Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study
Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study
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DOI：
10.1016/s2468-2667(17)30045-2
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发表时间：
2017-04-01
影响因子：
50
通讯作者：
Fong, Geoffrey T.
中科院分区：
文献类型：
--
作者：
Gravely, Shannon;Giovino, Gary A.;Fong, Geoffrey T.
世卫组织烟草控制框架公约（世卫组织烟草控制框架公约）动员了180个缔约方的努力，以打击全球烟草流行。本研究考察了《世界卫生组织烟草控制框架公约》主要减少烟草控制需求措施的最高级别实施与该条约头十年吸烟率之间的关系。方法：我们使用来自126个国家的世卫组织数据，研究2007年至2014年期间关键减少需求措施（世卫组织烟草控制框架公约第6、8、11、13和14条）的最高级别实施数量与2005年至2015年期间吸烟率估计值之间的关系。进行McNemar测试是为了测试2007年至2014年期间以最高水平实施每项措施的国家比例的差异。计算了四个线性回归模型，以检验预测变量（2007年至2014年在最高水平实施的关键措施数量的变化）与结果变量（2005年至2015年吸烟率的百分比变化）之间的关联。2007年至2014年期间，全球在最高级别实施所有关键的减少需求措施方面显著增加。所有126个国家的平均吸烟率在2005年为24.73%（标准差10.32），2015年为22.18%（标准差8.87），患病率平均下降2.55个百分点（标准差5.08，相对下降10.31%）。未经调整的线性回归显示，2007年至2014年期间关键措施最高执行率的增加与2005年至2015年期间吸烟率的下降显著相关。在最高水平实施的每一项额外措施与吸烟率平均下降1.57个百分点（95% CI 2.51至0.63,p=0.001）和平均相对下降7.09%（-12.55至1.63,p=0.011）相关。在控制了地理分区域、收入水平和《世界卫生组织烟草控制框架公约》缔约方地位后，每项措施的患病率下降了0.94个百分点（-1.76至0.13,p=0.023），平均相对下降了3.18%（-6.75至0.38,p=0.079）。这种关联在所有三个控制变量中都是一致的。实施世卫组织《烟草控制框架公约》减少需求的关键措施与降低吸烟率显著相关，预计未来将降低烟草相关发病率和死亡率。这些发现证实了在世卫组织《2013-2020年预防和控制非传染性疾病全球行动计划》中大力实施《世界卫生组织烟草控制框架公约》的呼吁，并推动联合国可持续发展目标3，即到2030年将烟草使用和非传染性疾病导致的过早死亡减少三分之一的全球目标。
Background The WHO Framework Convention on Tobacco Control (WHO FCTC) has mobilised efforts among 180 parties to combat the global tobacco epidemic. This study examined the association between highest-level implementation of key tobacco control demand-reduction measures of the WHO FCTC and smoking prevalence over the treaty's first decade.Methods We used WHO data from 126 countries to examine the association between the number of highest-level implementations of key demand-reduction measures (WHO FCTC articles 6,8,11,13, and 14) between 2007 and 2014 and smoking prevalence estimates between 2005 and 2015. McNemar tests were done to test differences in the proportion of countries that had implemented each of the measures at the highest level between 2007 and 2014. Four linear regression models were computed to examine the association between the predictor variable (the change between 2007 and 2014 in the number of key measures implemented at the highest level), and the outcome variable (the percentage point change in tobacco smoking prevalence between 2005 and 2015).Findings Between 2007 and 2014, there was a significant global increase in highest-level implementation of all key demand-reduction measures. The mean smoking prevalence for all 126 countries was 24.73% (SD 10.32) in 2005 and 22.18% (SD 8.87) in 2015, an average decrease in prevalence of 2.55 percentage points (SD 5.08; relative reduction 10.31%). Unadjusted linear regression showed that increases in highest-level implementations of key measures between 2007 and 2014 were significantly associated with a decrease in smoking prevalence between 2005 and 2015). Each additional measure implemented at the highest level was associated with an average decrease in smoking prevalence of 1.57 percentage points (95% CI 2.51 to 0.63, p=0.001) and an average relative decrease of 7.09% (-12.55 to 1.63, p=0.011). Controlling for geographical subregion, income level, and WHO FCTC party status, the per-measure decrease in prevalence was 0.94 percentage points (-1.76 to 0.13, p=0.023) and an average relative decrease of 3.18% (-6.75 to 0.38, p=0.079). This association was consistent across all three control variables.Interpretation Implementation of key WHO FCTC demand-reduction measures is significantly associated with lower smoking prevalence, with anticipated future reductions in tobacco-related morbidity and mortality. These findings validate the call for strong implementation of the WHO FCTC in the WHO's Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2020, and in advancing the UN's Sustainable Development Goal 3, setting a global target of reducing tobacco use and premature mortality from non-communicable diseases by a third by 2030.