Strategies for Tobacco Control in India: A Systematic Review

BackgroundTobacco control needs in India are large and complex. Evaluation of outcomes to date has been limited.AimTo review the extent of tobacco control measures, and the outcomes of associated trialled interventions, in India.MethodsInformation was identified via database searches, journal hand-searches, reference and citation searching, and contact with experts. Studies of any population resident in India were included. Studies where outcomes were not yet available, not directly related to tobacco use, or not specific to India, were excluded. Pre-tested proformas were used for data extraction and quality assessment. Studies with reliability concerns were excluded from some aspects of analysis. The Framework Convention on Tobacco Control (FCTC) was use as a framework for synthesis. Heterogeneity limited meta-analysis options. Synthesis was therefore predominantly narrative.ResultsAdditional to the Global Tobacco Surveillance System data, 80 studies were identified, 45 without reliability concerns. Most related to education (FCTC Article 12) and tobacco-use cessation (Article 14). They indicated widespread understanding of tobacco-related harm, but less knowledge about specific consequences of use. Healthcare professionals reported low confidence in cessation assistance, in keeping with low levels of training. Training for schoolteachers also appeared suboptimal. Educational and cessation assistance interventions demonstrated positive impact on tobacco use. Studies relating to smoke-free policies (Article 8), tobacco advertisements and availability (Articles 13 and 16) indicated increasingly widespread smoke-free policies, but persistence of high levels of SHS exposure, tobacco promotions and availability—including to minors. Data relating to taxation/pricing and packaging (Articles 6 and 11) were limited. We did not identify any studies of product regulation, alternative employment strategies, or illicit trade (Articles 9, 10, 15 and 17).ConclusionsTobacco-use outcomes could be improved by school/community-based and adult education interventions, and cessation assistance, facilitated by training for health professionals and schoolteachers. Additional tobacco control measures should be assessed.

印度的烟草控制需求规模庞大且形势复杂。迄今为止，针对相关研究成果的评估仍较为有限。
本研究旨在全面回顾印度境内烟草控制措施的覆盖范围，以及与之相关的试验性干预措施的实施效果。
研究数据通过数据库检索、手工期刊检索、参考文献与引文追踪，以及联络领域专家的方式获取。纳入所有以印度居民为研究对象的文献；排除未公开研究结果、未直接关联烟草使用主题，或研究场景并非针对印度的研究。采用经过预测试的标准化数据提取模板开展数据提取与质量评估，存在信度瑕疵的研究将被排除在部分分析环节之外。本研究以《烟草控制框架公约》（Framework Convention on Tobacco Control, FCTC）作为综合分析的理论框架。由于研究间异质性较高，限制了元分析的实施可行性，因此本次综合分析主要采用叙述性综合方法。
除全球烟草监测系统（Global Tobacco Surveillance System）的公开数据外，本次研究共检索到80项相关研究，其中45项未存在信度问题。多数研究聚焦于教育干预（对应《烟草控制框架公约》第12条）与烟草使用戒断干预（对应第14条）。研究结果显示，公众对烟草相关危害已有广泛认知，但对烟草使用的具体健康后果了解仍显不足。医护人员普遍表示，其为吸烟者提供戒断辅助服务的信心不足，这与他们接受的相关培训水平较低的现状相符；针对学校教师的烟草控制培训同样未达最优标准。教育干预与戒断辅助服务对改善烟草使用行为展现出积极效果。针对无烟政策（对应第8条）、烟草广告与产品可及性（对应第13条与第16条）的研究表明，无烟政策的覆盖范围正逐步扩大，但二手烟（Secondhand Smoke, SHS）暴露、烟草促销与产品可及性（包括向未成年人售卖烟草产品）的问题仍普遍存在，且程度较高。关于税收/定价与包装警示措施（对应第6条与第11条）的相关数据较为有限。本次研究未检索到涉及烟草产品监管、替代就业策略或烟草非法贸易（对应第9、10、15与17条）的相关研究。
通过开展面向学校与社区的成人教育干预，以及为医护人员和学校教师提供针对性培训以辅助其开展戒断服务，可有效改善烟草使用相关的健康结局。未来应进一步评估其他各类烟草控制措施的实施效果。