Letters of Intent for Early Scoping Work
In our discussions with members of the public health community, it became apparent that some areas need more detailed scoping and development before the FSFW issues large-scale requests for proposals in 2018. Mindful that many complementary initiatives are underway, we solicited Letters of Intent on this early scoping work from research organizations, academic institutions and other entities with relevant expertise, from organizations based in developed and developing countries, and from organizations with a track record of successfully leading multi-disciplinary collaboration to address complex health and social issues. We also welcome indications of interest from organizations and people with relevant expertise and experience but no prior background in tobacco control.
the submission period for letters of intent is now closed.
Based on the positive response to the initial call for letters of intent and the diversity of ideas on the three broad categories of health and cessation, innovation in harm reduction products, and tobacco agriculture, grant applicants were notified of a modified timeline for awarding early scoping grants. The modified approach is intended to encourage collaboration by bringing applicants together at workshop events to discuss and strategize the way ahead.
The modified timeline is:
- Call for letters of intent: Monday, November 27, 2017
- Deadline for submitting letters of intent Monday, December 11, 2017
- Decisions on letters of intent announced: Saturday, December 16, 2017
- Draft proposals submitted: Tuesday, January 16, 2018
- Workshop events: February 18-21, 2018
Final decisions on funding will be announced after the workshop event in February.
we seek outputs for the following areas:
LOOKING TO THE FUTURE: EMERGING INNOVATIONS TO END SMOKING
Over next ten years, what are the emerging technologies and behavioral interventions that could massively improve the success rate for quitting smoking, or greatly reduce health risks for those unable or unwilling to stop smoking? We hope this work will:
- Draw on a wide range of fields, including IT, life sciences, medical devices, consumer technology, behavioral psychology, sociology and cultural anthropology
- Be relevant to smokers from a wide range of income levels
REDUCING THE HEALTH IMPACT OF SMOKING IN PEOPLE WITH CHRONIC DISEASES
Smoking is causal to many chronic conditions (e.g. coronary artery disease, COPD), further worsens health in many others (e.g., tuberculosis, HIV/AIDS, and substance abuse), and is highly prevalent in some mental health conditions,particularly schizophrenia. We hope an early systematic review of smoking in these conditions will:
- Clarify the epidemiology of smoking in these conditions, the additional burden of disease caused and the potential health gains of quitting or switching at different ages
- Describe current best practices for smoking cessation or switching to reduced-risk products in people with these conditions
- Describe current incentives and obstacles to the integration of smoking cessation into chronic disease management programs
WHY DO SMOKERS SWITCH, AND WHAT HAPPENS WHEN THEY DO? DETERMINANTS AND IMPACT OF SWITCHING TO REDUCED-RISK PRODUCTS
There is significant experience across the world of people switching from smoking cigarettes to using non-combustible forms of tobacco or to tobaccoless nicotine products, such as snus, heat-not-burn or electronic cigarettes. Insights from these experiences will be critical to the design of large-scale studies to measure the impact of reduced-risk products on population health outcomes. We hope an early systematic review of these experiences will:
- Identify and describe a range of relevant case studies of significant switching
- Assess the cultural, financial and demographic determinants of switching in each case
- Describe the impact of switching on users’ health, and on broader issues including population health and behaviors and public finances
- Propose implications from this review for the design of large-scale cohort studies to measure the impact of reduced-risk products on health outcomes
We hope each team will address at least two different types of reduced-risk products and compare and contrast the experiences.
PREDICTING LONG-TERM HEALTH OUTCOMES IN SMOKERS, THOSE WHO QUIT, AND THOSE WHO SWITCH TO REDUCED-RISK PRODUCTS
Biomarkers and early clinical measures predictive of long-term health outcomes in smokers, ex-smokers and users of reduced-risk products are needed, both to support individual smokers in their decisions about smoking and to provide early assessment of the potential impact of new products and services for cessation and risk reduction while long-term clinical trials run their course. We hope an early systematic review of the current state of this area will:
- Identify existing and in-development biomarkers and early clinical measures predictive of long-term health outcomes in these groups, with a focus on six-month, one-, two- and five-year measures
- Describe the strengths and weaknesses of each, and their appropriateness, individually or in combination, for use in clinical trials of new products or services
- Describe gaps in the science that would need to be addressed to develop better biomarkers or early clinical measures
A “FORESIGHT MAP FOR SMOKING": BUILDING A CAUSAL MAP FOR SMOKING HARM
Foresight’s Tackling Obesities: Future Choices, released ten years ago, has had significant impact on policies to reduce obesity, on incorporating ‘systems thinking’ into research on the topic, and on economic modelling of the issue. Core to the report was the development of a qualitative causal loop system map for obesity. We seek indications of interest to lead the development of an analogous map for smoking, looking at the full range of issues from genetics and physiology through to individual choices and activities, environmental influences, and the role of industry and farming. We hope this work will:
- Provide a global system map, then refine it for a number of specific countries
- Identify the main gaps in our current understanding of causal relationships, and point to where further researcher is needed
- Identify promising levers for accelerating the reduction of smoking harm
We expect this to be a significant effort over at least 12 months, with substantial background research and consultations bringing together a wide range of relevant disciplines.
TRANSITIONING TOBACCO FARMERS TO ALTERNATIVE LIVELIHOODS
We believe that smoking rates and use of leaf tobacco will decline faster then previously projected. However, this future public health success will impact some the poorest and most vulnerable smallholder farmers. We hope this work will:
- Define the global trends in smoking and tobacco use and the impact of these trends on tobacco demand now and for the next two decades, including the factors affecting change, the pace of change and differences by region/country, demographic group and other relevant factors
- Assess current and projected land under tobacco production by smallholder farmers in Malawi, Mozambique and Tanzania, total incomes and percent from tobacco, and the impact of tobacco farming on environment and health of farmers
- Scope agricultural value chain innovations, partnerships, financing models and investments that can be leveraged to transition smallholder tobacco farmers in Malawi, Mozambique and Tanzania to productive and sustainable agricultural alternatives and livelihoods
ACCELERATING THE DEVELOPMENT OF CENTERS OF EXCELLENCE TO END SMOKING
The initial scoping projects outlined above will be used to identify the content of major research projects to be supported by the FSFW. These will be led by Centers of Excellence that ideally straddle strong and well-established organizations, and countries where capacity remains weak. The Centers of Excellence will explicitly develop multi-disciplinary teams capable of addressing emerging areas of laboratory and clinical innovation in smoking science, draw upon advances in behavioral economics to design smarter regulatory processes, take advantage of related advances underway in areas outside of traditional tobacco control, and have a strong focus on implementation.
To do this we seek ideas about best practices to initiate, build and sustain capacity-building Centers of Excellence capable of having the fastest possible impact on reducing smoking. These ideas could be built into all proposals above or could be addressed in separate submissions.
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