The effects of interventions targeting multiple health behaviors on smoking cessation outcomes: a rapid realist review protocol.

BACKGROUND: Health behaviors directly impact the health of individuals, and populations. Since individuals tend to engage in multiple unhealthy behaviors such as smoking, excessive alcohol use, physical inactivity, and eating an unhealthy diet simultaneously, many large community-based interventions have been implemented to reduce the burden of disease through the modification of multiple health behaviors. Smoking cessation can be particularly challenging as the odds of becoming dependent on nicotine increase with every unhealthy behavior a smoker exhibits. This paper presents a protocol for a rapid realist review which aims to identify factors associated with effectively changing tobacco use and target two or more additional unhealthy behaviors. METHODS: An electronic literature search will be conducted using the following bibliographic databases: MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, Social Science Abstracts, Social Work Abstracts, and Web of Science. Two reviewers will screen titles and abstracts for relevant research, and the selected full papers will be used to extract data and assess the quality of evidence. Throughout this process, the rapid realist approach proposed by Saul et al., 2013 will be used to refine our initial program theory and identify contextual factors and mechanisms that are associated with successful multiple health behavior change. DISCUSSION: This review will provide evidence-based research on the context and mechanisms that may drive the success or failure of interventions designed to support multiple health behavior change. This information will be used to guide curriculum and program development for a government funded project on improving smoking cessation by addressing multiple health behaviors in people in Canada. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017064430.

Third study on WHO MPOWER Tobacco Control Scores in Eastern Mediterranean countries 2011-2015.

This study was conducted to quantify the implementation of the MPOWER policies and to assess any possible changes across Eastern Mediterranean Region (EMR) countries. In this comparative cross-sectional study based on 10 categories mentioned in MPOWER report 2015 a checklist was designed. Seven questions were scored from 0-4 and three from 0-3. The 22 EMR countries were ranked and compared by their total score on a scale of 0-37. The highest scores were achieved by Egypt and the Islamic Republic of Iran. Pakistan, Sudan and Yemen showed progress, while Bahrain, Jordan, Kuwait, Oman, and the Syrian Arab Republic had decreased scores. The total score of the EMR countries had decreased compared to 2013. Thus, there remains a need for greater focus on tobacco taxation and smoke-free policies to address this retrograde step.