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Evidence reviews and recommendations on interventions to reduce tobacco use and exposure to environmental tobacco smoke: A summary of selected guidelines

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Introduction

The r eports in this supplement to the American Journal of Preventive Medicine by the Task Force on Community Preventive Services1 (TFCPS) and Hopkins et al.2 represent the work of the TFCPS, an independent, nonfederal group of national, regional, and local public health and prevention services experts supported by public and private partners. These reports are the second published section of what will be the forthcoming Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Methods. The first published section was on vaccine-preventable diseases.3, 4, 5

In addition to expanding the Guide to Community Preventive Serives (the Community Guide), these reviews and evidence-based recommendations add to the growing body of guidelines that identify and document the effectiveness of interventions to reduce tobacco use and exposure to environmental tobacco smoke (ETS). The TFCPS reports complement other recent efforts that provide information and guidance to health care providers, health care systems, and communities on strategies to reduce the annual tobacco-related toll of addiction, illness, disability, and death. This article presents a summary of selected guidelines and evidence reviews available as of August 2000, and provides an accessible review of the current evidence of effectiveness of interventions to reduce tobacco use and exposure to ETS.

The first section of this article describes the focus and general content of selected evidence reviews and guidelines, and information on the organization of the summary tables. The second section presents the summary evidence tables, organized by type or category of intervention. The third section provides a brief discussion of the comparisons across evidence reviews.

Section snippets

Selected evidence reviews and guidelines on tobacco use prevention and control

The primary objective of this article is to compare the evidence reviews and recommendations from the Community Guide with reviews and recommendations recently produced by other groups. The two reports most often cited are Treating Tobacco Use and Dependence: Clinical Practice Guideline6 (CPG) and Reducing Tobacco Use: A Report of the Surgeon General7 (SGR). Other guidelines are also included to provide an additional assessment of the strength of the evidence for an intervention,8 another

Organization of the summary tables

Evidence reviews and recommendations are summarized in tables in this article as follows:

  • 1.

    Table 1. Clinical interventions to identify and to treat tobacco use and dependence

  • 2.

    Table 2. Health care system interventions to identify and to treat tobacco use and dependence

  • 3.

    Table 3. Community interventions to reduce exposure to ETS

  • 4.

    Table 4. Community interventions to reduce tobacco use initiation by children and adolescents

  • 5.

    Table 5. Community interventions to increase tobacco use cessation

All tables are

Recommendations

Three of the selected evidence reviews—Guide to Clinical Preventive Services, the Community Guide, and the CPG—present formal recommendations concerning the evidence of effectiveness for each intervention. In summarizing the recommendations from these reviews, the strength of evidence rating or recommendation is presented. In some cases, a brief quotation or statement is also presented. For several interventions, longer recommendation statements in the original document were abbreviated to fit

Narrative reviews

Some of the selected guidelines provided a narrative evaluation of the evidence of effectiveness of the intervention. For presentation in the summary tables of this article, pertinent sections of the text were quoted and identified. In most cases, the included text represents a summation or conclusion from an extended narrative evaluation of the studies providing evidence.

Summary effect measurements

Three of the evidence reviews—the Community Guide, the CPG, and the reports from the Cochrane Collaboration—provide summary effect measurements in evaluations of the evidence of effectiveness of the intervention. This information is provided in the tables with additional comments or information as needed. In all cases, the original document included a more detailed presentation and discussion of the summary effect measurements than is provided in these summary tables.

Discussion

Comparison of the evidence summaries presented here reveals considerable general agreement on the effectiveness or ineffectiveness of the interventions reviewed, with only a few instances in which different reviews reached different conclusions.

There is uniform agreement on the effectiveness of the clinical interventions, although the magnitude of the effects differed slightly. Screening patients for tobacco use, delivering brief advice or more intense or frequent counseling to quit, and the

Conclusion

This article is unique in pulling together information from various tobacco control guidelines and summarizing evidence and recommendations for complementary tobacco prevention and control activities at the individual, health care system, and community levels. The included guidelines used many of the same studies and explicitly referred to one another. Their similarity, therefore, is not surprising. Nonetheless, the similarity of the findings and recommendations in these evidence reviews and

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