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The Lancet. Public Health Aug 2021Smoke-free policies in outdoor areas and semi-private and private places (eg, cars) might reduce the health harms caused by tobacco smoke exposure (TSE). We aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Smoke-free policies in outdoor areas and semi-private and private places (eg, cars) might reduce the health harms caused by tobacco smoke exposure (TSE). We aimed to investigate the effect of smoke-free policies covering outdoor areas or semi-private and private places on TSE and respiratory health in children, to inform policy.
METHODS
In this systematic review and meta-analysis, we searched 13 electronic databases from date of inception to Jan 29, 2021, for published studies that assessed the effects of smoke-free policies in outdoor areas or semi-private or private places on TSE, respiratory health outcomes, or both, in children. Non-randomised and randomised trials, interrupted time series, and controlled before-after studies, without restrictions to the observational period, publication date, or language, were eligible for the main analysis. Two reviewers independently extracted data, including adjusted test statistics from each study using a prespecified form, and assessed risk of bias for effect estimates from each study using the Risk of Bias in Non-Randomised Studies of Interventions tool. Primary outcomes were TSE in places covered by the policy, unplanned hospital attendance for wheezing or asthma, and unplanned hospital attendance for respiratory tract infections, in children younger than 17 years. Random-effects meta-analyses were done when at least two studies evaluated policies that regulated smoking in similar places and reported on the same outcome. This study is registered with PROSPERO, CRD42020190563.
FINDINGS
We identified 5745 records and assessed 204 full-text articles for eligibility, of which 11 studies met the inclusion criteria and were included in the qualitative synthesis. Of these studies, seven fit prespecified robustness criteria as recommended by the Cochrane Effective Practice and Organization of Care group, assessing smoke-free cars (n=5), schools (n=1), and a comprehensive policy covering multiple areas (n=1). Risk of bias was low in three studies, moderate in three, and critical in one. In the meta-analysis of ten effect estimates from four studies, smoke-free car policies were associated with an immediate TSE reduction in cars (risk ratio 0·69, 95% CI 0·55-0·87; 161 466 participants); heterogeneity was substantial (I 80·7%; p<0·0001). One additional study reported a gradual TSE decrease in cars annually. Individual studies found TSE reductions on school grounds, following a smoke-free school policy, and in hospital attendances for respiratory tract infection, following a comprehensive smoke-free policy.
INTERPRETATION
Smoke-free car policies are associated with reductions in reported child TSE in cars, which could translate into respiratory health benefits. Few additional studies assessed the effect of policies regulating smoking in outdoor areas and semi-private and private places on children's TSE or health outcomes. On the basis of these findings, governments should consider including private cars in comprehensive smoke-free policies to protect child health.
FUNDING
Dutch Heart Foundation, Lung Foundation Netherlands, Dutch Cancer Society, Dutch Diabetes Research Foundation, Netherlands Thrombosis Foundation, and Health Data Research UK.
Topics: Child; Environmental Exposure; Humans; Non-Randomized Controlled Trials as Topic; Randomized Controlled Trials as Topic; Respiratory Tract Diseases; Smoke-Free Policy; Tobacco Smoke Pollution
PubMed: 34274050
DOI: 10.1016/S2468-2667(21)00097-9 -
International Journal of Environmental... Jul 2022This review paper provides preliminary analysis and answers to three key questions that were identified by synthesizing qualitative evidence from climate security... (Review)
Review
This review paper provides preliminary analysis and answers to three key questions that were identified by synthesizing qualitative evidence from climate security research in Japan. The questions identified are: (1) Has Japan participated in the global climate security debate at all? (2) Why did climate security struggle to become a major political theme in Japan until 2020? (3) Why did Japan explicitly start dealing with climate security as a policy issue in 2020? We identify and discuss four key reasons relative to the second question. The review provides key details (and general parameters) of these questions that have been overlooked by not only Japanese researchers but also climate security research conducted between 2017 and 2022 in Europe and the United States. Climate security suddenly became a trending topic among Japanese researchers and political elites in 2020; we find evidence that future studies could provide important and more robust insight if an analysis of the above questions is supported by interview data obtained from Japanese government officials. In doing so, researchers will be able to provide valuable insight into the possibility (and extent) that inter-ministerial rivalry between key ministries has impeded domestic progress on climate security action. Furthermore, three separate projects on climate security have been commissioned and recently implemented in Japan. These form the basis for this first systematic literature review of 34 papers and the related research reports resulting from these projects. These papers and reports were retrieved from the electronic databases of Google Scholar, ProQuest, and the National Institute for Environmental Studies in April 2022. While the main limitation of this review paper is that readers are expected to connect these questions to their own experiences at the global level, we reduce the possibility of presenting biased information by identifying and verifying missing details. For example, we had difficulty identifying the method used in one of the co-authored papers and contacted the corresponding author. In summary, sustained discussion in academia and high-politics settings should eventually lead to a greater awareness about climate security.
Topics: Climate; Climate Change; Japan; Policy; Politics; United States
PubMed: 35886111
DOI: 10.3390/ijerph19148253 -
Preventive Medicine Aug 2023Policy, systems, and environmental (PSE) approaches can facilitate physical activity in priority populations (e.g., racial and ethnic minority, low wealth groups) within... (Review)
Review
Policy, systems, and environmental (PSE) approaches can facilitate physical activity in priority populations (e.g., racial and ethnic minority, low wealth groups) within early childhood education (ECE) settings. The purpose of this review was to 1) characterize the inclusion of priority populations within ECE physical activity interventions containing PSE approaches and 2) identify and describe interventions within these populations. Seven databases were systematically searched (January 2000-Febrary 2022) for ECE-based interventions focusing on children (0-6 years) that utilized at least one PSE approach. Eligible studies included a child physical activity or physical activity environment outcome and child or center-level population characteristics. Forty-four studies, representing 42 interventions were identified. For Aim 1, half of interventions included one PSE approach (21/42), with only 11/42 including three or more approaches. Physical environment changes [e.g., adding play equipment, modifying space (25/42)] were the most used PSE approaches followed by system [e.g., integrating activity into routines, (21/42)] and policy [e.g., outdoor time (20/42)] approaches. Nearly half of interventions were conducted in predominantly priority populations (18/42). Studies were primarily rated as good (51%) or fair (38%) methodological quality using the Downs and Black checklist. In Aim 2, of the 12 interventions assessing child physical activity in priority populations, 9/12 reported at least one physical activity outcome in the expected direction. Of the 11 interventions assessing the physical activity environment, 9/11 reported an effect in the expected direction. Findings indicate clear opportunities exist to target priority populations by incorporating PSE approaches in ECE physical activity interventions.
Topics: Child; Child, Preschool; Humans; Ethnicity; Minority Groups; Exercise; Policy
PubMed: 37414226
DOI: 10.1016/j.ypmed.2023.107606 -
Globalization and Health Nov 2023Emerging infectious diseases of zoonotic origin present a critical threat to global population health. As accelerating globalisation makes epidemics and pandemics more... (Review)
Review
BACKGROUND
Emerging infectious diseases of zoonotic origin present a critical threat to global population health. As accelerating globalisation makes epidemics and pandemics more difficult to contain, there is a need for effective preventive interventions that reduce the risk of zoonotic spillover events. Public policies can play a key role in preventing spillover events. The aim of this review is to identify and describe evaluations of public policies that target the determinants of zoonotic spillover. Our approach is informed by a One Health perspective, acknowledging the inter-connectedness of human, animal and environmental health.
METHODS
In this systematic scoping review, we searched Medline, SCOPUS, Web of Science and Global Health in May 2021 using search terms combining animal health and the animal-human interface, public policy, prevention and zoonoses. We screened titles and abstracts, extracted data and reported our process in line with PRISMA-ScR guidelines. We also searched relevant organisations' websites for evaluations published in the grey literature. All evaluations of public policies aiming to prevent zoonotic spillover events were eligible for inclusion. We summarised key data from each study, mapping policies along the spillover pathway.
RESULTS
Our review found 95 publications evaluating 111 policies. We identified 27 unique policy options including habitat protection; trade regulations; border control and quarantine procedures; farm and market biosecurity measures; public information campaigns; and vaccination programmes, as well as multi-component programmes. These were implemented by many sectors, highlighting the cross-sectoral nature of zoonotic spillover prevention. Reports emphasised the importance of surveillance data in both guiding prevention efforts and enabling policy evaluation, as well as the importance of industry and private sector actors in implementing many of these policies. Thoughtful engagement with stakeholders ranging from subsistence hunters and farmers to industrial animal agriculture operations is key for policy success in this area.
CONCLUSION
This review outlines the state of the evaluative evidence around policies to prevent zoonotic spillover in order to guide policy decision-making and focus research efforts. Since we found that most of the existing policy evaluations target 'downstream' determinants, additional research could focus on evaluating policies targeting 'upstream' determinants of zoonotic spillover, such as land use change, and policies impacting infection intensity and pathogen shedding in animal populations, such as those targeting animal welfare.
Topics: Animals; Humans; Zoonoses; Communicable Diseases, Emerging; Global Health; Policy Making; Policy
PubMed: 37940941
DOI: 10.1186/s12992-023-00986-x -
The International Journal on Drug Policy Oct 2022Continuing professional development (CPD) for opioid agonist therapy (OAT) has been identified as a key health policy strategy to improve care for people living with... (Review)
Review
BACKGROUND
Continuing professional development (CPD) for opioid agonist therapy (OAT) has been identified as a key health policy strategy to improve care for people living with opioid use disorder (OUD) and to address rising opioid-related harms. To design and deliver effective CPD programs, there is a need to clarify how they work within complex health system and policy contexts. This review synthesizes the literature on OAT CPD programs and educational theory to clarify which interventions work, for whom, and in what contexts.
METHODS
A systematic review and realist synthesis of evaluations of CPD programs focused on OAT was conducted. This included record identification and screening, theory familiarization, data collection, analysis, expert consultation, and iterative context-intervention-mechanism-outcome (CIMO) configuration development.
RESULTS
Twenty-four reports comprising 21 evaluation studies from 5 countries for 3373 providers were reviewed. Through iterative testing of included studies with relevant theory, five CIMO configurations were developed. The programs were categorized by who drove the learning outcomes (i.e., system/policy, instructor, learner) and their spheres of influence (i.e., micro, meso, macro). There was a predominance of instructor-driven programs driving change at the micro level, with few policy-driven macro-influential programs, inconsistent with the promotion of CPD as a clear opioid crisis policy-level intervention.
CONCLUSION
OAT CPD is challenged by mismatches in program justifications, objectives, activities, and outcomes. Depending on how these program factors interact, OAT CPD can operate as a barrier or facilitator to OUD care. With more deliberate planning and consideration of program theory, programs more directly addressing diverse learner and system needs may be developed and delivered. OAT CPD as drug policy does not operate in isolation; programs may feed into each other and intercalate with other policy initiatives to have micro, meso, and macro impacts on educational and population health outcomes.
Topics: Analgesics, Opioid; Health Policy; Humans; Opiate Substitution Treatment; Opioid Epidemic; Opioid-Related Disorders
PubMed: 35930903
DOI: 10.1016/j.drugpo.2022.103807 -
International Journal of Environmental... Jul 2022Ethiopia passed a law prohibiting tobacco smoking in all public places in 2019. We conducted a scoping review to identify gaps in the existing literature on second-hand... (Review)
Review
Ethiopia passed a law prohibiting tobacco smoking in all public places in 2019. We conducted a scoping review to identify gaps in the existing literature on second-hand smoke (SHS) exposure and smoke-free environments in Ethiopia that need to be prioritised for future research to support policy and practice. We conducted systematic searches in January 2022 in the following databases: Medline, EMBASE, and PsycInfo. Two reviewers independently screened the identified study reports for eligibility and extracted data from the eligible studies. The extracted data was descriptively analysed, and research recommendations were drawn. A stakeholder consultation workshop was held to identify research topics on SHS exposure and smoke-free environments in Ethiopia that they perceived to be priorities for primary research. Of the 388 research reports identified, only nine were included in the scoping review. The topics explored includes prevalence of SHS exposure (six studies); knowledge on SHS exposure (three studies); compliance to smoke-free environments legislation (two studies); and exposure to anti-smoking messages (one study). The stakeholders prioritised further research addressing compliance monitoring and enforcement of the smoke free laws in Ethiopia. There is a need for studies that test new methods for compliance monitoring and enforcement, evaluate strategies to increase knowledge on the harms of SHS exposure and the smoke-free legislation, and evaluate the current smoke-free legislation in Ethiopia.
Topics: Ethiopia; Narration; Prevalence; Smoke-Free Policy; Tobacco Smoke Pollution
PubMed: 35886256
DOI: 10.3390/ijerph19148404 -
BMC Public Health Aug 2014Intimate partner violence (IPV) is a significant global public health issue. The consistent evidence that alcohol use by one or both partners contributes to the risk and... (Review)
Review
BACKGROUND
Intimate partner violence (IPV) is a significant global public health issue. The consistent evidence that alcohol use by one or both partners contributes to the risk and severity of IPV suggests that interventions that reduce alcohol consumption may also reduce IPV. This study sought to review the evidence for effects on IPV of alcohol interventions at the population, community, relationship and individual levels using the World Health Organization ecological framework for violence.
METHODS
Eleven databases including Medline, PsycINFO, CINAHL and EMBASE were searched for English-language studies and grey literature published 1 January 1992 - 1 March 2013 investigating whether alcohol interventions/policies were associated with IPV reduction within adult (≥ 18) intimate relationships. Eleven studies meeting design criteria for attributing effects to the intervention and ten studies showing mediation of alcohol consumption were included in the review. The heterogeneity of study designs precluded quantitative meta analysis; therefore, a critical narrative approach was used.
RESULTS
Population-level pricing and taxation studies found weak or no evidence for alcohol price changes influencing IPV. Studies of community-level policies or interventions (e.g., hours of sale, alcohol outlet density) showed weak evidence of an association with IPV. Couples-based and individual alcohol treatment studies found a relationship between reductions in alcohol consumption and reductions in IPV but their designs precluded attributing changes to treatment. Randomized controlled trials of combined alcohol and violence treatment programs found some positive effects of brief alcohol intervention as an adjunct to batterer treatment for hazardous drinking IPV perpetrators, and of brief interventions with non-dependent younger populations, but effects were often not sustained.
CONCLUSIONS
Despite evidence associating problematic alcohol use with IPV, the potential for alcohol interventions to reduce IPV has not been adequately tested, possibly because studies have not focused on those most at risk of alcohol-related IPV. Research using rigorous designs should target young adult populations among whom IPV and drinking is highly prevalent. Combining alcohol and IPV intervention/policy approaches at the population, community, relationship and individual-level may provide the best opportunity for effective intervention.
Topics: Adult; Alcohol Drinking; Databases, Factual; Female; Health Policy; Humans; Interpersonal Relations; Male; Spouse Abuse; Young Adult
PubMed: 25160510
DOI: 10.1186/1471-2458-14-881 -
Environmental Science and Pollution... Dec 2020Green consumption can facilitate sustainable industrial development and improve the overall efficiency of resource utilization. In response to rapid economic development... (Meta-Analysis)
Meta-Analysis Review
Green consumption can facilitate sustainable industrial development and improve the overall efficiency of resource utilization. In response to rapid economic development and increasing environmental emissions, it is critical to promote green consumption so that the whole society can move toward sustainable development. This study aims to systematically review studies on green consumption by means of meta-analysis, bibliometric analysis, and social network analysis. The results show that green consumption is an interdisciplinary research field, involving environmental science, social science, medical science, economics, and other disciplines. Most productive countries, institutions, authors are identified so that the new researchers in this field can find their research partners. Keywords analysis results help identify the research hotpots in this field. It is suggested that future green consumption research should focus on behavior mechanism, stakeholder coordination, and policy evaluation. In general, the results obtained from this study provide valuable information for researchers and practitioners to promote green consumption research.
Topics: Bibliometrics; Efficiency; Knowledge; Sustainable Development
PubMed: 33001398
DOI: 10.1007/s11356-020-11029-y -
Health Research Policy and Systems May 2021Various interventions have been undertaken in Iran to promote evidence-informed health policy-making (EIHP). Identifying the challenges in EIHP is the first step toward...
BACKGROUND
Various interventions have been undertaken in Iran to promote evidence-informed health policy-making (EIHP). Identifying the challenges in EIHP is the first step toward strengthening EIHP in each country through the design of tailored interventions. Therefore, the current study was conducted to synthesize the results of earlier studies and to finalize the list of barriers to EIHP in Iran.
METHODS
To identify the barriers to EIHP in Iran, two steps were taken: a systematic review and policy dialogue. To conduct the systematic review, three Iranian databases and PubMed, Health Systems Evidence (HSE), Embase, and Scopus were searched. The reference lists of included papers and documentation from some local organizations were hand-searched. Upon conducting the systematic review, given the significance of stakeholders in clarifying the problem of EIHP, policy dialogue was used to complete the list previously extracted and to do advocacy. Selection criteria for the stakeholders included influential and informed individuals from knowledge-producing, knowledge-utilizing, and knowledge-brokering organizations. Semi-structured interviews were held with three important absent stakeholders.
RESULTS
Challenges specific to Iran that were identified included the lack of integration of the health ministry and the medical universities, lack of ties between health knowledge utilization organizations, failure to establish long-term research plans, neglect of national research needs at the time of recruiting human resources in knowledge-producing organizations, and duplication and lack of coordination in routine data obtained from surveillance systems, disease registration systems, and censuses. It seems that some challenges are common across countries, including neglecting the importance of inter- and intra-disciplinary studies, the capacity of policy-makers and managers to utilize evidence, the criteria for evaluating the performance of policy-makers, managers, and academic members, the absence of long-term programmes in knowledge-utilizing organizations, the rapid replacement of policy-makers and managers, and lack of use of evaluation studies.
CONCLUSIONS
In this study, we tried to identify the challenges regarding EIHP in Iran using a systematic review and policy dialogue approach. This is the first step toward determining the best interventions to improve evidence-informed policy-making in each country, because these challenges are contextual and need to be investigated contextually.
Topics: Administrative Personnel; Government Programs; Health Policy; Humans; Iran; Policy Making
PubMed: 33947402
DOI: 10.1186/s12961-021-00717-x -
The Milbank Quarterly Jun 2015POLICY POINTS: Many barriers hamper advocacy for health equity, including the contemporary economic zeitgeist, the biomedical health perspective, and difficulties... (Review)
Review
UNLABELLED
POLICY POINTS: Many barriers hamper advocacy for health equity, including the contemporary economic zeitgeist, the biomedical health perspective, and difficulties cooperating across policy sectors on the issue. Effective advocacy should include persistent efforts to raise awareness and understanding of the social determinants of health. Education on the social determinants as part of medical training should be encouraged, including professional training within disadvantaged communities. Advocacy organizations have a central role in advocating for health equity given the challenges bridging the worlds of civil society, research, and policy.
CONTEXT
Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to-and distributions of-the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts.
METHODS
This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature.
FINDINGS
The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by "packaging" it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with or experience of hardship, can be particularly persuasive in advocacy efforts. Different types of advocacy messages can accompany evidence, but messages should be tailored to advocacy target. Several barriers hamper advocacy efforts. The most frequently cited in the academic literature are the current political and economic zeitgeist and related public opinion, which tend to blame disadvantaged people for their ill health, even though biomedical approaches to health and political short-termism also act as barriers. These barriers could be tackled through long-term actions to raise public awareness and understanding of the SDH and through training of health professionals in advocacy. Advocates need to take advantage of "windows of opportunity," which open and close quickly, and demonstrate expertise and credibility.
CONCLUSIONS
This article brings together for the first time evidence from the academic and the gray literature and provides a building block for efforts to advocate for health equity. Evidence regarding many of the dimensions is scant, and additional research is merited, particularly concerning the applicability of findings outside the English-speaking world. Advocacy organizations have a central role in advocating for health equity, given the challenges bridging the worlds of civil society, research, and policy.
Topics: Cost-Benefit Analysis; Global Health; Health Policy; Health Status Disparities; Human Rights; Humans; International Agencies; Patient Advocacy; Politics; Social Determinants of Health; Social Justice
PubMed: 26044634
DOI: 10.1111/1468-0009.12112