Historique
Article de Périodique
Community interventions for reducing smoking among adults (Review) (2002)
(Interventions communautaires pour la réduction du tabagisme chez les adultes)
Auteur(s) :
SECKER-WALKER, R. H. ;
GNICH, W. ;
PLATT, S. ;
LANCASTER, T.
Année
2002
Page(s) :
CD001745 ; 114 p.
Sous-type de document :
Revue de la littérature / Literature review
Langue(s) :
Anglais
Domaine :
Tabac / Tobacco / e-cigarette
Thésaurus mots-clés
TABAC
;
INTERVENTION
;
ACTION COMMUNAUTAIRE
;
ADULTE
;
REDUCTION DE CONSOMMATION
;
EVALUATION
;
EFFICACITE
;
ABSTINENCE
Résumé :
FRANÇAIS :
Bien que les communautés mettant en œuvre des interventions se soient souvent montrées très concernées par leur programme, cela a rarement conduit à une hausse des taux de sevrage. De même, une meilleure connaissance des risques pour la santé, la modification du rapport au tabagisme, de plus nombreuses tentatives de sevrage et un meilleur soutien environnemental et social pour le sevrage n'ont pas été accompagnées de réductions des taux de tabagisme au niveau de la communauté. Dans les essais les mieux conçus, les fumeurs légers à modérés avaient fait un peu mieux que les gros fumeurs (étude américaine COMMIT) et les hommes avaient fait un peu mieux que les femmes (étude australienne CART), mais les taux de tabagisme étaient demeurés similaires entre les communautés recevant l'intervention et le contrôle.
ENGLISH:
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 STRATEGY: We searched the Cochrane Tobacco Addiction Group specialised register, MEDLINE (1966-August 2001) and EMBASE (1980-August 2001) 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 two studies were included, of which seventeen 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 27 studies. The estimated net decline ranged from -1.0% to 3.0% for men and women combined (10 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.
REVIEWER'S 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.
Bien que les communautés mettant en œuvre des interventions se soient souvent montrées très concernées par leur programme, cela a rarement conduit à une hausse des taux de sevrage. De même, une meilleure connaissance des risques pour la santé, la modification du rapport au tabagisme, de plus nombreuses tentatives de sevrage et un meilleur soutien environnemental et social pour le sevrage n'ont pas été accompagnées de réductions des taux de tabagisme au niveau de la communauté. Dans les essais les mieux conçus, les fumeurs légers à modérés avaient fait un peu mieux que les gros fumeurs (étude américaine COMMIT) et les hommes avaient fait un peu mieux que les femmes (étude australienne CART), mais les taux de tabagisme étaient demeurés similaires entre les communautés recevant l'intervention et le contrôle.
ENGLISH:
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 STRATEGY: We searched the Cochrane Tobacco Addiction Group specialised register, MEDLINE (1966-August 2001) and EMBASE (1980-August 2001) 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 two studies were included, of which seventeen 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 27 studies. The estimated net decline ranged from -1.0% to 3.0% for men and women combined (10 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.
REVIEWER'S 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.
Affiliation :
Health Promotion Research, University of Vermont, Burlington, Vermont, USA