When outcomes threaten incomes: a case study of the obstruction of research to reduce teenage smoking.
A case study is presented of Australian efforts to promote an evidence-based, outcome-oriented intervention designed to reduce purchasing of cigarettes by minors. The intervention was supported by a wealth of international research literature, yet for several years was declared unethical by local institutional ethics committees. Eight objections that were raised are reviewed. Each of these objections was spurious yet initially influential. Various advocacy strategies were employed by proponents of the intervention to reframe its public definition. These gradually transformed perceptions of the intervention from one that considered it unethical, to one that considered it a virtual 'vaccine against teenage access to cigarettes' that should be incorporated into routine public health best practice. Those advocating outcome-oriented interventions should not assume that the imperative of influencing health outcomes will dominate perceptions of best practice within the health care system. In situations where competing definitions of the meaning of an intervention dominate decision makers' perceptions of outcome-oriented research, advocacy can be used to reframe these definitions more toward perceptions which are conducive to support and implementation.
Chapman
S
S
Department of Public Health and Community Medicine, University of Sydney, Australia.
D000293:Adolescent; D001315:Australia; D035841:Behavioral Research; D003132:Commerce; D003659:Decision Making, Organizational; D026724:Ethical Review; D017041:Ethics Committees; D028744:Ethics Committees, Research; D019317:Evidence-Based Medicine; D015276:Health Care Rationing; D006801:Humans; D007182:Income; D035846:Law Enforcement; D016730:Program Development; D012106:Research / Q000458:organization & administration / Q000592:standards*; D018570:Risk Assessment; D000074606:Smoking Prevention; D019460:Tobacco Industry / Q000191:economics*