Taking Stock

Background

Little is known about the body of tobacco research as a whole.

Purpose

This paper examines the changes in literature focus (1980s to 2000s) and identifies areas in need of increased attention.

Methods

Tobacco articles randomly selected from searches of the MEDLINE and Web of Science databases were coded according to (1) epidemiologic framework component; (2) study focus; and (3) form of tobacco. Frequencies, cross-tabulations, and tests of proportions were conducted. The analysis was conducted in 2009.

Results

From the 1980s to the 2000s, there was a significant decrease in tobacco-related articles focusing on the “agent” and an increase in articles focusing on the “host.” Few articles in either decade focused on the “environment” or on the “vector” (<10%). The percentage of study foci addressing health effects decreased, whereas prevalence/use and cessation foci increased. Approximately two thirds of articles focused on the cigarette.

Conclusions

The nature of tobacco research has shifted from examining the links between cigarettes and disease to understanding why people smoke and how to help them quit. Proportionately more research could focus on the environment and vector components of the epidemiologic framework, to expand strategies for reducing tobacco-related disease.

Introduction

Tobacco research is a mature field of study, with at least three academic journals now dedicated to this topic: Tobacco Control, Nicotine & Tobacco Research, Tobacco-Induced Diseases. Although the tobacco literature is replete with reviews, there have been few studies examining the focus of published tobacco research as a whole.

Bibliometrics is a research method used in library and information science that often uses quantitative analysis to describe publications within a given field or body of literature. Five studies were identified that have used bibliometric analysis to examine components of the tobacco literature. Two of these studies focused exclusively on research originating from Spain: (1) Garcia-Lopez¹ reported on collaboration among authors, research centers, and institutions; productivity by Spanish communities; journals where the research was published; and the number of authors per paper; and (2) de Granda-Orive et al.² described international collaborations, number of citations, and journals where the research was published. Qui and Chen³ described nicotine research originating from China, reporting on citations, impact factors, international and institutional collaboration, and subject disciplines within the broader area of nicotine research. de Granda-Orive and colleagues⁴ examined scientific collaboration in the published literature on smoking over a 5-year period (1999 to 2003). They found that the United Kingdom published the highest number of articles with inter-institutional collaboration, followed by the U.S. and Germany, whereas the U.S. published the highest number of articles with international collaboration, followed by the United Kingdom and France. Articles resulting from collaborations received a higher number of citations than those with no collaborations. Finally, Kusma et al.⁵ analyzed research self-identified as “tobacco control”; they visually describe country and institutional collaboration, the number of subject disciplines reported in the database, and the journals where this research was published.

Although these studies provide some information about the body of tobacco research, and especially about collaboration, very little is known about what this body of research is actually studying. By understanding how the areas of study have changed over time, and which areas of study currently receive more attention and which receive less, one might identify areas that are in need of further investigation.

Moreover, although not without limitations, the epidemiologic framework is a useful framework for gaining comprehensive understanding of disease and its prevention. Traditionally, the framework has been composed of agent, host, and environment; the addition of vector has sometimes been described as the “public health model.”6, 7 Slade⁸ is one of the first to use these terms in discussing the prevention and control of cigarette use.

According to this conceptualization of agent, host, environment and vector, a change in any of the four components will alter the existing equilibrium to increase or decrease the frequency of disease. The implication is that all components of this epidemiologic framework need to be understood and addressed if efforts to reduce death and disease are to be maximally effective.

The purpose of this study is to take stock of the recent body of tobacco research by comparing its focus from the most recent decade to that from the 1980s. In addition to examining changes in the nature of the tobacco literature over time, areas that might be in need of increased focus are also identified. It was hypothesized that research on the vector was least represented in the tobacco literature and that the proportion of the tobacco literature focused on health effects would show a decline over time.