Cummings K M
Department of Cancer Control & Epidemiology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Nicotine Tob Res. 1999;1 Suppl 1:S113-6. doi: 10.1080/14622299050011701.
This article describes the rationale and evidence supporting community-wide interventions for tobacco control. Data were collected from published evaluation studies, government reports, and commentaries that describe the use of community-based approaches to tobacco control. Community-wide interventions attempt to change tobacco use in populations--not just individuals--and have increasingly begun to focus on influencing policies that promote and/or tolerate tobacco use. Examples of community-based tobacco-control activities include organizing community groups to advocate adoption of tobacco-control ordinances (e.g., smoke-free restaurants, ban on self-service tobacco displays); media advocacy to raise public awareness about illegal tobacco sales to minors; paid counter-advertising; and sponsorship of community-wide stop-smoking events such as a quit-and-win contest. Evidence in support of the effectiveness of community-based interventions to reduce smoking is found in the consistently sharper decline in tobacco consumption observed in states that have invested in comprehensive tobacco-prevention and control programs compared to those that have not. However, the results from several randomized controlled trials of community-based tobacco-control interventions have been disappointing in demonstrating large-scale changes in tobacco use. Although there appears to be a wide consensus that community-based approaches to tobacco control are an important part of a comprehensive program to reduce tobacco use, the essential elements and methods of implementation of some community-based tobacco-control efforts are less well defined. Also, given the dynamic nature of community tobacco-control interventions, the traditional randomized controlled trial model probably is not applicable for evaluation purposes. It is more likely that research models based on time-series designs will be most applicable for evaluating the impact of community-based interventions.
本文介绍了支持社区层面烟草控制干预措施的基本原理和证据。数据收集自已发表的评估研究、政府报告以及描述基于社区的烟草控制方法应用情况的评论文章。社区层面的干预措施旨在改变人群而非仅仅个体的烟草使用行为,并且越来越开始注重影响那些促进和/或容忍烟草使用的政策。基于社区的烟草控制活动示例包括组织社区团体倡导通过烟草控制条例(例如,无烟餐厅、禁止自助式烟草展示);媒体宣传以提高公众对向未成年人非法销售烟草的认识;付费反宣传;以及赞助社区范围的戒烟活动,如戒烟竞赛。与未投资全面烟草预防和控制项目的州相比,在投资此类项目的州观察到烟草消费持续更显著下降,这为基于社区的干预措施减少吸烟的有效性提供了证据。然而,基于社区的烟草控制干预措施的几项随机对照试验结果在证明烟草使用的大规模变化方面令人失望。尽管似乎存在广泛共识,即基于社区的烟草控制方法是减少烟草使用综合项目的重要组成部分,但一些基于社区的烟草控制努力的基本要素和实施方法界定得并不清晰。此外,鉴于社区烟草控制干预措施的动态性质,传统的随机对照试验模型可能不适用于评估目的。基于时间序列设计的研究模型更有可能最适用于评估基于社区的干预措施的影响。