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19 juillet 2011

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

Sélection réalisée par Jean-François Etter

Le 19 juillet 2011


- Prevention and control of chronic diseases - BMJ
- Web-based Questionnaires: The Future in Epidemiology?
- Youth smoking cessation interventions and recruitment strategies
- Chattez avec un médecin tabacologue


Prevention and control of chronic diseases - BMJ

A UN General Assembly meeting is a unique opportunity to put them on the world's agenda

Chronic diseasescardiovascular diseases, cancers, chronic respiratory diseases, and diabetesare the leading global causes of death. Mental illnesses, injuries, osteoarthritis, and chronic kidney diseases also contribute substantially to disability but are often excluded from consideration. Of 58.8 million deaths globally, 60% were attributed to chronic diseases in 2004.1 Even in sub-Saharan Africa, where infectious diseases remain the major disease burden, with AIDS as the single leading cause of death, chronic diseases account for 25% of all deaths. Deaths from chronic diseases are projected to increase dramatically between now and 2030?.2

Chronic diseases are a heterogeneous group but many share underlying causes. Direct causes and risk factors for chronic disease, such as high blood pressure, diabetes, and raised blood lipids, are linked to lifestyle factorsfor example, smoking, unhealthy eating, and physical inactivity. Although it is not unusual to blame individuals for their behaviours, societal factors often determine these behaviours.3 Such factors include the promotion of tobacco; the high levels of saturated and trans-fats, sugars, and salt hidden in processed foods; and urbanisation. Lack of progress on the control of chronic diseases is one of the major obstacles to achieving the health related millennium development goals.4

Myths about chronic disease have contributed to their neglect. A first myth is that they are diseases of affluence, which places them outside of a global concern with poverty. In fact, risk factors are socially patternedrates of smoking are higher in poorer people, and age standardised mortality rates for chronic diseases are almost twice as high in low high income countries than in high income ones.1 A second myth is that you have to die from something, and that chronic diseases are not a cause of premature death. In fact, about 60% of chronic disease deaths in low and middle income countries occur in people aged under 60 years.5 A third myth is that no cost effective interventions exist. In fact, highly cost effective interventions are available to prevent and control common chronic diseases.6 Tobacco control, together with population wide restriction of salt, would stop 13.8 million premature deaths over 10 years in low and middle income countries and would cost about $0.5 (0.3; 0.4) per person per year.7 Treating people at high risk of cardiovascular disease with aspirin, a statin, and two blood pressure lowering drugs is highly cost effective and would save about as many premature deaths as the population strategies.8 However, focusing on the distal determinants by means of fiscal and legal mechanisms is more attractive than individual interventions because this can provide a final fix, whereas individual interventions require continued surveillance, diagnosis, and treatment.

There are many other reasons why chronic diseases have not yet acquired their place at the top of the world's health and political agendas.9 10 These include lack of unified international leadership and of powerful actors and community activists, including people affected by the diseases; lack of a clear and unified strategy, in particular about how to tackle the problem and at what cost; an emphasis on technical debates and on treatment, instead of creating and using favourable political contexts; a lack of documentation and of recognition of the role of chronic diseases in the alleviation of poverty, which is also reflected by their absence from the millennium development goals.11

The decision by the United Nations General Assembly to convene a high level meeting on the prevention and control of non-communicable diseases worldwide in September 2011 provides a unique opportunity to elevate chronic diseases to the global political agendajust as the 2001 UN General Assembly special session on HIV/AIDS was a tipping point in the global response to AIDS.11 However, generating such a paradigm shift for the global response to chronic diseases will require a dramatic change in how they are framed and linked with global development and the alleviation of poverty; a well coordinated alliance across the various disease constituencies (as initiated by the NCD Alliance) and funders (Global Alliance for Chronic Diseases); and a unified strategy including technical consensus on cost effective solutions.

UN sessions tend to pass very general resolutions and agree on grandiose goals, with little accountability. Crucially, therefore, the chronic disease communities must develop as soon as possible the concrete ask for this UN sessiona platform for action for political negotiation by UN member states. Elements of such a call to action include full and immediate implementation of the Framework Convention on Tobacco Control by all member states; endorsement of the World Health Organization's strategy on non-communicable diseases12; regulation of the salt, fat, and sugar content of processed foods; elimination of national and European Union subsidies for harmful crops; and access to essential treatments for the most common chronic diseases, which will require the strengthening of health systems. A strong declaration would set specific goals for reducing the incidence and burden of chronic diseases, and possibly for funding these efforts, as well as committing to public policy audits of health impacts in various sectors such as education, employment, transport, urban and rural development. Lobbying for the specific inclusion of every single disease or for technical elementsas important as they may bewould be counterproductive, because this would risk dividing the field, creating confusion among diplomats, and diverting attention from the core agenda, which by definition is political in the General Assembly.

Finally, besides a unified platform, the road map to a successful high level session requires three forces to work in synergy. Firstly, political champions among the UN member states, including a few permanent representatives in New York who are willing to dedicate a large proportion of their time to the preparation of the session. Secondly, a proactive secretariat in New York within the UN system to support political process and ensure technical accuracy (this may require the appointment by the UN secretary general of a personal representative for 12 months, with support from WHO). And, lastly, a unified activist civil society, comprising not only disease specialists and public health experts, but also businesses and the people directly concerned, such as patients with diabetes and survivors of breast cancer, because such people have been powerful agents in the AIDS movement.

BMJ 2010;341:c4865

1. Peter Piot, director 1, 2. Shah Ebrahim, professor of public health2 http://www.bmj.com/content/341/bmj.c4865.full (22 11 2010)
(19 07 2011)


Web-based Questionnaires: The Future in Epidemiology?

The traditional epidemiologic modes of data collection, including paper-and-pencil questionnaires and interviews, have several limitations, such as decreasing response rates over the last decades and high costs in large study populations. The use of Web-based questionnaires may be an attractive alternative but is still scarce in epidemiologic research because of major concerns about selective nonresponse and reliability of the data obtained. The authors discuss advantages and disadvantages of Web-based questionnaires and current developments in this area. In addition, they focus on some practical issues and safety concerns involved in the application of Web-based questionnaires in epidemiologic research. They conclude that many problems related to the use of Web-based questionnaires have been solved or will most likely be solved in the near future and that this mode of data collection offers serious benefits. However, questionnaire design issues may have a major impact on response and completion rates and on reliability of the data. Theoretically, Web-based questionnaires could be considered an alternative or complementary mode in the range of epidemiologic methods of data collection. Practice and comparisons with the traditional survey techniques should reveal whether they can fulfill their expectations.

Source: http://aje.oxfordjournals.org/content/172/11/1292.full.pdf+html (30 11 2010)
(19 07 2011)


Youth smoking cessation interventions and recruitment strategies

The ACCESS report is now available on the ACCESS website www.access-europe.com in English and 8 further languages). Developed in the frame of an EU funded project, the report proposes guiding principles to increase youth participation in cessation interventions, recruitment strategies and activities and practice examples from the 10 partner countries in the EU.

The report is based on an international literature review, the results of a questionnaire on smoking cessation interventions and recruitment strategies in the partner countries (Germany, Belgium, Denmark, the Netherlands, Spain, Latvia, Slovakia, Slovenia, Czech Republic, Austria) and the personal input of 100 experts at a European stakeholder consultation conference in Vienna. In the frame of the project, networks among health professionals concerned with youth smoking cessation has been established in each of the partner countries.

One of the major findings of the project is that recruitment strategies have been mostly neglected in the development of youth smoking cessation interventions. This lack was identified as a major reason for poor impact of youth cessation programmes. The ACCESS report suggests 26 strategies and lists even more activities that are used in Europe to motivate young smokers to use professional cessation aids.

www.access-europe.com (30 11 2010)
(19 07 2011)


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