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The news on tobacco control: time to bring the background into the foreground
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  1. SIMON CHAPMAN, Editor

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    Against a background of declining tobacco use and generally positive changes in other heart disease risk factors, a systematic review of 14 multiple risk factor intervention trials for preventing coronary heart disease1 concluded that reductions in mortality in the intervention groups were insignificant and changes in risk factors only modest, when compared with the reductions also seen in control groups. The Minnesota Heart Health Program reported similar outcomes2 3 and the major multi-community smoking cessation trial, COMMIT4 5 had a similar modest effect on smoking. Compared with typical community health promotion initiatives which operate on token budgets, all of these interventions were large scale, although still were funded with petty cash when compared with the promotional budgets used by the tobacco industry. Favourable improvements in the secular trend for risk factors such as smoking, and programme contamination of control groups have generally been cited as putative explanations of the lack of difference between intervention and control groups, with media leakage—being the most uncontrollable factor—deemed responsible.6 Doubtless, some of this leakage involved news coverage of specific interventions intended only for the eyes and ears of the experimental populations. However it is myopic to assume that it is only discrete efforts orchestrated by health agencies leaking into control areas which, in aggregate, constitute the possible forces generating positive secular trends in the wider population.

    In a recent issue of Tobacco Control, Melanie Wakefield and Frank Chaloupka called for more attention to the description and quantification of tobacco control “inputs”.7 They noted that the preoccupation with outcomes in evaluation research is often accompanied by overly casual accounts of the policy and intervention variables that are assumed to be the causative factors potentially producing change. In their editorial they argued for the further development of a range of …

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