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Can public health policies on alcohol and tobacco reduce a cancer epidemic? Australia's experience.

ABSTRACT: BACKGROUND:Although long-term alcohol and tobacco use have widely been recognised as important risk factors for cancer, the impacts of alcohol and tobacco health policies on cancer mortality have not been examined in previous studies. This study aims to estimate the association of key alcohol and tobacco policy or events in Australia with changes in overall and five specific types of cancer mortality between the 1950s and 2013. METHODS:Annual population-based time-series data between 1911 and 2013 on per capita alcohol and tobacco consumption and head and neck (lip, oral cavity, pharynx, larynx and oesophagus), lung, breast, colorectum and anus, liver and total cancer mortality data from the 1950s to 2013 were collected from the Australian Bureau of Statistics and Cancer Council Victoria, the WHO Cancer Mortality Database and the Australian Institute of Health and Welfare. The policies with significant relations to changes in alcohol and tobacco consumption were identified in an initial model. Intervention dummies with estimated lags were then developed based on these key alcohol and tobacco policies and events and inserted into time-series models to estimate the relation of the particular policy changes with cancer mortality. RESULTS:Liquor licence liberalisation in the 1960s was significantly associated with increases in the level of population drinking and thereafter of male cancer mortality. The introduction of random breath testing programs in Australia after 1976 was associated with a reduction in population drinking and thereafter in cancer mortality for both men and women. Meanwhile, the release of UK and US public health reports on tobacco in 1962 and 1964 and the ban on cigarette ads on TV and radio in 1976 were found to have been associated with a reduction in Australian tobacco consumption and thereafter a reduction in mortality from all cancer types except liver cancer. Policy changes on alcohol and tobacco during the 1960s-1980s were associated with greater changes for men than for women, particularly for head and neck, lung and colorectum cancer sites. CONCLUSION:This study provides evidence that some changes to public health policies in Australia in the twentieth century were related to the changes in the population consumption of alcohol and tobacco, and in subsequent mortality from various cancers over the following 20?years.

SUBMITTER: Jiang H

PROVIDER: S-EPMC6880568 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Can public health policies on alcohol and tobacco reduce a cancer epidemic? Australia's experience.

Jiang Heng H Livingston Michael M Room Robin R Gan Yong Y English Dallas D Chenhall Richard R

BMC medicine 20191127 1

<h4>Background</h4>Although long-term alcohol and tobacco use have widely been recognised as important risk factors for cancer, the impacts of alcohol and tobacco health policies on cancer mortality have not been examined in previous studies. This study aims to estimate the association of key alcohol and tobacco policy or events in Australia with changes in overall and five specific types of cancer mortality between the 1950s and 2013.<h4>Methods</h4>Annual population-based time-series data betw ...[more]

PMID: 31771596

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Project description:There is growing evidence for the effectiveness of choice architecture or 'nudge' interventions to change a range of behaviours including the consumption of alcohol, tobacco and food. Public acceptability is key to implementing these and other interventions. However, few studies have assessed public acceptability of these interventions, including the extent to which acceptability varies with the type of intervention, the target behaviour and with evidence of intervention effectiveness. These were assessed in an online study using a between-participants full factorial design with three factors: Policy (availability vs size vs labelling vs tax) x Behaviour (alcohol consumption vs tobacco use vs high-calorie snack food consumption) x Evidence communication (no message vs assertion of policy effectiveness vs assertion and quantification of policy effectiveness [e.g., a 10% change in behaviour]). Participants (N = 7058) were randomly allocated to one of the 36 groups. The primary outcome was acceptability of the policy. Acceptability differed across policy, behaviour and evidence communication (all ps < .001). Labelling was the most acceptable policy (supported by 78%) and Availability the least (47%). Tobacco use was the most acceptable behaviour to be targeted by policies (73%) compared with policies targeting Alcohol (55%) and Food (54%). Relative to the control group (60%), asserting evidence of effectiveness increased acceptability (63%); adding a quantification to this assertion did not significantly increase this further (65%). Public acceptability for nudges and taxes to improve population health varies with the behaviour targeted and the type of intervention but is generally favourable. Communicating that these policies are effective can increase support by a small but significant amount, suggesting that highlighting effectiveness could contribute to mobilising public demand for policies. While uncertainty remains about the strength of public support needed, this may help overcome political inertia and enable action on behaviours that damage population and planetary health.

Project description:BackgroundOpioid addiction and overdose rates are reaching unprecedented levels in the U.S., with around 47,736 overdose deaths in 2017. Many stakeholders affect the opioid epidemic, including government entities, healthcare providers and policymakers, and opioid users. Simulation and conceptual modeling can help us understand the dynamics of the opioid epidemic by simplifying the real world and informing policymakers about different health interventions that could reduce the deaths caused by opioid overdose in the United States every year.ObjectivesTo conduct a scoping review of simulation and conceptual models that propose policies capable of controlling the opioid epidemic. We demonstrate the strengths and limitations of these models and provide a framework for further improvement of future decision support tools.MethodsUsing the methodology of a scoping review, we identified articles published after 2000 from eight electronic databases to map the literature that uses simulation and conceptual modeling in developing public health policies to address the opioid epidemic.ResultsWe reviewed 472 papers of which 14 were appropriate for inclusion. Each used either system dynamics simulation modeling, mathematical modeling, conceptual modeling, or agent-based modeling. All included studies tested and proposed strategies to improve health outcomes related to the opioid epidemic. Factors considered in the models included physicians prescribing opioids, trafficking, users recruiting new users, and doctor shopping; no model investigated the impact of age and spatial factors on the dynamics of the epidemic. Key findings from these studies were (1) prevention of opioid initiation is better than treatment of opioid addiction, (2) the analysis of an intervention's impact should include both benefits and harms, and (3) interventions with short-term benefits might have a counterproductive impact on the epidemic in long run.ConclusionsWhile most studies examined the role of prescription opioids and trafficking on this epidemic, the transition of patients from prescription opioid use to nonprescription use including heroin and synthetic opioids such as fentanyl impacts the system significantly and results in an epidemic with quite different characteristics than what it had a decade ago. We recommend including the impact of age and geographic location on the opioid epidemic using modeling methods.

Project description:OBJECTIVE:The aim of this study was to assess public acceptance of four possible healthcare policies supporting tobacco dependence treatment in line with the Framework Convention for Tobacco Control, Article 14 recommendations in Germany. DESIGN:Cross-sectional household survey. SETTING:Data were drawn from the German population and collected through computer-assisted, face-to-face interviews. PARTICIPANTS:Representative random sample of 2087 people (>14 years) from the German population. OUTCOME MEASURES:Public acceptance was measured regarding (1) treatment cost reimbursement, (2) standard training for health professionals on offering cessation treatment, and making cessation treatment a standard part of care for smokers with (3) physical or (4) mental disorders. Association characteristics with smoking status and socio-economic status (SES) were assessed. RESULTS:Support for all policies was high (50%-68%), even among smokers (48%-66%). Ex-smokers and never-smokers were more likely to support standard training on cessation for health professionals than current smokers (OR 1.43, 95%?CI 1.07 to 1.92; OR 1.43; 95%?CI 1.14 to 1.79, respectively). Ex-smokers were also more likely than current smokers to support cessation treatment for smokers with mental disorders (OR 1.39, 95%?CI 1.11 to 1.73). Men were less likely than women to support cessation treatment for smokers with physical diseases (OR 0.74, 95%?CI 0.60 to 0.91) and free provision of treatment (OR 0.80, 95%?CI 0.66 to 0.97). Offering cessation treatment to smokers with physical disorders was generally more accepted than to those with mental health issues. CONCLUSIONS:The majority of the German population supports healthcare policies to improve the availability and affordability of tobacco dependence treatment. Non-smokers were more supportive than current smokers of two of the four policies, but odds of support were only about 40% higher. SES characteristics were not consistently associated with public acceptance. TRIAL REGISTRATION NUMBER:DRKS00011322.

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Can public health policies on alcohol and tobacco reduce a cancer epidemic? Australia's experience.

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Can public health policies on alcohol and tobacco reduce a cancer epidemic? Australia's experience.

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