Effect of smoke-free policies in military settings on tobacco smoke exposure and smoking behaviour: a systematic review.
Effect of smoke-free policies in military settings on tobacco smoke exposure and smoking behaviour: a systematic review.
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军事环境中无烟政策对烟草烟雾暴露和吸烟行为的影响：系统评价。
DOI：
10.1136/bmjmilitary-2021-001795
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发表时间：
2021
影响因子：
1.5
通讯作者：
Falconer Hall T
中科院分区：
文献类型：
--
作者：
Falconer Hall T
无烟立法在减少公共场所二手烟暴露方面发挥了重要作用。然而，在医疗保健和国防等领域，制度性无烟政策产生影响的证据较弱。具体而言，关于军事环境中无烟政策影响的文献尚未综合。方法本综述旨在识别、批判性评估和综合现有证据，以评估国防无烟政策对二手烟暴露的影响。从成立到2020年6月检索了8个电子数据库（如EMBASE， MEDLINE）。我们纳入了在防御环境中引入的无烟政策的英语研究，评估了它们对SHS暴露（主要结果）和医疗保健利用、吸烟行为和防御效率（次要结果）的影响。使用ROBINS-I评估偏倚风险。综合不进行荟萃分析使用选票计数的影响方向。结果共检索到文献4503篇，其中8篇符合纳入标准；两项对照研究和六项非对照研究的前后对比。一项研究的证据虽然质量不高，但表明在引入防御性无烟政策后，二手烟暴露减少。对于次要结果，审查发现了混合结果，戒烟率是支持无烟政策的一个结果。证据的累积置信度是不确定的，因此不能从这些研究中得出可靠的结论。结论对国防无烟政策影响的高质量研究存在研究缺口，这些研究应该使用比较物，如果可能的话，采用随机化。决策者应在评估框架内在国防环境中引入制度性无烟政策，以产生此类证据。
IntroductionSmoke-free legislation has been instrumental in reducing secondhand smoke (SHS) exposure in public places. However, the evidence of the impact of institutional smoke-free policies in settings such as healthcare and defence is weaker. Specifically, the literature on the effect of smoke-free policies in military settings has not yet been synthesised.MethodsThis review aimed to identify, critically appraise and synthesise the available evidence to evaluate the effect of defence smoke-free policies on SHS exposure. Eight electronic databases (eg, EMBASE, MEDLINE) were searched from inception to June 2020. We included English-language studies on smoke-free policies introduced in a defence setting, assessing their impact on SHS exposure (primary outcome) and healthcare utilisation, smoking behaviours and defence efficiency (secondary outcomes). Risk of bias was assessed using ROBINS-I. Synthesis without meta-analysis was conducted using vote counting of direction of effect.ResultsThe search retrieved 4503 citations of which eight met inclusion criteria; two controlled and six uncontrolled before-and-after studies. The evidence, although low-quality, from one study indicated reduced SHS exposure following the introduction of a defence smoke-free policy. For secondary outcomes the review found mixed results, with the quit rate being the one outcome favouring smoke-free policies. The cumulative confidence of evidence is uncertain and therefore reliable conclusions cannot be drawn from these studies.ConclusionsA research gap exists for high-quality studies on the impact of defence smoke-free policies which should use comparators and, if possible, randomisation. Policy-makers should introduce institutional smoke-free policies in defence settings within an evaluative framework to generate such evidence.