Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia.
The Malaysian Armed Forces, Wilayah Persekutuan, Kuala Lumpur 50634, Malaysia.
Mil Med. 2024 Nov 5;189(11-12):e2357-e2368. doi: 10.1093/milmed/usad507.
Tobacco use is synonymous with the military. Despite that military personnel are trained to follow commands, opportunities exist to implement various tobacco control strategies. We conducted a systematic review to evaluate the impact of tobacco control policy employed in military settings.
We searched for published English articles in Medline, Web of Science, Scopus, and Google Scholar databases using relevant subject headings without year restriction. We included randomized controlled trials, nonrandomized controlled trials, case-control, cohort, controlled before and after, and uncontrolled before and after studies evaluating the impact of tobacco control policy in the military population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, three independent reviewers independently screened initially identified articles, reviewed the full text, and extracted the data and any disagreements resolved by consensus after data recheck. Five reviewers used a validated tool to assess the quality of the included studies. The primary outcome was the reduction of any tobacco or nicotine-contained products (TNCPs) use among the troops. The impacts of the tobacco control policy were synthesized and analyzed qualitatively. This study is registered with the International Prospective Register of Systematic Review (CRD42022314117).
Fourteen studies were included in the analysis from 5372 studies screened. Most of the studies were from the USA, and fractions were from Thailand, France, and Taiwan. These studies were methodologically heterogeneous. Most studies employed a total ban policy on TNCP use during basic military training or operational deployment as the primary strategy. Other methods utilized were the brief tobacco intervention, targeted treatment, support, and counseling provided through telephone or mailing systems, the adjunctive behavioral intervention, providing free nicotine gum, the "Pharsai clinic", active and regular smoking restriction, and interventions aimed at intrapersonal, interpersonal, and organizational levels. There is a moderate quality of evidence that the tobacco control policies effectively reduced the prevalence of TNCP use, increased the cessation rate, reduced the intake, and lowered the dependency. The adjunctive interventions provided after the total ban on TNCP use may increase its effectiveness. However, findings from this review need to be carefully considered as the definition of TNCP use status was not universal between studies and lacked a biochemical validation procedure.
There is reasonable evidence to support that the tobacco control policy employed in the military population has multiple positive impacts in reducing the prevalence of TNCP use, increasing the cessation rates, reducing the intake, and lowering dependency. Other evidence-based strategies need to be fully utilized to materialize the tobacco endgame.
吸烟与军队如影随形。尽管军人奉命行事，但仍有机会实施各种烟草控制策略。我们进行了一项系统评价，以评估在军事环境中实施的烟草控制政策的影响。
我们使用相关主题词在 Medline、Web of Science、Scopus 和 Google Scholar 数据库中检索了已发表的英文文章，没有时间限制。我们纳入了评估军队人群中烟草控制政策影响的随机对照试验、非随机对照试验、病例对照、队列、对照前后和非对照前后研究。根据系统评价和荟萃分析的首选报告项目指南，三名独立审查员独立筛选最初确定的文章、审查全文并提取数据，任何分歧在重新检查数据后通过共识解决。五名审查员使用经过验证的工具评估纳入研究的质量。主要结果是部队中任何烟草或含尼古丁产品（TNCP）使用的减少。对烟草控制政策的影响进行了定性综合和分析。这项研究已在国际前瞻性系统评价注册（CRD42022314117）。
从筛选出的 5372 篇文章中，有 14 篇被纳入分析。这些研究大多来自美国，还有一部分来自泰国、法国和中国台湾。这些研究在方法上存在异质性。大多数研究采用在基础军事训练或作战部署期间全面禁止 TNCP 使用作为主要策略。其他方法包括简短的烟草干预、通过电话或邮件系统提供的针对性治疗、支持和咨询、辅助行为干预、提供免费尼古丁口香糖、“Pharsai 诊所”、积极和定期限制吸烟以及针对个人、人际和组织层面的干预。有中等质量的证据表明，烟草控制政策有效地降低了 TNCP 使用的流行率，提高了戒烟率，减少了摄入量，并降低了依赖性。在全面禁止 TNCP 使用后提供的辅助干预可能会提高其效果。然而，由于研究之间 TNCP 使用状况的定义不统一且缺乏生化验证程序，因此需要仔细考虑本综述的结果。
有合理的证据支持，在军队人群中实施的烟草控制政策在降低 TNCP 使用的流行率、提高戒烟率、减少摄入量和降低依赖性方面有多种积极影响。需要充分利用其他基于证据的策略来实现烟草控制的最终目标。
