support.4 Furthermore, ...worldwide success in tobacco cessation is imperative to attain the goal of WHO and the UN of a 25% reduction in premature mortality from non-communicable diseases (NCDs) by 2025.5 Only effective tobacco cessation will have a sufficient effect on mortality in the 10 years left to reach that goal.
ABSTRACT
Aims The purpose of this study was to update global estimates of the illicit cigarette trade, based on recent data, and estimate how many lives could be saved by eliminating it and how much ...revenue governments would gain.
Data sources and methods Our estimates of illicit market share are based on formal and informal sources. Our method for estimating the effect of eliminating the illicit trade on tobacco related deaths is based on West et al. with some minor modifications, and involves calculating the size of the illicit cigarette trade; the effect of eliminating it on the price of cigarettes and thus on consumption; the revenue governments are losing because of it; and the number of tobacco‐related premature deaths that would be avoided if this illicit trade were eliminated.
Results According to available estimates, the size of the illicit trade varies between countries from 1% to about 40–50% of the market, 11.6% globally, 16.8% in low‐income and 9.8% in high‐income countries. The total lost revenue is about $40.5 billion a year. If this illicit trade were eliminated governments would gain at least $31.3 billion a year, and from 2030 onwards more than 164 000 premature deaths a year would be avoided, the vast majority in middle‐ and low‐income countries.
Conclusions The burden of deaths and lost revenue caused by the illicit cigarette trade falls disproportionately on low‐ and middle‐income countries. Eliminating this trade would avoid millions of premature deaths, and recover billions of dollars for governments.
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