Comparing effects of tobacco use prevention modalities: need for complex system models
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Departments of Preventive Medicine and Psychology, University of Southern California, Los Angeles, USA
Department of Oncology, Georgetown University, Washington, DC, USA
University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, USA
University of North Carolina, School of Medicine, Chapel Hill, USA
University of North Carolina, Cecil G. Sheps Center for Health Services Research and the NCTRaCS Institute, Chapel Hill, USA
Institute for Health Research and Policy, Health Policy Center, University of Illinois, Chicago, USA
Steve Sussman   

Departments of Preventive Medicine and Psychology, University of Southern California, Soto Street Building 302A, 2001 N. Soto Street, Los Angeles, CA 90033-9045, USA
Publish date: 2013-01-22
Tobacco Induced Diseases 2013;11(January):2
Many modalities of tobacco use prevention programming have been implemented including various policy regulations (tax increases, warning labels, limits on access, smoke-free policies, and restrictions on marketing), mass media programming, school-based classroom education, family involvement, and involvement of community agents (i.e., medical, social, political). The present manuscript provides a glance at these modalities to compare relative and combined impact of them on youth tobacco use. In a majority of trials, community-wide programming, which includes multiple modalities, has not been found to achieve impacts greater than single modality programming. Possibly, the most effective means of prevention involves a careful selection of program type combinations. Also, it is likely that a mechanism for coordinating maximally across program types (e.g., staging of programming) is needed to encourage a synergistic impact. Studying tobacco use prevention as a complex system is considered as a means to maximize effects from combinations of prevention types. Future studies will need to more systematically consider the role of combined programming.
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