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["National Institute for Health and Care Excellence (NICE)","NICE Guidance browse by topic- Lifestyle and Wellbeing- Smoking and tobacco. Limit: Guidance + Quality Standards. Sort by Date","Tobacco"]
["NICE Accredited Guidance ","The accreditation programme stopped accepting new applications in September 2016.","N/A anymore"]
["Scottish Intercollegiate Guidelines Network (SIGN) clinical guidelines","Click on Our Guidelines. The Guidelines are listed in descending order of Publication Date. Have a quick scan for any relevant guidelines. "]
["Agency for Healthcare Research and Quality (AHRQ).","Basic freetext search. Limit using Publication Date and EPC Type: Comparative Effectiveness Reviews and Evidence Reports.","Tobacco\nSmoke, Smoking\nCigarette"]
["Campbell Collaboration systematic reviews","Use Advanced search using Keyword+ Type of Document (Reviews) + Published Date.","It is easier to apply the date limits and scan the titles instead of using keywords and running individual searches."]
["Canadian Agency for Drugs and Technologies in Health (CADTH). ","Basic Freetext search. Limit by Project Line: Health technology Review. Use 'Last Updated' to select date range. Only Health Technology Reviews with: 'Project Sub Line: Summary with Critical Appraisal' to be included.","Tobacco\nSmoke, Smoking\nCigarette"]
["Cochrane systematic reviews","Browse by topic: Tobacco, drug & alcohol OR search by Cochrane Review Group OR search Cochrane Library using Advanced search .","Tobacco\nSmoke, Smoking\nCigarette"]
["Department of Veterans Affairs Evidence-based synthesis programme","In the left panel, click Publications>Evidence Synthesis Program>Published reports and Filter by Title .","Tobacco\nSmoke, Smoking\nCigarette"]
["Evidence for Policy and Practice Information and Co-ordinating Centre","Chronological list of EPPII- Centre systematic reviews. Scan the titles for appropriate titles."]
["National Institute for Health Research (NIHR) \n-Health Technology Assessment Journal\n-Public Health Research Journal\n\n","Enter and search the term. Refine search by journal by selecting two journals: Health Technology Assessment Journal and Public Health Journal. Further refine by date and Research Type ('Evidence Synthesis'). Ctrl+ systematic helps to filter.","Tobacco\nSmoking, Smoke\nCigarette"]
["The Community Guide","Basic freetext search. Select ‘Systematic Reviews’ tab. Can also use Topics filter if an applicable. Unfortunately no filter for publication date so have to look through for new publications.","September 2021, the following number of results were found. If numbers are different, try Ctrl+F for 2021:\nTobacco (70)\nSmoke, Smoking (70)\nCigarette (70)"]
["What Works Clearinghouse (USA)","'Find Evidence' > 'Find what works from Systematic Reviews' > Basic freetext search > Scan titles. There is also an option to find individual studies that have been reviewed by the WWC.\n\n","Tobacco\nSmoke, Smoking\nCigarette"]
["What Works Centre for Wellbeing"]
["Health Technology Assessment Wales\n","Searched from June 2021. Basic freetext search.","Tobacco\nSmoke, Smoking\nCigarette"]
["Health Technology Assessment Ireland\n","Searched from June 2021. Basic freetext search.","Tobacco\nSmoke, Smoking\nCigarette"]
["Joanna Briggs Institute\n","Searched from June 2021. Basic or advanced search (advanced search gives access to content type and publication dates). Use double quotation marks to specify search and limit results. Only systematic reviews to be included.","Tobacco\nSmoke, Smoking\nCigarette"]

{"sheet":"Evidence map","index":2,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

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[null,"Canllaw - Y map tystiolaeth llawn"]
[null,"Ffynhonnell:","Poblogaeth: ","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD\n","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"National Institute for Health and Care Excellence. Community pharmacies: Promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.\n\n","Not specified","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. \n\nIt includes recommendations on:\n- Health and wellbeing hub\n- Overarching principles of good practice\n- Awareness raising and providing information\n- Advice and education\n- Behavioural support\n- Referrals and signposting\n\nThis guidance may also be relevant for:\n- Private and voluntary sector organisations providing health‑promoting services\n- People working in related services, for example GP practices and out-of-hours services\n- Members of the public"]
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH\n"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [A] Digital mass media and mobile phone application for preventing uptake of smoking. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-24 years)","Evidence review A: Digital mass media and mobile phone applications for preventing uptake of smoking\n\nReview questions:\nWhich campaigns delivered through digital mass media and mobile phone applications are effective and cost effective in preventing children, young people and young adults from taking up smoking?\nDo these interventions change children, young people and young adults’ perceptions of the social acceptability of smoking or people who smoke? In what way, and what aspects of interventions are perceived as having caused the change?\n\nTwo studies were included for review A,  one was a cluster randomised controlled trial (cRCT) and one was a qualitative study. No previous includes from the original review were included as they were published previous to 2008.\n\nSummary of the evidence: Only findings relevant to this evidence map have been reported below.\n\nNon-smokers taking up smoking: The intervention could not differentiate between comparators.\n\nIntention to smoke: The intervention could not differentiate between comparators.\n","A joint search was used to identify relevant studies for review question A (digital mass media and apps) and review question B (cessation campaigns) combined. Although only studies published since 2008 were eligible for inclusion in review A as it is an update of a previous review question (which included 41 papers on mass media), the joint search included all studies published since 1998 as review question B is a new review and therefore any studies from the past 20 years were eligible for inclusion. The joint systematic search was undertaken in October 2018 for studies published in the English language. A top-up was done for studies about people aged 5-11 years. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review."]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [B] Evidence reviews for mass media cessation campaigns for preventing uptake of smoking. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-24 years)","Evidence B: Mass media cessation campaigns for preventing uptake of smoking\n\nReview questions:\nAre smoking cessation campaigns delivered through mass media and mobile phone applications aimed at adults effective and cost effective in preventing uptake of smoking among children, young people and young adults?\nDo these interventions change children, young people and young adults’ perceptions of the social acceptability of smoking or people who smoke? In what way, and what aspects of interventions are perceived as having caused the change?\n\nOne RCT was included in review B; no qualitative studies were identified for this review.\n\nSummary of the evidence: Only outcomes relevant to this evidence map have been reported below.\nSmoking initiation among children: The intervention could not differentiate between comparators (either for intervention group vs control group, or for children of parents who quit vs children of parents who did not quit).\n\nChildren's susceptibility to smoking: Self-help brochure vs telephone counselling: The intervention could not differentiate between comparators.","A joint search was used to identify relevant studies for review question A (digital mass media and apps) and review question B (cessation campaigns) combined. Although only studies published since 2008 were eligible for inclusion in review A as it is an update of a previous review question (which included 41 papers on mass media), the joint search included all studies published since 1998 as review question B is a new review and therefore any studies from the past 20 years were eligible for inclusion. The joint systematic search was undertaken in October 2018 for studies published in the English language. A top-up was done for studies about people aged 5-11 years. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [C] Evidence reviews for reducing proxy purchasing of tobacco. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-17 years)","Evidence review C: Reducing proxy purchasing of tobacco\n\nReview questions:\nWhich interventions are effective and cost effective at reducing proxy purchasing of tobacco on behalf of children and young people, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of proxy purchasing? In what way, and what aspects of interventions are perceived as having caused the change?\n\nThe evidence base was very limited, with just one study identified for inclusion in the review. The included study was a (cluster) controlled before and after study with two schools in the intervention group and two schools in the control group. Both children and their parents from these schools were included in the study.\n\nSummary of evidence:\nParents willing to provide cigarettes to their children: The intervention could not differentiate between comparators.\n\nChildren who smoke reporting parents as the main source of cigarettes: The intervention could not differentiate between comparators.\n\n","A joint search was used to identify relevant studies for review question C (proxy purchasing) and review question D (illicit supply) combined. The main search was done in October 2018 for studies published since 1998 and in the English language. A top-up was done for studies about people aged 5-11 years. An additional top-up search of terms related to online sales was conducted in November 2018. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [D] Evidence reviews for reducing illicit supply of tobacco. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-24 years)","Evidence review D: Reducing the supply of illicit tobacco \n\nReview questions:\nWhich interventions are effective and cost effective at reducing the supply of illicit tobacco to children, young people and young adults, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of supply of illicit tobacco? In what way, and what aspects of interventions are perceived as having caused the change?\n\nThis review aims to ascertain which interventions that attempt to engage and educate both retailers and the general public are effective at reducing supply of illicit tobacco to children, young people and young adults. As illicit tobacco supply may be concentrated in areas of deprivation, this is an important equality consideration.\n\nIllicit tobacco includes brands with no legal market in the country of sale, genuine brands brought into the country and sold without duty being paid, or illegally manufactured tobacco made to look like recognised brands (Fresh, 2018 as part of the Keep it Out campaign; Illicit Tobacco Partnership).\n\nNo studies were identified for inclusion from either the database or website searches.","A joint search was used to identify relevant studies for review question C (proxy purchasing) and review question D (illicit supply) combined. The main search was done in October 2018 for studies published since 1998 and in the English language. A top-up was done for studies about people aged 5-11 years. An additional top-up search of terms related to online sales was conducted in November 2018. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [E] Evidence reviews for Smokefree class competitions. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-24 years)","Evidence review E: Smokefree class competitions\n\nReview questions:\nWhich interventions are effective and cost effective at reducing the supply of illicit tobacco to children, young people and young adults, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of supply of illicit tobacco? In what way, and what aspects of interventions are perceived as having caused the change?\n\nSmokefree Class Competitions (SFCC) are a school-based incentive intervention for preventing the uptake of smoking, usually among children between 11 and 14 years old. SFCC gives responsibility for preventing smoking uptake (and stopping smoking for the duration of the competition, for those who already smoke) to the class of students. The intended effect is to denormalise smoking and create a smokefree class through the use of peer expectations of each other.\nSix studies were identified for inclusion in this review. Limited meta-analysis was possible as some studies reporting smoking and some reporting non-smoking, and due to the data reported by the studies. Only findings relevant to this evidence map have been extracted below:\n\nNon-smokers taking up smoking: The intervention is effective at reducing the outcome compared with no intervention.\n\nNon-smokers not taking up smoking: The intervention could not differentiate between comparators.\n\nTotal smoking among whole group: Evidence from one RCT suggests the intervention was effective at reducing the outcome compared with no intervention. Evidence from one nRCT suggests the  intervention could not differentiate between comparators.","This review is an update of part of an existing review. Included studies from the original review were sifted and two studies were identified for inclusion and were ordered for full-text review. This new review includes non-randomised controlled studies which the original review did not, so all studies excluded from the original review on the basis of study design were also sifted but no papers were identified for inclusion from this route.\n\nA joint search was undertaken in January 2019 for studies published in the English language from 1998-29 January 2019 to identify relevant studies for the cost effectiveness elements of review questions A (digital mass media and apps), B (cessation campaigns), C (proxy sales), D (illicit supply) and E (smokefree class competitions) combined. This search incorporated the search strategies of the original effectiveness searches plus the top-up searches and then applied an agreed cost effectiveness filter. \n\nNo recommendations were made from this evidence review.\n "]
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[null,"Angus K et al. Review 6: A review of the effectiveness of smokefree strategies and interventions in secondary care settings. 2013. NICE. NG209.\nAvailable here.","Adults with pre-existing health conditions: patients in secondary care settings including acute and mental health settings","This NICE evidence review aimed to systematically review the effectiveness of smokefree strategies and interventions in secondary care settings (acute, maternity and mental health settings). \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Acute and Maternity Settings): There is weak evidence in an acute and maternity setting that ‘no smoking outdoors’ signage decreases compliance with state indoor (hospital buildings and vehicles) smokefree legislation and a local (hospital board’s) outdoor partial smokefree policy. \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Mental Healthcare Settings): There is weak evidence that staff aiding inpatients’ compliance through strategies such as encouraging patients to participate in smoking cessation groups and addressing patients’\nurge to smoke increases patient compliance a local smokefree buildings policy.\n\nAs the extent of evidence on the effectiveness of smokefree strategies was limited to two studies, the data presented in the following two sections reviews studies using a comparative design to measure indicators of compliance in settings which had a smokefree policy covering the whole\nestate or an indoors-only smokefree policy with at least one supporting strategy.\n\nStaff Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is moderate evidence that the implementation of local-level\npolicy and national legislation for smokefree implementation in an acute and maternity setting decreases the number of staff smoking.\n\nVisitor Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that\nimplementation of local smokefree policies with supporting strategies decreases hospital visitor smoking.\n\nPatient Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence about the impact of local smokefree policies with supporting strategies on inpatient smoking behaviour in an acute and maternity setting. \n\nAll Hospital Users’ Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that local smokefree policy implementation with supporting strategies decreases observed smoking amongst all hospital users as a whole (patients, staff and visitors).\n\nOther Consequences from Smokefree for Staff (Acute & Maternity):\nStaff smoking: There is moderate evidence to suggest that local-level policy and national legislation for smokefree implementation with supporting strategies decreases smoking rates and number of cigarettes smoked both during working hours and overall in an acute and maternity setting amongst staff in an acute and maternity setting.\nStaff quiting activity: There is inconsistent evidence to suggest that smokefree implementation with supporting strategies decreases or has no effect on the number of quit attempts by staff.  There is weak evidence to suggest that implementation of a local smokefree policy for buildings or buildings and grounds with supporting strategies does not change the proportion of staff who quit smoking.\n\nOther Impacts on Patients (Mental healthcare): \nInpatient Smoking and Quitting Behaviours: There is inconsistent evidence that the introduction of smokefree in mental health care settings impacts on inpatient smoking and cessation behaviour outcomes in mental healthcare settings.\nLong Term Smoking Cessation: There is moderate evidence that the introduction of smokefree with appropriate supporting strategies in mental health care settings minimal impact on long term smoking cessation.","This 2012 NICE evidence review formed part of PH48 recommendations and NICE guidance on:\n- 'Smoking cessation in secondary care: acute and maternity services'\n- 'Smoking cessation in secondary care: mental health services'\n\nSome of the recommendations labelled [2013] or [2013, amended 2021] in the updated guideline were based on this evidence reviews. \n\nThe literature searches for this review were conducted in February 2012. A more up-to-date review/s on the topic may be available."]
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[null,"Hemsing et al. Interventions to Improve Partner Support and Partner Cessation During Pregnancy. 2009. NICE. NG209.\nAvailable here.","Adults\nPregnant and postpartum women","This NICE evidence review comprises of three reviews. However, only review one fulfilled the inclusion criteria of this evidence map. It aimed to address the following research question:\nWhich interventions are effective and cost effective in encouraging the establishment of smoke free homes?\n\nThe searches identified seventeen papers that met the inclusion criteria for smoke-free homes (although three did not fully consider the effectiveness of the intervention and so are included here for information only, they do not contribute to the evidence statements). The studies were biased towards interventions conducted in the USA (ten of seventeen), with only one conducted in the UK. Therefore there may be some reservations with respect to the applicability of the interventions in a UK population.\n\nEvidence statements from this review:\nES 1. Mixed evidence from six studies reported on counselling interventions to promote smoke free homes\nES 2. Mixed evidence from two studies was identified for interventions which combine counselling with additional elements such as the provision of written materials or telephone support\nES 3. Good evidence from four studies looked at programmes to implement individually adapted smoke free home polices. These interventions generally had problems with low compliance and loss to follow up. However, Sockrider et al. 2003 demonstrated a significant reduction in smoking as a result of their home smoking control index.\nES 4. Good evidence from one study which reported on the use of motivational interviewing to promote smoke free homes demonstrated a significant decrease in nicotine levels in intervention households over six months (however, this was not supported by self-reported smoking rates).\nES 5. One study reported on the effect of an educational intervention on the screening and counselling activities of physicians with regard to passive smoking. This study did not consider the effect of those who attended the intervention compared to those who did not so the effectiveness of the intervention is unclear.","This 2009 NICE evidence review formed part of PH26 recommendation. NICE guideline PH26 (June 2010) has been updated and replaced by NG209.\n\nThis guideline contains the evidence and committee discussion for recommendations from PH26 dated [2010] and [2010, amended 2021]. \n\nThe literature searches for this systematic review were conducted in March to June 2009. A more up-to-date review/s on the topic may be available."]
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[null,"Richardson L et al. Interventions to Prevent the Uptake of Smoking in Children and Young People. NICE Rapid review 2008. NG209.\nAvailable here.\n\n\n","Children and Young People (<18 years)","This NICE rapid review examines the effectiveness of: (a) mass media interventions designed to prevent the uptake of smoking in children and young people and (b) interventions that are designed to prevent the illegal sale of tobacco to children and young people.\n\nEvidence statements based on this review that meet the inclusion criteria of this map have been extracted below:\nMass media interventions\nES 1: There is evidence that mass media campaigns can prevent the uptake of smoking and also influence knowledge, attitudes and intentions of children and young people. Factors that have been shown to influence effectiveness in terms of smoking behaviour (i.e. smoking in the past 30 days, decreased initiation of smoking, quitting, number of cigarettes smoked) include message content, target audience, duration of the mass media campaign, demographics of the audience, the number of antitobacco message sources and the TRUTH campaign. Overall, the factors outlined above work best when combined with broader tobacco control initiatives produced by tobacco control bodies. Furthermore, campaigns are most effective when they are long in duration and greater in intensity of exposure.\nES 1.1: Some mass media interventions are more effective than others. Comparing interventions, prevention campaigns produced by the tobacco industry are less effective than anti-tobacco campaigns produced by tobacco control bodies. Youth perceive industry campaigns to be less effective, less interesting and less engaging. Industry campaigns also while an industry-sponsored campaign ”appeared to move youths’ attitudes in a protobacco direction”.\nES 1.2: It is not clear whether mass media interventions are delaying rather than preventing the uptake of smoking in children and youth. No studies identified in the literature examined this question.\n\nAccess restrictions\nES 2: There is evidence that access restriction interventions impact effectiveness in terms of the number of sales to young people, young people’s ability to access cigarettes and store clerk compliance. Only two studies addressed the impact of interventions on smoking behaviour. Factors that have been shown to influence number sales, young people’s ability to access cigarettes and store clerk compliance include active enforcement, comprehensive interventions, interventions produced by tobacco control bodies, requesting age/proof of ID, demographics of the vendor/store clerk, site setting of the access intervention, and the demographics of the target audience. Overall, the factors outlined above work best when combined with requesting proof of age/ID, active enforcement (in relation to both retailer-youth purchaser and trading standards-retailers) and other youth prevention strategies.\nES2.1: : Some access restrictions appear to be more effective than others. Compared to interventions created by tobacco control bodies, interventions produced by the tobacco industry do not decrease the sale of tobacco to youth. Store clerks participating in the tobacco industry intervention were still willing to illegally sell tobacco to children even after state mandated warnings were issued.\nES2.2: It is not clear if access interventions are delaying rather than preventing the uptake of smoking among children and youth. When faced with restrictions, youth appear to acquire tobacco from non-retail sources such as family members or peers. As a result, it is not clear if interventions have a direct effect on smoking uptake or behaviour.","In November 2021: NICE guidelines PH14 (July 2008) was updated and replaced by NG209. \n\nSome of the recommendations labelled [2008] or [2008, amended 2021] in the updated guideline were based on this evidence review.\n\nThe literature searches for this rapid review were conducted in July 2007. A more up-to-date review/s on the topic may be available."]
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[null,"Adolygiadau Systemataidd - Y map tystiolaeth llawn"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.\nAvailable here.","Children and Young People (upto 25 years)","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed."]
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[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here\n","Age not specified","The amount and strength of evidence varies across the six topics. There was moderate evidence that mass media campaigns can influence treatment-seeking behaviours (e.g. use of smoking quitlines). The impact on tobacco use was mixed. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. \nThe evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that (1) campaigns can contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective."]
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[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"van den Brand FA et al. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD004305. DOI: 10.1002/14651858.CD004305.pub5.\nAvailable here.","Adults","This Cochrane review primarily aimed to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). \n\nIn the current update, the reviewers have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both. \n\nFull financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, I² = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, I² = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, I² = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from $97 to $7646 for the comparison of full coverage with partial or no coverage. \n\nThere was no clear evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%, 2311 participants). \n\nFull financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95% CI 1.04 to 1.17, I² = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, I² = 88%, 6944 participants). \n\nFull financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: NRT: RR 1.79, 95% CI 1.54 to 2.09, I² = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, I² = 75%, 9215 participants. \n\nThere was evidence that partial coverage compared to no coverage reported a small positive effect on the use of bupropion (RR 1.15, 95% CI 1.03 to 1.29, I² = 0%, 6765 participants). Interventions directed at healthcare providers increased the use of behavioural therapy (RR 1.69, 95% CI 1.01 to 2.86, I² = 85%, 25820 participants), but not the use of NRT and/or bupropion (RR 0.94, 95% CI 0.76 to 1.18, I² = 6%, 2311 participants). \n\nThe reviewers assessed the quality of the evidence for the main outcome, abstinence from smoking, as moderate. In most studies participants were not blinded to the different study arms and researchers were not blinded to the allocated interventions. Furthermore, there was not always sufficient information on attrition rates. They detected some imprecision but judged this to be of minor consequence on the outcomes of this study. ","The authors concluded that:\n- Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting \n- There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers\n- The reviewers were only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates"]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Children and Young People (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"Hefler M, Liberato SC and Thomas DP. Incentives for preventing smoking in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008645. DOI: 10.1002/14651858.CD008645.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review aimed to assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It also aimed to assess, where possible, the dose‐response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives. \n\nThe reviewers identified three eligible RCTs and five controlled trials, including participants aged 11 to 14 years, who were non‐smokers at baseline. Of the eight trials identified, six had analyzable data relevant for this review, which contributed to meta‐analyses (7275 participants in total: 4003 intervention; 3272 control; 2484 participants after adjusting for clustering). All except one of the studies tested the 'Smokefree Class Competition' (SFC), which has been widely implemented throughout Europe. In this competition, classes with youth generally between the ages of 11 and 14 years commit to being smoke‐free for a six‐month period, and report their smoking status regularly. If 90% or more of the class are non‐smokers at the end of the six months, the class goes into a competition to win prizes. The one study that was not a trial of the SFC was a controlled trial in which schools in two communities were assigned to the intervention, with schools in a third community acting as controls. Students in the intervention community with lower smoking rates at the end of the project (one school year) received rewards.\n \nMost studies resulted in statistically non‐significant results. Only one study of the SFC reported a significant effect of the competition on the prevention of smoking at the longest follow‐up. However, this study was at risk of multiple biases, and when the adjusted RR was calculated, the difference was statistically insignificant. The pooled RR for the more robust RCTs (3 studies, n =   3056 participants/1107 adjusted for clustering) suggests that there is no statistically significant effect of incentives, in the form of the SFC, to prevent smoking initiation among children and adolescents in the long term (RR 1.00, 95% CI 0.84 to 1.19). Pooled results from the non‐randomised trials also did not detect a significant effect of the SFC, and the reviewers were unable to extract data on the outcome of interest from the one trial that did not study the SFC. There is little robust evidence to suggest that unintended consequences (such as making false claims about their smoking status and bullying of smoking students) are consistently associated with such interventions, although this has not been the focus of much research. There was insufficient information to assess the dose‐response relationship or to report costs of incentives for preventing smoking uptake. \n\nThe reviewers judged the included RCTs to be at unclear risk of bias, and the non‐RCTs to be at high risk of bias. Using GRADE, they rated the overall quality of the evidence for our primary outcome as 'low' (for RCTs) and 'very low' (for non‐RCTs), because of imprecision (all studies had wide CIs), and for the risks of bias identified. They further downgraded the non‐RCT evidence, due to issues with the non‐RCT study design, likely to introduce further bias.","The authors concluded that:\n- Very limited evidence currently available suggests that incentive programmes do not prevent smoking initiation among youth. However, there are relatively few published studies and these are of variable quality\n- Trials included in the meta‐analyses were all studies of the SFC, which distributed small to moderately‐sized prizes to whole classes, usually through a lottery system. It is therefore possible that other incentive programmes could be more successful at preventing smoking uptake in young people\n- Future studies might investigate the efficacy of a wider range of incentives, including those given to individual participants to prevent smoking uptake, whilst considering both the effect of incentives on smoking initiation and the progression to smoking. \n- It would be useful if incentives were evaluated in varying populations from different socioeconomic and ethnic backgrounds, and if intervention components were described in detail "]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Children and Young People\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Children and Young People\nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Children and Young People (age group not specified)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]

{"sheet":"Prevention-All","index":4,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Guidance","index":5,"n_rows":71,"n_cols":4,"rows_kept":71,"cut":false,"hidden":false,"merged":[[8,1,8,4],[10,1,69,1],[10,2,69,2],[10,3,69,4],[70,1,85,1],[70,2,85,2],[70,3,85,4]]}
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[null,"CANLLAW: ATAL"]
[null,"Ffynhonnell:","Poblogaeth: ","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"National Institute for Health and Care Excellence. Community pharmacies: Promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.\n\n","Not specified","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. \n\nIt includes recommendations on:\n- Health and wellbeing hub\n- Overarching principles of good practice\n- Awareness raising and providing information\n- Advice and education\n- Behavioural support\n- Referrals and signposting\n\nThis guidance may also be relevant for:\n- Private and voluntary sector organisations providing health‑promoting services\n- People working in related services, for example GP practices and out-of-hours services\n- Members of the public"]

{"sheet":"Psychosocial","index":6,"n_rows":101,"n_cols":5,"rows_kept":101,"cut":false,"hidden":false,"merged":[[62,1,99,1],[62,2,99,2],[62,3,99,3],[62,4,99,4],[100,1,139,1],[100,2,139,2],[100,3,139,3],[100,4,139,4],[42,1,61,1],[42,2,61,2],[42,3,61,3],[42,4,61,4],[40,1,40,4],[9,1,9,4],[11,1,38,1],[11,2,38,2],[11,3,38,3],[11,4,38,4]]}
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [E] Evidence reviews for Smokefree class competitions. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-24 years)","Evidence review E: Smokefree class competitions\n\nReview questions:\nWhich interventions are effective and cost effective at reducing the supply of illicit tobacco to children, young people and young adults, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of supply of illicit tobacco? In what way, and what aspects of interventions are perceived as having caused the change?\n\nSmokefree Class Competitions (SFCC) are a school-based incentive intervention for preventing the uptake of smoking, usually among children between 11 and 14 years old. SFCC gives responsibility for preventing smoking uptake (and stopping smoking for the duration of the competition, for those who already smoke) to the class of students. The intended effect is to denormalise smoking and create a smokefree class through the use of peer expectations of each other.\nSix studies were identified for inclusion in this review. Limited meta-analysis was possible as some studies reporting smoking and some reporting non-smoking, and due to the data reported by the studies. Only findings relevant to this evidence map have been extracted below:\n\nNon-smokers taking up smoking: The intervention is effective at reducing the outcome compared with no intervention.\n\nNon-smokers not taking up smoking: The intervention could not differentiate between comparators.\n\nTotal smoking among whole group: Evidence from one RCT suggests the intervention was effective at reducing the outcome compared with no intervention. Evidence from one nRCT suggests the  intervention could not differentiate between comparators.","This review is an update of part of an existing review. Included studies from the original review were sifted and two studies were identified for inclusion and were ordered for full-text review. This new review includes non-randomised controlled studies which the original review did not, so all studies excluded from the original review on the basis of study design were also sifted but no papers were identified for inclusion from this route.\n\nA joint search was undertaken in January 2019 for studies published in the English language from 1998-29 January 2019 to identify relevant studies for the cost effectiveness elements of review questions A (digital mass media and apps), B (cessation campaigns), C (proxy sales), D (illicit supply) and E (smokefree class competitions) combined. This search incorporated the search strategies of the original effectiveness searches plus the top-up searches and then applied an agreed cost effectiveness filter. \n\nNo recommendations were made from this evidence review.\n "]
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[null,"ADOLYGIADAU SYSTEMATAIDD: THERAPI SEICOGYMDEITHASOL "]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.\nAvailable here.","Children and Young People (up to 25 years of age)","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed."]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]

{"sheet":"Universal","index":7,"n_rows":238,"n_cols":5,"rows_kept":238,"cut":false,"hidden":false,"merged":[[216,1,236,1],[216,2,236,2],[216,3,236,3],[216,4,236,4],[237,1,257,1],[237,2,257,2],[237,3,257,3],[237,4,257,4],[176,1,215,1],[176,2,215,2],[176,3,215,3],[176,4,215,4],[50,1,50,4],[131,1,175,1],[131,2,175,2],[131,3,175,3],[104,1,130,1],[104,2,130,2],[104,3,130,3],[104,4,130,4],[131,4,175,4],[71,1,87,1],[71,2,87,2],[71,3,87,3],[71,4,87,4],[88,1,103,1],[88,2,103,2],[88,3,103,3],[88,4,103,4],[29,1,48,1],[29,2,48,2],[29,3,48,3],[29,4,48,4],[52,1,70,1],[52,2,70,2],[52,3,70,3],[52,4,70,4],[8,1,8,4],[10,1,28,1],[10,2,28,2],[10,3,28,3],[10,4,28,4]]}
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [C] Evidence reviews for reducing proxy purchasing of tobacco. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People(5-17 years)","Evidence review C: Reducing proxy purchasing of tobacco\n\nReview questions:\nWhich interventions are effective and cost effective at reducing proxy purchasing of tobacco on behalf of children and young people, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of proxy purchasing? In what way, and what aspects of interventions are perceived as having caused the change?\n\nThe evidence base was very limited, with just one study identified for inclusion in the review. The included study was a (cluster) controlled before and after study with two schools in the intervention group and two schools in the control group. Both children and their parents from these schools were included in the study.\n\nSummary of evidence:\nParents willing to provide cigarettes to their children: The intervention could not differentiate between comparators.\n\nChildren who smoke reporting parents as the main source of cigarettes: The intervention could not differentiate between comparators.\n\n","A joint search was used to identify relevant studies for review question C (proxy purchasing) and review question D (illicit supply) combined. The main search was done in October 2018 for studies published since 1998 and in the English language. A top-up was done for studies about people aged 5-11 years. An additional top-up search of terms related to online sales was conducted in November 2018. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [D] Evidence reviews for reducing illicit supply of tobacco. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-24 years)","Evidence review D: Reducing the supply of illicit tobacco \n\nReview questions:\nWhich interventions are effective and cost effective at reducing the supply of illicit tobacco to children, young people and young adults, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of supply of illicit tobacco? In what way, and what aspects of interventions are perceived as having caused the change?\n\nThis review aims to ascertain which interventions that attempt to engage and educate both retailers and the general public are effective at reducing supply of illicit tobacco to children, young people and young adults. As illicit tobacco supply may be concentrated in areas of deprivation, this is an important equality consideration.\n\nIllicit tobacco includes brands with no legal market in the country of sale, genuine brands brought into the country and sold without duty being paid, or illegally manufactured tobacco made to look like recognised brands (Fresh, 2018 as part of the Keep it Out campaign; Illicit Tobacco Partnership).\n\nNo studies were identified for inclusion from either the database or website searches.","A joint search was used to identify relevant studies for review question C (proxy purchasing) and review question D (illicit supply) combined. The main search was done in October 2018 for studies published since 1998 and in the English language. A top-up was done for studies about people aged 5-11 years. An additional top-up search of terms related to online sales was conducted in November 2018. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"ADOLYGIADAU SYSTEMATAIDD: YMYRIADAU CYFFREDINOL"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.\nAvailable here.","Children and Young People (up to 25 years of age)","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed."]
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[null,"Stead M et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here\n","Age not specified","The amount and strength of evidence varies across the six topics. There was moderate evidence that mass media campaigns can influence treatment-seeking behaviours (e.g. use of smoking quitlines). The impact on tobacco use was mixed. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. \nThe evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that (1) campaigns can contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective."]
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[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","Six studies involved availability interventions, of which four changed the relative proportion of less-healthy to healthier options, and two changed the absolute number of different options available. In statistical analyses that combined results from multiple studies, it was found that reducing the number of available options for a particular range or category of food(s) reduced selection of those food products (from analysing 154 participants) and possibly reduced consumption of those products (from 150 participants). However, the certainty of the evidence for these effects was low.\n\nEighteen studies involved proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. One study found that this reduced selection of food (from analysing 41 participants), whilst in a statistical analysis combining results from multiple studies, it was found that placing food farther away reduced consumption of those food products (from analysing 1098 participants). However, the certainty of the evidence for these effects was very low and low, respectively.","Mindful of its limitations, the current evidence suggests that changing the number of available food options or changing where foods are positioned could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes to food environments. However, more high-quality studies in real-world settings are needed to make this finding more certain."]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Children and Young People (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Children and Young People\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Hefler M, Liberato SC and Thomas DP. Incentives for preventing smoking in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008645. DOI: 10.1002/14651858.CD008645.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review aimed to assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It also aimed to assess, where possible, the dose‐response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives. \n\nThe reviewers identified three eligible RCTs and five controlled trials, including participants aged 11 to 14 years, who were non‐smokers at baseline. Of the eight trials identified, six had analyzable data relevant for this review, which contributed to meta‐analyses (7275 participants in total: 4003 intervention; 3272 control; 2484 participants after adjusting for clustering). All except one of the studies tested the 'Smokefree Class Competition' (SFC), which has been widely implemented throughout Europe. In this competition, classes with youth generally between the ages of 11 and 14 years commit to being smoke‐free for a six‐month period, and report their smoking status regularly. If 90% or more of the class are non‐smokers at the end of the six months, the class goes into a competition to win prizes. The one study that was not a trial of the SFC was a controlled trial in which schools in two communities were assigned to the intervention, with schools in a third community acting as controls. Students in the intervention community with lower smoking rates at the end of the project (one school year) received rewards.\n \nMost studies resulted in statistically non‐significant results. Only one study of the SFC reported a significant effect of the competition on the prevention of smoking at the longest follow‐up. However, this study was at risk of multiple biases, and when the adjusted RR was calculated, the difference was statistically insignificant. The pooled RR for the more robust RCTs (3 studies, n =   3056 participants/1107 adjusted for clustering) suggests that there is no statistically significant effect of incentives, in the form of the SFC, to prevent smoking initiation among children and adolescents in the long term (RR 1.00, 95% CI 0.84 to 1.19). Pooled results from the non‐randomised trials also did not detect a significant effect of the SFC, and the reviewers were unable to extract data on the outcome of interest from the one trial that did not study the SFC. There is little robust evidence to suggest that unintended consequences (such as making false claims about their smoking status and bullying of smoking students) are consistently associated with such interventions, although this has not been the focus of much research. There was insufficient information to assess the dose‐response relationship or to report costs of incentives for preventing smoking uptake. \n\nThe reviewers judged the included RCTs to be at unclear risk of bias, and the non‐RCTs to be at high risk of bias. Using GRADE, they rated the overall quality of the evidence for our primary outcome as 'low' (for RCTs) and 'very low' (for non‐RCTs), because of imprecision (all studies had wide CIs), and for the risks of bias identified. They further downgraded the non‐RCT evidence, due to issues with the non‐RCT study design, likely to introduce further bias.","The authors concluded that:\n- Very limited evidence currently available suggests that incentive programmes do not prevent smoking initiation among youth. However, there are relatively few published studies and these are of variable quality\n- Trials included in the meta‐analyses were all studies of the SFC, which distributed small to moderately‐sized prizes to whole classes, usually through a lottery system. It is therefore possible that other incentive programmes could be more successful at preventing smoking uptake in young people\n- Future studies might investigate the efficacy of a wider range of incentives, including those given to individual participants to prevent smoking uptake, whilst considering both the effect of incentives on smoking initiation and the progression to smoking. \n- It would be useful if incentives were evaluated in varying populations from different socioeconomic and ethnic backgrounds, and if intervention components were described in detail "]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Age not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Children and Young People (age not specified)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]

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[null,"ADOLYGIADAU SYSTEMATAIDD: YMYRIADAU AML-ELFEN"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]
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[null,"Patnode CD et al. Primary Care Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 97. AHRQ Publication No. 12-05175-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; December 2012.\nAvailable here.","Children and Young People (age not specified)","This review aimed to systematically review evidence for the efficacy and harms of primary care interventions to prevent tobacco initiation and encourage tobacco cessation among children and adolescents.\n\nThe reviewers included 24 articles representing 19 unique studies. None of the studies examined childhood or longer-term health outcomes (e.g., respiratory health or adult smoking). Seven trials evaluating combined prevention and cessation interventions were mainly rated as fair quality and included a diverse mix of intervention components and approaches. Pooled analyses of six of the combined trials (n =  8,749) resulted in a nonstatistically significant difference in the smoking prevalence among the intervention group compared with the control group at 6- to 12-months followup. Pooled analyses across all of the prevention trials suggested a small reduction in smoking initiation at 6- to 12-months followup among intervention participants compared with control group participants (RR 0.81, 95% CI 0.70 to 0.93]; k=9; n =  26,624). Meta-analyses of the behavior-based cessation trials (k=7; n =  2,328) and the medication (bupropion) cessation trials (k=2; n =  256) did not show a statistically significant effect on self-reported smoking status among baseline smokers at 6- to 12-months followup. \n\nNo trials evaluating behavior-based interventions (both prevention and cessation) reported possible harms from interventions. Some trials, however, reported a higher absolute prevalence of smoking in the intervention groups compared with the control groups, although none were statistically significant. Three studies were included that examined adverse effects related to bupropion use, and findings were mixed.","The authors concluded that:\n- Interventions designed to reduce the prevalence of tobacco use among children and adolescents represent a clinically and methodologically heterogeneous body of literature\n- Overall, methodological differences between the included trials limits their ability to determine if the relatively small effect found on smoking initiation in this subset of trials represents true benefit across this body of literature\n- In particular, the measurement of smoking status, including what constituted smoking initiation and cessation, varied across all studies\n- In addition, the diversity of both the components and the intensity of the interventions limits their ability to draw conclusions about common efficacious elements"]

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[null,"CANLLAW: DAD-NORMALEIDDIO YMYRIADAU\n "]
[null,"Ffynhonnell:","Poblogaeth: ","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [A] Digital mass media and mobile phone application for preventing uptake of smoking. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-24 years)","Evidence review A: Digital mass media and mobile phone applications for preventing uptake of smoking\n\nReview questions:\nWhich campaigns delivered through digital mass media and mobile phone applications are effective and cost effective in preventing children, young people and young adults from taking up smoking?\nDo these interventions change children, young people and young adults’ perceptions of the social acceptability of smoking or people who smoke? In what way, and what aspects of interventions are perceived as having caused the change?\n\nTwo studies were included for review A,  one was a cluster randomised controlled trial (cRCT) and one was a qualitative study. No previous includes from the original review were included as they were published previous to 2008.\n\nSummary of the evidence: Only findings relevant to this evidence map have been reported below.\n\nNon-smokers taking up smoking: The intervention could not differentiate between comparators.\n\nIntention to smoke: The intervention could not differentiate between comparators.\n","A joint search was used to identify relevant studies for review question A (digital mass media and apps) and review question B (cessation campaigns) combined. Although only studies published since 2008 were eligible for inclusion in review A as it is an update of a previous review question (which included 41 papers on mass media), the joint search included all studies published since 1998 as review question B is a new review and therefore any studies from the past 20 years were eligible for inclusion. The joint systematic search was undertaken in October 2018 for studies published in the English language. A top-up was done for studies about people aged 5-11 years. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review."]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [B] Evidence reviews for mass media cessation campaigns for preventing uptake of smoking. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-24 years)","Evidence B: Mass media cessation campaigns for preventing uptake of smoking\n\nReview questions:\nAre smoking cessation campaigns delivered through mass media and mobile phone applications aimed at adults effective and cost effective in preventing uptake of smoking among children, young people and young adults?\nDo these interventions change children, young people and young adults’ perceptions of the social acceptability of smoking or people who smoke? In what way, and what aspects of interventions are perceived as having caused the change?\n\nOne RCT was included in review B; no qualitative studies were identified for this review.\n\nSummary of the evidence: Only outcomes relevant to this evidence map have been reported below.\nSmoking initiation among children: The intervention could not differentiate between comparators (either for intervention group vs control group, or for children of parents who quit vs children of parents who did not quit).\n\nChildren's susceptibility to smoking: Self-help brochure vs telephone counselling: The intervention could not differentiate between comparators.","A joint search was used to identify relevant studies for review question A (digital mass media and apps) and review question B (cessation campaigns) combined. Although only studies published since 2008 were eligible for inclusion in review A as it is an update of a previous review question (which included 41 papers on mass media), the joint search included all studies published since 1998 as review question B is a new review and therefore any studies from the past 20 years were eligible for inclusion. The joint systematic search was undertaken in October 2018 for studies published in the English language. A top-up was done for studies about people aged 5-11 years. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"Angus K et al. Review 6: A review of the effectiveness of smokefree strategies and interventions in secondary care settings. 2013. NICE. NG209.\nAvailable here.","Adults with pre-existing health conditions: patients in secondary care settings including acute and mental health settings","This NICE evidence review aimed to systematically review the effectiveness of smokefree strategies and interventions in secondary care settings (acute, maternity and mental health settings). \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Acute and Maternity Settings): There is weak evidence in an acute and maternity setting that ‘no smoking outdoors’ signage decreases compliance with state indoor (hospital buildings and vehicles) smokefree legislation and a local (hospital board’s) outdoor partial smokefree policy. \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Mental Healthcare Settings): There is weak evidence that staff aiding inpatients’ compliance through strategies such as encouraging patients to participate in smoking cessation groups and addressing patients’\nurge to smoke increases patient compliance a local smokefree buildings policy.\n\nAs the extent of evidence on the effectiveness of smokefree strategies was limited to two studies, the data presented in the following two sections reviews studies using a comparative design to measure indicators of compliance in settings which had a smokefree policy covering the whole\nestate or an indoors-only smokefree policy with at least one supporting strategy.\n\nStaff Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is moderate evidence that the implementation of local-level\npolicy and national legislation for smokefree implementation in an acute and maternity setting decreases the number of staff smoking.\n\nVisitor Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that\nimplementation of local smokefree policies with supporting strategies decreases hospital visitor smoking.\n\nPatient Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence about the impact of local smokefree policies with supporting strategies on inpatient smoking behaviour in an acute and maternity setting. \n\nAll Hospital Users’ Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that local smokefree policy implementation with supporting strategies decreases observed smoking amongst all hospital users as a whole (patients, staff and visitors).\n\nOther Consequences from Smokefree for Staff (Acute & Maternity):\nStaff smoking: There is moderate evidence to suggest that local-level policy and national legislation for smokefree implementation with supporting strategies decreases smoking rates and number of cigarettes smoked both during working hours and overall in an acute and maternity setting amongst staff in an acute and maternity setting.\nStaff quiting activity: There is inconsistent evidence to suggest that smokefree implementation with supporting strategies decreases or has no effect on the number of quit attempts by staff.  There is weak evidence to suggest that implementation of a local smokefree policy for buildings or buildings and grounds with supporting strategies does not change the proportion of staff who quit smoking.\n\nOther Impacts on Patients (Mental healthcare): \nInpatient Smoking and Quitting Behaviours: There is inconsistent evidence that the introduction of smokefree in mental health care settings impacts on inpatient smoking and cessation behaviour outcomes in mental healthcare settings.\nLong Term Smoking Cessation: There is moderate evidence that the introduction of smokefree with appropriate supporting strategies in mental health care settings minimal impact on long term smoking cessation.","This 2012 NICE evidence review formed part of PH48 recommendations and NICE guidance on:\n- 'Smoking cessation in secondary care: acute and maternity services'\n- 'Smoking cessation in secondary care: mental health services'\n\nSome of the recommendations labelled [2013] or [2013, amended 2021] in the updated guideline were based on this evidence reviews. \n\nThe literature searches for this review were conducted in February 2012. A more up-to-date review/s on the topic may be available."]
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[null,"Hemsing et al. Interventions to Improve Partner Support and Partner Cessation During Pregnancy. 2009. NICE. NG209.\nAvailable here.","Adults\nPregnant and postpartum women","This NICE evidence review comprises of three reviews. However, only review one fulfilled the inclusion criteria of this evidence map. It aimed to address the following research question:\nWhich interventions are effective and cost effective in encouraging the establishment of smoke free homes?\n\nThe searches identified seventeen papers that met the inclusion criteria for smoke-free homes (although three did not fully consider the effectiveness of the intervention and so are included here for information only, they do not contribute to the evidence statements). The studies were biased towards interventions conducted in the USA (ten of seventeen), with only one conducted in the UK. Therefore there may be some reservations with respect to the applicability of the interventions in a UK population.\n\nEvidence statements from this review:\nES 1. Mixed evidence from six studies reported on counselling interventions to promote smoke free homes\nES 2. Mixed evidence from two studies was identified for interventions which combine counselling with additional elements such as the provision of written materials or telephone support\nES 3. Good evidence from four studies looked at programmes to implement individually adapted smoke free home polices. These interventions generally had problems with low compliance and loss to follow up. However, Sockrider et al. 2003 demonstrated a significant reduction in smoking as a result of their home smoking control index.\nES 4. Good evidence from one study which reported on the use of motivational interviewing to promote smoke free homes demonstrated a significant decrease in nicotine levels in intervention households over six months (however, this was not supported by self-reported smoking rates).\nES 5. One study reported on the effect of an educational intervention on the screening and counselling activities of physicians with regard to passive smoking. This study did not consider the effect of those who attended the intervention compared to those who did not so the effectiveness of the intervention is unclear.","This 2009 NICE evidence review formed part of PH26 recommendation. NICE guideline PH26 (June 2010) has been updated and replaced by NG209.\n\nThis guideline contains the evidence and committee discussion for recommendations from PH26 dated [2010] and [2010, amended 2021]. \n\nThe literature searches for this systematic review were conducted in March to June 2009. A more up-to-date review/s on the topic may be available."]
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[null,"Richardson L et al. Interventions to Prevent the Uptake of Smoking in Children and Young People. NICE Rapid review 2008. NG209.\nAvailable here.\n\n\n","Children and Young People (<18 years)","This NICE rapid review examines the effectiveness of: (a) mass media interventions designed to prevent the uptake of smoking in children and young people and (b) interventions that are designed to prevent the illegal sale of tobacco to children and young people.\n\nEvidence statements based on this review that meet the inclusion criteria of this map have been extracted below:\nMass media interventions\nES 1: There is evidence that mass media campaigns can prevent the uptake of smoking and also influence knowledge, attitudes and intentions of children and young people. Factors that have been shown to influence effectiveness in terms of smoking behaviour (i.e. smoking in the past 30 days, decreased initiation of smoking, quitting, number of cigarettes smoked) include message content, target audience, duration of the mass media campaign, demographics of the audience, the number of antitobacco message sources and the TRUTH campaign. Overall, the factors outlined above work best when combined with broader tobacco control initiatives produced by tobacco control bodies. Furthermore, campaigns are most effective when they are long in duration and greater in intensity of exposure.\nES 1.1: Some mass media interventions are more effective than others. Comparing interventions, prevention campaigns produced by the tobacco industry are less effective than anti-tobacco campaigns produced by tobacco control bodies. Youth perceive industry campaigns to be less effective, less interesting and less engaging. Industry campaigns also while an industry-sponsored campaign ”appeared to move youths’ attitudes in a protobacco direction”.\nES 1.2: It is not clear whether mass media interventions are delaying rather than preventing the uptake of smoking in children and youth. No studies identified in the literature examined this question.\n\nAccess restrictions\nES 2: There is evidence that access restriction interventions impact effectiveness in terms of the number of sales to young people, young people’s ability to access cigarettes and store clerk compliance. Only two studies addressed the impact of interventions on smoking behaviour. Factors that have been shown to influence number sales, young people’s ability to access cigarettes and store clerk compliance include active enforcement, comprehensive interventions, interventions produced by tobacco control bodies, requesting age/proof of ID, demographics of the vendor/store clerk, site setting of the access intervention, and the demographics of the target audience. Overall, the factors outlined above work best when combined with requesting proof of age/ID, active enforcement (in relation to both retailer-youth purchaser and trading standards-retailers) and other youth prevention strategies.\nES2.1: : Some access restrictions appear to be more effective than others. Compared to interventions created by tobacco control bodies, interventions produced by the tobacco industry do not decrease the sale of tobacco to youth. Store clerks participating in the tobacco industry intervention were still willing to illegally sell tobacco to children even after state mandated warnings were issued.\nES2.2: It is not clear if access interventions are delaying rather than preventing the uptake of smoking among children and youth. When faced with restrictions, youth appear to acquire tobacco from non-retail sources such as family members or peers. As a result, it is not clear if interventions have a direct effect on smoking uptake or behaviour.","In November 2021: NICE guidelines PH14 (July 2008) was updated and replaced by NG209. \n\nSome of the recommendations labelled [2008] or [2008, amended 2021] in the updated guideline were based on this evidence review.\n\nThe literature searches for this rapid review were conducted in July 2007. A more up-to-date review/s on the topic may be available."]
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[null,"ADOLYGIADAU SYSTEMATAIDD: YMYRIADAU CYFFREDINOL"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Children and Young People (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"Bala MM, Strzeszynski L and Topor‐Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004704. DOI: 10.1002/14651858.CD004704.pub4.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of mass media interventions in reducing smoking among adults. \n\nEleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow‐up, methods of evaluation and also, in definitions and measures of smoking behaviour used. \n\nAmong seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large‐scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. \n\nAmong the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex‐smokers combined. ","The authors concluded that:\n- There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality\n- One state‐wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign\n- Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme\n- Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney)\n- The intensity and duration of mass media campaigns may influence effectiveness, but length of follow‐up and concurrent secular trends and events can make this difficult to quantify\n- No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Children and Young People\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Age not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Age not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Children and Young People\nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Children and Young People (10-18 years)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]

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[null,"POPLOGAETH OEDOLION"]
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[null,"CANLLAW: POPLOGAETH OEDOLION"]
[null,"Ffynhonnell:","Poblogaeth: ","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here.\n","Adults","This guideline includes the following guidleines on smoking cessation:\nActive Smoking: All people who smoke should be advised to stop and offered support to help facilitate this in order to minimise cardiovascular and general health risk.\nPassive smoking: Exposure to passive smoking increases cardiovascular risk and should be minimised\n \nSmoking cessation interventions:\n- Varenicline or combination nicotine replacement therapy (NRT) should be offered alone or as part of a smoking cessation programme to augment professional advice and increase long-term abstinence rates\n- Bupropion and single NRT may also be considered as smoking cessation treatments\n \nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Hemsing et al. Interventions to Improve Partner Support and Partner Cessation During Pregnancy. 2009. NICE. NG209.\nAvailable here.","Adults\nPregnant and postpartum women","This NICE evidence review comprises of three reviews. However, only review one fulfilled the inclusion criteria of this evidence map. It aimed to address the following research question:\nWhich interventions are effective and cost effective in encouraging the establishment of smoke free homes?\n\nThe searches identified seventeen papers that met the inclusion criteria for smoke-free homes (although three did not fully consider the effectiveness of the intervention and so are included here for information only, they do not contribute to the evidence statements). The studies were biased towards interventions conducted in the USA (ten of seventeen), with only one conducted in the UK. Therefore there may be some reservations with respect to the applicability of the interventions in a UK population.\n\nEvidence statements from this review:\nES 1. Mixed evidence from six studies reported on counselling interventions to promote smoke free homes\nES 2. Mixed evidence from two studies was identified for interventions which combine counselling with additional elements such as the provision of written materials or telephone support\nES 3. Good evidence from four studies looked at programmes to implement individually adapted smoke free home polices. These interventions generally had problems with low compliance and loss to follow up. However, Sockrider et al. 2003 demonstrated a significant reduction in smoking as a result of their home smoking control index.\nES 4. Good evidence from one study which reported on the use of motivational interviewing to promote smoke free homes demonstrated a significant decrease in nicotine levels in intervention households over six months (however, this was not supported by self-reported smoking rates).\nES 5. One study reported on the effect of an educational intervention on the screening and counselling activities of physicians with regard to passive smoking. This study did not consider the effect of those who attended the intervention compared to those who did not so the effectiveness of the intervention is unclear.","This 2009 NICE evidence review formed part of PH26 recommendation. NICE guideline PH26 (June 2010) has been updated and replaced by NG209.\n\nThis guideline contains the evidence and committee discussion for recommendations from PH26 dated [2010] and [2010, amended 2021]. \n\nThe literature searches for this systematic review were conducted in March to June 2009. A more up-to-date review/s on the topic may be available."]
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[null,"ADOLYGIADAU SYSTEMATAIDD: POPLOGAETH OEDOLION"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here\n","Age not specified","The amount and strength of evidence varies across the six topics. There was moderate evidence that mass media campaigns can influence treatment-seeking behaviours (e.g. use of smoking quitlines). The impact on tobacco use was mixed. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. \nThe evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that (1) campaigns can contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective."]
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[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"van den Brand FA et al. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD004305. DOI: 10.1002/14651858.CD004305.pub5.\nAvailable here.","Adults","This Cochrane review primarily aimed to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). \n\nIn the current update, the reviewers have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both. \n\nFull financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, I² = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, I² = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, I² = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from $97 to $7646 for the comparison of full coverage with partial or no coverage. \n\nThere was no clear evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%, 2311 participants). \n\nFull financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95% CI 1.04 to 1.17, I² = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, I² = 88%, 6944 participants). \n\nFull financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: NRT: RR 1.79, 95% CI 1.54 to 2.09, I² = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, I² = 75%, 9215 participants. \n\nThere was evidence that partial coverage compared to no coverage reported a small positive effect on the use of bupropion (RR 1.15, 95% CI 1.03 to 1.29, I² = 0%, 6765 participants). Interventions directed at healthcare providers increased the use of behavioural therapy (RR 1.69, 95% CI 1.01 to 2.86, I² = 85%, 25820 participants), but not the use of NRT and/or bupropion (RR 0.94, 95% CI 0.76 to 1.18, I² = 6%, 2311 participants). \n\nThe reviewers assessed the quality of the evidence for the main outcome, abstinence from smoking, as moderate. In most studies participants were not blinded to the different study arms and researchers were not blinded to the allocated interventions. Furthermore, there was not always sufficient information on attrition rates. They detected some imprecision but judged this to be of minor consequence on the outcomes of this study. ","The authors concluded that:\n- Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting \n- There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers\n- The reviewers were only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Adolescents\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Age not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Age not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]

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[null,"POBLOGAETH Y GLASOED"]
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[null,"CANLLAW: POBLOGAETH Y GLASOED"]
[null,"Ffynhonnell:","Poblogaeth: ","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"National Institute for Health and Care Excellence. Community pharmacies: Promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.\n\n","Not specified","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. \n\nIt includes recommendations on:\n- Health and wellbeing hub\n- Overarching principles of good practice\n- Awareness raising and providing information\n- Advice and education\n- Behavioural support\n- Referrals and signposting\n\nThis guidance may also be relevant for:\n- Private and voluntary sector organisations providing health‑promoting services\n- People working in related services, for example GP practices and out-of-hours services\n- Members of the public"]
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [A] Digital mass media and mobile phone application for preventing uptake of smoking. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children, adolescents and young adults (5-24 years)","Evidence review A: Digital mass media and mobile phone applications for preventing uptake of smoking\n\nReview questions:\nWhich campaigns delivered through digital mass media and mobile phone applications are effective and cost effective in preventing children, young people and young adults from taking up smoking?\nDo these interventions change children, young people and young adults’ perceptions of the social acceptability of smoking or people who smoke? In what way, and what aspects of interventions are perceived as having caused the change?\n\nTwo studies were included for review A,  one was a cluster randomised controlled trial (cRCT) and one was a qualitative study. No previous includes from the original review were included as they were published previous to 2008.\n\nSummary of the evidence: Only findings relevant to this evidence map have been reported below.\n\nNon-smokers taking up smoking: The intervention could not differentiate between comparators.\n\nIntention to smoke: The intervention could not differentiate between comparators.\n","A joint search was used to identify relevant studies for review question A (digital mass media and apps) and review question B (cessation campaigns) combined. Although only studies published since 2008 were eligible for inclusion in review A as it is an update of a previous review question (which included 41 papers on mass media), the joint search included all studies published since 1998 as review question B is a new review and therefore any studies from the past 20 years were eligible for inclusion. The joint systematic search was undertaken in October 2018 for studies published in the English language. A top-up was done for studies about people aged 5-11 years. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review."]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [B] Evidence reviews for mass media cessation campaigns for preventing uptake of smoking. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children, adolescents and young adults (5-24 years)","Evidence B: Mass media cessation campaigns for preventing uptake of smoking\n\nReview questions:\nAre smoking cessation campaigns delivered through mass media and mobile phone applications aimed at adults effective and cost effective in preventing uptake of smoking among children, young people and young adults?\nDo these interventions change children, young people and young adults’ perceptions of the social acceptability of smoking or people who smoke? In what way, and what aspects of interventions are perceived as having caused the change?\n\nOne RCT was included in review B; no qualitative studies were identified for this review.\n\nSummary of the evidence: Only outcomes relevant to this evidence map have been reported below.\nSmoking initiation among children: The intervention could not differentiate between comparators (either for intervention group vs control group, or for children of parents who quit vs children of parents who did not quit).\n\nChildren's susceptibility to smoking: Self-help brochure vs telephone counselling: The intervention could not differentiate between comparators.","A joint search was used to identify relevant studies for review question A (digital mass media and apps) and review question B (cessation campaigns) combined. Although only studies published since 2008 were eligible for inclusion in review A as it is an update of a previous review question (which included 41 papers on mass media), the joint search included all studies published since 1998 as review question B is a new review and therefore any studies from the past 20 years were eligible for inclusion. The joint systematic search was undertaken in October 2018 for studies published in the English language. A top-up was done for studies about people aged 5-11 years. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [C] Evidence reviews for reducing proxy purchasing of tobacco. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and adolescents (5-17 years)","Evidence review C: Reducing proxy purchasing of tobacco\n\nReview questions:\nWhich interventions are effective and cost effective at reducing proxy purchasing of tobacco on behalf of children and young people, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of proxy purchasing? In what way, and what aspects of interventions are perceived as having caused the change?\n\nThe evidence base was very limited, with just one study identified for inclusion in the review. The included study was a (cluster) controlled before and after study with two schools in the intervention group and two schools in the control group. Both children and their parents from these schools were included in the study.\n\nSummary of evidence:\nParents willing to provide cigarettes to their children: The intervention could not differentiate between comparators.\n\nChildren who smoke reporting parents as the main source of cigarettes: The intervention could not differentiate between comparators.\n\n","A joint search was used to identify relevant studies for review question C (proxy purchasing) and review question D (illicit supply) combined. The main search was done in October 2018 for studies published since 1998 and in the English language. A top-up was done for studies about people aged 5-11 years. An additional top-up search of terms related to online sales was conducted in November 2018. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [D] Evidence reviews for reducing illicit supply of tobacco. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children, adolescents and young adults (5-24 years)","Evidence review D: Reducing the supply of illicit tobacco \n\nReview questions:\nWhich interventions are effective and cost effective at reducing the supply of illicit tobacco to children, young people and young adults, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of supply of illicit tobacco? In what way, and what aspects of interventions are perceived as having caused the change?\n\nThis review aims to ascertain which interventions that attempt to engage and educate both retailers and the general public are effective at reducing supply of illicit tobacco to children, young people and young adults. As illicit tobacco supply may be concentrated in areas of deprivation, this is an important equality consideration.\n\nIllicit tobacco includes brands with no legal market in the country of sale, genuine brands brought into the country and sold without duty being paid, or illegally manufactured tobacco made to look like recognised brands (Fresh, 2018 as part of the Keep it Out campaign; Illicit Tobacco Partnership).\n\nNo studies were identified for inclusion from either the database or website searches.","A joint search was used to identify relevant studies for review question C (proxy purchasing) and review question D (illicit supply) combined. The main search was done in October 2018 for studies published since 1998 and in the English language. A top-up was done for studies about people aged 5-11 years. An additional top-up search of terms related to online sales was conducted in November 2018. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [E] Evidence reviews for Smokefree class competitions. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children, adolescents and young adults (5-24 years)","Evidence review E: Smokefree class competitions\n\nReview questions:\nWhich interventions are effective and cost effective at reducing the supply of illicit tobacco to children, young people and young adults, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of supply of illicit tobacco? In what way, and what aspects of interventions are perceived as having caused the change?\n\nSmokefree Class Competitions (SFCC) are a school-based incentive intervention for preventing the uptake of smoking, usually among children between 11 and 14 years old. SFCC gives responsibility for preventing smoking uptake (and stopping smoking for the duration of the competition, for those who already smoke) to the class of students. The intended effect is to denormalise smoking and create a smokefree class through the use of peer expectations of each other.\nSix studies were identified for inclusion in this review. Limited meta-analysis was possible as some studies reporting smoking and some reporting non-smoking, and due to the data reported by the studies. Only findings relevant to this evidence map have been extracted below:\n\nNon-smokers taking up smoking: The intervention is effective at reducing the outcome compared with no intervention.\n\nNon-smokers not taking up smoking: The intervention could not differentiate between comparators.\n\nTotal smoking among whole group: Evidence from one RCT suggests the intervention was effective at reducing the outcome compared with no intervention. Evidence from one nRCT suggests the  intervention could not differentiate between comparators.","This review is an update of part of an existing review. Included studies from the original review were sifted and two studies were identified for inclusion and were ordered for full-text review. This new review includes non-randomised controlled studies which the original review did not, so all studies excluded from the original review on the basis of study design were also sifted but no papers were identified for inclusion from this route.\n\nA joint search was undertaken in January 2019 for studies published in the English language from 1998-29 January 2019 to identify relevant studies for the cost effectiveness elements of review questions A (digital mass media and apps), B (cessation campaigns), C (proxy sales), D (illicit supply) and E (smokefree class competitions) combined. This search incorporated the search strategies of the original effectiveness searches plus the top-up searches and then applied an agreed cost effectiveness filter. \n\nNo recommendations were made from this evidence review.\n "]
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[null,"Richardson L et al. Interventions to Prevent the Uptake of Smoking in Children and Young People. NICE Rapid review 2008. NG209.\nAvailable here.\n\n\n","Children and Young People (<18 years)","This NICE rapid review examines the effectiveness of: (a) mass media interventions designed to prevent the uptake of smoking in children and young people and (b) interventions that are designed to prevent the illegal sale of tobacco to children and young people.\n\nEvidence statements based on this review that meet the inclusion criteria of this map have been extracted below:\nMass media interventions\nES 1: There is evidence that mass media campaigns can prevent the uptake of smoking and also influence knowledge, attitudes and intentions of children and young people. Factors that have been shown to influence effectiveness in terms of smoking behaviour (i.e. smoking in the past 30 days, decreased initiation of smoking, quitting, number of cigarettes smoked) include message content, target audience, duration of the mass media campaign, demographics of the audience, the number of antitobacco message sources and the TRUTH campaign. Overall, the factors outlined above work best when combined with broader tobacco control initiatives produced by tobacco control bodies. Furthermore, campaigns are most effective when they are long in duration and greater in intensity of exposure.\nES 1.1: Some mass media interventions are more effective than others. Comparing interventions, prevention campaigns produced by the tobacco industry are less effective than anti-tobacco campaigns produced by tobacco control bodies. Youth perceive industry campaigns to be less effective, less interesting and less engaging. Industry campaigns also while an industry-sponsored campaign ”appeared to move youths’ attitudes in a protobacco direction”.\nES 1.2: It is not clear whether mass media interventions are delaying rather than preventing the uptake of smoking in children and youth. No studies identified in the literature examined this question.\n\nAccess restrictions\nES 2: There is evidence that access restriction interventions impact effectiveness in terms of the number of sales to young people, young people’s ability to access cigarettes and store clerk compliance. Only two studies addressed the impact of interventions on smoking behaviour. Factors that have been shown to influence number sales, young people’s ability to access cigarettes and store clerk compliance include active enforcement, comprehensive interventions, interventions produced by tobacco control bodies, requesting age/proof of ID, demographics of the vendor/store clerk, site setting of the access intervention, and the demographics of the target audience. Overall, the factors outlined above work best when combined with requesting proof of age/ID, active enforcement (in relation to both retailer-youth purchaser and trading standards-retailers) and other youth prevention strategies.\nES2.1: : Some access restrictions appear to be more effective than others. Compared to interventions created by tobacco control bodies, interventions produced by the tobacco industry do not decrease the sale of tobacco to youth. Store clerks participating in the tobacco industry intervention were still willing to illegally sell tobacco to children even after state mandated warnings were issued.\nES2.2: It is not clear if access interventions are delaying rather than preventing the uptake of smoking among children and youth. When faced with restrictions, youth appear to acquire tobacco from non-retail sources such as family members or peers. As a result, it is not clear if interventions have a direct effect on smoking uptake or behaviour.","In November 2021: NICE guidelines PH14 (July 2008) was updated and replaced by NG209. \n\nSome of the recommendations labelled [2008] or [2008, amended 2021] in the updated guideline were based on this evidence review.\n\nThe literature searches for this rapid review were conducted in July 2007. A more up-to-date review/s on the topic may be available."]
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[null,"ADOLYGIADAU SYSTEMATAIDD: POBLOGAETH Y GLASOED "]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.\nAvailable here.","Children and Young People (upto 25 years)","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed."]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Children and Young People (< 25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"Hefler M, Liberato SC and Thomas DP. Incentives for preventing smoking in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008645. DOI: 10.1002/14651858.CD008645.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review aimed to assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It also aimed to assess, where possible, the dose‐response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives. \n\nThe reviewers identified three eligible RCTs and five controlled trials, including participants aged 11 to 14 years, who were non‐smokers at baseline. Of the eight trials identified, six had analyzable data relevant for this review, which contributed to meta‐analyses (7275 participants in total: 4003 intervention; 3272 control; 2484 participants after adjusting for clustering). All except one of the studies tested the 'Smokefree Class Competition' (SFC), which has been widely implemented throughout Europe. In this competition, classes with youth generally between the ages of 11 and 14 years commit to being smoke‐free for a six‐month period, and report their smoking status regularly. If 90% or more of the class are non‐smokers at the end of the six months, the class goes into a competition to win prizes. The one study that was not a trial of the SFC was a controlled trial in which schools in two communities were assigned to the intervention, with schools in a third community acting as controls. Students in the intervention community with lower smoking rates at the end of the project (one school year) received rewards.\n \nMost studies resulted in statistically non‐significant results. Only one study of the SFC reported a significant effect of the competition on the prevention of smoking at the longest follow‐up. However, this study was at risk of multiple biases, and when the adjusted RR was calculated, the difference was statistically insignificant. The pooled RR for the more robust RCTs (3 studies, n =   3056 participants/1107 adjusted for clustering) suggests that there is no statistically significant effect of incentives, in the form of the SFC, to prevent smoking initiation among children and adolescents in the long term (RR 1.00, 95% CI 0.84 to 1.19). Pooled results from the non‐randomised trials also did not detect a significant effect of the SFC, and the reviewers were unable to extract data on the outcome of interest from the one trial that did not study the SFC. There is little robust evidence to suggest that unintended consequences (such as making false claims about their smoking status and bullying of smoking students) are consistently associated with such interventions, although this has not been the focus of much research. There was insufficient information to assess the dose‐response relationship or to report costs of incentives for preventing smoking uptake. \n\nThe reviewers judged the included RCTs to be at unclear risk of bias, and the non‐RCTs to be at high risk of bias. Using GRADE, they rated the overall quality of the evidence for our primary outcome as 'low' (for RCTs) and 'very low' (for non‐RCTs), because of imprecision (all studies had wide CIs), and for the risks of bias identified. They further downgraded the non‐RCT evidence, due to issues with the non‐RCT study design, likely to introduce further bias.","The authors concluded that:\n- Very limited evidence currently available suggests that incentive programmes do not prevent smoking initiation among youth. However, there are relatively few published studies and these are of variable quality\n- Trials included in the meta‐analyses were all studies of the SFC, which distributed small to moderately‐sized prizes to whole classes, usually through a lottery system. It is therefore possible that other incentive programmes could be more successful at preventing smoking uptake in young people\n- Future studies might investigate the efficacy of a wider range of incentives, including those given to individual participants to prevent smoking uptake, whilst considering both the effect of incentives on smoking initiation and the progression to smoking. \n- It would be useful if incentives were evaluated in varying populations from different socioeconomic and ethnic backgrounds, and if intervention components were described in detail "]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Children and Young People\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Children and Young People\nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Children and Young People (10- 18 years)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]

{"sheet":"Pregnant & Postpartum women","index":12,"n_rows":157,"n_cols":5,"rows_kept":157,"cut":false,"hidden":false,"merged":[[156,1,180,1],[156,2,180,2],[156,3,180,3],[156,4,180,4],[122,4,134,4],[135,1,155,1],[135,2,155,2],[135,3,155,3],[135,4,155,4],[91,1,118,1],[91,2,118,2],[91,3,118,3],[91,4,118,4],[24,1,24,4],[26,1,87,1],[26,2,87,2],[26,3,87,4],[89,1,89,4],[120,1,120,4],[122,1,134,1],[122,2,134,2],[122,3,134,3],[21,1,22,4]]}
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[null,"MENYWOD BEICHIOG A MENYWOD SYDD WEDI CAEL BABI"]
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[null,"CANLLAW: MENYWOD BEICHIOG A MENYWOD SYDD WEDI CAEL BABI"]
[null,"Ffynhonnell:","Poblogaeth: ","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH\n"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Hemsing et al. Interventions to Improve Partner Support and Partner Cessation During Pregnancy. 2009. NICE. NG209.\nAvailable here.","Adults\nPregnant and postpartum women","This NICE evidence review comprises of three reviews. However, only review one fulfilled the inclusion criteria of this evidence map. It aimed to address the following research question:\nWhich interventions are effective and cost effective in encouraging the establishment of smoke free homes?\n\nThe searches identified seventeen papers that met the inclusion criteria for smoke-free homes (although three did not fully consider the effectiveness of the intervention and so are included here for information only, they do not contribute to the evidence statements). The studies were biased towards interventions conducted in the USA (ten of seventeen), with only one conducted in the UK. Therefore there may be some reservations with respect to the applicability of the interventions in a UK population.\n\nEvidence statements from this review:\nES 1. Mixed evidence from six studies reported on counselling interventions to promote smoke free homes\nES 2. Mixed evidence from two studies was identified for interventions which combine counselling with additional elements such as the provision of written materials or telephone support\nES 3. Good evidence from four studies looked at programmes to implement individually adapted smoke free home polices. These interventions generally had problems with low compliance and loss to follow up. However, Sockrider et al. 2003 demonstrated a significant reduction in smoking as a result of their home smoking control index.\nES 4. Good evidence from one study which reported on the use of motivational interviewing to promote smoke free homes demonstrated a significant decrease in nicotine levels in intervention households over six months (however, this was not supported by self-reported smoking rates).\nES 5. One study reported on the effect of an educational intervention on the screening and counselling activities of physicians with regard to passive smoking. This study did not consider the effect of those who attended the intervention compared to those who did not so the effectiveness of the intervention is unclear.","This 2009 NICE evidence review formed part of PH26 recommendation. NICE guideline PH26 (June 2010) has been updated and replaced by NG209.\n\nThis guideline contains the evidence and committee discussion for recommendations from PH26 dated [2010] and [2010, amended 2021]. \n\nThe literature searches for this systematic review were conducted in March to June 2009. A more up-to-date review/s on the topic may be available."]
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[null,"ADOLYGIADAU SYSTEMATAIDD: MENYWOD BEICHIOG A MENYWOD SYDD WEDI CAEL BABI"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here\n","Age not specified","The amount and strength of evidence varies across the six topics. There was moderate evidence that mass media campaigns can influence treatment-seeking behaviours (e.g. use of smoking quitlines). The impact on tobacco use was mixed. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. \nThe evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that (1) campaigns can contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective."]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]

{"sheet":"Pre-existing health condition","index":13,"n_rows":179,"n_cols":5,"rows_kept":179,"cut":false,"hidden":false,"merged":[[178,2,202,2],[178,3,202,3],[178,4,202,4],[88,1,88,4],[23,1,23,4],[25,1,86,1],[25,2,86,2],[25,3,86,4],[90,1,140,1],[90,2,140,2],[90,3,140,3],[90,4,140,4],[144,1,156,1],[144,2,156,2],[144,3,156,3],[144,4,156,4],[157,1,177,1],[157,2,177,2],[142,1,142,4],[157,3,177,3],[157,4,177,4],[178,1,202,1],[20,1,21,4]]}
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[null,"CYFLWR IECHYD SYDD EISOES YN BODOLI"]
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[null,"CANLLAW: CYFLWR IECHYD SYDD EISOES YN BODOLI"]
[null,"Ffynhonnell:","Poblogaeth: ","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH\n"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Angus K et al. Review 6: A review of the effectiveness of smokefree strategies and interventions in secondary care settings. 2013. NICE. NG209.\nAvailable here.","Adults with pre-existing health conditions: patients in secondary care settings including acute and mental health settings","This NICE evidence review aimed to systematically review the effectiveness of smokefree strategies and interventions in secondary care settings (acute, maternity and mental health settings). \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Acute and Maternity Settings): There is weak evidence in an acute and maternity setting that ‘no smoking outdoors’ signage decreases compliance with state indoor (hospital buildings and vehicles) smokefree legislation and a local (hospital board’s) outdoor partial smokefree policy. \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Mental Healthcare Settings): There is weak evidence that staff aiding inpatients’ compliance through strategies such as encouraging patients to participate in smoking cessation groups and addressing patients’\nurge to smoke increases patient compliance a local smokefree buildings policy.\n\nAs the extent of evidence on the effectiveness of smokefree strategies was limited to two studies, the data presented in the following two sections reviews studies using a comparative design to measure indicators of compliance in settings which had a smokefree policy covering the whole\nestate or an indoors-only smokefree policy with at least one supporting strategy.\n\nStaff Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is moderate evidence that the implementation of local-level\npolicy and national legislation for smokefree implementation in an acute and maternity setting decreases the number of staff smoking.\n\nVisitor Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that\nimplementation of local smokefree policies with supporting strategies decreases hospital visitor smoking.\n\nPatient Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence about the impact of local smokefree policies with supporting strategies on inpatient smoking behaviour in an acute and maternity setting. \n\nAll Hospital Users’ Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that local smokefree policy implementation with supporting strategies decreases observed smoking amongst all hospital users as a whole (patients, staff and visitors).\n\nOther Consequences from Smokefree for Staff (Acute & Maternity):\nStaff smoking: There is moderate evidence to suggest that local-level policy and national legislation for smokefree implementation with supporting strategies decreases smoking rates and number of cigarettes smoked both during working hours and overall in an acute and maternity setting amongst staff in an acute and maternity setting.\nStaff quiting activity: There is inconsistent evidence to suggest that smokefree implementation with supporting strategies decreases or has no effect on the number of quit attempts by staff.  There is weak evidence to suggest that implementation of a local smokefree policy for buildings or buildings and grounds with supporting strategies does not change the proportion of staff who quit smoking.\n\nOther Impacts on Patients (Mental healthcare): \nInpatient Smoking and Quitting Behaviours: There is inconsistent evidence that the introduction of smokefree in mental health care settings impacts on inpatient smoking and cessation behaviour outcomes in mental healthcare settings.\nLong Term Smoking Cessation: There is moderate evidence that the introduction of smokefree with appropriate supporting strategies in mental health care settings minimal impact on long term smoking cessation.","This 2012 NICE evidence review formed part of PH48 recommendations and NICE guidance on:\n- 'Smoking cessation in secondary care: acute and maternity services'\n- 'Smoking cessation in secondary care: mental health services'\n\nSome of the recommendations labelled [2013] or [2013, amended 2021] in the updated guideline were based on this evidence reviews. \n\nThe literature searches for this review were conducted in February 2012. A more up-to-date review/s on the topic may be available."]
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[null,"ADOLYGIADAU SYSTEMATAIDD: CYFLWR IECHYD SYDD EISOES YN BODOLI "]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here\n","Not specified","The amount and strength of evidence varies across the six topics. There was moderate evidence that mass media campaigns can influence treatment-seeking behaviours (e.g. use of smoking quitlines). The impact on tobacco use was mixed. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. \nThe evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that (1) campaigns can contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective."]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]

{"sheet":"Primary Care","index":14,"n_rows":268,"n_cols":5,"rows_kept":268,"cut":false,"hidden":false,"merged":[[267,1,313,1],[267,2,313,2],[267,3,313,3],[267,4,313,4],[124,1,150,1],[124,2,150,2],[124,3,150,3],[124,4,150,4],[151,1,192,1],[151,2,192,2],[151,3,192,3],[151,4,192,4],[193,1,222,1],[193,2,222,2],[193,3,222,3],[193,4,222,4],[26,1,87,1],[26,2,87,2],[26,3,87,4],[88,1,103,1],[88,2,103,2],[88,3,103,4],[107,1,123,1],[107,2,123,2],[107,3,123,3],[107,4,123,4],[24,1,24,4],[223,1,266,1],[223,2,266,2],[223,3,266,3],[223,4,266,4],[105,1,105,4],[21,1,22,4]]}
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[null,"LLEOLIAD GOFAL SYLFAENOL"]
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[null,"CANLLAW: LLEOLIAD GOFAL SYLFAENOL"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"National Institute for Health and Care Excellence. Community pharmacies: Promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.\n\n","Not specified","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. \n\nIt includes recommendations on:\n- Health and wellbeing hub\n- Overarching principles of good practice\n- Awareness raising and providing information\n- Advice and education\n- Behavioural support\n- Referrals and signposting\n\nThis guidance may also be relevant for:\n- Private and voluntary sector organisations providing health‑promoting services\n- People working in related services, for example GP practices and out-of-hours services\n- Members of the public"]
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[null,"ADOLYGIADAU SYSTEMATAIDD: LLEOLIAD GOFAL SYLFAENOL"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.\nAvailable here.","Children and Young People (upto 25 years)","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed."]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Children and Young People (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Children and Young People\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Children and Young People(5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]

{"sheet":"Secondary & Tertiary Care","index":15,"n_rows":240,"n_cols":5,"rows_kept":240,"cut":false,"hidden":false,"merged":[[209,1,238,1],[209,2,238,2],[209,3,238,3],[209,4,238,4],[239,1,252,1],[239,2,252,2],[239,3,252,3],[239,4,252,4],[188,1,208,1],[188,2,208,2],[188,3,208,3],[188,4,208,4],[26,1,87,1],[26,2,87,2],[26,3,87,4],[89,1,89,4],[91,1,141,1],[91,2,141,2],[91,3,141,3],[91,4,141,4],[145,1,187,1],[145,2,153,2],[145,3,187,3],[145,4,166,4],[143,1,143,4],[21,1,22,4],[24,1,24,4]]}
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[null,"LLEOLIAD GOFAL EILAIDD A THRYDYDDOL"]
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[null,"CANLLAW: LLEOLIAD GOFAL EILAIDD A THRYDYDDOL"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH\n"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Angus K et al. Review 6: A review of the effectiveness of smokefree strategies and interventions in secondary care settings. 2013. NICE. NG209.\nAvailable here.","Adults with pre-existing health conditions: patients in secondary care settings including acute and mental health settings","This NICE evidence review aimed to systematically review the effectiveness of smokefree strategies and interventions in secondary care settings (acute, maternity and mental health settings). \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Acute and Maternity Settings): There is weak evidence in an acute and maternity setting that ‘no smoking outdoors’ signage decreases compliance with state indoor (hospital buildings and vehicles) smokefree legislation and a local (hospital board’s) outdoor partial smokefree policy. \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Mental Healthcare Settings): There is weak evidence that staff aiding inpatients’ compliance through strategies such as encouraging patients to participate in smoking cessation groups and addressing patients’\nurge to smoke increases patient compliance a local smokefree buildings policy.\n\nAs the extent of evidence on the effectiveness of smokefree strategies was limited to two studies, the data presented in the following two sections reviews studies using a comparative design to measure indicators of compliance in settings which had a smokefree policy covering the whole\nestate or an indoors-only smokefree policy with at least one supporting strategy.\n\nStaff Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is moderate evidence that the implementation of local-level\npolicy and national legislation for smokefree implementation in an acute and maternity setting decreases the number of staff smoking.\n\nVisitor Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that\nimplementation of local smokefree policies with supporting strategies decreases hospital visitor smoking.\n\nPatient Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence about the impact of local smokefree policies with supporting strategies on inpatient smoking behaviour in an acute and maternity setting. \n\nAll Hospital Users’ Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that local smokefree policy implementation with supporting strategies decreases observed smoking amongst all hospital users as a whole (patients, staff and visitors).\n\nOther Consequences from Smokefree for Staff (Acute & Maternity):\nStaff smoking: There is moderate evidence to suggest that local-level policy and national legislation for smokefree implementation with supporting strategies decreases smoking rates and number of cigarettes smoked both during working hours and overall in an acute and maternity setting amongst staff in an acute and maternity setting.\nStaff quiting activity: There is inconsistent evidence to suggest that smokefree implementation with supporting strategies decreases or has no effect on the number of quit attempts by staff.  There is weak evidence to suggest that implementation of a local smokefree policy for buildings or buildings and grounds with supporting strategies does not change the proportion of staff who quit smoking.\n\nOther Impacts on Patients (Mental healthcare): \nInpatient Smoking and Quitting Behaviours: There is inconsistent evidence that the introduction of smokefree in mental health care settings impacts on inpatient smoking and cessation behaviour outcomes in mental healthcare settings.\nLong Term Smoking Cessation: There is moderate evidence that the introduction of smokefree with appropriate supporting strategies in mental health care settings minimal impact on long term smoking cessation.","This 2012 NICE evidence review formed part of PH48 recommendations and NICE guidance on:\n- 'Smoking cessation in secondary care: acute and maternity services'\n- 'Smoking cessation in secondary care: mental health services'\n\nSome of the recommendations labelled [2013] or [2013, amended 2021] in the updated guideline were based on this evidence reviews. \n\nThe literature searches for this review were conducted in February 2012. A more up-to-date review/s on the topic may be available."]
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[null,"ADOLYGIADAU SYSTEMATAIDD: LLEOLIAD GOFAL EILAIDD A THRYDYDDOL"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"van den Brand FA et al. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD004305. DOI: 10.1002/14651858.CD004305.pub5.\nAvailable here.","Adults","This Cochrane review primarily aimed to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). \n\nIn the current update, the reviewers have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both. \n\nFull financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, I² = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, I² = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, I² = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from $97 to $7646 for the comparison of full coverage with partial or no coverage. \n\nThere was no clear evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%, 2311 participants). \n\nFull financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95% CI 1.04 to 1.17, I² = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, I² = 88%, 6944 participants). \n\nFull financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: NRT: RR 1.79, 95% CI 1.54 to 2.09, I² = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, I² = 75%, 9215 participants. \n\nThere was evidence that partial coverage compared to no coverage reported a small positive effect on the use of bupropion (RR 1.15, 95% CI 1.03 to 1.29, I² = 0%, 6765 participants). Interventions directed at healthcare providers increased the use of behavioural therapy (RR 1.69, 95% CI 1.01 to 2.86, I² = 85%, 25820 participants), but not the use of NRT and/or bupropion (RR 0.94, 95% CI 0.76 to 1.18, I² = 6%, 2311 participants). \n\nThe reviewers assessed the quality of the evidence for the main outcome, abstinence from smoking, as moderate. In most studies participants were not blinded to the different study arms and researchers were not blinded to the allocated interventions. Furthermore, there was not always sufficient information on attrition rates. They detected some imprecision but judged this to be of minor consequence on the outcomes of this study. ","The authors concluded that:\n- Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting \n- There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers\n- The reviewers were only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Children and Young People\nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]

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[null,"LLEOLIAD SEFYDLIAD ADDYSGOL"]
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[null,"CANLLAW: LLEOLIAD SEFYDLIAD ADDYSGOL"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH\n"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [C] Evidence reviews for reducing proxy purchasing of tobacco. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-17 years)","Evidence review C: Reducing proxy purchasing of tobacco\n\nReview questions:\nWhich interventions are effective and cost effective at reducing proxy purchasing of tobacco on behalf of children and young people, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of proxy purchasing? In what way, and what aspects of interventions are perceived as having caused the change?\n\nThe evidence base was very limited, with just one study identified for inclusion in the review. The included study was a (cluster) controlled before and after study with two schools in the intervention group and two schools in the control group. Both children and their parents from these schools were included in the study.\n\nSummary of evidence:\nParents willing to provide cigarettes to their children: The intervention could not differentiate between comparators.\n\nChildren who smoke reporting parents as the main source of cigarettes: The intervention could not differentiate between comparators.\n\n","A joint search was used to identify relevant studies for review question C (proxy purchasing) and review question D (illicit supply) combined. The main search was done in October 2018 for studies published since 1998 and in the English language. A top-up was done for studies about people aged 5-11 years. An additional top-up search of terms related to online sales was conducted in November 2018. Website searches were conducted in line with the protocol. Further details on the search strategy are available in Appendix B.\n\nNo recommendations were made from this evidence review.\n "]
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[null,"Tobacco: preventing uptake, promoting quitting and treating dependence: update. [E] Evidence reviews for Smokefree class competitions. 2021. NICE. NG209.\nAvailable here.\n\n\n","Children and Young People (5-24 years)","Evidence review E: Smokefree class competitions\n\nReview questions:\nWhich interventions are effective and cost effective at reducing the supply of illicit tobacco to children, young people and young adults, through engaging and educating retailers and the general public?\nDo these interventions change perceptions of the social acceptability of supply of illicit tobacco? In what way, and what aspects of interventions are perceived as having caused the change?\n\nSmokefree Class Competitions (SFCC) are a school-based incentive intervention for preventing the uptake of smoking, usually among children between 11 and 14 years old. SFCC gives responsibility for preventing smoking uptake (and stopping smoking for the duration of the competition, for those who already smoke) to the class of students. The intended effect is to denormalise smoking and create a smokefree class through the use of peer expectations of each other.\nSix studies were identified for inclusion in this review. Limited meta-analysis was possible as some studies reporting smoking and some reporting non-smoking, and due to the data reported by the studies. Only findings relevant to this evidence map have been extracted below:\n\nNon-smokers taking up smoking: The intervention is effective at reducing the outcome compared with no intervention.\n\nNon-smokers not taking up smoking: The intervention could not differentiate between comparators.\n\nTotal smoking among whole group: Evidence from one RCT suggests the intervention was effective at reducing the outcome compared with no intervention. Evidence from one nRCT suggests the  intervention could not differentiate between comparators.","This review is an update of part of an existing review. Included studies from the original review were sifted and two studies were identified for inclusion and were ordered for full-text review. This new review includes non-randomised controlled studies which the original review did not, so all studies excluded from the original review on the basis of study design were also sifted but no papers were identified for inclusion from this route.\n\nA joint search was undertaken in January 2019 for studies published in the English language from 1998-29 January 2019 to identify relevant studies for the cost effectiveness elements of review questions A (digital mass media and apps), B (cessation campaigns), C (proxy sales), D (illicit supply) and E (smokefree class competitions) combined. This search incorporated the search strategies of the original effectiveness searches plus the top-up searches and then applied an agreed cost effectiveness filter. \n\nNo recommendations were made from this evidence review.\n "]
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[null,"ADOLYGIADAU SYSTEMATAIDD: LLEOLIAD SEFYDLIAD ADDYSGOL"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.\nAvailable here.","Children and Young People (upto 25 years)","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed."]
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[null,"Hefler M, Liberato SC and Thomas DP. Incentives for preventing smoking in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008645. DOI: 10.1002/14651858.CD008645.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review aimed to assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It also aimed to assess, where possible, the dose‐response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives. \n\nThe reviewers identified three eligible RCTs and five controlled trials, including participants aged 11 to 14 years, who were non‐smokers at baseline. Of the eight trials identified, six had analyzable data relevant for this review, which contributed to meta‐analyses (7275 participants in total: 4003 intervention; 3272 control; 2484 participants after adjusting for clustering). All except one of the studies tested the 'Smokefree Class Competition' (SFC), which has been widely implemented throughout Europe. In this competition, classes with youth generally between the ages of 11 and 14 years commit to being smoke‐free for a six‐month period, and report their smoking status regularly. If 90% or more of the class are non‐smokers at the end of the six months, the class goes into a competition to win prizes. The one study that was not a trial of the SFC was a controlled trial in which schools in two communities were assigned to the intervention, with schools in a third community acting as controls. Students in the intervention community with lower smoking rates at the end of the project (one school year) received rewards.\n \nMost studies resulted in statistically non‐significant results. Only one study of the SFC reported a significant effect of the competition on the prevention of smoking at the longest follow‐up. However, this study was at risk of multiple biases, and when the adjusted RR was calculated, the difference was statistically insignificant. The pooled RR for the more robust RCTs (3 studies, n =   3056 participants/1107 adjusted for clustering) suggests that there is no statistically significant effect of incentives, in the form of the SFC, to prevent smoking initiation among children and adolescents in the long term (RR 1.00, 95% CI 0.84 to 1.19). Pooled results from the non‐randomised trials also did not detect a significant effect of the SFC, and the reviewers were unable to extract data on the outcome of interest from the one trial that did not study the SFC. There is little robust evidence to suggest that unintended consequences (such as making false claims about their smoking status and bullying of smoking students) are consistently associated with such interventions, although this has not been the focus of much research. There was insufficient information to assess the dose‐response relationship or to report costs of incentives for preventing smoking uptake. \n\nThe reviewers judged the included RCTs to be at unclear risk of bias, and the non‐RCTs to be at high risk of bias. Using GRADE, they rated the overall quality of the evidence for our primary outcome as 'low' (for RCTs) and 'very low' (for non‐RCTs), because of imprecision (all studies had wide CIs), and for the risks of bias identified. They further downgraded the non‐RCT evidence, due to issues with the non‐RCT study design, likely to introduce further bias.","The authors concluded that:\n- Very limited evidence currently available suggests that incentive programmes do not prevent smoking initiation among youth. However, there are relatively few published studies and these are of variable quality\n- Trials included in the meta‐analyses were all studies of the SFC, which distributed small to moderately‐sized prizes to whole classes, usually through a lottery system. It is therefore possible that other incentive programmes could be more successful at preventing smoking uptake in young people\n- Future studies might investigate the efficacy of a wider range of incentives, including those given to individual participants to prevent smoking uptake, whilst considering both the effect of incentives on smoking initiation and the progression to smoking. \n- It would be useful if incentives were evaluated in varying populations from different socioeconomic and ethnic backgrounds, and if intervention components were described in detail "]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Children and Young People\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Children and Young People (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Children and Young People\nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Children and Young People (age not specified)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Children and Young People (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]

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[null,"LLEOLIAD GWEITHLE"]
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[null,"CANLLAW: LLEOLIAD GWEITHLE"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. NG209. London: NICE; 2021. Available here.\n\n","Children and Young People (≤ 12years)\n\nAdults\n\nPregnant women \n\nPre-existing health condition:\nHospitalised patients\nUsers of acute care services\nInpatient secondary care\nMental health illness including severe mental health conditions\nMilitary related PTSD","This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines (PH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92) on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.\n\nThis guideline includes new and updated recommendations on:\n- Adult-led interventions in schools\n- Stop-smoking interventions\n- Support to stop smoking in secondary care services\n- Adherence and relapse prevention\n- Identifying pregnant women who smoke and referring them for stop-smoking support\n- Providing support for women to stop smoking during and after pregnancy\n- Commissioning and designing services\n\nIt also includes recommendations on:\n- Organising and planning national, regional or local mass-media campaigns\n- Campaign strategies to prevent uptake and denormalise tobacco use\n- Helping retailers avoid illegal tobacco sales\n- Coordinated approach to school-based interventions\n- Whole-school or organisation-wide smokefree policies\n- Peer-led interventions in schools\n- Using medicinally licensed nicotine-containing products\n- Promoting stop-smoking support\n- Promoting support for people to stop using smokeless tobacco\n- Identifying and quantifying people's smoking\n- Support to stop smoking in primary care and community settings\n- Supporting people who do not want, or are not ready, to stop smoking in one go to reduce their harm from smoking\n- Stopping use of smokeless tobacco\n- Following up pregnant women who have been referred for stop smoking support\n- Policy\n- Training\n\nThis guidance may also be relevant for:\n- Researchers and policy makers\n- Manufacturers and retailers of medicinally licensed nicotine-containing products and nicotine-containing e-cigarettes\n- Members of the public, including:\n● Children, young people, their parents and carers\n● People using health and social care services, and their families and carers\n● Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers\n● People over 16 who smoke and are in paid or voluntary employment\n\nThis guideline updates and replaces the following NICE guidelines:\nSmoking: workplace interventions (PH5, published April 2007)\nSmoking: preventing uptake in children and young people (PH14, published July 2008)\nSmoking prevention in schools (PH23, published February 2010)\nSmoking: stopping in pregnancy and after childbirth (PH26, published February 2010)\nSmokeless tobacco: South Asian communities (PH39, published September 2012)\nSmoking: harm reduction (PH45, published June 2013)\nSmoking: acute, maternity and mental health services (PH48, published November 2013)\nStop-smoking interventions and services (NG92, published March 2018)\n\nPlease note: In November 2021, varenicline was unavailable in the UK due to product manufacturing and release delay due to product/ingredient testing. The manufacturer has taken precautionary measures to stop distribution whilst further testing takes place. In the meantime, the Medicines and Healthcare products Regulatory Agency (MHRA) has advised all Healthcare professionals and trained Stop Smoking advisors in primary, secondary or specialist healthcare services to switch all patients currently prescribed Varenicline to NRT and to prescribe all new patients NRT or bupropion 150mg prolonged release tablets unless contraindicated. For further details, please see the MHRA alert on varenicline."]
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[null,"ARWEINIAD NICE- ADOLYGIADAU TYSTIOLAETH\n"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Angus K et al. Review 6: A review of the effectiveness of smokefree strategies and interventions in secondary care settings. 2013. NICE. NG209.\nAvailable here.","Adults with pre-existing health conditions: patients in secondary care settings including acute and mental health settings","This NICE evidence review aimed to systematically review the effectiveness of smokefree strategies and interventions in secondary care settings (acute, maternity and mental health settings). \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Acute and Maternity Settings): There is weak evidence in an acute and maternity setting that ‘no smoking outdoors’ signage decreases compliance with state indoor (hospital buildings and vehicles) smokefree legislation and a local (hospital board’s) outdoor partial smokefree policy. \n\nEffectiveness of Supporting Strategies and Interventions for Ensuring Compliance (Mental Healthcare Settings): There is weak evidence that staff aiding inpatients’ compliance through strategies such as encouraging patients to participate in smoking cessation groups and addressing patients’\nurge to smoke increases patient compliance a local smokefree buildings policy.\n\nAs the extent of evidence on the effectiveness of smokefree strategies was limited to two studies, the data presented in the following two sections reviews studies using a comparative design to measure indicators of compliance in settings which had a smokefree policy covering the whole\nestate or an indoors-only smokefree policy with at least one supporting strategy.\n\nStaff Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is moderate evidence that the implementation of local-level\npolicy and national legislation for smokefree implementation in an acute and maternity setting decreases the number of staff smoking.\n\nVisitor Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that\nimplementation of local smokefree policies with supporting strategies decreases hospital visitor smoking.\n\nPatient Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence about the impact of local smokefree policies with supporting strategies on inpatient smoking behaviour in an acute and maternity setting. \n\nAll Hospital Users’ Compliance with Smokefree: Smoking Behaviour (Acute & Maternity): There is weak evidence in an acute and maternity setting that local smokefree policy implementation with supporting strategies decreases observed smoking amongst all hospital users as a whole (patients, staff and visitors).\n\nOther Consequences from Smokefree for Staff (Acute & Maternity):\nStaff smoking: There is moderate evidence to suggest that local-level policy and national legislation for smokefree implementation with supporting strategies decreases smoking rates and number of cigarettes smoked both during working hours and overall in an acute and maternity setting amongst staff in an acute and maternity setting.\nStaff quiting activity: There is inconsistent evidence to suggest that smokefree implementation with supporting strategies decreases or has no effect on the number of quit attempts by staff.  There is weak evidence to suggest that implementation of a local smokefree policy for buildings or buildings and grounds with supporting strategies does not change the proportion of staff who quit smoking.\n\nOther Impacts on Patients (Mental healthcare): \nInpatient Smoking and Quitting Behaviours: There is inconsistent evidence that the introduction of smokefree in mental health care settings impacts on inpatient smoking and cessation behaviour outcomes in mental healthcare settings.\nLong Term Smoking Cessation: There is moderate evidence that the introduction of smokefree with appropriate supporting strategies in mental health care settings minimal impact on long term smoking cessation.","This 2012 NICE evidence review formed part of PH48 recommendations and NICE guidance on:\n- 'Smoking cessation in secondary care: acute and maternity services'\n- 'Smoking cessation in secondary care: mental health services'\n\nSome of the recommendations labelled [2013] or [2013, amended 2021] in the updated guideline were based on this evidence reviews. \n\nThe literature searches for this review were conducted in February 2012. A more up-to-date review/s on the topic may be available."]
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[null,"ADOLYGIADAU SYSTEMATAIDD: LLEOLIAD GWEITHLE"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Children and Young People\nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Children and Young People (age group not specified)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]

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["Talfyriadau gyda’u ffurfiau llawn (yn nhrefn yr wyddor)"]
["Talfyriadau","Ffurf lawn"]
["CADTH","CANADIAN AGENCY FOR DRUGS AND TECHNOLOGIES IN HEALTH"]
["CBT","COGNITIVE BEHAVIOURAL THERAPY"]
["CI","CONFIDENCE INTERVAL"]
["CPSTF","COMMUNITY PREVENTIVE SERVICES TASK FORCE"]
["CredI","CREDIBLE INTERVAL"]
["CVD","CARDIOVASCULAR DISEASE"]
["EC","ELECTRONIC CIGARETTE"]
["GAD","GENERALISED ANXIETY DISORDER"]
["GRADE","GRADING OF RECOMMENDATIONS ASSESSMENT, DEVELOPMENT AND EVELUATION"]
["HIV","HUMAN IMMUNODEFICIENCY VIRUS"]
["HTA","HEALTH TECHNOLOGY ASSESSMENT"]
["I2","MEASURE OF HETEROGENEITY"]
["IQI","INTERQUARTILE INTERVAL"]
["MD","MEAN DIFFERENCE"]
["MDD","MAJOR DEPRESSIVE DISORDER"]
["MI","MOTIVATIONAL INTERVIEWING"]
["n","SAMPLE SIZE"]
["NHB ","NON HISPANIC BLACKS"]
["NHS","NATIONAL HEALTH SERVICE"]
["NHW"," NON HISPANIC WHITES"]
["NMR","NICOTINE METABOLITE RATIO"]
["NRT","NICOTINE REPLACEMENT SERVICE"]
["OES","OBSERVATORY EVIDENCE SERVICE"]
["OR","ODDS RATIO"]
["PLWHA","PEOPLE LIVING WITH HIV/AIDS"]
["PTSD ","POST-TRAUMATIC STRESS DISORDER"]
["QALY","QUALITY-ADJUSTED LIFE YEARS"]
["RCT","RANDOMISED CONTROLLED TRIALS"]
["RR","RISK RATIO"]
["SAMe","S‐ADENOSYL‐L‐METHIONINE"]
["SFC","SMOKE FREE CLASS COMPETION"]
["SMD","STANDARDISED MEAN DIFFERENCE"]
["SR","SYSTEMATIC REVIEW"]
["TB","TUBERCULOSIS"]