Building knowledge for action through research
Research at The Union focuses on describing the burden of tobacco-related lung disease, understanding the underlying drivers of tobacco use, and helping people to stop smoking:
Tobacco smoking and tuberculosis care outcomes
- A joint Union-WHO/Stop TB report and systematic qualitative review of the evidence linking tobacco smoke exposure to tuberculosis outcomes has been written. It will be published by Stop TB.
- A shorter version of the above report was published in the October 2007 issue of the International Journal on Tuberculosis and Lung Disease (IJTLD). It featured a meta-analysis of pooled results prepared by the Union. It examined the strength of the evidence and the odds ratios for the association between: (1) passive smoking and tuberculosis disease (2) active smoking and tuberculous infection, tuberculosis disease, retreatment of tuberculosis disease and tuberculosis mortality
- In February 2007 the IJTLD published the results of a joint Union-Epilab study in Sudan. This showed the feasibility, and potentially important treatment outcome benefits, of adding tobacco cessation interventions to tuberculosis case management.
- The next step in the development of cessation interventions for TB patients was the creation of a large randomised clinical trial in TB clinics in Morocco (ETTAM). This was a joint collaboration between the Union, the Morocco National TB Programme, and the Departments of Respiratory Medicine and Epidemiology and Public Health at the University of Fez. The trial investigated both the results of smoking cessation interventions on smoking rates and on TB treatment outcomes. The study is currently at the stage of data analysis.
- The above studies were instrumental in the development of a Union Guide on tobacco cessation treatment for tuberculosis patients. It is based on a series of six educational articles published from March to August 2007 in the IJTLD. The Guide covers the steps necessary for successfully integrating cessation treatments into tuberculosis case management.
- In late 2007 The Union and members of the Tobacco Prevention Section, in collaboration with the Global Treatment Partnership, will develop demonstration programmes and protocols to build on the Guide. They will also propose alternative cessation intervention projects for health care systems.
- The Union is developing, with funding from the World Bank, iterative demonstration projects for building comprehensive lung health. They will have a tobacco cessation component for tuberculosis patients, which is being developed in collaboration with partners in Sudan, China and Bénin.
- An important part of the development of tobacco control activities is the understanding of the current state of smoking attitudes and behaviours. The Union, and the Department of Epidemiology and Public Health of the University of Fez, undertook a national survey (the MARTA survey) of tobacco use and tobacco-related attitudes. They sampled almost 11,000 people across Morocco. The survey data is currently being analysed.
- In light of recent developments in international tobacco control, the 1998 Union Guide on Tobacco Control and Prevention for low-income countries is being rewritten for 2008.
- The Union collaborated in a French survey investigating belief in and use of tobacco control interventions in primary care. It was organised by a private research institute and the French Agency on Disease Surveillance. The data has been analysed and the Union and partners are preparing a paper to submit for publication in 2008.
- Many of the difficulties experienced by health care practices are due to the behaviour of patients and health professionals, and health infrastructures. These experiences are currently being documented for a Guide on Behaviour and Lung Health that will be available in 2008.