Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review.
BACKGROUND
Policymakers need estimates of the impact of tobacco control (TC) policies to set priorities and targets for reducing tobacco use. We systematically reviewed the independent effects of TC policies on smoking behavior.


METHODS
We searched MEDLINE (through January 2012) and EMBASE and other databases through February 2009, looking for studies published after 1989 in any language that assessed the effects of each TC intervention on smoking prevalence, initiation, cessation, or price participation elasticity. Paired reviewers extracted data from studies that isolated the impact of a single TC intervention.


RESULTS
We included 84 studies. The strength of evidence quantifying the independent effect on smoking prevalence was high for increasing tobacco prices and moderate for smoking bans in public places and antitobacco mass media campaigns. Limited direct evidence was available to quantify the effects of health warning labels and bans on advertising and sponsorship. Studies were too heterogeneous to pool effect estimates.


CONCLUSIONS
We found evidence of an independent effect for several TC policies on smoking prevalence. However, we could not derive precise estimates of the effects across different settings because of variability in the characteristics of the intervention, level of policy enforcement, and underlying tobacco control environment.
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. lisawilson@jhmi.edu
Lisa M
LM
Wilson
Erika
E
Avila Tang
Geetanjali
G
Chander
Heidi E
HE
Hutton
Olaide A
OA
Odelola
Jessica L
JL
Elf
Brandy M
BM
Heckman-Stoddard
Eric B
EB
Bass
Emily A
EA
Little
Elisabeth B
EB
Haberl
Benjamin J
BJ
Apelberg
D000293:Adolescent; D000328:Adult; D000329:Advertising / Q000379:methods; D000367:Age Factors; D000368:Aged; D002648:Child; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D008402:Mass Media; D008875:Middle Aged; D015995:Prevalence; D011640:Public Policy; D012907:Smoking / Q000191:economics / Q000453:epidemiology* / Q000331:legislation & jurisprudence; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D055815:Young Adult