美國全面菸害防制方案有效降低吸菸之盛行率


  June 22, 2007 — 一項刊載於6月22日《發病率暨死亡率周報》上的報告指出,兩項全面性反菸媒體運動的立即效應,肯定其能降低吸菸盛行率之重要性。
  
  紐約市健康暨心理衛生局的J. A. Ellis博士及研究同仁表示,2002年,在吸菸盛行率未降低的10年之後,紐約市開始執行五項菸害防制方案,包括在2002年提高菸稅、計畫在2003時建立無菸工作環境、公衛及醫護人員之菸害防制相關教育、戒菸服務以及嚴謹的評估,其中包括運用和美國疾病管制局(CDC)以州為主的行為風險因素監測系統(Behavioral Risk Factor Surveillance System,以下縮寫為BRFSS)相同的措施,每年進行具代表性的、全市的電訪。
  
  於2002-2004年期間,所預估的成人吸菸盛行率從21.5% 降低至18.4%,亦即代表著約少於20萬名美國人是癮君子;然而,到了2005年,不論是紐約市的全體居民,或是人口統計學上的分組人口,成人吸菸盛行率並無改變。
  
  為使紐約市吸菸率降低的成效更佳,紐約市健康暨心理衛生局(Department of Health and Mental Hygiene,以下縮寫為DOHMH)於2006年開始一個廣泛性、以電視宣傳為主的反菸媒體運動,其中採用吸菸所造成之健康影響的圖像,該運動和一個大型的紐約州反菸媒體運動同時播出。
  
  在媒體運動推行的第一年,成人吸菸盛行率有明顯降低的為男性(下降了11.6%)和西班牙裔(下降了15.2%),肯定了全面菸害防制方案的成效,同時顯示此一密集、以大範圍為基礎的媒體運動對某些特定的族群,已有降低吸菸盛行率的效果。
  
  2006年的DOHMH媒體運動,其所推出的反菸廣告同時以英語和西班牙語播出,藉由提出患病及瀕死癮君子的親身見證,及癮君子罹病的肺臟、血管和腦部的圖像,將重點置於提高癮君子戒菸的動機;在2006年1月至10月的40週中,電視運動播出了23週,其總收視率評點(gross ratings points,以下簡稱GRPs)為每週100-600(總共約6500 GRPs)。
  
  同一時期,紐約州健康局則同步向全州收視戶播出另一項反菸媒體運動,紐約市亦作為目標區域,它是以吸菸所造成之健康影響的圖像,並強調二手菸對兒童的影響為內容的廣告;2006年一整年,在兩項運動總合的影響力下,紐約市成人癮君子所接觸到的反菸訊息有將近11,000 GRPs,相當於紐約市一般收視觀眾在一整年當中看同一則廣告約110次。
  
  自2002年起,每年由DOHMH對將近10,000名紐約市成年居民,所作之以人口數為準、隨機撥打電話所進行的健康調查,業已評估出紐約市整體吸菸狀況;1993至2001年間的吸菸盛行率資料,摘錄自紐約州BRFSS每年對紐約市居民調查所獲得的資料。
  
  以紐約市居民為分析群組,吸菸盛行率從2002年的21.5%下降至2004年的18.4%(P < .001),在主要的年齡層、人種/族裔、性別和教育次團體及出生都有下降;從2004到2005年,紐約市整體居民中,吸菸率並沒有明顯改變,次群組也沒有任何改變。
  
  2006年,在電視反菸運動播放的期間,紐約市居民整體的吸菸盛行率並沒有明顯改變(2006年有17.5% vs 2005年有18.9%;P = .055);然而,男性的吸菸盛行率是有下降的(從22.5%降至19.9%;P = .021),西班牙裔亦是如此(從20.2%降至17.1%;P =.027)。
  
  紐約市居民於2006年的吸菸盛行率為17.5%,從2002年的19%降了下來,顯示從2002至2006年癮君子減少了24萬名,平均年降率為5%;從2002到2006年來觀察,18-24歲青少年下降的幅度最大,有35%。
  
  共同發表的一篇評論提到,減少吸菸最有效的方法是課稅,其他方法包括訂定法律於工作場所和其他公共場所禁菸。
  
  這些調查資料的侷限包括無法做出關於任何疾病和介入療法(包括媒體運動)間因果關係的結論;吸菸習慣為自行回報,可信度待確認;排除特定族群;缺乏美國全國的資料作為對照。
  
  評論執筆者總結指出,在降低吸菸率上,政府相關部門能做得更多,特別是再度提高菸稅、拓展禁菸的公共空間並播放持續、內含圖像及具滲透力的反菸廣告;此報告中所呈現的資料顯示出,在提高菸稅及執行無菸工作環境立法的背景下,額外獲贊助之內含圖像的媒體運動,以高頻率的方式播放,或許可以更進一步地降低吸菸率。
  
  發病率暨死亡率周報。2007年;56(24):604-608

Comprehensive Tobacco Control<

By Laurie Barclay, MD
Medscape Medical News

June 22, 2007 — The immediate effects of two comprehensive antitobacco media campaigns confirm their importance in reducing smoking prevalence, according to a report in the June 22 issue of the Morbidity and Mortality Weekly Report.

"In 2002, after a decade with no decrease in smoking prevalence, New York City began implementation of a five-point tobacco-control program consisting of increased taxation in 2002, establishment of smoke-free workplaces in 2003, public and health-care-provider education, cessation services, and rigorous evaluation, including annual cross-sectional, citywide telephone surveys using the same measures as [the Centers for Disease Control and Prevention's] CDC's state-based Behavioral Risk Factor Surveillance System (BRFSS)," write J. A. Ellis, PhD, and colleagues from the New York City Department of Health and Mental Hygiene. "During 2002-2004, estimated adult smoking prevalence decreased from 21.5% to 18.4%, representing nearly 200,000 fewer smokers. However, in 2005, no change in adult smoking prevalence occurred, either among New York City residents overall or among demographic subpopulations."

To further reduce smoking in New York City, in 2006 the New York City Department of Health and Mental Hygiene (DOHMH) began an extensive, television-based antitobacco media campaign using graphic imagery of the health effects of smoking, which aired simultaneously with a large New York state antitobacco media campaign.

During the first year of the media campaigns, adult smoking prevalence decreased significantly in men (11.6% decrease) and in Hispanics (15.2% decrease), confirming the importance of comprehensive tobacco-control programs and suggesting that this intensive, broad-based media campaign has reduced smoking prevalence among certain subgroups.

The 2006 DOHMH media campaign, with advertisements in both English and Spanish, focused on increasing smokers' motivation to quit by providing testimonials from sick and dying smokers and graphic images of the diseased lungs, arteries, and brains of smokers. During January to October 2006, the television campaign broadcast for 23 of 40 weeks, with 100-600 gross ratings points (GRPs) per week (total, approximately 6500 GRPs).

At the same time, the New York State Department of Health aired a separate, simultaneous statewide television-based antitobacco media campaign that also targeted New York City, with advertisements featuring graphic images of the effects of smoking and highlighting the effects of secondhand smoke on children. From January through December 2006, New York City adult smokers were exposed to nearly 11,000 GRPs as a result of both campaigns combined, equating to the average viewer in NYC seeing an advertisement approximately 110 times during the year.

Population-based, random-digit-dialed health surveys of approximately 10,000 adult New York City residents conducted by the DOHMH annually since 2002 has evaluated smoking status. Smoking prevalence data for 1993-2001 were obtained from surveys of New York City residents, excerpted from the annual New York state BRFSS.

For New York City residents, smoking prevalence decreased from 21.5% in 2002 to 18.4% in 2004 (P < .001), with decreases in all major age, race/ethnicity, sex, and education subgroups and by location of birth. From 2004 to 2005, smoking prevalence did not change significantly among New York City residents overall, and there were no changes within any subgroup.

In 2006, during the television campaigns, smoking prevalence did not change significantly among New York City residents overall (17.5% in 2006 vs 18.9% in 2005; P = .055). However, smoking prevalence did decrease in men (from 22.5% to 19.9%; P = .021) and in Hispanics (from 20.2% to 17.1%; P =.027).

The 17.5% smoking prevalence in New York City residents during 2006 corresponds to a 19% decrease from 2002, representing 240,000 fewer adult smokers and an average annual rate of decrease of 5%. Young adults (aged 18-24 years) had the largest decrease (35%) from 2002 to 2006.

An accompanying editorial notes that the foremost measure proven to reduce tobacco use is taxation; other measures include legislation that makes workplaces and other public areas smoke-free.

Limitations of these survey data include an inability to draw conclusions regarding causality of the relation between any decreases and any intervention, including the media campaign; reliance on self-reported smoking behaviors; exclusion of certain populations; and lack of nationwide data for comparison purposes.

"Jurisdictions can make additional progress in reducing tobacco use, particularly by further increasing taxes, expanding smoke-free public places, and airing sustained, graphic, and pervasive anti-tobacco advertising," the editorial concludes. "The data presented in this report suggest that, in the context of increases in taxation and implementation of smoke-free workplace legislation, additional well-funded media campaigns that have graphic content and are aired with high frequency might further reduce smoking prevalence."

MMWR Morb Mortal Wkly Rep. 2007;56(24):604-608.

    
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