Monitoring the tobacco use epidemic I. Overview: Optimizing measurement to facilitate change.
ABSTRACT This Overview paper (I of V) summarizes research work to date on monitoring the tobacco use epidemic, discusses the recommendations made at the November, 2002 National Tobacco Monitoring, Research and Evaluation Workshop sponsored by the U.S. National Cancer Institute (NCI), Centers for Disease Control and Prevention (CDC), the American Legacy Foundation, and the Robert Wood Johnson Foundation on the topic of tobacco surveillance and evaluation, and discusses the current state of affairs.
A conceptual model based on the classical infectious diseases framework/paradigm focusing on the Agent, Host, Vector and Environment is used to integrate the work presented in the four other papers that appear in this supplemental issue of Preventive Medicine.
The Agent paper (II) describes surveillance on tobacco products and biomarkers; the Host paper (III) describes surveillance on the smoker/user, or potential smoker/user; the Vector paper (IV) describes monitoring of industry activity; and the Environment paper (V) describes several key strategies for monitoring influential environmental factors. Overall, some improvements to the nation's surveillance system have been made in recent years. However, additional steps are needed to optimize measurement of tobacco use and factors influencing use in the United States.
Tobacco monitoring efforts play a vital role in combating the epidemic of addiction and disease produced by various tobacco products. The knowledge and experience gained by the tobacco use prevention and control community through this commitment to linkages of data collected in the domains of Vector and Environment, in addition to Agent and Host, could inform monitoring of a wide range of other public health issues as well, including diet and nutrition, physical activity, overweight and obesity, and substance abuse.
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- "However nicotine dependence is the single most consistent predictor of success following a quit attempt (Vangeli et al., 2011). Various key indicators have been defined for population level monitoring and evaluation of tobacco cessation/ control programs, which include classification of smokers by intention and attempts to quit smoking (WHO, 1998; Giovino et al., 2009). Global Adult Tobacco Survey (GATS) is a part of Global Adult Tobacco Surveillance System (GTSS) that monitors tobacco control indicators among adults of 15 years old and above. "
ABSTRACT: Background: Tobacco use and quit attempts are two key indicators of the Global Adult Tobacco Survey (GATS) that assess quit attempts among current as well as former tobacco users. The relevant data have inherent policy implications for tobacco cessation programme evaluation. This study aimed to review the concepts of quit attempt assessment and quantifying invalid responses considering GATS-India data. Materials and Methods: GATS assessment of tobacco use and quit attempts were examined in the current literature. Two categories of invalid responses were identified by stratified analysis of the duration of last quit attempt among current users and duration of abstinence among former users. Category A included absolute invalid responses when time- frame of assessment of current tobacco use and less than former tobacco use were violated. Category B included responses that violated the unit of measurement of time. Results: Current daily use, current less than daily use and former use in GATS were imprecisely defined with overlapping of time-frame of assessment. Overall responses of 3,102 current smokers, 4,036 current smokeless users, 1,904 former smokers and 1,343 former smokeless users were analyzed to quantify invalid responses. Analysis indicated overall 21.2% (category A: 7.32%; category B: 17.7%) and 22.7% (category A: 8.05%; category B: 18.1%) invalid responses among current smokers and smokeless users respectively regarding their duration of last quit attempt. Similarly overall 6.62% (category A: 4.7%; category B: 2.3%) and 10.6% (category A: 8.6%; category B: 3.5%) invalid responses were identified among former smokers and smokeless users respectively regarding their duration of abstinence. Conclusions: High invalid responses for a single assessment are due to the imprecise definition of current use, former use and quit attempt; and failure to utilize opportunity of direct data entry interface use during the survey to validate responses instantly. Redefining tobacco use and quit attempts considering an appropriate timeframe would reduce invalid responses.Asian Pacific journal of cancer prevention: APJCP 11/2013; 14(11):6563-8. DOI:10.7314/APJCP.2013.14.11.6563 · 2.51 Impact Factor
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- "Understanding, documenting, and quantifying the characteristics of the tobacco user, or potential user, have been key to tobacco control efforts . A variety of existing monitoring, research, and evaluation systems are available to collect such information , with increasing demand for surveillance data to inform evidence-based public health tobacco initiatives necessitating their periodic review . At the national level, the National Health Interview Survey (NHIS) has been the data source used to measure progress on that consumption is a crude measure of both toxin exposure and nicotine dependence and, with respect to toxin exposure, likely inaccurate as well. "
ABSTRACT: To compare prevalence estimates and assess issues related to the measurement of adult cigarette smoking in the National Health Interview Survey (NHIS) and the National Survey on Drug Use and Health (NSDUH). 2008 data on current cigarette smoking and current daily cigarette smoking among adults ≥18 years were compared. The standard NHIS current smoking definition, which screens for lifetime smoking ≥100 cigarettes, was used. For NSDUH, both the standard current smoking definition, which does not screen, and a modified definition applying the NHIS current smoking definition (i.e., with screen) were used. NSDUH consistently yielded higher current cigarette smoking estimates than NHIS and lower daily smoking estimates. However, with use of the modified NSDUH current smoking definition, a notable number of subpopulation estimates became comparable between surveys. Younger adults and racial/ethnic minorities were most impacted by the lifetime smoking screen, with Hispanics being the most sensitive to differences in smoking variable definitions among all subgroups. Differences in current cigarette smoking definitions appear to have a greater impact on smoking estimates in some sub-populations than others. Survey mode differences may also limit intersurvey comparisons and trend analyses. Investigators are cautioned to use data most appropriate for their specific research questions.Journal of Environmental and Public Health 05/2012; 2012(8):918368. DOI:10.1155/2012/918368
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- "Monitoring, Research, and Evaluation Workshop (Giovino et al., 2009) compiled a series of reviews covering tobacco surveillance with respect to the agent (product characteristics; Stellman & Djordjevic, 2009), vector (industry activities; Cruz, 2009), host (tobacco user characteristics ; Delnevo & Bauer, 2009), and environment (regulations and policies; Farrelly, 2009). The tracking of a newly introduced product into the population may be further conceptualized by diffusion approaches (e.g., Rogers, 2003; Wejnert, 2002). "
ABSTRACT: The U.S. Food and Drug Administration (FDA) acquired authority to regulate tobacco products in 2009. This authority will provide a structured process for manufacturers to introduce products that may have "modified-risk" for morbidity or mortality relative to traditional tobacco products, with postmarketing surveillance and studies a condition of marketing. A narrative review approach was taken. The author searched and integrated publicly accessible literature on tobacco product surveillance as well as drug and medical device postmarket activities currently performed by FDA. FDA relies on active and passive methods for postmarket surveillance and can require specific studies and risk evaluation and mitigation strategies for certain products, including those with abuse liability. Past efforts at examining the individual and population effects of reduced harm tobacco products provide an example of integrating different data streams. Postmarket surveillance can be viewed in terms of the Agent-Host-Vector-Environment model, and concepts from diffusion of innovations are relevant to understanding factors associated with the adoption of new products by the population. Given that active and passive surveillance approaches have different strengths and weaknesses, multiple approaches may be necessary to evaluate population-level effects. Assuring that required studies are properly conducted and reported and that data indicating significant public health harms are quickly recognized will be important going forward. The advent of broad regulatory authority over tobacco provides opportunities for policy evaluation research. The research community can provide FDA with the independent science it needs to evaluate the public health impact of novel tobacco products.Nicotine & Tobacco Research 12/2011; 14(1):29-42. DOI:10.1093/ntr/ntq243 · 2.81 Impact Factor