Clearing the Smoke Assessing the Science Base for Tobacco Harm Reduction (2001) / Chapter Skim
Currently Skimming:
6 Surveillance for the Health and Behavioral Consequences of Exposure Reduction
6 Surveillance for the Health and Behavioral Consequences of Exposure Reduction
Pages 180-200
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 180... ...
The Centers for Disease Control and Prevention (CDC) offers the following definition of surveillance (Thacker and Berkelman, 1988~: Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know.
|
From page 181... ...
Active surveillance would seem to be essential for helping to assess the impact of PREPs in population context. This chapter reviews existing surveillance systems and activities for monitoring tobacco product exposure and their health consequences, with emphasis on the introduction and use of PREPs and the issue of harm reduction in the United States.
|
From page 182... ...
Central to any surveillance system is accurate characterization of environmental exposures of interest. With respect to conventional tobacco products and PREPs, documenting the physical and chemical content of these products, including additives and structural components, is critical.
|
From page 183... ...
Current surveillance of tobacco-related illnesses through mechanisms such as vital records and disease registries provide important information. The development of additional types of registries, clinical record monitoring systems, and systems measuring aggregate health outcomes would add further useful information.
|
From page 184... ...
Several researchers analyze and report industry lobbying, sponsorship, and public relations activities (Glantz and Begay, 1994; Glantz et al., 1996; Siegel, 2000~. Biomarkers of Exposure to Tobacco Products The National Health and Nutrition Examination Survey (NHANES)
|
From page 185... ...
However, there is insufficient but growing ascertainment of specific tobacco product brands or detailed smoking behaviors. The National Center for Environmental Health at CDC is building capacity for monitoring and research on tobacco products, including studies of biomarkers in human body fluids.
|
From page 186... ...
Stage of change Motivation to quit MD discuss tobacco MD advise quitting Dentist discuss tobacco Dentist advise quitting Methodist used to quit Ever use other tobacco products Current use of other tobacco products Self-esteem Stress Depressive symptoms/other mental health indicators Perception of youth smoking prevalence Family/peer use of tobacco Parental relationship quality Parental monitoring Anti-tobacco socialization by parents Home bans Home exposure to ETS Worksite indoor air policy X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X continues
|
From page 187... ...
As noted above, the NHANES assesses adult use and serum cotinine values to biochemically validate active use and assess exposure to environmental tobacco smoke. Two ongoing surveys provide information on tobacco and reproductive health issues.
|
From page 188... ...
Further, tobacco usage histories on vital record documents has not been fully validated, and linking mortality to tobacco product use generally requires special studies. Other Surveillance Activities: The Social and Legislative Environment Current systems monitor state and local legislation and programmatic activities (CDC, 2001; Robert Wood Johnson Foundation, 2001; Stillman et al.
|
From page 189... ...
Specific Tobacco Constituents of Both the Products and the Smoke They Generate At the time of PREP and other new product release, there should be detailed, manufacturer-derived information on important and major physical and chemical constituents of all tobacco products, including additives and the structural components of the products, such as filters, fibers, and fragments of fibers. Some independent postmarketing monitoring of product constituents may be necessary to ensure that changes are known to the public and the scientific community.
|
From page 190... ...
The specific biomarkers to be determined would evolve over time with scientific advancements and would be aimed at biomarker-based determination of exposure to tobacco products in general, including environmental tobacco smoke, and to specific constituents that might allow determination of specific tobacco product usage or that have predictive value for tobacco-related diseases and conditions. Additional relevant biomarkers are suggested in Section II of this volume.
|
From page 191... ...
Baseline data on a number of relevant variables would provide researchers with information that may explain, at least in part, why some tobacco users adopt PREPs, others do not, and others simply quit. This study would need to measure and statistically control for other environmental factors (e.g., prices of tobacco products, policy changes, treatment options, and emerging medical information)
|
From page 192... ...
National morbidity data could in itself provide important insights into tobacco product and PREP outcomes, but could also be used for other analytical studies. For example, ecological comparisons of lung cancer mortality rates (from the National Vital Statistics System)
|
From page 193... ...
As noted elsewhere in this volume, current tobacco products cause many other important health conditions as well as dysfunction and disability; and the effects of new tobacco products may be in opposite directions, causing lesser incidence of some but greater incidence of other outcomes. Thus, in addition to specific major disease outcomes, more summary and inclusive measures of health status and outcomes should be used in assessing PREP effects.
|
From page 194... ...
However, it seems important to define aggregate health measures that are sufficiently comprehensive and sensitive to the changing constituents of new tobacco products, in order to define health problems in global as well as specific terms.
|
From page 195... ...
It is likely that the elements of surveillance will come from many sources, and a coordinated effort will be needed to plan, assimilate, and interpret information for reasons of efficiency and standardization. As noted elsewhere in this volume, it will be important to include all conventional tobacco products, since they become one critical reference for health outcome studies, and to monitor changes in these products themselves.
|
From page 196... ...
Some of the biomarkers of exposure used in the past, such as cotinine, may still have utility for assessing conventional tobacco product exposure, but as new PREPs come to the marketplace, these markers may no longer be fully suitable because they won't necessarily serve as adequate surrogate markers for the range of major tobacco constituents. Some elements of a comprehensive surveillance system, such as mandating tobacco manufacturers to report product characteristics, ingredients, additives, and brand-specific sales and distribution data might require a legislative or regulatory approach to enforce.
|
From page 197... ...
Given this approach, the committee makes the following recommendations: 1. There is an urgent need for a national comprehensive surveillance system that collects information on a broad range of elements necessary to understand the population impact of tobacco products and PREPs, including attitudes, beliefs, product characteristics, product distribution and usage patterns, marketing messages such as harm reduction claims and advertising, the incidence of initiation and quitting and nontobacco risk factors for tobacco-related conditions.
|
From page 198... ...
2000a. "Tar, nicotine, and carbon monoxide of the smoke of 1294 varieties of domestic cigarettes for the year 1998." A Federal Trade Commission Report to Congress Quly 2000~.
|
From page 199... ...
1999. Health status assessment methods for adults: past accomplishments and future challenges.
|
From page 200... ...
. NVSS (National Vital Statistics System)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.