Intervention Review

Community interventions for reducing smoking among adults

  1. Roger Secker-Walker2,
  2. Wendy Gnich3,
  3. Stephen Platt3,
  4. Tim Lancaster1

Editorial Group: Cochrane Tobacco Addiction Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 30 JAN 2006

DOI: 10.1002/14651858.CD001745

Database Title

Additional Information

How to Cite

Secker-Walker R, Gnich W, Platt S, Lancaster T. Community interventions for reducing smoking among adults. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD001745. DOI: 10.1002/14651858.CD001745.

Author Information

  1. 1

    University of Oxford, Department of Primary Health Care, Oxford, UK

  2. 2

    University of Vermont, Health Promotion Research, Burlington, Vermont, USA

  3. 3

    University of Edinburgh, Research Unit in Health, Behaviour and Change, Edinburgh, UK

*Lindsay F Stead, Department of Primary Health Care, University of Oxford, Rosemary Rue Building, Old Road Campus, Oxford, OX3 7LF, UK. lindsay.stead@dphpc.ox.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Since smoking behaviour is determined by social context, the best way to reduce the prevalence of smoking may be to use community-wide programmes which use multiple channels to provide reinforcement, support and norms for not smoking.

Objectives

To assess the effectiveness of community interventions for reducing the prevalence of smoking.

Search methods

We searched the Cochrane Tobacco Addiction Group specialised register, MEDLINE (1966-January 2006) and EMBASE (1980-January 2006) and reference lists of articles.

Selection criteria

Controlled trials of community interventions for reducing smoking prevalence in adult smokers. The primary outcome was smoking behaviour.

Data collection and analysis

Data were extracted by one person and checked by a second.

Main results

Thirty-seven studies were included, of which 17 included only one intervention and one comparison community. Only four studies used random assignment of communities to either the intervention or comparison group. The population size of the communities ranged from a few thousand to over 100,000 people. Change in smoking prevalence was measured using cross-sectional follow-up data in 21 studies. The estimated net decline ranged from -1.0% to +3.0% for men and women combined (11 studies). For women, the decline ranged from -0.2% to + 3.5% per year (n=11), and for men the decline ranged from -0.4% to +1.6% per year (n=12). Cigarette consumption and quit rates were only reported in a small number of studies. The two most rigorous studies showed limited evidence of an effect on prevalence. In the US COMMIT study there was no differential decline in prevalence between intervention and control communities, and there was no significant difference in the quit rates of heavier smokers who were the target intervention group. In the Australian CART study there was a significantly greater quit rate for men but not women.

Authors' conclusions

The failure of the largest and best conducted studies to detect an effect on prevalence of smoking is disappointing. A community approach will remain an important part of health promotion activities, but designers of future programmes will need to take account of this limited effect in determining the scale of projects and the resources devoted to them.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Can community interventions reduce smoking among adults

Although intervention communities often showed substantial awareness of their programme, this rarely led to higher quit rates. Similarly, increased knowledge of health risks, changes in attitudes to smoking, more quit attempts, and better environmental and social support for quitting were not accompanied by reductions in community smoking levels. In the best designed trials, light to moderate smokers did slightly better than heavy smokers (the US COMMIT study), and men did a little better than women (the Australian CART study), but overall smoking rates remained similar between intervention and control communities.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

減少成人吸菸的社區處置

由於吸菸行為會受社會情境所影響，因此減少吸菸最好的方法是廣泛性的社區計畫，使用多管道的方式提供不吸菸的增強、支持、和規範。

目標

評估減少成人吸菸的社區處置的效果

搜尋策略

我們搜尋 the Cochrane Tobacco Addiction Group specialised register, MEDLINE (1966January 2006) and EMBASE (1980January 2006) 和文章後的參考文獻目錄。

選擇標準

減少成人吸菸社區處置的控制試驗，主要的結果是吸菸行為。

資料收集與分析

由一個作者摘錄資料，另一名作者檢查。

主要結論

納入37篇研究，其中17篇只有一個處置及一個比較的社區，只有4篇研究使用隨機分配到實驗組或者控制組。社區的樣本數由幾千到超過十萬。在21篇研究中，吸菸盛行率變化的測量是為橫面追蹤的數據。男女合併，評估淨值下降的範圍由−1.0%至 +3.0%(11個研究). 在女性中，每年淨值下降由−0.2%至 + 3.5% (n = 11),在男性 每年下降由−0.4%至 +1.6% (n = 12)。香菸的消耗量及戒菸率只有在少數的研究中報告。兩個最嚴謹的研究只有有限的證據顯示對盛行率的影響。在美國的COMMIT社區研究中盛行率在實驗組及控制組中並無差異的下降，在重度吸菸者中戒菸率並無顯著的差異。在澳洲的CART研究中，男性有顯著較高的戒菸率，女性並沒有。

作者結論

用來驗證吸菸盛行率的大型、設計良好的研究的失敗是相當令人沮喪的。在健康促進的活動中社區取向仍是相當重要的一部份，但是未來計畫的設計者必須考量決定方案的規模及多少資源可運用會影響計畫的有限的效果。

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

減少成人吸菸的社區處置只有很少令人信服的證據。雖然方案的處置經常宣導，但是這樣並沒有帶來較高的戒菸率。同樣的，增加對危害健康的知識、改變對吸菸的態度、增加戒菸的嘗試、建立較好的戒菸環境及社會支持並沒有減少社區吸菸的情況。在一個良好設計的研究中發現，輕度到中度的吸菸者比起重度吸菸者稍好一些(美國的COMMIT研究，男人比女人稍好些(澳洲的CART研究)，但整體而言，吸菸率在實驗組和控制組相當。

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