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08 février 2011

La newsletter de stop-tabac: les sujets clés de l?actualité mondiale sur le tabagisme

Sélection réalisée par Jean-François Etter

 

Le 08 Février 2011

- Doit-on aider les fumeurs à arrêter de fumer?
- Le tabagisme pèse entre 40 et 60% dans la différence de longévité homme-femme
- Book Review:Methods for Evaluating Tobacco Control Policies
- Chattez avec un médecin tabacologue


Doit-on aider les fumeurs à arrêter de fumer?

De nombreux gouvernements se demandent s'ils doivent, et comment ils peuvent, aider l'ensemble de la population des fumeurs à arrêter de fumer. Des voix se sont élevées contre cela, mais leurs arguments sont souvent fallacieux (ex: la plupart des fumeurs arrête sans aide, donc leur procurer une aide n'est pas nécessaire). Cet éditorial démontre les erreurs d'interprétation à l'origine de ces mythes, ceci afin de lancer un débat constructif sur le rôle de l'aide à l'arrêt du tabac dans les stratégies de contrôle du tabac pour une population donnée. Lire la suite:

http://www.treatobacco.net/en/uploads/documents/Publications/West%20et%20al%20Addiction%20Editorial%20Falacies%20French.pdf (03 02 2011)
(08 02 2011)


Le tabagisme pèse entre 40 et 60% dans la différence de longévité homme-femme

PARIS La mortalité due au tabac pèse entre 40 et 60% dans la différence de longévité entre les hommes et les femmes en Europe, selon une étude publiée en ligne mardi dans la revue spécialisée Tobacco Control.

Les raisons pour lesquelles les femmes vivent plus longtemps que les hommes, particulièrement dans les pays européens développés, font toujours débat, même si le tabac a été reconnu comme un facteur majeur de cette différence dans le passé, soulignent les auteurs de l'étude.

Des causes biologiques ont été invoquées. Le fait que les femmes ont plus volontiers recours aux soins de santé que les hommes a été aussi avancé.

L'équipe conduite par Gerry McCartney (Social and Public Health Sciences Unit, Glasgow, Royaume-Uni) a utilisé les données de l'Organisation mondiale de la Santé (OMS) sur les taux de décès chez les hommes et les femmes, toutes causes confondues, et ceux attribuables au tabac et à l'alcool, dans 30 pays européens, pour l'année la plus proche de 2005.

Les décès liés au tabac incluent les cancers des voies respiratoires, les infarctus et attaques cérébrales et la bronchite chronique obstructive (BPCO). Ceux liés à l'alcool comprennent les cancers de la gorge et de l'oesophage, les maladies chroniques du foie, aussi bien que la psychose alcoolique et les actes de violence.

L'excès de décès masculins varie considérablement selon les pays étudiés. La plupart des pays présentant un tel décalage hommes-femmes très important se trouvent en Europe de l'Est. La Belgique, l'Espagne, la France, la Finlande et le Portugal ont aussi un décalage assez important.

Selon les chercheurs, le tabac expliquerait 40 à 60% du décalage de mortalité entre les hommes et les femmes dans tous les pays, à l'exception du Danemark, du Portugal et de la France, où son rôle est moindre, et de Malte où il est au contraire plus important (74%). Les décès attribuables à l'alcool expliqueraient quant à eux environ 20% du décalage hommes-femmes.

Selon les auteurs de l'étude, les changements profonds dans la consommation de tabac devraient contribuer à diminuer les différences de mortalité entre les sexes dans les prochaines décennies.

(AFP) - http://www.google.com/hostednews/afp/article/ALeqM5hC25xzml1ny7SpTBZmqdyXOIhwYQ?docId=CNG.9380cfad08d00fe679b138a78606a8c3.c01 (19 01 2011)
(08 02 2011)


Book Review:Methods for Evaluating Tobacco Control Policies

Book Review:Methods for Evaluating Tobacco Control Policies by the International Agency for Research on Cancer

Book Review Prepared by Stanton Glantz

SRNT Newsletter Feb 2010

The WHO Framework Convention on Tobacco Control (FCTC) requires developing and implementing a wide range of policies to reduce tobacco use, from increases in prices through restrictions on where people can smoke to controls over product design and support for smoking cessation. This treaty also includes provisions to establish public health surveillance systems and support research on tobacco control. It is widely accepted that in pursuing tobacco control measures such as those listed in the FCTC (or any other public health or medical intervention), the steps taken to implement the policies be evidence based and effective.

As anyone who has seriously considered this issue knows, evaluating tobacco control programs in the real world is easier said than done. Data are hard to collect, definitions and methods differ, and interventions are often hard to deliver in a consistent way. Furthermore, the tobacco industry is always morphing strategies in response to tobacco control interventions and working to undermine them. Against this background, Methods for Evaluating Tobacco Control Policies provides an exceptionally well done guide on how to design and conduct such evaluations in the real world.

Before diving in to the specifics of how to monitor and estimate the effects a wide range of tobacco control interventions, the IARC Working Group, led by Ron Borland and K. Michael Cummings, presents a simple but elegant and practical theoretical framework for understanding how and why different tobacco control interventions work that is carried through the entire book and provides a common structure for thinking about the various tobacco control interventions it discusses.

After a general discussion of over-arching issues, such as how to design data collection systems, currently available data and measures of tobacco use behaviors and nicotine dependence, the book considers the pros and cons of different data sources for future work, including production, trade and sales data as well as population-based surveys and interviews with key informants. In addressing each topic, the approach, while theoretically-grounded, reflects the practical experience of the members of the Working Group in actually trying to use these data sources. Having laid that groundwork, the Working Group next discusses strategies for evaluating specific policy domains outlined in the FCTC: tobacco taxation, smoke-free policies, tobacco product regulation, restrictions on tobacco industry marketing communications, product (warning) labels, anti-tobacco media and education campaigns and cessation. Each chapter begins with a discussion of how the policy domain fits into the broad area of tobacco control (with very helpful flow charts linking policy with behavioral and health outcomes that identify mediators and moderators of the linkages) and the underlying evidence that justifies the intervention. In contrast to other more general discussions of program evaluation, which focus solely on the intervention, the Working Group considers changes to the environment that may occur after the intervention is applied, and particularly what the tobacco industry might do to blunt the effects of each intervention by adapting its behavior through strategies such as changes in pricing policy, product modification, packages designed to obscure warning labels or seeking different promotional venues.

Having established this foundation, the discussion moves on to practical issues of what kind of data to use and how to collect and analyze these data. Rather than dealing with these important issues in general terms, the Working Group presents very specific guidance, including informative tables listing specific questions to be used in surveys (or other measures of policy effectiveness), the source for this measure, information on validity, available variations of the measure and comments on the measure. These tables alone make the book a must have for anyone seriously interested in evaluating tobacco control policies.

There are only two shortcomings of the handbook worth mentioning. First, the focus is entirely at the national level. While this restriction may make sense on the grounds that the FCTC applies to nations, the fact is that much of the progress on tobacco control has been made at the sub-national level. Many of the methods and issues that the Working Group presents from a national perspective also apply at the sub-national level, but the handbook would have been more useful with some attention to the special issues and opportunities that exist through sub-national action. This national focus also could reinforce biases that the only good policies are national policies, which could lead to weaker policies than can be obtained through step-by-step local action. The focus on national policies by researchers also could lead to incomplete conclusions by ignoring sub-national policies. For example, important parts of the United States, Mexico, Argentina and other countries are covered by strong sub-national smoke-free policies at the same time that there is no effective national policy. In these cases, tobacco control advocates have tried to avoid national policies because they were (justifiably) confident that tobacco industry dominance of national policy making would lead to weak ineffectual policies.

Second, while the handbook includes well-integrated treatments of how the tobacco industry often responds (or can be anticipated to respond) to specific policies, there is no discussion of how the tobacco industry intervenes to influence the development and implementation of the policies themselves. This omission was surprising, since the handbook is organized around specific FCTC provisions, and Article 5.3 calls on parties to take steps to limit the influence of the tobacco industry in the policy making process. A discussion of how to evaluate the way that the industry influences policy making through such devices as political campaign contributions (or bribes), alliances with influential organizations and individuals, partnerships with government agencies for youth smoking prevention, use of surrogates and third parties and sponsoring research at academic institutions and steps that parties take to mitigate these actions is the one real missing element of the handbook.

These limitations aside, Methods for Evaluating Tobacco Control Policies is a wonderful readable contribution to global public health that anyone concerned with policy development and evaluation should not only buy, but actually read.

About the Reviewer: Stanton Glantz, Ph.D. is Professor of Medicine and American Legacy Foundation Distinguished Professor in Tobacco Control at the University of California San Francisco. He is the Director, Center for Tobacco Control Research and Education. (15 04 2010)
(08 02 2011)



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