Academic journal article Bulletin of the World Health Organization

Building the Evidence Base for Global Tobacco Control

Academic journal article Bulletin of the World Health Organization

Building the Evidence Base for Global Tobacco Control

Article excerpt

Voir page 889 le resume en francais. En la pagina 889 figura un resumen en espanol.

Introduction

It has been estimated that some three million deaths are attributable to smoking annually and that the number could rise to ten million within 30 to 40 years (1). Effective action against tobacco requires countries to understand the magnitude of the adverse effects of smoking on their populations. As country representatives negotiate WHO's Framework Convention on Tobacco Control, the need for reliable and timely data on tobacco and its use is greater than ever before. The effects of tobacco use could be monitored through a global system routinely assembling information on the tobacco trade, tobacco farming, the tobacco industry, the prevalence of tobacco use, associated mortality, and national resources for combating tobacco. Anticipating the demand for a global information system to support new tobacco control efforts, WHO and the Centers for Disease Control and Prevention initiated the development of the National Tobacco Information Online System (known provisionally as NATIONS) in 1998. The baseline data for this system were collected for the Tobacco Control Country Profiles (TCCP) project, led by the American Cancer Society. The project has produced a monograph to be presented at the 11th World Conference on Tobacco or Health (Chicago, 6-11 August 2000).

In order to demonstrate the potential utility of the data available from the TCCP project and later from NATIONS, we have analysed gender-specific smoking prevalence, per capita cigarette consumption, and changes in cigarette prices. The analyses illustrate the type of comparison that can easily be made between regions and countries by means of data from the TCCP project, which represents the first step in the development of a global tobacco information system. In addition, we highlight issues surrounding the quality of available data, priorities for future data collection, and the need to maintain and improve the system in order to support tobacco control efforts.

Methods

For analyses of smoking prevalence we categorized 191 Member States of WHO, two Associaate Members, Hong Kong SAR, China (Province of Taiwan) and the West Bank and Gaza Strip, thus allowing comparison with previous studies conducted by WHO. For analyses of manufactured cigarette consumption we categorized countries according to the Human Development Index (HDI) (2), whereby 174 countries are placed in high, medium or low categories based on life expectancy, educational attainment and income, giving a better measure of basic human capabilities or deprivation than income alone. This made it possible to examine how manufactured cigarette consumption varied with basic standards of living.

Country-specific statistics on smoking prevalence in the TCCP database were obtained through Medline literature searches, personal contacts with investigators and nongovernmental organizations engaged in tobacco control, and reports from health ministries, national statistical offices and WHO country representatives. The minimum inclusion criteria for a survey were the following items of information: date of the survey or its publication; characteristics of respondents (age and sex distribution); a description of sampling and data collection methods; and the questions used in assessing smoking behaviour.

When several studies from the same country met these criteria they were compared with respect to geographical coverage, dates, sample sizes, response rates and methods. Wherever different sources yielded contradictory data on prevalence, historical data were reviewed and experts working in the country were consulted. The most recent and representative studies on adult smoking prevalence were included.

Regional estimates of smoking prevalence were derived on the assumption that all studies reported current daily and occasional smoking among persons aged 15 years and older and that they reflected the smoking statuses of the populations in 1998. …

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