Psychiatry, University of California San Diego Health Sciences, La Jolla, California, USA.
Naval Medical Center San Diego, San Diego, California, USA.
BMJ Open. 2024 Sep 20;14(9):e079092. doi: 10.1136/bmjopen-2023-079092.
We previously reported global regional differences in smoking cessation outcomes, with smokers of US origin having lower quit rates than smokers from some other countries. This post-hoc analysis examined global regional differences in individual-level and country-level epidemiological, economic and tobacco regulatory factors that may affect cessation outcomes.
EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study) was a randomised controlled trial that evaluated first-line cessation medications and placebo in 8144 smokers with and without psychiatric disorders from 16 countries across seven regions. Generalised linear and stepwise logistic regression models that considered pharmacotherapy treatment, psychiatric diagnoses, traditional individual-level predictors (eg, demographic and smoking characteristics) and country-specific smoking prevalence rates, gross domestic product (GDP) per capita, relative cigarette cost and WHO-derived MPOWER scores were used to predict 7-day point prevalence abstinence at the end of treatment.
In addition to several traditional predictors, three of four country-level variables predicted short-term abstinence: GDP (0.54 (95% CI 0.47, 0.63)), cigarette relative income price (0.62 (95% CI 0.53, 0.72)) and MPOWER score (1.03 (95% CI 1.01, 1.06)). Quit rates varied across regions (22.0% in Australasia to 55.9% in Mexico). With northern North America (USA and Canada) as the referent, the likelihood of achieving short-term abstinence was significantly higher in Western Europe (OR 1.4 (95% CI 1.14, 1.61)), but significantly lower in Eastern Europe (0.39 (95% CI 0.22, 0.69)) and South America (0.17 (95% CI 0.08, 0.35)).
Increased tobacco regulation was associated with enhanced quitting among participants in the EAGLES trial. Paradoxically, lower GDP, and more affordable cigarette pricing relative to a country's GDP, were also associated with higher odds of quitting. Geographical region was also a significant independent predictor.
ClinicalTrials.gov, NCT01456936.
我们之前报告了全球戒烟结果的区域差异，与来自某些其他国家的吸烟者相比，美国起源的吸烟者戒烟率较低。本事后分析研究了可能影响戒烟结果的个体和国家层面的流行病学、经济和烟草监管因素的全球区域差异。
EAGLES（评估全球戒烟研究中的不良事件）是一项随机对照试验，评估了来自 7 个地区的 16 个国家的 8144 名患有和不患有精神障碍的吸烟者一线戒烟药物和安慰剂的效果。广义线性和逐步逻辑回归模型考虑了药物治疗、精神诊断、传统个体预测因素（如人口统计学和吸烟特征）以及特定国家的吸烟流行率、国内生产总值（人均 GDP）、相对香烟成本和世卫组织衍生的 MPOWER 评分，用于预测治疗结束时 7 天点戒烟的患病率。
除了几个传统预测因素外，四个国家层面变量中的三个预测了短期戒烟：国内生产总值（0.54（95%置信区间 0.47,0.63））、香烟相对收入价格（0.62（95%置信区间 0.53,0.72））和 MPOWER 评分（1.03（95%置信区间 1.01,1.06））。戒烟率因地区而异（从大洋洲的 22.0%到墨西哥的 55.9%）。以北美北部（美国和加拿大）为参照，西欧（OR1.4（95%置信区间 1.14,1.61））实现短期戒烟的可能性明显更高，但东欧（0.39（95%置信区间 0.22,0.69））和南美洲（0.17（95%置信区间 0.08,0.35））则明显较低。
烟草监管的加强与 EAGLES 试验参与者戒烟率的提高有关。矛盾的是，与一个国家的国内生产总值相比，较低的国内生产总值和香烟价格相对更便宜也与更高的戒烟几率有关。地理位置也是一个重要的独立预测因素。
ClinicalTrials.gov，NCT01456936。
