Tackling smoking, childhood obesity and back pain: it’s not for want of trying

Humans are complex beings, and few of even our simplest actions are entirely rational. The more of us there are, the more unpredictable things get. It’s not entirely unexpected then that evidence on how to tackle complex health conditions, particularly at the population level, has been limited and simple solutions elusive. A recent crop of Cochrane reviews shows mixed results.

Let’s start with good news. Reducing exposure to second-hand smoke through legislation banning smoking in public and work places has been commonplace in Australia for many years. It’s reassuring then that a review of 77 studies from 21 countries demonstrated consistent evidence of a positive impact of these laws, especially on improving cardiovascular health outcomes and reducing mortality from smoking-related illnesses. However, the evidence was less consistent for respiratory and perinatal health, and for smoking prevalence and tobacco consumption (doi: 10.1002/14651858.CD005992.pub3).

Tackling childhood obesity is a huge challenge, even more so when many parents struggle with their own weight. Might interventions directed at helping parents change their family’s diet and lifestyle have an impact on their children’s weight? The evidence from a review of 20 wide-ranging studies is not especially encouraging. Diet, physical activity and behavioural treatments delivered to parents only had similar effects compared with parent–child interventions and compared with minimal contact controls (doi: 10.1002/14651858.CD012008).

Chronic low back pain is a common condition for which exercise is a modestly effective treatment. A recent review sought to find out if motor control exercise, a popular form of exercise similar to core strength training, is superior to other forms of exercise in relieving pain and disability. Despite the inclusion of 29 studies, little or no difference was observed in any of the outcomes measured. The effects were the same when motor control exercise was compared with manual therapy (therapy associated with physiotherapists or physical therapists). Only when compared with a minimal intervention was a clinically important effect found, which at least confirms that doing something is better than nothing (doi: 10.1002/14651858.CD012004).

One less talked about consequence of higher antibiotic prescribing rates in children is the increasing likelihood of antibiotic-associated diarrhoea. At least here there is some reason to cheer. A new review of 23 studies involving nearly 4000 children found that probiotics were generally well tolerated and have a protective effect in preventing antibiotic-associated diarrhoea, with a respectable number needed to treat of 10 (doi: 10.1002/14651858.CD004827.pub4).

For more on these and other reviews, visit the Cochrane Library at www.cochranelibrary.com.