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  • Perhaps counter intuitively the most strategic tobacco contr

    2019-05-30

    Perhaps counter-intuitively, the most strategic tobacco control policies to reduce adolescent smoking and secondhand smoke exposure in LMICs may not be those targeting adolescents. Targeted campaigns can be expensive, and are unlikely to be as effective as the more affordable tobacco control policies in the WHO , and its MPOWER package of policies. For example, raising tobacco taxes can lead to rapid decreases in tobacco consumption, has a greater impact on younger than older smokers, is achievable in LMICs, and leads to increased government revenue for other tobacco control policies. Adolescents will also benefit from LMICs banning tobacco advertising and promotion, and introducing regulations to protect non-smokers from secondhand smoke. Because the current and future profitability of transnational tobacco companies is reliant on smoking increasing in LMICs, these companies continue to target children in their marketing and promotion of tobacco. They use their considerable political influence to consistently oppose the introduction of evidence-based tobacco control policies in LMICs, and undermine these policies when introduced. Without exposing and combating the influence of these tobacco companies, we will not be able to effectively reduce adolescent smoking or deaths from smoking in LMICs.
    In 2015, WHO announced a plan to end tuberculosis by 2035 (their End TB Strategy) and set ambitious intermediate targets to reduce tuberculosis incidence by 50% and mortality by 75% by 2025. In , two related papers by Rein Houben and Nicolas Menzies and their colleagues describe the results of a unique international collaboration between 11 different tuberculosis modelling groups, and public health officials from national tuberculosis programmes. They assessed the feasibility, costs, and epidemiological outcomes of country-specific interventions in India, China, and South Africa, and determined that prostaglandin f2 alpha these 10-year targets could be achievable only in South Africa with a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expanded facility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care. In China and India, important reductions could be achieved, but eccrine glands fell short of the WHO targets. All models that considered costs projected the need for massive and sustained increases in government health spending, to more than three times current levels, although most judged that these interventions could be considered cost-effective. Interestingly, all predicted that patients\' costs would be substantially reduced with most interventions. This project showed the potential value of two innovative collaborations toward achieving global tuberculosis control. First, this investigation was accomplished simultaneously by several different modelling groups and investigators from a total of ten different countries—in itself a major achievement! The modelling groups worked independently, using their preferred modelling approaches, but with similar parameters and assumptions. Readers will usually want to know if the findings are unchanged when key assumptions are varied in sensitivity analyses, and if results are similar in studies published separately by different groups. We think readers should be sceptical, given the grand scale of assumptions made by the investigators of these two studies. In these Articles, results from 11 models are presented together—a sort of uber-sensitivity analysis. The results are quite consistent and provide a coherent message, which we find reassuring. The second innovation was the partnership of these modelling teams with personnel from national tuberculosis programmes, who were responsible for the selection of interventions and helping to estimate their expected effects. This should make the results more applicable and realistic for the countries selected, while also enhancing knowledge translation.