Brown Tamara, Platt Stephen, Amos Amanda
UK Centre for Tobacco Control Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK.
Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK.
Drug Alcohol Depend. 2014 May 1;138:7-16. doi: 10.1016/j.drugalcdep.2014.03.001. Epub 2014 Mar 13.
There is strong evidence about which tobacco control policies reduce smoking. However, their equity impact is uncertain. The aim was to assess the effectiveness of population-level interventions/policies to reduce socioeconomic inequalities in adult smoking.
Systematic review of studies of population-level interventions/policies reporting smoking-related outcomes in adults of lower compared to higher socioeconomic status (SES). References were screened and independently checked. Studies were quality assessed. Results are presented in a narrative synthesis. Equity impact was assessed as: positive (reduced inequality), neutral (no difference by SES), negative (increased inequality), mixed (equity impact varied) or unclear.
117 studies of 130 interventions/policies were included: smokefree (44); price/tax (27); mass media campaigns (30); advertising controls (9); cessation support (9); settings-based interventions (7); multiple policies (4). The distribution of equity effects was: 33 positive, 36 neutral, 38 negative, 6 mixed, 17 unclear. Most neutral equity studies benefited all SES groups. Fourteen price/tax studies were equity positive. Voluntary, regional and partial smokefree policies were more likely to be equity negative than national, comprehensive smokefree policies. Mass media campaigns had inconsistent equity effects. Cigarette marketing controls were equity positive or neutral. Targeted national smoking cessation services can be equity positive by achieving higher reach among low SES, compensating for lower quit rates.
Few studies have assessed the equity impact of tobacco control policy/interventions. Price/tax increases had the most consistent positive equity impact. More research is needed to strengthen the evidence-base for reducing smoking inequalities and to develop effective equity-orientated tobacco control strategies.
有充分证据表明哪些烟草控制政策可减少吸烟行为。然而，其公平性影响尚不确定。本研究旨在评估针对人群层面的干预措施/政策在减少成年人吸烟方面社会经济不平等现象的有效性。
对有关人群层面干预措施/政策的研究进行系统综述，这些研究报告了社会经济地位较低与较高的成年人的吸烟相关结果。对参考文献进行筛选并独立核查。对研究进行质量评估。结果以叙述性综合形式呈现。公平性影响评估如下：积极（不平等减少）、中性（社会经济地位无差异）、消极（不平等增加）、混合（公平性影响各异）或不明确。
纳入了117项关于130种干预措施/政策的研究：无烟政策（44项）；价格/税收（27项）；大众媒体宣传活动（30项）；广告管制（9项）；戒烟支持（9项）；基于场所的干预措施（7项）；多项政策（4项）。公平性效应的分布情况为：33项积极、36项中性、38项消极、6项混合、17项不明确。大多数中性公平性研究使所有社会经济地位群体都受益。14项价格/税收研究的公平性为积极。自愿性、区域性和部分无烟政策比全国性、综合性无烟政策更有可能产生消极的公平性影响。大众媒体宣传活动的公平性效应不一致。香烟营销管制的公平性为积极或中性。有针对性的全国戒烟服务通过在社会经济地位较低人群中获得更高的覆盖面，弥补较低的戒烟率，从而可能产生积极的公平性影响。
很少有研究评估烟草控制政策/干预措施的公平性影响。提高价格/税收具有最一致的积极公平性影响。需要更多研究来加强减少吸烟不平等现象的证据基础，并制定有效的以公平为导向的烟草控制策略。
