Suchergebnisse

Objectives: The Spanish government has strengthened tobacco control policies since 2005, including changes in tobacco taxes. Because these changes have targeted cigarettes mainly, the tobacco industry has marketed cheaper alternative tobacco products, offering smokers the possibility to downtrade. This paper traces the evolution of patterns of demand for cigarettes and other tobacco products in Spain over the period 2005-2011 in order to assess the impact of such tax loopholes. Methods: The authors use data on tobacco products prices and sales as well as changes in the structure and levels of tobacco taxes to relate tax changes to price changes and subsequent market share changes. Results: Tax reforms have lifted the bottom end of the cigarette price distribution, but the industry has been successful in marketing fine-cut tobacco at cheap prices. There have been partial attempts to correct this asymmetric tax treatment, but these have not avoided a remarkable increase in the market share of fine-cut tobacco. The absence of a minimum tax on quantity for the rest of tobacco products allows the industry to place them as potential future downtrading vehicles. Conclusions: In order to address public health objectives, tax policies should aim to equalise the cost of smoking across different tobacco products. Otherwise the tobacco industry can exploit tax loopholes to market cheap alternatives to cigarettes. This requires all tobacco products to bear a minimum tax on quantity, whose levels need to be adjusted in order to reflect the equivalence between different forms of smoking.

La Promoción de la Salud es el proceso que proporciona a las poblaciones los medios necesarios para ejercer un mayor control sobre su propia salud y así poder mejorarla. La Promoción de la Salud tiene un importante papel en la lucha contra las desigualdades en salud. Los responsables de salud pública han intentado introducir diferentes medidas para promocionar estilos de vida saludables y reducir las diferencias sociales. Estas medidas deberían incluir también cambios estructurales tanto en el ámbito legislativo y fiscal, como organizativos y de desarrollo comunitario. La Promoción de la Salud comprende acciones dirigidas a informar sobre las posibilidades de decisión individual y familiar, así como a fomentar la participación responsable de los ciudadanos en actividades comunitarias decisivas encaminadas a proteger su derecho a la salud. Este enfoque tiene como fin alcanzar la equidad en materia de salud.

Background: Some countries have recently extended smoke-free policies to particular outdoor settings; however, there is controversy regarding whether this is scientifically and ethically justifiable. Objectives: The objective of the present study was to review research on secondhand smoke (SHS) exposure in outdoor settings. Data sources: We conducted different searches in PubMed for the period prior to September 2012. We checked the references of the identified papers, and conducted a similar search in Google Scholar. Study selection: Our search terms included combinations of"secondhand smoke,""environmental tobacco smoke,""passive smoking" OR"tobacco smoke pollution" AND"outdoors" AND"PM" (particulate matter),"PM2.5" (PM with diameter ≤ 2.5 µm),"respirable suspended particles,""particulate matter,""nicotine,""CO" (carbon monoxide),"cotinine,""marker,""biomarker" OR"airborne marker." In total, 18 articles and reports met the inclusion criteria. Results: Almost all studies used PM2.5 concentration as an SHS marker. Mean PM2.5 concentrations reported for outdoor smoking areas when smokers were present ranged from 8.32 to 124 µg/m3 at hospitality venues, and 4.60 to 17.80 µg/m3 at other locations. Mean PM2.5 concentrations in smoke-free indoor settings near outdoor smoking areas ranged from 4 to 120.51 µg/m3. SHS levels increased when smokers were present, and outdoor and indoor SHS levels were related. Most studies reported a positive association between SHS measures and smoker density, enclosure of outdoor locations, wind conditions, and proximity to smokers. Conclusions: The available evidence indicates high SHS levels at some outdoor smoking areas and at adjacent smoke-free indoor areas. Further research and standardization of methodology is needed to determine whether smoke-free legislation should be extended to outdoor settings.

Noncommunicable diseases (NCDs), including cancer, are responsible for almost 70% of all deaths worldwide. Tobacco use is a risk factor common to most NCDs. This article discusses tobacco control policies and highlights major achievements and open challenges to reduce smoking prevalence and attributable morbidity and mortality in the 21st century. The introduction of the WHO Framework Convention on Tobacco Control in 2005 has been a key achievement in the field and has already facilitated a drop in both smoking prevalence and exposure to secondhand smoke. Indicatively, the size of the worldwide population benefiting from at least one cost-effective tobacco control policy has quadrupled since 2007. In addition, plain cigarette packaging has been successfully introduced as a tobacco control policy, surmounting efforts of the tobacco industry to challenge this based on trade and investment law. Nevertheless, tobacco control still faces major challenges. Smoking prevalence needs to be further reduced in a rather expedited manner. Smoke-free environments should be extended, and the use of plain tobacco packaging with large pictorial health warnings for all tobacco products should be further promoted in some parts of the world. Some of these measures will require prompt determination and diligence. For example, bold political decisions are needed to significantly increase real prices of tobacco products through excise taxes, ban added ingredients that are currently used to increase the attractiveness of tobacco products and ban the tobacco industry's corporate social responsibility initiatives. Finally, the debate on harm reduction strategies for tobacco control still needs to be resolved.

Background: tobacco control policies can reduce smoking prevalence. These measures may be less effective where smoking prevalence has significantly declined, as the remaining smokers have 'hardened'. Our aim was to empirically evaluate the 'hardening hypothesis' at the population level in the European Union (EU) and explore factors associated with hardcore smoking. Methods: we conducted two separate analyses in the EU using data on smoking from the Eurobarometer surveys (2009-2017, n=112 745). 1) A panel-data fixed-effects linear regression to investigate changes over time in the percentage of hardcore smokers in relation to standardised smoking prevalence at the country level. 2) A multilevel logistic regression analysis with hardcore (daily smokers, ≥15 cigarettes per day who have not attempted to quit in the last 12 months) or light (<5 cigarettes per day) smoking as the dependent variable and time as the main independent variable, controlling for individual and ecological variables. Results: we studied 29 010 current smokers (43.8% hardcore smokers and 14.7% light smokers). The prevalence of hardcore smoking among adult smokers increased by 0.55 (95% CI 0.14-0.96) percentage points per each additional percentage point in the overall smoking prevalence. The odds of being a hardcore smoker increased over time and were higher in middle-aged males and people with financial difficulties, while the odds of being a light smoker significantly declined among females. Conclusion: this study does not support the 'hardening hypothesis' in the EU between 2009 and 2017, but suggests a softening of the smoking population. Existing tobacco control policies are likely to be suitable to further decrease smoking prevalence in Europe.

Introduction: There are limited data on the potential effects of e-cigarette experimentation on support for tobacco control policies. To bridge this gap, we assessed associations between e-cigarette experimentation and support for tobacco control policies in the European Union 2012-2014. We also investigated variations across tobacco-use status, e-cigarette experimentation and sociodemographic characteristics. Methods: Datasets were used from the Special Eurobarometer for Tobacco surveys performed in 2012 (n=26 751) and 2014 (n=27 801). Tobacco control policies assessed were: banning advertising, policies to keep tobacco out of sight, banning online sales, banning flavors, standardized packaging, tax increases, and policies to reduce illicit trade in tobacco. We use multilevel logistic regression models to assess variations in socio-demographics and tobacco/e-cigarette use with support for these policies in 2014, and examined changes in support for these policies, between 2012 and 2014, separately by tobacco-use status (never, current, and former smokers). Results: Population support for tobacco control policies was high in 2014: policies to reduce illicit trade had the highest level of support at 70.1%, while tax increases were the least likely measure to be supported with 52.3% support. Among never and former smokers, experimentation with e-cigarettes was associated with reduced support for all tobacco control policies assessed. For example, never smokers who had experimented with e-cigarettes were less likely to support either tobacco advertising bans (adjusted odds ratio aOR=0.57, 95% confidence interval 0.46-0.71) or standardized packaging for tobacco (aOR=0.58, 95% CI: 0.47-0.71). Former smokers who had experimented with e-cigarettes were less likely to either support standardized packaging for tobacco (aOR=0.70, 95% CI: 0.60-0.82) or keeping tobacco out of sight (aOR=0.77, 95% CI: 0.65-0.90). Among current smokers, e-cigarette experimentation was not associated with support for the tobacco control policies assessed. Conclusions: E-cigarette experimentation was consistently associated with reduced support for tobacco control policies among never and former smokers but not among current smokers. The implications of these findings for tobacco control are unknown, but the data support concerns that e-cigarette experimentation may affect public support for established tobacco control policies within specific subgroups. Further research is needed to assess potential long-term impacts on tobacco control policies.

A partial smoke-free regulation in Spain was introduced on January 1, 2006, which was sub-sequently amended to introduce a comprehensive smoke-free policy from 2 January 2011 onward. The objective of this study was to compare the prevalence of tobacco consumption in Spain and the profile of smokers before (2006) and after (2011) the comprehensive smoking ban passed in 2010.

Introduction: The Tobacco Control Scale (TCS) was designed for advocacy purposes but has also been used as a research tool. In the present study, we characterized TCS use, its limitations and strengths, and critically assessed its use as a research instrument. Methods: We conducted an extensive search of the biomedical databases PubMed and Web of Science for the keyword 'tobacco control scale' in all fields. The search was limited to studies published in the period March 2006 to December 2019. Out of 69 hits, 32 studies met the inclusion criteria. Two reviewers independently extracted information from each publication regarding their general characteristics, publication and research aspects, and the characteristics of the use of the TCS. Results: We found that researchers have used the TCS as a tool to monitor tobacco control policies mainly in cross-sectional observational studies with ecological and multilevel designs directed to advocacy and the promotion of further research. Different outcomes, such as smoking prevalence and quit ratios, have been associated with tobacco control policy scores. The main reported limitations of the TCS were a low variance across countries and a failure to express enforcement and to incorporate the most recent legislation. Conclusions: The TCS has been commonly used to assess differences in outcomes according to tobacco control policies. However, there are still areas for improvement in its use in research regarding the lack of comparability of TCS scores across time. The lessons that have been learned should be used to adapt and expand the TCS overseas.

Background: While smoke-free policies in most European countries are established for public places, private areas are mainly not regulated and may represent an important source of second-hand smoke exposure. We aimed to describe and characterise smoking rules in homes and cars of smokers from 6 European countries. Methods: We used data from the first wave (2016) of the International Tobacco Control (ITC) 6 European Country Survey, part of the EUREST-PLUS Project, in representative national samples of adult (18+ years) smokers in Germany, Greece, Hungary, Poland, Romania and Spain (1000 in each country). We analysed questions about smoking rules in smokers' homes and cars with children and differentiated among: no rules, partial (allowed in some rooms or under special circumstances) and total ban (smoke-free homes and cars). We computed the prevalence (%) of homes and cars according to the rules, and used Poisson regression models to identify factors associated with total smoking ban. We incorporated weights from the complex sample design. Results: In homes, more smokers opted for partial ban rather than for a total ban. The highest and lowest proportions of smoke-free homes were found in Hungary (35.5%) and Spain (13.1%), respectively, while partial ban prevalence ranged from 41.3% (Spain) to 49.9% (Greece). The proportion of smoke-free cars with children was overall higher compared to homes, ranging from 51.8% (Greece) to 67.7% (Germany). Having moderate or high level of education, presence of children, smoking less than 10 cigarettes per day and having previous attempts to quit smoking were positively associated with total smoking ban in homes and cars. Conclusions: European smokers tend to opt for partial smoking ban at homes and for total ban in cars with children. Prevalence of smoke-free homes is relatively low and further legal and educational enforcement is needed to promote smoke-free environments.

Background: Smoking is still highly prevalent in Europe. According to the WHO, tobacco control policies vary substantially across countries. The Tobacco Control Scale (TCS) was developed to quantify the implementation of tobacco control policies at country level in Europe. The objective was to assess the impact of tobacco control policies (quantified by TCS scores) on smoking prevalence and quit ratios and their relative changes from 2006-2014 in 27 European Union (EU27) countries. Methods: We conducted an ecological study at the country level. We used TCS scores in EU27 in 2007, and the prevalence of tobacco and quit ratios (No. ex-smokers/ No. ever smokers) data from the Eurobarometer surveys (2006 and 2014 waves). We analysed the relationship between the TCS scores and smoking prevalence and quit ratios and their relative changes by means of scatter plots, Spearman rank-correlation coefficients (rsp), and a multiple linear regression model adjusted for all TCS components. Results: In EU27, the smoking prevalence decreased by 14% (95%CI:7.3%-20.6%) (2006-2014) and varied from a relative decrease of 48.9% in Sweden to 0.4% in Bulgaria. The increase in the quit ratio in EU27 was 19.2% (95%CI:5.4%-33.1%) (2006-2014) and ranged from 125.8% in Sweden to 4.3% in Bulgaria. The correlation between TCS scores and smoking prevalence was negative (rsp=-0.444;p=0.02). A positive correlation was observed between TCS scores and quit ratios in 2014 (rsp=0.373;p=0.06) and in the relative changes in smoking prevalence (rsp=0.415;p=0.03). The percentage of smoking prevalence in 2014 explained by all TCS components in the regression model was 28.9% Conclusions: European countries with higher TCS scores, which indicates higher tobacco control efforts, have lower prevalence of smokers, higher quit ratios, and higher relative decreases in their smoking prevalence over the last decade. Funding: EC Horizon2020 HCO-6-2015 (EUREST-PLUS No. 681109); Government of Spain & European Regional Development Fund (RTICC RD12/0036/0053); Government of Catalonia (2014SGR999).

Background and challenges to implementation The Catalan Network of Smoke-Free Hospitals (XCHSF), with 82 hospitals of Catalonia, is coordinated by the Catalan Institute of Oncology and supported by the Health Department of the Catalan Government. This public health programme is intended to design, scale down, and evaluate tobacco-control policies within its members. In this context, we aim to describe the Tobacco Control Training Programme initiated in 2006 addressed to health professionals to provide knowledge and skills to effectively uphold tobacco cessation services. Intervention or response The XCHSF's Training Programme is based on the identified needs detected in a baseline study conducted in 2005. It offers specific contents provided annually by a qualified group of experts in the field. Three modalities have been launched since 2006: a) face-to-face training courses on specific topics about smoking cessation intervention, b) a Train-the-Trainer Programme, and c) an on-line course about brief intervention on smoking cessation. Courses information is spread among hospital coordinators and posted online. All courses are accredited by the Official Administration and a certificate of completion is provided after participants' knowledge assessment. Participants are also required to evaluate the course and the trainer/s. Results and lessons learnt Since its beginnings in 2006, the XCHSF's Training Programme has increased its offer from 1 to 7 different topics of courses. Results on participation up to July 2017 indicate that 1,427 professionals have attended face-to-face courses since 2006; more than 2,700 professionals have been trained through the Train-the-Trainer Programme since 2009, and 1,474 professionals have finished the online course through several editions since 2014. The overall satisfaction reaches ≥8.5/10. Conclusions and key recommendations Offering a wide and continuous range of training activities is essential for having skilled health professionals in smoking cessation in hospitals. The XCHSF's Training Programme is an educational resource that reinforces public health promotion in the territory and fosters the implementation of tobacco control strategies in hospitals.

Objective: to describe where smokers smoke outdoors, where non-smokers are exposed outdoors to secondhand smoke (SHS), and attitudes towards smoke-free outdoor areas after the implementation of national smoke-free legislation. Design: this cross-sectional study was conducted between June 2011 and March 2012 (n=1307 participants). Setting: Barcelona Participants: representative, random sample of the adult (≥16 years) population. Primary and secondary outcomes: proportion of smoking and prevalence of exposure to SHS in the various settings according to type of enclosure. Percentages of support for outdoor smoke-free policies according to smoking status. Results: smokers reported smoking outdoors most in bars and restaurants (54.8%), followed by outdoor places at work (46.8%). According to non-smokers, outdoor SHS exposure was highest at home (42.5%) and in bars and restaurants (33.5%). Among non-smoking adult students, 90% claimed exposure to SHS on university campuses. There was great support for banning smoking in the majority of outdoor areas, which was stronger among non-smokers than smokers. Over 70% of participants supported smoke-free playgrounds, school and high school courtyards, and the grounds of healthcare centres. Conclusions: extending smoking bans to selected outdoor settings should be considered in further tobacco control interventions to protect non-smokers from SHS exposure and to establish a positive model for youth. The majority of public support for some outdoor smoke-free areas suggests that it is feasible to extend smoking bans to additional outdoor settings.

The six most important cost-effective policies on tobacco control can be measured by the Tobacco Control Scale (TCS). The objective of our study was to describe the correlation between the TCS and smoking prevalence, self-reported exposure to secondhand smoke (SHS) and attitudes towards smoking restrictions in the 27 countries of the European Union (EU27).

Introduction: Exposure to secondhand aerosol from e-cigarette (SHA) may pose harmful effects to bystanders. This study aims to investigate the prevalence, duration and determinants of SHA exposure in various indoor settings in 12 European countries. Methods: In 2017–2018, we conducted a cross-sectional study, the TackSHS survey, on a representative sample of the population aged ≥15 years in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). We described the prevalence and duration of exposure to SHA in several indoor settings among 11 604 e-cigarette non-users. Individual-level and country-level characteristics associated with SHA exposure were also explored using multilevel logistic regression analyses. Results: Overall, 16.0% of e-cigarette non-users were exposed to SHA in any indoor setting at least weekly, ranging from 4.3% in Spain to 29.6% in England. The median duration of SHA exposure among those who were exposed was 43 min/day. 'Other indoor settings' (eg, bar and restaurant) was reported as the place where most of e-cigarette non-users were exposed (8.3%), followed by workplace/educational venues (6.4%), home (5.8%), public transportation (3.5%) and private transportation (2.7%). SHA exposure was more likely to occur in certain groups of non-users: men, younger age groups, those with higher level of education, e-cigarette past users, current smokers, those perceiving SHA harmless and living in countries with a higher e-cigarette use prevalence. Conclusions: We found inequalities of SHA exposure across and within European countries. Governments should consider extending their tobacco smoke-free legislation to e-cigarettes to protect bystanders, particularly vulnerable populations such as young people.

Background: Influencing the life-style risk-factors alcohol, body mass index (BMI), and smoking is an European Union (EU) wide objective of public health policy. The population-level health effects of these risk-factors depend on population specific characteristics and are difficult to quantify without dynamic population health models. Methods: For eleven countries-approx. 80 % of the EU-27 population-we used evidence from the publicly available DYNAMO-HIA data-set. For each country the age- and sex-specific risk-factor prevalence and the incidence, prevalence, and excess mortality of nine chronic diseases are utilized; including the corresponding relative risks linking risk-factor exposure causally to disease incidence and all-cause mortality. Applying the DYNAMO-HIA tool, we dynamically project the country-wise potential health gains and losses using feasible, i.e. observed elsewhere, risk-factor prevalence rates as benchmarks. The effects of the 'worst practice', ' best practice', and the currently observed risk-factor prevalence on population health are quantified and expected changes in life expectancy, morbidity-free life years, disease cases, and cumulative mortality are reported. Results: Applying the best practice smoking prevalence yields the largest gains in life expectancy with 0.4 years for males and 0.3 year for females (approx. 332,950 and 274,200 deaths postponed, respectively) while the worst practice smoking prevalence also leads to the largest losses with 0.7 years for males and 0.9 year for females (approx. 609,400 and 710,550 lives lost, respectively). Comparing morbidity-free life years, the best practice smoking prevalence shows the highest gains for males with 0.4 years (342,800 less disease cases), whereas for females the best practice BMI prevalence yields the largest gains with 0.7 years (1,075,200 less disease cases). Conclusion: Smoking is still the risk-factor with the largest potential health gains. BMI, however, has comparatively large effects on morbidity. Future research should aim to improve knowledge of how policies can influence and shape individual and aggregated life-style-related risk-factor behavior.