New set of research priorities identified to support tobacco control

A new set of research priorities to support tobacco control will help ensure future research provides the greatest benefit to public health and value for money, according to an international group led by Oxford University researchers.

The Cochrane Tobacco Addiction Group’s research prioritization exercise involving over 300 people identified a total of 183 unanswered questions in tobacco control through two online surveys and an Oxford-based workshop, narrowed down to 24 priority questions.

This prioritization exercise was funded by the NIHR School for Primary Care. The Cochrane Tobacco Addiction Group is funded by the NIHR Systematic Reviews Programme. Results from the prioritization exercise are published in the journal Addiction.

The top 24 unanswered questions are grouped into eight priority research themes:

• Addressing inequalities in tobacco use
• Delivery of smoking cessation treatments
• Electronic cigarettes
• Quit attempt triggers
• Preventing tobacco use in young people
• Tobacco use in people with mental health problems and/or substance abuse issues
• Interventions targeting whole populations rather than individuals
• Quitting during pregnancy

“The range, appearance and accessibility of tobacco products has changed significantly in recent years,” said Dr Jamie Hartmann-Boyce, Senior Researcher and Managing Editor in the Cochrane Tobacco Addiction Group, which is based in Oxford University’s Nuffield Department of Primary Care Health Sciences. “Technology has given rise to new ways of delivering nicotine that can help reduce the harms associated with traditional cigarettes.

“To ensure our research continues to address the contemporary issues in tobacco control, we aimed to develop a set of research priorities that represent the views of the widest group possible.”

The Cochrane Tobacco Addiction Group, part of the global independent Cochrane network, gathers and summarizes the best evidence from research on the most effective methods of supporting smoking prevention and cessation. Their reviews, presenting what is considered “gold standard evidence”, often inform healthcare policy, guidance and practice and have contributed to global and national health guidelines in both the UK and US, and professional clinical training programmes.

Dr Hartmann-Boyce and colleagues from the Universities of Oxford, Vermont and University College London consulted with doctors, stop smoking advisers, smokers, ex-smokers, health service commissions, researchers, funding bodies and policymakers representing 28 countries, though the majority were based in the UK and USA. Their project differed from traditional health research priority setting exercises, which typically target just clinicians and patients.

At the Oxford workshop, attendees commented on the “moral issue” of addressing inequalities in tobacco use as a reason for putting it in the top spot. Also discussed were the issues surrounding electronic cigarette safety and their long-term side-effects, as well as the difficulty in maintaining the motivation to quit smoking.

Unanswered research questions identified as most important for researchers to consider include:

• What are the most effective stop-smoking interventions for smokers are part of a hard-to-reach group?
• How can we make sure that all healthcare providers provide stop-smoking treatment which research has been found to be effective, safe and cost-effective?
• How safe are e-cigarettes, and are they as safe as other products?

Professor Robert West, Professor of Health Psychology and Director of Tobacco Studies at University College London, who contributed to the project, said:

It is important that research designed to evaluate tobacco control interventions is aimed at the people that need it most, and investigates the latest products and services to understand their potential to make a difference at both the individual and population level.

This new set of research priorities has relevance to the entire research community and can support the design of future studies in tobacco control, helping to maximize the likelihood that research findings are useful in reducing the harms associated with tobacco use.