Suchergebnisse

Background: Defining harm reduction and regulating potentially reduced exposure products (PREPs), including low nicotine products, are key issues in tobacco control policy. The US Congress has been considering legislation authorising the Food and Drug Administration (FDA) to regulate tobacco products.

OBJECTIVE—To identify, from policy makers' perspectives, strategies that enhance tobacco control advocates' effectiveness in the regulatory arena. DESIGN—Key informant interview component of a comparative case study of regulatory agencies in the USA. SUBJECTS—Policy makers involved in the development of four regulatory tobacco control policies (three state and one federal). METHODS—Interviews of policy makers, field notes, and deliberation minutes were coded inductively. RESULTS—Policy makers considered both written commentary and public testimony when developing tobacco control regulations. They triaged written commentary based upon whether the document was from a peer reviewed journal, a summary of research evidence, or from a source considered credible. They coped with in-person testimony by avoiding being diverted from the scientific evidence, and by assessing the presenters' credibility. Policy makers suggested that tobacco control advocates should: present science in a format that is well organised and easily absorbed; engage scientific experts to participate in the regulatory process; and lobby to support the tobacco control efforts of the regulatory agency. CONCLUSIONS—There is an important role for tobacco control advocates in the policy development process in regulatory agencies. Keywords: health policy; regulations; policy makers

OBJECTIVES: The purpose of this study was to examine print media coverage of cigars during the period 1987 to 1997. METHODS: A content analysis of 790 cigar-focused newspaper and magazine articles was conducted. RESULTS: Cigar-focused articles increased substantially over the study period, paralleling increased cigar consumption. Articles focused on cigar business (39%) and events (19%). Only 4% of articles focused on health effects. Sixty-two percent portrayed cigars favorably. The tobacco industry was mentioned in 54% of articles and portrayed positively in 78%. Forty-two percent of the individuals quoted or described in articles were affiliated with the tobacco industry; only 5% were government/public health figures. CONCLUSIONS: Print coverage of cigars failed to communicate health risk messages and contributed to positive images of cigars.

The Framingham Heart Study (henceforth Framingham) is among the gold standards for epidemiological research. A prospective cohort study of 5,000+ men and women, it provided early findings about causes of coronary heart disease (CHD), following a cohort over 24 years. After US government funding ended, the tobacco industry-funded Council for Tobacco Research (CTR) provided continued funding for analyses related to smoking.

OBJECTIVE—To study the role of science related and other arguments in the development of workplace smoking regulations. DESIGN—Case study, content analysis SUBJECTS—Written commentaries and hearing transcripts on proposed indoor air regulations in Maryland and Washington. MAIN OUTCOME MEASURES—We coded each written commentary and hearing testimony for position toward the regulation, affiliation of the person submitting it, criteria used to evaluate science and scientific, ideological, economic, political, engineering and procedural arguments. RESULTS—In both states, opposition to the regulations came primarily from the tobacco industry, small businesses, and business organisations and appeared to be coordinated. There was little coordination of public health support for the regulations. Arguments about science were used more often by those opposed to the regulations than by those in favour. Supporters emphasised the quantity of the evidence, while opponents criticised its reliability, validity, and quality. Arguments not related to science (61% of total arguments; 459/751), were more common than scientific arguments (39% of total arguments; 292/751). Economic and ideological arguments were used to a similar extent by regulation supporters and opponents. CONCLUSIONS—Advocates can support health related regulations by submitting commentary emphasising the sound research base for regulation and countering criticisms of research. National coordination of these efforts could avoid duplication of effort and make more efficient use of limited public health resources. Keywords: workplace smoking regulations; science based arguments

Poor control of cardiovascular disease accounts for a substantial proportion of the disease burden in developing countries, but often essential anticoagulant medicines for preventing strokes and embolisms are not widely available. In 2019, direct oral anticoagulants were added to the World Health Organization's WHO Model list of essential medicines. The aims of this paper are to summarize the benefits of direct oral anticoagulants for patients with cardiovascular disease and to discuss ways of increasing their usage internationally. Although the cost of direct oral anticoagulants has provoked debate, the affordability of introducing these drugs into clinical practice could be increased by: price negotiation; pooled procurement; competitive tendering; the use of patent pools; and expanded use of generics. In 2017, only 14 of 137 countries that had adopted national essential medicines lists included a direct oral anticoagulant on their lists. This number could increase rapidly if problems with availability and affordability can be tackled. Once the types of patient likely to benefit from direct oral anticoagulants have been clearly defined in clinical practice guidelines, coverage can be more accurately determined and associated costs can be better managed. Government action is required to ensure that direct oral anticoagulants are covered by national budgets because the absence of reimbursement remains an impediment to achieving universal coverage. Tackling cardiovascular disease with the aid of direct oral anticoagulants is an essential component of efforts to achieve the World Health Organization's target of reducing premature deaths due to noncommunicable disease by 25% by 2025.

The objective of health technology assessment (HTA) is to support decision making in health care. HTA does not claim to provide a definite solution to a health care problem, but to assist decision makers with evidence-based information about the clinical, ethical, social, and economic implications of the development, diffusion, and use of health care technology.Although technology assessments are primarily based on evidence of effectiveness from clinical research findings, they also contain cost-effectiveness analyses, discussions of organizational and managerial issues related to adopting the assessment's recommendations, and policy analyses of the resources that are needed to implement the recommendations. Therefore, technology assessments contain information that will be interpreted differently depending on the context in which the assessment is implemented.Local circumstances, such as availability of personnel and financial resources, competition for limited resources, and the political situation, will influence the implementation of the findings of technology assessment. Cultural factors, such as the perceived importance of the subject of the technology assessment, attitudes toward technology, and acceptance of change, will also influence the adoption of recommendations from technology assessments.In this report of the EUR-ASSESS Subgroup on Dissemination and Impact, we strive to draw conclusions and make recommendations that will be useful to technology assessment programs in all European countries. However, organizations that attempt to implement the recommendations of this report must take the local and cultural circumstances of their regions into consideration.This report discusses several strategies for informing policy makers and communities of technology assessments:Diffusion is a passive process by which information is spread to an audience,Dissemination is an active process of spreading a message to defined target groups, andImplementation is a still more active process, including interventions to reduce or eliminate barriers to behavior change and/or activities to promote behavior change.In general, technology assessment organizations have given little attention to dissemination or implementation activities. However, as organizations have realized that the results of their assessments may have delayed or no impact on practice, dissemination has moved into the agenda.The goal of the report of the EUR-ASSESS Subgroup on Dissemination and Impact is to provide guidance to technology assessment programs in Europe on: a) the effective dissemination of the products of health care technology assessments programs; and b) the evaluation of the effects of such dissemination.The approach to this task was to: a) conduct a literature review to examine the evidence for the effectiveness of different methods of dissemination and implementation of research findings; b) conduct a survey to determine what technology assessment agencies are currently doing to disseminate and implement technology assessments; and c) describe a marketing strategy for disseminating technology assessments.This summary presents our methods and major conclusions. The overall conclusions of the report are rated according to the strength of the evidence on which they are based. The summary concludes with recommendations for technology assessment agencies that are derived from the major findings of the report as well as the practical experience of the committee members.