Moolchan Eric T, Fagan Pebbles, Fernander Anita F, Velicer Wayne F, Hayward Mark D, King Gary, Clayton Richard R
National Institute on Drug Abuse, Baltimore, MD 21224, USA.
Addiction. 2007 Oct;102 Suppl 2:30-42. doi: 10.1111/j.1360-0443.2007.01953.x.
The aim of this review is to outline a transdisciplinary research framework for identifying, explaining and intervening to address tobacco-related health disparities (TRHD). We will show the importance of an approach that integrates the human life-cycle (developmental) and tobacco addiction cycle (behavioral) for interventions that address group-specific vulnerabilities.
The existing empirical knowledge base on tobacco-related health disparities is mapped onto a conceptual framework built around life-cycle and addiction cycle trajectories for disparate population groups.
Current knowledge about developmental trajectories of tobacco use is based on general population studies with minimal information on group differences. At the national level, early onset of tobacco use is associated with a high level of tobacco dependence, low number of quit attempts, long-term smoking history and tobacco-related health harm. These relationships cannot be assumed for all population groups: African Americans and Asian Americans typically have a later age of tobacco use onset compared to European Americans, yet health consequences of smoking are higher among African Americans but not Asian Americans. Even less is known about group differences in the temporal progression from smoking onset to daily smoking. Determining the time-frame from initial to regular smoking seems crucial for targeted secondary prevention, before the establishment of addictive tobacco use patterns. Group-specific data characterizing the duration from daily tobacco use to a quit attempt or request for cessation treatment are also scant.
A comprehensive, integrated, transdisciplinary framework is needed to guide efforts to understand tobacco-related health disparities and to increase the effectiveness of evidence-based interventions delivered in culturally appropriate and economically practicable ways, while optimizing the balance between demand for and access to services.
本综述的目的是概述一个跨学科研究框架，用于识别、解释和干预以解决与烟草相关的健康差异（TRHD）。我们将展示一种整合人类生命周期（发育）和烟草成瘾周期（行为）的方法对于针对特定群体脆弱性的干预措施的重要性。
将现有的关于与烟草相关的健康差异的实证知识库映射到一个围绕不同人群的生命周期和成瘾周期轨迹构建的概念框架上。
目前关于烟草使用发育轨迹的知识基于一般人群研究，关于群体差异的信息极少。在国家层面，烟草使用的早发与高烟草依赖水平、低戒烟尝试次数、长期吸烟史以及与烟草相关的健康危害相关。但不能假定所有人群都存在这些关系：非裔美国人和亚裔美国人开始使用烟草的年龄通常比欧裔美国人晚，然而非裔美国人吸烟的健康后果更高，亚裔美国人则不然。关于从开始吸烟到每日吸烟的时间进展方面的群体差异了解得更少。确定从开始吸烟到经常吸烟的时间框架对于在成瘾性烟草使用模式建立之前进行有针对性的二级预防似乎至关重要。关于从每日烟草使用到戒烟尝试或寻求戒烟治疗的持续时间的特定群体数据也很少。
需要一个全面、综合的跨学科框架来指导相关工作，以理解与烟草相关的健康差异，并以文化上合适且经济上可行的方式提高循证干预措施的有效性，同时优化服务需求与可及性之间的平衡。
