Building the evidence base for effective tobacco control policies: the International Tobacco Control Policy Evaluation Project (the ITC Project)

The Framework Convention on Tobacco Control (FCTC) is a seminal event in tobacco control and in global health. Scientific evidence guided the creation of the FCTC, and as the treaty moves into its implementation phase, scientific evidence can be used to guide the formulation of evidence-based tobacco control policies. The International Tobacco Control Policy Evaluation Project (ITC Project) is a transdisciplinary international collaboration of tobacco control researchers who have created research studies to evaluate and understand the psychosocial and behavioural impact of FCTC policies as they are implemented in participating ITC countries, which together are inhabited by over 45% of the world's smokers. This introduction to the ITC Project supplement of Tobacco Control presents a brief outline of the ITC Project, including a summary of key findings to date. The overall conceptual model and methodology of the ITC Project--involving representative national cohort surveys created from a common conceptual model, with common methods and measures across countries--may hold promise as a useful paradigm in efforts to evaluate and understand the impact of population-based interventions in other important domains of health, such as obesity.     

The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles

Objective: To examine the incremental cost effectiveness of the five first line pharmacological smoking cessation therapies in the Seychelles and other developing countries.     

Dissemination of an effective inpatient tobacco use cessation program.

The present study aimed to determine whether tobacco use cessation rates observed in controlled trials of a hospital-based tobacco use cessation program could be replicated when the program was disseminated to a wide range of hospitals in a two-stage process including implementation and institutionalization phases. Using a nonrandomized, observational design, we recruited six hospitals to participate in the study. The research team helped implement the program during the first year of participation (implementation) and then withdrew from active involvement during the second year (institutionalization). The mean 6-month self-reported cessation rates were 26.3% (range = 17.6%-52.8%) for the implementation phase and 22.7% (range = 12.9%-48.2%) for the institutionalization phase. Hospitals with paid professionals providing the program had the best outcomes. Inpatient tobacco use cessation programs are feasible to implement and should target a 6-month self-reported cessation rate of at least 25%.     

Tobacco use and cessation counselling: Global Health Professionals Survey Pilot Study, 10 countries, 2005

One of the strategies to reduce the number of smoking-related deaths is to encourage the involvement of health professionals in tobacco-use prevention and cessation counselling. The World Health Organization, the US Centers for Disease Control and Prevention, and the Canadian Public Health Association developed the Global Health Professionals Survey (GHPS) to collect data on tobacco use and cessation counselling among health-profession students in all WHO member states. This report summarises findings from the GHPS Pilot Study, which consisted of 16 surveys conducted in 10 countries among third year students in four health-profession disciplines (dentistry, medicine, nursing, and pharmacy) during the first quarter of 2005. The findings indicated that current cigarette smoking among these students was higher than 20% in seven of the 10 countries surveyed. Nevertheless, 87-99% of the students surveyed believed they should have a role in counselling patients to quit smoking; only 5-37% of these third-year students had actually received formal training in how to conduct such counselling. Schools for health professionals, public health organisations, and education officials should work together to design and implement training in smoking cessation counselling for all health-profession students.     

International Quit and Win 1996: comparative evaluation study in China and Finland

OBJECTIVES: To compare background and process variables, as well as follow up status, of the participants in the International Quit and Win '96 contests of China and Finland, and analyse factors contributing to sustained maintenance. DESIGN: A standardised 12 month follow up was conducted in both countries with random samples of participants. The sample sizes were 3119 in China and 1448 in Finland, with response rates of 91.2% and 65.2%, respectively. INTERVENTIONS: The International Quit and Win '96 contest was the second coordinated, multinational smoking cessation campaign targeted at adult daily smokers. Altogether 25 countries participated, including China with 15 000 and Finland with 6000 smokers registered. MAIN OUTCOME MEASURES: Conservative (considering all non-respondents relapsed) and non-conservative (based on respondents only) estimates were calculated for one month abstinence, 12 month continuous abstinence, and point abstinence at the time point of follow up. RESULTS: Great differences were found in the background and process variables, as well as in the outcome measures. At one year follow up, the conservative continuous abstinence rates show that the Chinese participants maintained their abstinence better (38%) compared to the Finnish ones (12%). In China women reached higher abstinence rate (50%) than men (36%), whereas in Finland men achieved a better result (14%) than women (9%). CONCLUSIONS: The Quit and Win contest is a mass smoking cessation method feasible in countries showing great variance in smoking habits and rates. However, in countries with different stages of anti-smoking development, such as China and Finland, different practical implementation strategies may be needed.     

An overview of small-scale food fermentation technologies in developing countries with special reference to Thailand: scope for their improvement

Small-scale food fermentation technologies in developing countries have evolved through years of experience rather than through scientific breakthroughs. Many small-scale manufacturers are, therefore, reluctant to accept change and modify fermentation processes. Upgrading the quality and safety of fermented foods, while reducing their production cost and maintaining their authenticity and uniqueness, is of utmost importance. One strategic approach, which has been successfully implemented for the improvement of small-scale soy sauce fermentation in Thailand, is the consortium approach. This approach has allowed industry to work closely in sharing knowledge and common problems, which in turn has provided scientists with the research direction that would best benefit the industry. This consortium approach has brought about changes in the methodologies used in the production of soy sauce, by shortening processing times, introducing fiberglass tanks as bioreactors instead of the traditionally used small earthenware containers and introducing cost-effective waste management systems. One barrier to the application of starter cultures in the small-scale fermentation industry is the loss of uniqueness of fermented products. However, the advent of molecular biology techniques has allowed science to tailor starter cultures to the specific requirements of the manufacturer. Using the techniques of molecular biology, it has been shown that microflora of a specific product vary according to origin and sensory quality. A cell bank is being developed to serve as a resource base for Thai fermented pork sausage in order to facilitate the application of starter cultures in the manufacture of that product.     

Proceedings of the workshop on food-consumption surveys in developing countries: methodologic considerations in descriptive food-consumption surveys in developing countries

This paper reviews some methodologic issues relative to food-consumption studies in developing countries, including sampling considerations; capturing temporal variation in food consumption; choice of dietary instruments and protocols; and food-composition databases and needs for adequate software interfaces. Increasingly, issues of cross-country and regional comparability in food-consumption data are now coming into the decision mix. Comparability of data across countries requires comparability of several fundamental systems. Specific countries and cultural contexts must tackle problems of how to estimate individual intakes when one-dish serving is the norm; how to keep up with rapidly changing food supplies; how to capture ingredients added at the table that may be concentrated sources of nutrients or other components of interest; and how to document out-of-home eating. Assumptions about error, bias, and intra-individual variation in food intake need to be thoroughly tested in developing-country contexts. There is an urgent need for improvement in the availability of appropriate food-composition databases and software interfaces for developing-country use.     

International investments in Agriculture in Arab Countries: an overview and implications for policy

International investments in agriculture in the Arab region have increased considerably in recent years. This paper reviews foreign direct investment (FDI) in agriculture in the Arab region with an emphasis on Sudan, Egypt, and Morocco. The paper aims to (i) review past and current investment trends in the context of the unique characteristics of the region, including its food security challenges and resource constraints, and (ii) highlight some important policy issues to be addressed. Agriculture has traditionally received a very small share of international investments in the region (1–2% of total FDI), which largely focused on sectors other than primary agriculture. In the past few years, investments in agriculture have grown remarkably; particularly for resource-seeking investments, but information is incomplete as the changes are very rapid. Sudan is the primary destination for resource-seeking investments; Morocco and Egypt for market-seeking investments, mostly in food processing and fruit and vegetable production. Given the paucity of data, it is difficult to develop concrete policy recommendations. However, the analysis presented in this paper may be useful in guiding the development of FDI policies in the region, aimed at maximizing sustainable outcomes for both investors and host countries, with an emphasis on food security.     

Smoking cessation with smokeless tobacco and group therapy: an open, randomized, controlled trial

Smokeless tobacco might be effective as an adjunct for smoking cessation. We evaluated the efficacy of smokeless tobacco and group support for smoking cessation in an open, randomized study that compared smokeless tobacco plus group support versus group support only. The study enrolled 263 healthy smokers (M (age) = 49 years) who smoked a mean of 24 cigarettes/day, with a mean of 31 pack-years. Smokeless tobacco was provided for 7 weeks (or up to 12), combined with eight group support visits provided by nurses. The control group received group support only. Smoking cessation rates were statistically significantly better in the smokeless tobacco group than in the control group during the first 7 weeks. Point-prevalence abstinence rates at 7 weeks were 36.4% versus 20.8% (OR = 2.52, p = .001), respectively; and continuous abstinence rates from weeks 4 to 7 were 31.5% versus 19.2% (OR = 1.94, p = .023), respectively. The primary outcomes (i.e., 6-month point prevalence) were 23.1% versus 20.8%, respectively (OR = 1.31, ns). Smokeless tobacco was relatively well tolerated, although 15 subjects (11.2%) stopped use due to adverse events. A total of 25 subjects (17.5 %) were still using smokeless tobacco after 6 months. This trial demonstrated short-term efficacy of smokeless tobacco in combination with group support for smoking cessation but no long-term efficacy.