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What Are the Effects of Tobacco Policies on Vulnerable Populations?

A Better Practices Review

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Abstract

Methods: A better practices review model was used to assess the strength of studies published between 1990 and 2004 that examined the effects of these tobacco policies on the three vulnerable populations of interest. A total of 72 studies were assessed and 42 judged medium or high strength. A gender-based and diversity analysis was applied to assess the differential impacts on females and males and/or diverse characteristics within these populations. Intended and unintended consequences were examined.

Findings: Few studies assessed the potential or differential effects of tobacco policies on the three selected populations. In these, it was difficult to disentangle the effects of each policy in a comprehensive tobacco control environment, and there is need for improved indicators and greater attention to sex and gender analysis.

Conclusions: Research is required to measure the intended and unintended impacts of tobacco policies on populations vulnerable to tobacco use. There are problems in assessing these studies that could be resolved with more precise indicator development. An equity-based framework for assessing the effects of tobacco policies is needed that is conceptually linked to health determinants and inequities. The article concludes with a set of recommendations for research, evaluation, policy and ethics arising from this review.

Background: While comprehensive tobacco policies have reduced the prevalence of smoking in Canada, some groups remain vulnerable to tobacco use and display high rates of smoking. This article reviews three types of tobacco policies - tax and price, smoking location restrictions and sales restrictions - and examines the consequences for Aboriginal people, youth and low-income people.

Résumé

Contexte: Les politiques antitabac intégrées ont réduit la prévalence du tabagisme au Canada, mais certains groupes demeurent vulnérables et affichent des taux de tabagisme élevés. Notre article examine trois types de politiques antitabac (les politiques fiscales et de prix, les politiques de restriction des lieux où il est permis de fumer, et les politiques de restriction des ventes de tabac) et leurs conséquences pour les Autochtones, les jeunes et les personnes à faible revenu.

Méthode: Nous avons utilisé un modèle d’examen des pratiques exemplaires pour évaluer la qualité des études publiées entre 1990 et 2004 portant sur les effets de ces politiques antitabac sur les trois populations vulnérables qui nous intéressent. En tout, nous avons évalué 72 études, dont 42 ont été jugées de qualité moyenne ou bonne. Au moyen d’une analyse de la diversité et de l’égalité, nous avons évalué les répercussions différentes sur les femmes et les hommes et/ou les diverses caractéristiques dans ces populations. Les conséquences prévues et imprévues ont été examinées.

Constatations: Peu d’études évaluent les effets possibles ou différents des politiques antitabac sur les trois populations sélectionnées. Dans ces études, il a été difficile de démêler les effets de chaque politique dans le cadre général de la lutte contre le tabagisme; de plus, il faudrait trouver de meilleurs indicateurs et accorder plus d’attention à l’analyse selon le sexe et à celle des rapports entre les sexes.

Conclusions: Il faudrait pousser la recherche pour mesurer les répercussions prévues et imprévues des politiques antitabac sur les populations vulnérables au tabagisme. Les problèmes d’évaluation des études publiées pourraient être résolus avec des indicateurs plus précis. Il faudrait un cadre d’évaluation des effets des politiques antitabac qui soit fondé sur l’égalité et qui soit conceptuellement lié aux déterminants de la santé et aux inégalités sur le plan de la santé. À la fin de l’article, nous formulons un ensemble de recommandations pour la recherche, l’évaluation, les politiques et les questions éthiques découlant de notre examen.

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Authors and Affiliations

  1. British Columbia Centre of Excellence for Women’s Health, BC Women’s Hospital, E-311 4500 Oak St., Vancouver, BC, V6H 3N1, Canada

    Lorraine Greaves PhD, Natasha Jategaonkar MSc, Melissa McGowan MHK, Lucy McCullough BSc & Lupin Battersby MA

  2. School of Nursing, University of British Columbia, Vancouver, Canada

    Joy Johnson PhD, RN

  3. Faculty of Health and Social Development, University of British Columbia Okanagan, Canada

    Joan Bottorff PhD, RN

  4. Dept. of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada

    Susan Kirkland PhD

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  1. Lorraine Greaves PhD
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  2. Joy Johnson PhD, RN
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  3. Joan Bottorff PhD, RN
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  4. Susan Kirkland PhD
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  5. Natasha Jategaonkar MSc
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  8. Lupin Battersby MA
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Correspondence to Lorraine Greaves PhD.

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Acknowledgements: This paper stems from a larger work entitled, “Reducing Harm: A Better Practices Review of Tobacco Policy and Vulnerable Populations,” funded by the Canadian Tobacco Control Research Initiative.

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Greaves, L., Johnson, J., Bottorff, J. et al. What Are the Effects of Tobacco Policies on Vulnerable Populations?. Can J Public Health 97, 310–315 (2006). https://doi.org/10.1007/BF03405610

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