PulsE
Quarterly eBulletin of public health and health services systematic reviews
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PulsE is a quarterly eBulletin that provides information about newly published systematic reviews of public health and health services interventions. The reviews are drawn from a range of open access sources and are selected for inclusion in the eBulletin because of their relevance to local health policy priorities. More information about the development of PulsE is available here.
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Issue 12 - May 2010
New Reviews
Effectiveness of legislative smoking bans
This Cochrane review aimed to assess the extent to which legislation-based smoking bans or restrictions reduce exposure to second-hand smoke, help people who smoke to reduce tobacco consumption or lower smoking prevalence, and affect the health of those in areas which have a ban or restriction in place. The review synthesised findings from 50 studies and considered both comprehensive bans, which prohibit smoking indoors including in bars and restaurants, and partial bans, which are less comprehensive and allow smoking in designated rooms or areas. Findings from studies which considered exposure to second-hand smoke (SHS) showed a clear reduction in self-reported SHS exposure among hospitality employees. However, there was no evidence of a reduction in exposure to SHS in cars or homes. Studies which considered measures of active smoking as an outcome revealed no consistent evidence of a reduction in smoking prevalence attributable to smoking bans, but several did indicate a drop in average consumption of tobacco. Research which measured the effects of smoking bans on health outcomes suggested a reduction in respiratory and sensory (e.g. eye, nose or throat) symptoms. There was also evidence of a reduction in hospital admission rates for acute myocardial infarction. The authors conclude that legislative smoking bans lead to a reduction in exposure to passive smoking, particularly among hospitality workers, and improved health outcomes; however the impact on active smoking is not yet conclusively demonstrated. Click here.
Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD005992.
Smoke-free policies to reduce tobacco use
Smoke-free policies, which prohibit the smoking of tobacco products in the workplace and in public areas, have been shown to be effective in reducing exposure to second-hand tobacco smoke. This review was conducted by the US Task Force on Community Preventive Services to determine whether smoke-free policies are also effective in reducing tobacco use. The review synthesised findings from 37 studies reported in 35 papers. Among studies which evaluated changes in the prevalence of self-reported smoking, there was a median absolute reduction in tobacco use of 3.4%. Studies which evaluated the impact of smoke-free policies on tobacco-use cessation among workers reported a median absolute improvement in smoking cessation of 6.4%. The review also found that workers who smoke and who were exposed to smoke-free policies reported more cessation attempts and lower levels of daily cigarette consumption than did workers who smoke but were not exposed to these policies. Data from five economic evaluation studies indicated that smoke-free policies could provide substantial savings to an employer, as well as health benefits for former tobacco users. The authors conclude that the review provides sufficient evidence that smoke-free policies are effective in reducing tobacco use when implemented in worksites and communities. Click here.
Hopkins DP, Razi S, Leeks KD, Kalra GP, Chattopadhyay SK, Soler RE, the Task Force on Community Preventive Services. Smokefree policies to reduce tobacco use: A systematic review. American Journal of Preventive Medicine 2010;38(2S):275-89.
Worksite-based incentives and competitions to reduce tobacco use
Thie review, conducted by the US Task Force on Community Preventive Services, aimed to determine the effectiveness of incentives and competitions, alone or when combined with additional interventions, in increasing the cessation of tobacco use among workers. The review synthesised findings from 14 studies which evaluated worksite-based incentives and competitions (e.g. financial rewards, lottery tickets, self-imposed payroll withholdings) combined with additional interventions to reduce tobacco use (e.g. smoking cessation groups, self-help cessation materials, telephone cessation support, workplace smoke-free policies). Compared with controls, smokers who were provided with incentives demonstrated a median absolute increase of 4.4% in rates of tobacco-use abstinence. There was insufficient evidence to determine whether or not worksite-based incentives and competitions alone were effective in reducing tobacco use among workers. A review of costing studies indicated cost savings for employers that implemented programs combining incentives with additional interventions. The authors conclude that there is strong evidence that worksite-based incentives and competitions, when combined with additional interventions to support individual cessation efforts, are effective in reducing tobacco use among workers. Click here.
Leeks KD, Hopkins DP, Soler RE, Aten A, Chattopadhyay SK, the Task Force on Community Preventive Services. Worksite-based incentives and competitions to reduce tobacco use: A systematic review. American Journal of Preventive Medicine 2010;38(2S):264-74.
Effects of worksite health promotion interventions on employee diets
While much research has investigated the promotion of weight loss and increased physical activity opportunities in worksites, little is known regarding the effects of such interventions on dietary habits. This review therefore aimed to assess the effects of worksite interventions on dietary outcomes. The 16 studies included in the review implemented a range of programs, including: employee education (e.g. counselling, shopping tours, individual diet plans, computer-tailored dietary feedback, weekly health promotion email messages); changes to worksite policy and/or environment (e.g. nutrition labelling, vending policies, canteen food supply/availability, menu reformulation); and a combination of both education and environmental changes. In two randomised controlled trials that measured proportional change in combined fruit and vegetable intake, average daily increases ranged from +3% to +16% in intervention groups compared with -2% to +4% in control groups. In five randomised controlled trials that measured total fat as a percent of energy by intervention group, average daily reductions ranged from -2.2% to -9.1% in intervention groups compared with to +1.3% to -1.8% in control groups. Based on these findings, the authors conclude that worksite interventions have a positive, but small, effect on some measures of dietary behaviour. However, it was noted that the quality of worksite studies was often sub-optimal and that the reliance on self-reported methods of dietary assessment increased the risk of bias. The authors suggest that more well-conducted studies are required to reliably determine the effectiveness and cost effectiveness of worksite interventions for improving employee diets. Click here.
Ni Mhurchu C, Aston LM, Jebb SA. Effects of worksite health promotion interventions on employee diets: a systematic review. BMC Public Health 2010;10:62.
Point of decision prompts to increase stair use
This systematic review was conducted by the US Task Force on Community Preventive to update a 2002 review of the effectiveness of point-of-decision stair prompts on increasing stair use. Point-of-decision prompts are motivational signs placed on or near stairwells or at the base of elevators and escalators encouraging people to use stairs; they can be used alone or with stairwell enhancements, such as painting walls, laying carpet, adding artwork, or playing music. A synthesis of findings from 11 studies of stair prompts alone indicated a median 2.4% increase in stair use during the intervention period; the median relative improvement in observed stair use was 50% from baseline. Stair prompts appeared to be effective in a range of settings (e.g. shopping centres, airports, office buildings) and had similar effects for both men and women. The authors concluded that this review provides strong evidence that point-of-decision prompts contribute to modest increases in the percentage of people choosing to take the stairs rather than an elevator or escalator. Two studies assessed the effectiveness of point-of-decision prompts combined with stairwell enhancements. Although both observed improvements in stair use over the period of observation, the authors concluded that there was insufficient evidence to draw conclusions about the effectiveness of combined interventions. Click here.
Soler RE, Leeks KD, Buchanan LR et al. Point-of-Decision Prompts to Increase Stair Use: A Systematic Review Update. American Journal of Preventive Medicine 2010;38(2S):S292-S300.
Effectiveness of primary care interventions for weight management in children and adolescents
This targeted systematic review was undertaken to assist the United States Preventive Services Task Force (USPSTF) in updating its previous recommendation on screening and interventions for overweight children and adolescents. The review aimed to synthesise the evidence on behavioural and pharmacological weight management interventions for overweight and/or obese children and adolescents that are relevant to primary care practice. The review suggests that comprehensive behavioural programs (e.g. dietary counselling, physical activity program or counselling, behaviour modification principles) involving medium- to high-intensity interventions are the most effective behavioural approach. Such interventions consistently resulted in small to moderate short-term improvements, with a weighted mean difference in BMI change of 2.4 kg/m2 between groups. More limited evidence suggests that these improvements can be maintained over the 12 months following treatment cessation, and that they are associated with few harms. Two medications (sibutramine, orlistat) combined with behavioural interventions resulted in small to moderate short-term weight loss in very obese adolescents (BMI reduction of 2.6 kg/m2 more than behavioural treatment plus placebo for sibutramine, 0.85 kg/m2 for orlistat); however, no studies followed weight changes after medication use ended. Potential side effects of medications were greater than for behavioural interventions and varied in severity. The authors conclude that behavioural interventions can be effective in managing weight in obese children and adolescents, and that combined behavioural-pharmacological interventions may be useful in very obese adolescents, particularly if research confirms that weight loss is maintained. Click here.
Whitlock EP, O'Connor EA, Williams SB, Beil TL, Lutz KW. Effectiveness of Primary Care Interventions for Weight Management in Children and Adolescents: An Updated, Targeted Systematic Review for the USPSTF. Rockville, Maryland: Agency for Healthcare Research and Quality; 2010.
Forthcoming Reviews
Community wide interventions for increasing physical activity (Cochrane Public Health Group)
This review will aim to determine the effects of community wide, multi-strategic interventions upon community levels of physical activity, including: whether any effects of the intervention are different within and between populations; other health and behavioural effects; the influence of context in the design, delivery, and outcomes of the interventions; and the relationship between the number of components, duration, and effects of the interventions. Click here.
The effect of early childhood education programs on cognitive and social development of children birth to 6 years of age (The Campbell Collaboration)
This review will aim to assess the effect of child care programs on the cognitive, literacy, communication and social development of children in kindergarten/preschool. The review will consider both type of program and structural conditions (e.g. educational qualification of the child care provider, child-child care provider ratio). Click here.