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Schürch K, Frahsa A, Liwanag HJ, Ruggia L. An expenditure analysis revealing how Philip Morris advertisements coincide with tobacco policymaking in Switzerland. Tob Prev Cessat 2024; 10:TPC-10-28. [PMID: 38948920 PMCID: PMC11212386 DOI: 10.18332/tpc/189922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Prior research has linked media tobacco promotion to increased tobacco use and favorable perceptions of tobacco products. Switzerland's tobacco lobby employs advertisements to sway policy decisions in its favor, yet no recent research has assessed this in detail. Our study aims to provide detailed estimates of tobacco industry (TI) advertisement costs, focusing on Philip Morris International (PMI) in Switzerland, and examine potential chronological links between TI advertisement campaigns and parliamentary discussions on tobacco bills. By spreading knowledge on this issue, we aim to support the development of future tobacco advertisement regulations. METHODS We conducted an expenditure analysis of tobacco-related press advertisements in Swiss print media published between August 2020 and August 2021, accessed through the media intelligence firm Argus Data Insights. Advertisement costs were estimated using publicly available data. We plotted expenditure sums of PMI against key parliamentary session dates featuring discussions on proposed tobacco control measures, such as tighter restrictions on advertising. RESULTS Over 12 months, 501 advertisements with tobacco-specific headlines were published in Swiss press media. Of these, 437 advertisements (87.22%) were linked to PMI. PMI accounted for 88.21% (CHF 6486969) of total advertisement expenditure. Notably, PMI advertisements coincided with key political sessions discussing tobacco legislation in parliament, with a limited presence outside these periods. CONCLUSIONS PMI advertisements were published parallel to key moments of parliamentary discussions, suggesting an attempt by TI to potentially influence discussions. Applying such an advertisement monitoring methodology helps understand the contextual conditions of public health in Switzerland. By analyzing TI advertisements in print media, we sought to highlight regulatory gaps and support the creation of stricter advertising regulations. We recommend continuing such research to strengthen tobacco control policymaking. Key public health efforts should include raising awareness of TI tactics, implementing a comprehensive ban on tobacco advertising, and strategically engaging with the media in tobacco control campaigns.
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Affiliation(s)
- Kris Schürch
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Swiss Association for Tobacco Control, Bern, Switzerland
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Harvy Joy Liwanag
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Luciano Ruggia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Association for Tobacco Control, Bern, Switzerland
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Lutman-White E, Patel R, Bell L, Lycett D, Hayward K, Sampson R, Arulrajah J, Whelan M. Provision of E-Cigarettes for Smoking Cessation in Pregnancy: Perceptions and Experiences of Pregnant Women from Two UK Sites. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:472. [PMID: 38673383 PMCID: PMC11049941 DOI: 10.3390/ijerph21040472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Smoking in pregnancy is associated with negative health outcomes for both mothers and babies; e-cigarettes, which contain nicotine without hazardous tobacco, may offer an additional smoking cessation strategy for pregnant women. Although e-cigarettes are being increasingly offered within services, there is limited understanding about whether e-cigarettes can improve smoking cessation support for pregnant individuals. This study aimed to explore service users' experiences of using e-cigarettes as a tool for smoking cessation during pregnancy. METHODS Semi-structured interviews were conducted with 14 women who had accepted one of two pilots and were analysed using inductive reflexive thematic analysis. The findings from each site were integrated to develop qualitative insight. RESULTS Participants largely had positive perceptions of the free and easy-to-use e-cigarette, preferring it to nicotine replacement therapies. The desire to have a healthy pregnancy and baby and the inclusion of non-judgemental behavioural support facilitated motivation to quit. Many participants reduced or quit tobacco use, with positive social and health implications reported. However, numerous barriers to quitting were present and intentions about long-term quitting of combustible cigarettes and e-cigarettes were mixed and uncertain. CONCLUSIONS Providing e-cigarettes within smoking cessation services was indicated to be a positive and effective strategy for pregnant women trying to quit tobacco. However, numerous barriers to quitting and staying quit remained, suggesting scope for further improvements to smoking cessation support for pregnant women.
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Affiliation(s)
- Eleanor Lutman-White
- Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (E.L.-W.); (L.B.); (D.L.)
| | - Riya Patel
- Centre for Ethnic Health Research, NIHR Applied Research Collaboration-East Midlands (ARC-EM), University of Leicester, Leicester LE1 7RH, UK;
| | - Lauren Bell
- Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (E.L.-W.); (L.B.); (D.L.)
| | - Deborah Lycett
- Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (E.L.-W.); (L.B.); (D.L.)
| | - Kelly Hayward
- Warwickshire Public Health Team, Warwick CV34 4UL, UK
| | - Ruth Sampson
- Bath and North Somerset Public Health Team, Bristol BS31 1FS, UK
| | - Janani Arulrajah
- Bath and North Somerset Public Health Team, Bristol BS31 1FS, UK
| | - Maxine Whelan
- Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (E.L.-W.); (L.B.); (D.L.)
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Nuszkiewicz J, Wróblewska J, Budek M, Czuczejko J, Woźniak A, Maruszak-Parda M, Szewczyk-Golec K. Exploring the Link between Inflammatory Biomarkers and Head and Neck Cancer: Understanding the Impact of Smoking as a Cancer-Predisposing Factor. Biomedicines 2024; 12:748. [PMID: 38672104 PMCID: PMC11048483 DOI: 10.3390/biomedicines12040748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Head and neck cancer (HNC) is associated with significant morbidity globally, with smoking recognized as a key risk factor. This study investigates the interplay between smoking and inflammatory biomarkers in HNC development. The study involved 50 HNC patients, divided into smoking and non-smoking groups, and a control group of 30 healthy individuals. Serum levels of 48 cytokines, chemokines, growth factors, and other inflammatory markers were meticulously assessed. Significant differences in the levels of an extensive panel of inflammatory markers were observed between the patient groups and healthy controls. Elevated macrophage colony-stimulating factor (M-CSF) in both HNC groups implicated increased activity in pathways known for immunomodulation, proliferation, and angiogenesis during HNC cancerogenesis. In contrast, non-smokers with HNC demonstrated higher levels of interleukin 10 (IL-10) and interleukin 15 (IL-15), suggesting a more robust immune response. Platelet-derived growth factor BB (PDGF-BB) levels were particularly high in smokers with HNC. Smoking seems to alter the levels of crucial biomarkers in HNC, potentially affecting disease progression and responses to treatment. The data indicate that smokers may experience a more aggressive cancer phenotype, while non-smokers maintain a profile suggestive of a more active and effective immune response against HNC.
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Affiliation(s)
- Jarosław Nuszkiewicz
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 24 Karłowicza St., 85-092 Bydgoszcz, Poland; (J.W.); (M.B.); (A.W.); (K.S.-G.)
| | - Joanna Wróblewska
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 24 Karłowicza St., 85-092 Bydgoszcz, Poland; (J.W.); (M.B.); (A.W.); (K.S.-G.)
| | - Marlena Budek
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 24 Karłowicza St., 85-092 Bydgoszcz, Poland; (J.W.); (M.B.); (A.W.); (K.S.-G.)
| | - Jolanta Czuczejko
- Department of Psychiatry, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 9 M. Curie Skłodowskiej St., 85-094 Bydgoszcz, Poland;
- Department of Nuclear Medicine, Oncology Centre Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, 2 Dr I. Romanowskiej St., 85-796 Bydgoszcz, Poland;
| | - Alina Woźniak
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 24 Karłowicza St., 85-092 Bydgoszcz, Poland; (J.W.); (M.B.); (A.W.); (K.S.-G.)
| | - Marta Maruszak-Parda
- Department of Nuclear Medicine, Oncology Centre Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, 2 Dr I. Romanowskiej St., 85-796 Bydgoszcz, Poland;
| | - Karolina Szewczyk-Golec
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 24 Karłowicza St., 85-092 Bydgoszcz, Poland; (J.W.); (M.B.); (A.W.); (K.S.-G.)
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Wang Z, Gu Y, Wang R, He Y, Ge H, Yang Z, Jin Z, Jin H, Lv S, Zhan H. The global magnitude and temporal trend of rheumatoid arthritis burden attributable to smoking from 1990 to 2019. Rheumatology (Oxford) 2024; 63:689-697. [PMID: 37279721 DOI: 10.1093/rheumatology/kead269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES The relationship between smoking and RA has been confirmed. Most nations have ratified the Framework Convention on Tobacco Control. However, there are considerable regional differences in how effectively tobacco control measures were implemented. This study was carried out to estimate the spatiotemporal trends of smoking-related RA burdens. METHODS Data were available from the Global Burden of Disease Study 2019 and were analysed by age, sex, year and region. Joinpoint regression analysis was applied to the analysis of temporal trends in the RA burden resulting from smoking over 30 years. RESULTS From 1990 to 2019, the number of global RA cases increased each year. The age-standardized prevalence, death and disability-adjusted life-year (DALY) rates also increased. However, there was a wave in the changing trend of the age-standardized death rate, with the lowest point in 2012 and the highest point in 1990. Smoking, in particular, was responsible for 11.9% of total RA deaths and 12.8% of total DALYs in 1990 but only 8.5% of total RA deaths and 9.6% of total DALYs in 2019. A greater burden from smoking exposure was borne by men, older adults and people living in high-middle and high sociodemographic index (SDI) countries and regions. Moreover, the UK demonstrated the highest reduction in age-standardized death and DALY rates over the three decades. CONCLUSION There were reductions in the age-standardized burdens of RA caused by smoking worldwide. Nevertheless, this continues to be an issue in some areas, and efforts to reduce smoking should be made to lessen this growing burden.
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Affiliation(s)
- Zhengming Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yong Gu
- Translational Medical Innovation Center, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
- Department of Orthopedics, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
| | - Rui Wang
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Yanlin He
- Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi, Jiangsu, China
| | - Haiya Ge
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Zongrui Yang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Zhaokai Jin
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Hengkai Jin
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Shuaijie Lv
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Hongsheng Zhan
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Jackson SE, Cox S, Brown J. Trends in cross-border and illicit tobacco purchases among people who smoke in England, 2019-2022. Tob Control 2023:tc-2023-057991. [PMID: 37463758 DOI: 10.1136/tc-2023-057991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/15/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES The last 5 years have seen substantial changes in England's social and economic landscape as a result of Brexit, the COVID-19 pandemic and cost of living crisis. We aimed to examine changes in cross-border and illicit tobacco purchasing over this period. DESIGN Nationally representative monthly cross-sectional survey. SETTING England, 2019-2022. PARTICIPANTS 11 232 adults (≥18 years) who smoked in the past year. MAIN OUTCOME MEASURES We estimated time trends in the proportion reporting purchasing tobacco from (1) cross-border and (2) illicit sources in the past 6 months. RESULTS Between February 2019 and October 2022, there was a non-linear increase in the proportion of participants reporting cross-border tobacco purchases (from 5.2% to 16.1% overall; prevalence ratio (PR)=3.10, 95% CI 2.03-4.73). Prevalence first increased from 5.2% to 15.4% between February 2019 and April 2020, before falling to 7.8% between April 2020 and September 2021 during the COVID-19 pandemic, and then increasing again to 16.1% by the end of the period. Changes in cross-border tobacco purchasing were more pronounced among participants from more advantaged (from 6.6% to 23.3%; PR=3.52, 95% CI 2.05-5.91) compared with less advantaged (4.4% to 11.5%; PR=2.61, 95% CI 1.17-5.20) social grades (pinteraction=0.034). There was no overall change in the proportion reporting illicit tobacco purchases (from 9.2% to 8.5%; PR=0.92, 95% CI 0.70-1.21), nor any significant difference in trends by social grade (pinteraction=0.783). CONCLUSIONS Despite a fall in cross-border tobacco purchasing during the first year of the COVID-19 pandemic among adults in England who smoke, the proportion reporting cross-border tobacco purchases is now three times higher than it was at the start of 2019. The proportion reporting illicit tobacco purchases has not changed substantially.
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Affiliation(s)
| | - Sharon Cox
- Behavioural Science and Health, UCL, London, UK
| | - Jamie Brown
- Behavioural Science and Health, UCL, London, UK
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Wen H, Xie C, Shi F, Liu Y, Liu X, Yu C. Trends in Deaths Attributable to Smoking in China, Japan, United Kingdom, and United States From 1990 to 2019. Int J Public Health 2022; 67:1605147. [PMID: 36188749 PMCID: PMC9519860 DOI: 10.3389/ijph.2022.1605147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study aimed to estimate the long-term trends of deaths attributable smoking in China, Japan, the United Kingdom (UK) and the United States (US). Methods: Using 2000–2019 death data from Global Burden of Disease (GBD) 2019, we estimated age-period-cohort effects on smoking attributable mortality, and decomposed of differences in smoking-attributable deaths in 1990 and 2019 into demographic factors. Results: From 1990 to 2019, smoking-attributable deaths increased in China, which was due to population growth and demographic aging. From 1990 to 2019, both age-standardized smoking attributable mortality rates trended downward across countries. Among four countries, age rate ratios (RRs) for smoking-attributable mortality increased with age, while period and cohort RRs decreased with year. Conclusion: The age-standardized mortality rates, period effects and cohort effects of smoking attributable mortality in China, Japan, UK, and US have been declining in both sexes from 1990 to 2019, which suggests that smoke-free policies, help to quit tobacco use, improved health education, more accessible healthcare service, and increased taxes have been effective. Additionally, increased smoking attributable deaths in elderly should got more attention.
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Affiliation(s)
- Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Cong Xie
- Hubei Provincial Center for Diseases Control and Prevention, Wuhan, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Xiaoxue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
- *Correspondence: Chuanhua Yu,
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Gelius P, Messing S, Tcymbal A, Whiting S, Breda J, Abu-Omar K. Policy Instruments for Health Promotion: A Comparison of WHO Policy Guidance for Tobacco, Alcohol, Nutrition and Physical Activity. Int J Health Policy Manag 2022; 11:1863-1873. [PMID: 34634879 PMCID: PMC9808214 DOI: 10.34172/ijhpm.2021.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/24/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Policy is an important element of influencing individual health-related behaviours associated to major risk factors for non-communicable diseases (NCDs) such as smoking, alcohol consumption, unhealthy eating and physical inactivity. However, our understanding of the specific measures recommended in NCD prevention policy-making remains limited. This study analysed recent World Health Organization (WHO) documents to identify common policy instruments suggested for national NCD prevention policy and to assess similarities and differences between policies targeting different health-related behaviours. METHODS Evert Vedung's typology of policy instruments, which differentiates between regulatory, economic/ fiscal and soft instruments, served as a basis for this analysis. A systematic search on WHO websites was conducted to identify documents relating to tobacco, alcohol, nutrition and physical activity. The staff of the respective units at the WHO Regional Office for Europe conducted an expert validation of these documents. The resulting documents were systematically searched for policy instruments. A word frequency analysis was conducted to estimate the use of individual instruments in the different policy fields, followed by an additional in-depth coding and content analysis by two independent reviewers. RESULTS Across all health-related behaviours, the following policy instruments were suggested most frequently in WHO guidance documents: laws, regulations, standards, taxes, prices, campaigns, recommendations, partnerships and coordination. The analysis showed that regulatory and economic/fiscal policy instruments are mainly applied in tobacco and alcohol policy, while soft instruments dominate in the fields of nutrition and especially physical activity. CONCLUSION The study confirms perceived differences regarding recommended policy instruments in the different policy fields and supports arguments that "harder" instruments still appear to be underutilized in nutrition and physical activity. However, more comprehensive research is needed, especially with respect to actual instrument use and effectiveness in national-level NCD prevention policy.
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Affiliation(s)
- Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Antonina Tcymbal
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephen Whiting
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - João Breda
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Willemsen MC, Mons U, Fernández E. Tobacco control in Europe: progress and key challenges. Tob Control 2022; 31:160-163. [PMID: 35241582 DOI: 10.1136/tobaccocontrol-2021-056857] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
We discuss progress made with respect to reducing the burden of disease caused by tobacco use within the WHO European Region and outline major issues and challenges regarding ongoing implementation of tobacco control policy. Although 50 of 53 countries in the WHO European Region are parties to the WHO Framework Convention for Tobacco Control (FCTC), smoking prevalence varies tremendously between European countries. While smoking rates are decreasing slowly, faster declines among smokers with a higher socioeconomic status are leading to growing inequalities in tobacco use. Governments in Europe increasingly formulate visions of 'tobacco-free' societies and it is encouraging that the European Commission aims to achieve a tobacco-free Europe in 2040 as part of its Europe's Beating Cancer Plan. While core WHO FCTC measures still have to be fully implemented in many European countries, some countries are implementing more advanced measures such as plain packaging, banning of characterising flavours from tobacco products, tobacco retailer licensing and extensions of smoking bans into spaces such as cars, outdoor areas and public streets. Remaining challenges include protecting tobacco control policymaking from tobacco industry interference, insufficient dedicated budget for scientific research and the need for Europe-wide monitoring data on use of tobacco and nicotine products.
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Affiliation(s)
- Marc C Willemsen
- Health Promotion, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
- Netherlands Expertise Centre for Tobacco Control (NET), Trimbos Institute, Utrecht, The Netherlands
| | - Ute Mons
- Cancer Prevention Unit, Heidelberg, Germany
- Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Esteve Fernández
- Tobacco Control Research Group, Epidemiology and Public Health Programme, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
- Tobacco Control Unit, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Spain
- School of Medicine and Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Berger J, Neuberger M. Occupational and Environmental Health Benefits of Smoking ban not yet Arrived in Austrian Youth. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2020. [DOI: 10.14302/issn.2690-0904.ijoe-20-3205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim was to record the smoking behaviour of 13- to 16-year-old Austrian pupils and to investigate changes in smoking behaviour following amendments of legislation and gender-specific differences.
The survey took place in Vienna, Lower Austria, Burgenland, Styria and Carinthia and was conducted at eight different school types. The data was collected by means of a questionnaire in a group setting at the beginning of a school lesson. The completion of the questionnaire was anonymous. 95,1% of the returned questionnaires could be used for this study, yielding data from a total of 1029 young people for analysis.
38.4% of the participants stated that they had at least once consumed tobacco or related products, with girls having tried them more often (41,6%) than boys (34,9%) (p = .028). At the time of the study, 3,3% used tobacco daily and 4,6% several times a week; thus 7,9% smoke regularly. Although friends or family are the most popular type of acquisition for girls and boys, girls buy their tobacco products from vending machines (11,6%) much more frequently than boys (6,0%) (p = .014) and prefer normal cigarettes (p < .001).
The results of this study show that while the number of adolescents who smoke daily is decreasing, the number of occasional smokers is increasing. Already 38,4% of the 13 to 16-year olds have had some experience consuming tobacco. Austria must take the measures recommended by the WHO to reduce the smoking prevalence and protect minors from the health damage caused by tobacco smoke.
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Affiliation(s)
- Julia Berger
- Center of Public Health, Medical University of Vienna, A-1090 Wien, Kinderspitalgasse 15, Austria
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Jebet A, Kibet JK, Kinyanjui T, Nyamori VO. Environmental inhalants from tobacco burning: Tar and particulate emissions. SCIENTIFIC AFRICAN 2018. [DOI: 10.1016/j.sciaf.2018.e00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Changes in health behaviours and body mass index after a breast cancer diagnosis: results from a prospective cohort study. Eur J Cancer Prev 2018; 28:330-337. [PMID: 30272598 DOI: 10.1097/cej.0000000000000469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the study was to describe changes in health behaviours and BMI after breast cancer diagnosis, depicting the potential influence of sociodemographic, clinical and psychological characteristics. A total of 428 breast cancer patients were prospectively followed for 3 years, since diagnosis. At the end of follow-up, women were classified regarding their adherence to recommendations for cancer prevention, prediagnosis and after 3 years, including not smoking, alcohol consumption up to one drink per day, intake of at least five portions per day of fruits and/or vegetables, physical activity and body mass index (BMI) less than 25.0 kg/m. To quantify associations between patients' characteristics and changes in adherence to each recommendation, age, education and cancer stage-adjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Among women adhering to each recommendation before diagnosis, 54.1% reduced their physical activity, 32.4% became overweight or obese and 6.1% reduced fruits and/or vegetables intake, but there were virtually no changes in alcohol consumption or smoking. Older and more educated participants were more likely to reduce their physical activity (OR=4.71, 95% CI: 1.17-18.99; OR=11.53, 95% CI: 2.20-60.53, respectively). Among participants not following each recommendation before diagnosis, 29.1% stopped smoking, 24.6% reduced alcohol consumption, 9.9% became physically active, 7.8% increased fruits and/or vegetables intake and 3.3% reduced their BMI to less than 25.0 kg/m. Older women were less likely to become physically active (OR=0.32, 95% CI: 0.14-0.75). Breast cancer patients showed some positive changes in their health behaviours after diagnosis. However, there is a large margin for improvement, which highlights the importance of health promotion interventions in this context.
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Van Hurck MM, Nuyts PAW, Monshouwer K, Kunst AE, Kuipers MAG. Impact of removing point-of-sale tobacco displays on smoking behaviour among adolescents in Europe: a quasi-experimental study. Tob Control 2018; 28:401-408. [PMID: 30030407 DOI: 10.1136/tobaccocontrol-2018-054271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND An increasing number of European countries implemented a point-of-sale (PoS) display ban on tobacco products. This study assessed the association between PoS display bans in Europe and adolescent smoking and perceived accessibility of tobacco, 2-6 years after PoS display ban implementation. METHODS In a quasi-experimental design, we compared individuals in countries that did and countries that did not implement a PoS display ban, before and after implementation. We used repeated cross-sectional data of 174 878 15-year-old and 16-year-old adolescents from 25 countries from the 2007, 2011 and 2015 European Survey Project on Alcohol and Other Drugs surveys. Multilevel logistic regression models examined smoking behaviour (regular smoking vs other) and perceived access (easy vs difficult) as a function of display ban implementation and controlled for survey year, gender, parental education and implementation of other tobacco control policies. Interaction with gender was tested. RESULTS The implementation of a PoS display ban was associated with a 15% larger drop in the odds of regular smoking (OR 0.85, 95% CI 0.79 to 0.91), but was not significantly associated with perceived accessibility of tobacco (OR 0.97, 95% CI 0.892 to 1.03). Associations were similar in males and females (cross-level interactions of gender with display ban were not statistically significant for either outcome). CONCLUSION The implementation of PoS display bans in Europe was associated with a stronger decrease in regular smoking among adolescents. This decrease does not appear to be driven by a decreasing accessibility of tobacco, but might be caused by further de-normalisation of tobacco as a result of PoS display bans.
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Affiliation(s)
- Maureen M Van Hurck
- Department of Public Health, Amsterdam Public Health research institute, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.,Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Paulien A W Nuyts
- Department of Public Health, Amsterdam Public Health research institute, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - Karin Monshouwer
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands.,Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health research institute, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - Mirte A G Kuipers
- Department of Public Health, Amsterdam Public Health research institute, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
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13
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Barlow P, McKee M, Reeves A, Galea G, Stuckler D. Time-discounting and tobacco smoking: a systematic review and network analysis. Int J Epidemiol 2018; 46:860-869. [PMID: 27818375 PMCID: PMC5637946 DOI: 10.1093/ije/dyw233] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Tobacco smoking harms health, so why do people smoke and fail to quit? An explanation originating in behavioural economics suggests a role for time-discounting, which describes how the value of a reward, such as better health, decreases with delay to its receipt. A large number of studies test the relationship of time-discounting with tobacco outcomes but the temporal pattern of this relationship and its variation according to measurement methods remain unclear. We review the association between time-discounting and smoking across (i) the life course, from initiation to cessation, and (ii) diverse discount measures. Methods: We identified 69 relevant studies in Web of Science and PubMed. We synthesized findings across methodologies and evaluated discount measures, study quality and cross-disciplinary fertilization. Results: In 44 out of 54 studies, smokers more greatly discounted the future than non-smokers and, in longitudinal studies, higher discounting predicted future smoking. Smokers with lower time-discount rates achieved higher quit rates. Findings were consistent across studies measuring discount rates using hypothetical monetary or cigarette reward scenarios. The methodological quality of the majority of studies was rated as ‘moderate’ and co-citation analysis revealed an isolation of economics journals and a dearth of studies in public health. Conclusion: There is moderate yet consistent evidence that high time-discounting is a risk factor for smoking and unsuccessful cessation. Policy scenarios assuming a flat rate of population discounting may inadequately capture smokers’ perceptions of costs and benefits.
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Affiliation(s)
- Pepita Barlow
- Department of Sociology, University of Oxford, Oxford, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Aaron Reeves
- International Inequalities Institute, London School of Economics, London, UK
| | - Gauden Galea
- Division of Noncommunicable Diseases and Life-course, Regional Office for Europe, World Health OrganizationCopenhagen, Denmark
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
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14
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Sun YQ, Chen Y, Langhammer A, Skorpen F, Wu C, Mai XM. Passive smoking in relation to lung cancer incidence and histologic types in Norwegian adults: the HUNT study. Eur Respir J 2017; 50:50/4/1700824. [PMID: 29025890 DOI: 10.1183/13993003.00824-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/14/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Yi-Qian Sun
- Dept of Laboratory Medicine, Children's and Women's Health (LBK), NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yue Chen
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Arnulf Langhammer
- Dept of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frank Skorpen
- Dept of Laboratory Medicine, Children's and Women's Health (LBK), NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Chunsen Wu
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Odense University Hospital, Odense, Denmark
| | - Xiao-Mei Mai
- Dept of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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15
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Baha M, Boussadi A, Le Faou AL. French smoking cessation services provide effective support even to the more dependent. Prev Med 2016; 90:34-8. [PMID: 27346755 DOI: 10.1016/j.ypmed.2016.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/14/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE France is one the few European countries offering a national quit line along with partially cost-covered nicotine replacement therapy (NRT) and cessation services. This study assesses outcomes and predictors of continued abstinence in French smoking cessation services. METHOD The French national smoking cessation registry (CDTnet) included 23,810 adult smokers followed-up between 2011 and 2013. We assessed 1-month continued abstinence among 10,161 who initiated a quit attempt before or during follow-up. Predictors of abstinence were determined using multivariable regression model. RESULTS Among quitters, 45.2% achieved CO-validated abstinence. Prescription of pharmacotherapy was associated with abstinence rates as high as 47% for combination NRT and 53% for varenicline. The effect of behavioural support associated with combination NRT versus behavioural support alone increased with attendance: OR 1.11 (95% CI 0.89-1.39) for 2-3 visits, OR 1.43 (95% CI 1.13-1.80) for 4-6 visits, OR 1.60 (95% CI 1.21-2.12) for ≥7 visits. Unemployed participants were as likely to be successful as participants in employment (OR 0.88; 95% CI 0.75-1.04). High cigarette dependence also did not significantly hinder abstinence. Young adults achieved the lowest abstinence rates. Predictors that significantly reduced odds of abstinence were: being aged 18 to 24 and a history of alcohol abuse. CONCLUSION With adapted treatment, even the more dependent or less affluent maintained abstinence. Our findings suggest that French cessation services have been successful in providing cessation support. Nevertheless, there is room for improvement in tailoring treatment for some subgroups of smokers.
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Affiliation(s)
- Monique Baha
- AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France.
| | - Abdelali Boussadi
- AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France; INSERM UMRs 1138, équipe 22, Paris, France
| | - Anne-Laurence Le Faou
- AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, UMRS1123, Hôtel-Dieu 1, place du Parvis Notre-Dame, F-75004 Paris, France
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16
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Abstract
Tobacco use remains the leading cause of preventable death in the US, emphasizing the need to understand which genes and environments are involved in the establishment of cigarette use behaviors. However, to date, no comprehensive review of the influence of genes, the environment, and their interaction on cigarette use exists. This narrative review provides a description of gene variants and environmental factors associated with cigarette use, as well as an overview of studies investigating gene-environment interaction (GxE) in cigarette use. GxE studies of cigarette use have been useful in demonstrating that the influence of genes changes as a function of both the phenotype being measured and the environment. However, it is difficult to determine how the effect of genes contributing to different phenotypes of cigarette use changes as a function of the environment. This suggests the need for more studies of GxE, to parse out the effects of genes and the environment across the development of cigarette use phenotypes, which may help to inform potential prevention and intervention efforts aimed at reducing the prevalence of cigarette use. Key Messages No comprehensive reviews of the influence of genes, the environment, and their interaction on cigarette use exist currently. The influence of genes may change as a function of the environment and the phenotype being measured. It is difficult to determine how the effect of genes contributing to different phenotypes of cigarette use changes according to environmental context, suggesting the need for more studies of gene-environment interaction related to cigarette use to parse out effects.
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Affiliation(s)
- Elizabeth Do
- a Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond , VA , USA ;,b Center for Clinical and Translational Research , Virginia Commonwealth University , Richmond , VA , USA
| | - Hermine Maes
- a Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond , VA , USA ;,c Department of Human and Molecular Genetics , Virginia Commonwealth University , Richmond , VA , USA ;,d Department of Psychiatry , Virginia Commonwealth University , Richmond , VA , USA ;,e Massey Cancer Center , Virginia Commonwealth University , Richmond , VA , USA
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17
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Bosdriesz JR, Willemsen MC, Stronks K, Kunst AE. Socioeconomic inequalities in smoking cessation in 11 European countries from 1987 to 2012. J Epidemiol Community Health 2015; 69:886-92. [PMID: 25841241 DOI: 10.1136/jech-2014-205171] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/13/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND During the 1990s, inequalities in smoking prevalence by socioeconomic status (SES) have widened in Europe. Since then, many tobacco control policies have been implemented. Yet, European overviews of recent trends in smoking inequalities are lacking. This paper aims to provide an overview of long-term trends of socioeconomic inequalities in smoking cessation in Europe. METHODS We used data for 11 countries taken from Eurobarometer surveys from 1987 to 1995 and 2002-2012, with a total study sample of 63 737 respondents. We performed multilevel logistic regression to model associations of the quit ratio (proportion former smokers of ever smokers) with SES, measured by education and occupation separately, with adjustments for age, sex and time. RESULTS We found a significant, positive association for education and occupation with the quit ratio. The strength of the association decreased slightly from 1987 to 1995 and increased again from 2002 to 2012. Inequalities increased between the two periods in most countries and decreased in only one country. While in 1987-1995, the quit ratio increased among all SES groups and most strongly among the low SES group, in 2002-2012 it increased only among the high-education group (OR=1.38, 95% CI 1.02 to 1.87), and non-manual occupation group (OR=1.59, 95% CI 1.19 to 2.12). CONCLUSIONS Socioeconomic inequalities in smoking cessation rates have strongly increased since the 1990s and during the 2000s. This suggests that the tobacco control policies implemented during the 2000s have not been able to counter the trend in increasing inequalities.
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Affiliation(s)
- Jizzo R Bosdriesz
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands Alliance Smokefree Holland, The Hague, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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18
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Wei X, E M, Yu S. A meta-analysis of passive smoking and risk of developing Type 2 Diabetes Mellitus. Diabetes Res Clin Pract 2015; 107:9-14. [PMID: 25488377 DOI: 10.1016/j.diabres.2014.09.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/25/2014] [Accepted: 09/14/2014] [Indexed: 10/24/2022]
Abstract
AIMS To assess passive smoking as a risk factor for developing type 2 Diabetes Mellitus (T2DM). METHODS A search of PubMed, Web of Knowledge, Elsevier ScienceDirect and Springer (up to March, 2014) databases were performed using subject and random words. Two authors independently extracted the data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of included studies. The odds ratio (ORs) for the association was determined using a fix-effects model. Subgroup and sensitivity analyses were performed and publication bias was assessed. RESULT 7 prospective studies were included in this meta-analysis which included a total of 162,001 subjects. The overall OR for developing T2DM for passive smoking was 1.33 (95% confidence interval (CI) 1.20-1.46), with no significant heterogeneity between studies. The result was stable in the subgroup and sensitivity analyses, however there was evidence of publication bias. After the "fill and trim" method, the recalculated OR was 1.27 (95%CI 1.16-1.40). CONCLUSIONS Passive smoking is a risk factor of T2DM even in those who were not themselves active smokers.
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Affiliation(s)
- Xiaomin Wei
- Institute of Occupational Health and Environmental, Health, Shandong University, 44 Wenhua Xi Road, Jinan, 250012 Shandong, PR China
| | - Meng E
- Institute of Occupational Health and Environmental, Health, Shandong University, 44 Wenhua Xi Road, Jinan, 250012 Shandong, PR China
| | - Sufang Yu
- Institute of Occupational Health and Environmental, Health, Shandong University, 44 Wenhua Xi Road, Jinan, 250012 Shandong, PR China.
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19
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Secondhand smoke exposure, indoor smoking bans and smoking-related knowledge in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12835-47. [PMID: 25514143 PMCID: PMC4276649 DOI: 10.3390/ijerph111212835] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 11/16/2022]
Abstract
Although previous studies have provided strong evidence that Chinese individuals are exposed to secondhand smoke (SHS) and lack knowledge of its harmful effects, there has not been an in-depth exploration of the variability in exposure and knowledge by geographic region, occupation, and socioeconomic status. The objectives of this study were to examine: (1) the demographic factors associated with the level of knowledge of the harmful effects of smoking; (2) the factors related to implementation of in-home and workplace smoking bans; and (3) geographic differences in being exposed to SHS in government buildings, healthcare facilities, restaurants, public transportations, and schools. We used data from the 2010 Global Adult Tobacco Survey-China. Chi-square tests were used for statistical analysis. The results suggested that among Chinese citizens age 15 years and older, there is poor knowledge of the harmful effects of tobacco, and knowledge varies with region and socioeconomic status. Over three-quarters of the households had no smoking restrictions, and a large percentage of workers reported working in places with no smoking ban. In public places, exposure to SHS was high, particularly in rural areas and in the Southwest. These results suggest Chinese individuals are not well informed of smoking and SHS associated risks and are regularly exposed to SHS at home, work and public places.
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20
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Martínez C, Fu M, Martínez-Sánchez JM, Antón L, Fernández P, Ballbè M, Andrés A, Riccobene A, Sureda X, Gallart A, Fernández E. Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys. BMC Public Health 2014; 14:1228. [PMID: 25427959 PMCID: PMC4289238 DOI: 10.1186/1471-2458-14-1228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/17/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws. METHODS Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001-2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law). RESULTS Baseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees' overall support for the smoke-free hospital project. CONCLUSIONS A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.
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Affiliation(s)
- Cristina Martínez
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, Sant Cugat del Valles, 08915 Barcelona, Spain
| | - Marcela Fu
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, Sant Cugat del Valles, 08915 Barcelona, Spain
| | - Jose María Martínez-Sánchez
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Biostatistic Unit, Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, C. Josep Trueta s/n, Sant Cugat del Valles, 08915 Barcelona, Spain
| | - Laura Antón
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Paz Fernández
- />Nursing Research Unit, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199–203, L’Hospitalet de Llobregat (Barcelona), Spain, 08908 Barcelona, Spain
| | - Montse Ballbè
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona - IDIBAPS, C. Villarroel 170, 08036 Barcelona, Spain
- />Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
| | - Ana Andrés
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Department of Methodology for the Behavioural Sciences, University of Barcelona, Barcelona, Spain
| | - Anna Riccobene
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Xisca Sureda
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
| | - Albert Gallart
- />Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, Sant Cugat del Valles, 08915 Barcelona, Spain
| | - Esteve Fernández
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
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Ravara SB, Miranda N, Calheiros JM, Berteletti F, Joossens L. Tobacco control progress in Portugal: The need for advocacy and civil society leadership. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:289-92. [PMID: 25310927 DOI: 10.1016/j.rppneu.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 09/08/2014] [Accepted: 09/08/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- S B Ravara
- Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; CHCB University Hospital, Covilhã, Portugal.
| | - N Miranda
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - J M Calheiros
- Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; CHCB University Hospital, Covilhã, Portugal
| | | | - L Joossens
- Association of European Cancer Leagues, Belgian Foundation Against Cancer, Brussels, Belgium
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22
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Ravara SB, Castelo-Branco M, Aguiar P, Calheiros JM. Are physicians aware of their role in tobacco control? A conference-based survey in Portugal. BMC Public Health 2014; 14:979. [PMID: 25239241 PMCID: PMC4177758 DOI: 10.1186/1471-2458-14-979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The crucial role of physicians in tobacco control (TC) is widely recognized. In 2008, Portugal implemented a non-comprehensive smoke-free policy (SFP). In 2009, a conference-survey was carried out to explore Portuguese physicians' engagement in tobacco control, by evaluating the following: 1) attendance at TC training and awareness of training needs; 2) participation in TC activities; 3) attitudes and beliefs regarding SFPs. METHODS Questionnaire-based cross-sectional study conducted during two major national medical conferences targeting GPs, hospitalists, and students/recent graduates. Descriptive analysis and logistic regression were performed. RESULTS Response rate was 63.7% (605/950). Of the 605 participants, 58.3% were GPs, 32.4% hospitalists, 9.3% others; 62.6% were female; mean age was 39.0 ± 12.9 years. Smoking prevalence was 29.2% (95% CI: 23.3-35.1) in males; 15.8% (95% CI: 12.1-19.5) in females, p < 0.001. While the overwhelming majority of physicians strongly agreed that second-hand smoke (SHS) endangers health, awareness of SFP benefits and TC law was limited, p < 0.001. A significant minority (35.5%) believed that SHS can be eliminated by ventilation systems. Most physicians lacked training; only a minority (9.0%) participated regularly in TC. Training was the most consistent predictor of participation in TC. General agreement with SFP was high; but significantly lower for indoor leisure settings, outdoors bans in healthcare/schools settings and smoking restrictions in the home/car, p < 0.001. Smoking behaviour strongly predicted support for smoking restrictions in restaurants and bars/discos, healthcare outdoors and private settings. CONCLUSIONS The findings suggest that Portuguese physicians are not aware of their role in tobacco control. Poor engagement of physicians in TC may contribute to the current lack of comprehensive policies in Portugal and Europe and undermine social norm change. Medical and professional continuing education on tobacco control should be made top priorities.
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Affiliation(s)
- Sofia B Ravara
- />Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilha, Portugal
- />CHCB University Hospital, Quinta do Alvito, 6200-251 Covilha, Portugal
| | - Miguel Castelo-Branco
- />Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilha, Portugal
- />CHCB University Hospital, Quinta do Alvito, 6200-251 Covilha, Portugal
| | - Pedro Aguiar
- />National School of Public Health, New University of Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Jose M Calheiros
- />Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilha, Portugal
- />National Institute of Health Doutor Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal
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The association between economic recession and public support for increased tobacco taxation in 27 European countries. Scand J Public Health 2014; 42:589-92. [DOI: 10.1177/1403494814542264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Increased taxation on tobacco products is an effective method of reducing tobacco use. This study assessed population support among respondents aged ≥15 years, from 27 European Union (EU) countries for increased taxation and other tobacco control measures during the 2009–2012 period. Methods: Nationally representative data were obtained from the 2009 (n=26,788) and 2012 (n=26,751) cross-sectional Eurobarometer surveys. Estimates were compared using chi-square statistics. The effect of the relative change in gross domestic product (GDP) on the change in support for increased taxation during 2009–2012 was calculated using the Pearson correlation coefficient and linear regression models. Results: Between 2009 and 2012, population support for increased taxes on tobacco products declined (56.1% to 53.2%; p<0.001). However, support for other tobacco control measures increased significantly. After adjusting for baseline GDP per capita (2009), a 10% increase in GDP per capita was associated with 4.5% increase in support of tax increases. When Latvia and Lithuania were excluded from the analyses (because of their marked deviation from the general trend), there was a strong correlation between the change in GDP and support for increased taxes (ρ=0.64; p<0.001). Also, after adjusting for baseline GDP, support for higher taxes on tobacco increased by 7.0% for every 10% increase in GDP between 2009 and 2012. Conclusions: Population support for tax increases declined in the EU between 2009 and 2012, especially in countries with declines in GDP. Nonetheless, public support for other tobacco control measures remains high, thus indicating a viable environment for more comprehensive tobacco control.
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Martínez C, Guydish J, Robinson G, Martínez-Sánchez JM, Fernández E. Assessment of the smoke-free outdoor regulation in the WHO European Region. Prev Med 2014; 64:37-40. [PMID: 24704133 PMCID: PMC4102698 DOI: 10.1016/j.ypmed.2014.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study is to assess the level of protection of secondhand smoke in outdoor locations among countries belonging to the WHO European Region. METHOD This cross-sectional study measures the level of protection provided by laws in outdoor locations. A protocol to evaluate the outdoor smoke-free legislation was developed according to the recommendations provided by the WHO Guidelines for implementing smoke-free outdoor places. For each law 6 main sectors and 28 outdoor locations were evaluated. RESULTS 68 laws from 48 countries were reviewed, totally assessing 1758 locations. Overall 3.1% of the locations specified 100% smoke-free outdoor regulation without exceptions, 2.5% permitted smoking in designated outdoor areas, 37.5% allowed smoking everywhere, and 56.9% did not provide information about how to deal with smoking in outdoor places. In the Education sector 17.8% of the laws specified smoke-free outdoor regulation, mainly in the primary and secondary schools. Three pioneering laws from recreational locations and two from general health facilities specified 100% outdoor smoke-free regulation. CONCLUSION Outdoor smoke-free policies among countries belonging to the WHO European Region are limited and mainly have been passed in the primary and secondary schools, which protect minors from the hazards of secondhand smoke in educational settings.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Gran Via de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat Barcelona, Spain; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona, Spain; Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States
| | - Gillian Robinson
- Tobacco Control Programme, City and Hackney Public Health Service, London Borough of Hackney, UK
| | - Jose María Martínez-Sánchez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Gran Via de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona, Spain; Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Gran Via de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain; Biostatistics Unit, Department of Basic Science, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
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Affiliation(s)
- Mohd Masood
- Centre of Population Oral Health and Clinical Prevention Studies, Faculty of Dentistry, University Technology MARA, Shah Alam 40450, Malaysia.
| | - Yaghma Masood
- Centre of Oral and Maxillofacial Diagnostics and Medicine Studies, Shah Alam, Malaysia
| | - Daniel D Reidpath
- Global Public Health, Jeffrey Cheah School of Medicine and Health Science, Monash University, Bandar Sunway, Malaysia
| | - Tim Newton
- Dental Public Health and Oral Health Services Research, King's College Dental Institute, King's College London, London, UK
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