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  • This week delegates are gathered in

    2019-05-15

    This week, delegates are gathered in Abu Dhabi, United Arab Emirates, for the . A large portion of the programme will be dedicated to global progress on demand reduction measures laid out in WHO\'s (FCTC), which celebrated its 10th birthday last month. Adopted at the 56th World Health Assembly in 2003, the treaty entered into force on Feb 27, 2005, and has now been ratified by 180 member states. It is regarded as a thoroughly successful piece of global health legislation, both in terms of outcomes and process. Yet success has been unevenly distributed, both across the world and across components of the treaty. MPOWER—the set of measures introduced by WHO in 2008 to facilitate implementation of FCTC interventions—covers monitoring of tobacco use and prevention policies; protection of people from tobacco smoke; offering help to quit tobacco use; warning about the dangers of tobacco; enforcing bans on tobacco advertising, promotion, and sponsorship; and raising taxes on tobacco. The latter is the measure with the most potential influence on tobacco consumption and yet the least compliance worldwide. A estimated that price increases led to the aversion of 3·5 million smoking-attributable deaths between 2007 and 2010 in the 14 countries that had raised taxes to the recommended 75% of final retail price (around ten times more deaths averted than by offering help to quit tobacco use and by enforcing marketing bans). Similarly, a by the International Agency for Research on Cancer showed that a 50% increase in tobacco prices can reduce consumption by about 20%. However, the latest indicated that only 8% of the world\'s population was covered by a sufficiently high taxation policy in 2012 (compared with 15% for cessation programmes and 10% for advertising bans) and that this Finally had shown the least Finally progress since 2010.
    The study by Cesar G Victora and colleagues in is an impressive long-term follow-up of a large sample, which included almost 3500 participants in Brazil who were followed up from birth in 1982 to 2012–13, at the mean age of 30·2 years. The exposure was breastfeeding and the outcome variables were intelligence—as assessed by a widely used intelligence test (Wechsler Adult Intelligence Scale, 3rd version)—educational attainment, and income. The study contributes important knowledge about three issues related to the effects of breastfeeding on cognitive development: first, the study\'s findings show the effects of breastfeeding in a cultural and economic setting without strong social patterning of breastfeeding; second, the study investigates long-term effects of breastfeeding during a substantial part of the full lifespan; and third, the study describes life course consequences of breastfeeding by incorporating socially important outcomes, such as education and income. If the reported effects of breastfeeding are the result of confounding by maternal intelligence and other maternal characteristics associated with breastfeeding, the effect estimates would be expected to differ between countries and cultures with different social patterns of breastfeeding. In fact, an argument exists that comparisons of the effects of breastfeeding in contexts with substantial differences in social patterning of breastfeeding might contribute to the ongoing discussion of breastfeeding as a causal factor in cognitive development versus residual confounding as an explanation for the apparent effects. From Staggered cuts perspective, the fact that blood pressure and BMI were associated with breastfeeding in a British study, but not in a previous Brazilian study, which still identified an association between breastfeeding and intelligence, is surprising. Victora and colleagues\' study is from the same area of Brazil as this previous study. The investigators incorporated adjustment for ten potentially important confounding factors, such as gestational age, birthweight, maternal smoking during pregnancy, and maternal prepregnancy BMI. Findings from a 2013 study suggest that the most important confounding factors in studies of cognitive development might be parental intelligence and education, and the results of another study suggested that most apparent effects of breastfeeding might be caused by the confounding effect of maternal intelligence. Victora and colleagues were unable to control for maternal intelligence, but in 1982, no strong social patterning of breastfeeding existed in the cohort and, according to the authors, awareness of the potential benefits of breastfeeding was uncommon in Brazil at the time. In this setting, controlling for maternal intelligence would be less important, although notably, the highest prevalence of breastfeeding at 6 months was in the subsamples with longest maternal schooling and highest family income. However, as the authors point out, adjustment for confounding factors increased the effect estimates, which seems to make residual confounding less likely. Furthermore, the findings are supported by those of studies about the effects of breastfeeding on cognitive development in randomised trials, and observational studies that control for maternal intelligence.