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Sreeramareddy CT, Manoharan A. Smokeless tobacco consumption and its association with tobacco control factors in the Western Pacific Region: results from the Global Youth Tobacco Survey 2015-2019. Epidemiol Health 2022; 44:e2022103. [PMID: 36397245 PMCID: PMC10185971 DOI: 10.4178/epih.e2022103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES We estimated the prevalence of smokeless tobacco (ST) consumption and its associations with tobacco control factors among school-going youth in 18 Western Pacific Region (WPR) countries. METHODS We analyzed school-based Global Youth Tobacco Survey (2014-2019) microdata from 18 WPR countries and estimated weighted prevalence rates of ST consumption, cigarette smoking, and dual use. We used multilevel binary logistic regression to examine the associations of ST consumption and dual use with demographic variables, exposure to pro-tobacco and anti-tobacco factors, national income, and MPOWER indicators. RESULTS Data from 58,263 school-going youth were analyzed. The prevalence of past 30-day ST consumption was highest in Kiribati (42.1%), the Marshall Islands (26.1%), Micronesia (21.3%), Palau (16.0%), and Papua New Guinea (15.2%). In adjusted multilevel models, ST consumption and dual use were significantly associated with sex, age, parental smoking, pro-tobacco factors, national income, and MPOWER score. For each unit increase in score for cessation programs, we observed approximately 1.4-fold increases in the odds of youth ST consumption (adjusted odds ratio [aOR], 1.38; 95% confidence interval [CI], 1.15 to 1.66) and dual use (aOR, 1.47; 95% CI, 1.16 to 1.86). Similarly, for each unit increase in score for health-related warnings, the odds of both ST consumption (aOR, 0.47; 95% CI, 0.42 to 0.53) and dual use (aOR, 0.35; 95% CI, 0.30 to 0.42) decreased by approximately 60%. CONCLUSIONS The prevalence of youth ST consumption was substantial in the Pacific Islands, exceeding that of cigarette smoking in some countries. Implementing MPOWER measures for ST products could help reduce ST consumption.
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Cerrai S, Benedetti E, Colasante E, Scalese M, Gorini G, Gallus S, Molinaro S. E-cigarette use and conventional cigarette smoking among European students: findings from the 2019 ESPAD survey. Addiction 2022; 117:2918-2932. [PMID: 35768962 DOI: 10.1111/add.15982] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Representative data on e-cigarette use among European adolescents are scant. This study reports current vaping and tobacco smoking individual and country-specific correlates among European students. DESIGN Cross-sectional survey: 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) collecting data on risk behaviours on a representative sample of 16-year-old students. SETTING A total of 35 European countries, 25-30 with Tobacco Control Scale (TCS) and TCS components PARTICIPANTS: A total of 99 648 students (49.1% males) turning 16 years in the survey year. MEASUREMENTS Data on current cigarette and e-cigarette use were gathered through a self-administered questionnaire which also collected socio-demographics and individual and family characteristics. ESPAD data were integrated with country-level data on TCS and selected TCS parameters to assess their association with the prevalence of current cigarette and e-cigarette use. FINDINGS Of the 99 648 participating students, 12.4% were current e-cigarette users, from 5.5% in Serbia to 41.4% in Monaco; 19.3% current smokers, from 5.1% in Iceland to 32.4% in Italy. Compared with non-users, current e-cigarette users less frequently came from an average well-off family [odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.80-0.90] and lived in countries with higher cigarette prices (OR = 0.71, 95% CI = 0.50-0.99), restrictive measures on tobacco advertising and promotion (OR = 0.79, 95% CI = 0.63-0.99) and intermediate implementation of tobacco control measures (OR = 0.57, 95% CI = 0.38-0.85). Current vapers were more frequently life ever smokers (OR = 7.31, 95% CI = 6.47-8.25), were early smokers (OR = 4.35, 95% CI = 3.66-5.17), males (OR = 1.61, 95% CI = 1.55-1.67), from non-traditional families (OR = 1.43, 95% CI = 1.34-1.53), with relatively low parental education (OR = 1.15, 95% CI = 1.10-1.20). Compared with non-smokers, current smokers had similar family characteristics to vapers, and were less likely to live in countries with higher cigarette prices (OR = 0.70, 95% CI = 0.49-0.99) and higher spending on public anti-tobacco media campaigns (OR = 0.23, 95% CI = 0.10-0.50). CONCLUSIONS E-cigarette use among European adolescents is associated with weaker tobacco control measures, particularly on tobacco price, advertising and promotion. Besides preventing tobacco smoking, the adoption of governmental tobacco control policies in European countries also seems to contribute to the prevention of vaping among adolescents.
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Affiliation(s)
- Sonia Cerrai
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Elisa Benedetti
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Emanuela Colasante
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Marco Scalese
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sabrina Molinaro
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
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de Looze ME, Henking C, Torsheim T, Currie DB, Weber MW, Alemán-Díaz AY. The association between MPOWER tobacco control policies and adolescent smoking across 36 countries: An ecological study over time (2006–2014). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103871. [DOI: 10.1016/j.drugpo.2022.103871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 10/31/2022]
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Strizek J, Uhl A, Schaub M, Malischnig D. Alcohol and Cigarette Use among Adolescents and Young Adults in Austria from 2004-2020: Patterns of Change and Associations with Socioeconomic Variables. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413080. [PMID: 34948689 PMCID: PMC8701464 DOI: 10.3390/ijerph182413080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
Background: Adolescents and young adults are a crucial target group for preventing harm related to substance use. Recently, declining alcohol and tobacco consumption in young people has been observed in many countries. Based on survey data from 2004 to 2020, we describe time trends for several subgroups of adolescents and young adults (based on consumption levels and socioeconomic variables) and analyze associations between the level of alcohol per capita consumption or daily smoking and socioeconomic variables. Methods: Time trends for males and females are analyzed by a two-way ANOVA and predictors of use by using multivariate regression and logistic regression. Results: Alcohol per capita consumption decreased significantly for both sexes in the 16-year period, with male and female consumption levels converging. Daily smoking was equally prevalent for young males and females and decreased to a similar degree for both sexes. Being male and living in rural areas are associated with a higher level of alcohol consumption. Daily smoking is associated with a low level of education and is more prevalent among young adults who have already started to work. Conclusions: The decline in alcohol use and daily smoking among adolescents and young adults is taking place simultaneously. However, higher levels of alcohol consumption and daily smoking occur in different groups of adolescents and young adults, which should be considered in prevention strategies.
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Affiliation(s)
- Julian Strizek
- Gesundheit Österreich GmbH (Austrian Public Health Institute), 1010 Vienna, Austria;
- Correspondence: (J.S.); (D.M.); Tel.: +43-1-51561-148 (J.S.); +43-1-4000-87321 (D.M.)
| | - Alfred Uhl
- Gesundheit Österreich GmbH (Austrian Public Health Institute), 1010 Vienna, Austria;
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, 1020 Vienna, Austria
| | - Michael Schaub
- Swiss Research Institute of Public Health and Addiction (ISGF), University of Zürich, 8006 Zurich, Switzerland;
| | - Doris Malischnig
- Institute for Addiction Prevention, Office of Addiction and Drug Policy of Vienna, 1030 Vienna, Austria
- Correspondence: (J.S.); (D.M.); Tel.: +43-1-51561-148 (J.S.); +43-1-4000-87321 (D.M.)
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Nuyts PAW, Hewer RMF, Kuipers MAG, Lorant V, Grard A, Hill S, Amos A. Youth Access to Cigarettes Across Seven European Countries: A Mixed-Methods Study. Nicotine Tob Res 2021; 22:1989-1996. [PMID: 31535686 PMCID: PMC7593358 DOI: 10.1093/ntr/ntz180] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022]
Abstract
Background Despite widespread age-of-sale restrictions on tobacco, adolescents continue to obtain cigarettes and experiment with smoking. This mixed-methods study aimed to understand how European adolescents access cigarettes and how the policy context may influence this process, using a realist evaluation approach. This is the first study to assess access to cigarettes across various European contexts. Methods A survey of 4104 students was combined with qualitative data from focus groups among 319 adolescents aged 14–19 across seven European countries. Data were synthesized to explore mechanisms via which young people obtain cigarettes despite age-of-sale restrictions. Results While purchasing cigarettes from supermarkets was widely regarded as difficult, many participants purchased cigarettes from noncompliant retailers (often in smaller shops or cafes). Other contra-mechanisms included circumventing age checks, proxy purchases, and/or social sources. Dominant forms of access differed across the seven contexts, with direct purchases more common where perceived enforcement was low (eg, Belgium) and proxy purchases more important where perceived enforcement of age-of-sale laws was high (eg, Finland). The effectiveness of age-of-sale restrictions in reducing youth access appears to be influenced by a range of contextual factors including retailer compliance, the availability of vending machines, and the specific minimum age-of-sale. Conclusions Our findings illustrate the relevance of programme theory in understanding the contra-mechanisms that undermine the effectiveness of age-of-sale laws in discouraging youth smoking. Young people’s access to cigarettes could be further limited by addressing these contra-mechanisms, including an increase in the legal sales age (particularly in Belgium), banning vending machines, and strengthening enforcement. Implications Despite widespread implementation of age-of-sale laws, a substantial proportion of minors continue to access cigarettes. Young people use a number of contra-mechanisms to circumvent age-of-sale restrictions. These include accessing cigarettes via social sources, proxy sales or by circumventing age checks. Our findings show that in contexts where perceived enforcement of age-of-sale restrictions is high, young people are more reliant on irregular forms of access such as proxy sales. Young people’s access to cigarettes may be further reduced by policy interventions that address these contra-mechanisms—for example, banning vending machines, strengthening enforcement of age-of-sale laws, and increasing the minimum age-of-sale.
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Affiliation(s)
- Paulien A W Nuyts
- Department of Public Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rebecca M F Hewer
- UK Centre for Tobacco and Alcohol Studies, Usher Institute for Population Health Sciences and Informatics University of Edinburgh, Edinburgh, UK
| | - Mirte A G Kuipers
- Department of Public Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Vincent Lorant
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Adeline Grard
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | | | - Sarah Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Amanda Amos
- UK Centre for Tobacco and Alcohol Studies, Usher Institute for Population Health Sciences and Informatics University of Edinburgh, Edinburgh, UK
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Feliu A, Fernández E, Baena A, Joossens L, Peruga A, Fu M, Martínez C. The Tobacco Control Scale as a research tool to measure country-level tobacco control policy implementation. Tob Induc Dis 2020; 18:91. [PMID: 33192223 PMCID: PMC7656742 DOI: 10.18332/tid/128318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Ariadna Feliu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Antoni Baena
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.,eHealth Center, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | | | - Armando Peruga
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain.,Center for Epidemiology and Health Policies, Clínica Alemana, School of Medicine, Universidad del Desarrollo, Santiago de Chile, Chile
| | - Marcela Fu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina Martínez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
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Leão T, Kunst AE, Schreuders M, Lindfors P, Kuipers MA, Perelman J. Adolescents' smoking environment under weak tobacco control: A mixed methods study for Portugal. Drug Alcohol Depend 2019; 204:107566. [PMID: 31568935 DOI: 10.1016/j.drugalcdep.2019.107566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bans on smoking in public places and on sales to minors have been widely implemented across the globe. However, many countries have either adopted non-comprehensive (i.e., partial) bans and/or weakly enforce those bans. Little is known, from the adolescents' perspective, how this affects their smoking-related perceptions and behaviors. We studied the case of Portugal, where bans are partial and/or weakly enforced. We sought to understand how the bans affect adolescents' access to cigarettes from commercial sources, the visibility of smoking in public places, and smoking locations. MATERIAL AND METHODS We used a mixed methods design on data gathered in 2016. Quantitative, cross-sectional surveys were conducted in six schools (n = 2,444) in Coimbra, Portugal. In two of these schools, qualitative data were collected in eight single-sex focus group interviews (n = 42). RESULTS Ninety-five percent of the adolescents who tried to buy cigarettes were able to do so from commercial sources, through vending machines, or directly from the vendor. Bans on smoking on school premises and at enclosed public places did not prevent these adolescents from observing smoking outside school gates (84.0%), in cafes and restaurants (97%), or from smoking at cafes, bars, or nightclubs (72.9%). DISCUSSION Partial and/or weakly enforced policies seem to not prevent adolescents from having access to cigarettes, frequently seeing smoking, and finding ample opportunities to smoke in public places. Adopting and enforcing comprehensive policies are necessary efforts to prevent unfavorable responses and more effectively reduce adolescents' smoking behavior.
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Affiliation(s)
- Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal; Public Health Unit, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Portugal.
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Michael Schreuders
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Pirjo Lindfors
- Faculty of Social Sciences, 33014 Tampere University, Finland
| | - Mirte Ag Kuipers
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Julian Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
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So VH, Best C, Currie D, Haw S. Association between tobacco control policies and current smoking across different occupational groups in the EU between 2009 and 2017. J Epidemiol Community Health 2019; 73:759-767. [PMID: 31213489 DOI: 10.1136/jech-2018-211935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/01/2019] [Accepted: 05/04/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study investigated the cross-national and longitudinal associations between national tobacco control policies and current smoking in 28 European Union (EU) member states between 2009 and 2017. It also examined the interaction between tobacco control policies and occupational status. METHODS We used data from four waves of Eurobarometer (2009, 2012, 2014 and 2017). The total sample size was 105 231 individuals aged ≥15 years. Tobacco Control Scale (TCS) scores (range 0 to 100) for years 2005, 2007, 2012 and 2014 measured the strength of country-level tobacco control policies. Logistic multilevel regression analyses with three levels (the individual, the country-year and the country) were performed with current smoker as the dependent variable. RESULTS Across the EU, average smoking prevalence fell from 29.4% (95% CI 28.5% to 30.2%) in 2009 to 26.3% (95% CI 25.4% to 27.1%) in 2017. We confirmed that cross-nationally, strong national tobacco control policies are significantly associated with a low probability of smoking. A one-point increase in TCS score was associated with lower odds of smoking (OR=0.990; 95% CI 0.983 to 0.998), but longitudinally (within-country) increases in TCS were not associated with current smoking (OR=0.999; 95% CI 0.994 to 1.005). Compared with those in manual occupations, the cross-national association was stronger in the upper occupational group (conditional OR for the interaction=0.985; 95% CI 0.978 to 0.992) and weaker in the economically inactive group (conditional OR for the interaction=1.009; 95% CI 1.005 to 1.013). CONCLUSION Differences in tobacco control policies between countries were associated with the probability of smoking but the changes in TCS within countries over time were not. Differences between countries in tobacco control policies were found to be most strongly associated with the likelihood of smoking in the highest occupational groups and were found to have only a weak association with smoking among the economically inactive in this sample.
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Affiliation(s)
- Vivian Ht So
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Catherine Best
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Dorothy Currie
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Sally Haw
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Serrano‐Alarcón M, Kunst AE, Bosdriesz JR, Perelman J. Tobacco control policies and smoking among older adults: a longitudinal analysis of 10 European countries. Addiction 2019; 114:1076-1085. [PMID: 30868688 PMCID: PMC6593806 DOI: 10.1111/add.14577] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/04/2018] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The impact of tobacco control on European older adults has not been studied, despite evidence that smoking cessation at old age can bring significant life expectancy gains. Our aim was to evaluate the impact of tobacco control policies on smoking among older adults in Europe from 2004 to 2013. DESIGN We used longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE, aged 50+ years) from four waves from 2004 to 2013. We used logistic regression models with clustered standard errors to determine whether the implementation of tobacco control policies was associated with changes in smoking status. Furthermore, we studied whether these associations varied by socio-demographic characteristics. Regression coefficients were converted to changes the probability of smoking [marginal effects (ME)]. MEASUREMENTS Smoking status was the dependent variable, and the Tobacco Control Scale (TCS) was the explanatory variable, overall and by its main policy components (pricing and smoke-free policies). Covariates included age, sex, education and country and wave fixed-effects. FINDINGS A 10-point increase in TCS was associated with a lower probability of smoking by 1.6 percentage points [95% confidence interval (CI) = -3.208, -0.056] for those aged 50-65, but not for older Europeans. Among those with primary school or no education, the associated drop was of 1.5 percentage points (95% CI = -2.751, -0.253). By contrast, no significant relation between TCS and smoking was observed among those with high education. Higher TCS scores for pricing (ME = -0.636, 95% CI = -0.998, -0.275) and smoke-free policies (ME = -0.243, 95% CI = -0.445, -0.041) were associated with a significantly lower probability of smoking (P = 0.001 and P = 0.018, respectively). CONCLUSION Increases in tobacco taxes and smoke-free policies are significantly related with a reduction in smoking among European older adults, suggesting potential health gains for this rising share of the population. These policies may be more effective among the lowest educated.
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Affiliation(s)
| | - Anton E. Kunst
- Department of Public Health, Academic Medical CenterUniversity of Amsterdamthe Netherlands
| | - Jizzo R. Bosdriesz
- Leiden University, Institute of Education and Child Studiesthe Netherlands
| | - Julian Perelman
- Escola Nacional de Saúde PúblicaNOVA University of LisbonPortugal,Centro de Investigação em Saúde PúblicaPortugal
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Holstein BE, Andersen A, Damsgaard MT, Due P, Bast LS, Rasmussen M. Trends in socioeconomic differences in daily smoking among 15-year-old Danes 1991–2014. Scand J Public Health 2019; 48:667-673. [DOI: 10.1177/1403494819848284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: To examine trends in socioeconomic differences in daily smoking among 15-year-old Danes between 1991–2014, using occupational social class as indicator of socioeconomic status. Methods: The study included 15-year-olds participating in seven Danish Health Behaviour in School-aged Children studies between 1991–2014, n = 8,641. The analyses focused on absolute socioeconomic differences (prevalence difference between low and high occupational social class) and relative socioeconomic differences communicated by odds ratio for daily smoking. Results: The prevalence of daily smoking declined from 18.6% in 1991 to 4.5% in 2014. Across all surveys, the prevalence was 8.9% in high, 12.8% in middle and 16.5% in low occupational social classes ( p < 0.0001). The absolute socioeconomic differences increased from 1991 to 2006 and declined thereafter. Across all survey years, the odds ratio (95% confidence interval) for daily smoking was 1.40 (1.19–1.65) in middle and 1.90 (1.56-2.32) in low versus high occupational social classes. The statistical interaction between occupational social class and survey year was significant ( p = 0.0404), suggesting increasing relative socioeconomic differences from 1991 to 2014. Conclusions: There was a substantial decline in daily smoking among 15-year-olds between 1991–2014 in all occupational social class groups. The prevalence of daily smoking was highest in the low occupational social class during the entire period. The absolute socioeconomic differences in daily smoking increased between 1991–2006 and declined thereafter. The relative socioeconomic differences increased over 1991–2014. Studies of change in socioeconomic differences over time should address both absolute and relative socioeconomic differences as they may result in different conclusions and because important improvement in prevalence patterns may be disguised by exclusive focus on changes in relative socioeconomic differences.
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Affiliation(s)
- Bjørn E. Holstein
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Anette Andersen
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Mogens Trab Damsgaard
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Pernille Due
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Lotus Sofie Bast
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Mette Rasmussen
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
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Pons-Vigués M, Rando-Matos Y, Rodriguez-Blanco T, Ballvé-Moreno JL, Ripoll J, Llobera J, Morán J, López-Jiménez T, Violán-Fors C, Bolibar B. Effect of the comprehensive smoke-free law on time trends in smoking behaviour in primary healthcare patients in Spain: a longitudinal observational study. BMJ Open 2019; 9:e020120. [PMID: 30833307 PMCID: PMC6443085 DOI: 10.1136/bmjopen-2017-020120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE This study aimed to analyse the impact of comprehensive smoke-free legislation (SFL) on the prevalence and incidence of adult smoking in primary healthcare (PHC) patients from three Spanish regions, overall and stratified by sex. DESIGN Longitudinal observational study conducted between 2008 and 2013. SETTING 66 PHC teams in Catalonia, Navarre and the Balearic Islands (Spain). PARTICIPANTS Population over 15 years of age assigned to PHC teams. PRIMARY AND SECONDARY OUTCOMES MEASURES Quarterly age-standardised prevalence of non-smoker, smoker and ex-smoker and incidence of new smoker, new ex-smoker and ex-smoker relapse rates were estimated with data retrieved from PHC electronic health records. Joinpoint analysis was used to analyse the trends of age-standardised prevalence and incidence rates. Trends were expressed as annual percentage change and average annual percent change. RESULTS The overall standardised smoker prevalence rate showed a significant downward trend (higher in men than women) and the overall standardised ex-smoker prevalence rate showed a significant increased trend (higher in women than men) in the three regions. Standardised smoker and ex-smoker prevalence rates were higher for men than women in all regions. With regard to overall trends of incidence rates, new smokers decreased significantly in Catalonia and Navarre and similarly in men and women, new ex-smokers decreased significantly and more in men in Catalonia and the Balearic Islands, and ex-smoker relapse increased in Catalonia (particularly in women) and decreased in Navarre. CONCLUSIONS Trends in smoking behaviour in PHC patients remain unchanged after the implementation of comprehensive SFL. The impact of the comprehensive SFL might have been lessened by the effect of the preceding partial SFL.
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Affiliation(s)
- Mariona Pons-Vigués
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Departament d’Infermeria, Universitat de Girona, Girona, Spain
| | - Yolanda Rando-Matos
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Rodriguez-Blanco
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Josep Lluís Ballvé-Moreno
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | - Joana Ripoll
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Palma, Spain
- Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Joan Llobera
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Palma, Spain
- Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Julio Morán
- Equipo de Atención Primaria de Tafalla, Servicio Navarro de Salud, Barasoain, Spain
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Concepción Violán-Fors
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Bonaventura Bolibar
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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12
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Feliu A, Filippidis FT, Joossens L, Fong GT, Vardavas CI, Baena A, Castellano Y, Martínez C, Fernández E. Impact of tobacco control policies on smoking prevalence and quit ratios in 27 European Union countries from 2006 to 2014. Tob Control 2019; 28:101-109. [PMID: 29472445 PMCID: PMC6317447 DOI: 10.1136/tobaccocontrol-2017-054119] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/16/2018] [Accepted: 01/25/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tobacco use is still highly prevalent in Europe, despite the tobacco control efforts made by the governments. The development of tobacco control policies varies substantially across countries. The Tobacco Control Scale (TCS) was introduced to quantify the implementation of tobacco control policies across European countries OBJECTIVE: To assess the midterm association of tobacco control policies on smoking prevalence and quit ratios among 27 European Union (EU) Member States (EU27). METHODS Ecological study. We used the TCS in EU27 in 2007 and the prevalence of tobacco and quit ratios data from the Eurobarometer survey (2006 (n=27 585) and 2014 (n=26 793)). We analysed the relationship between the TCS scores and smoking prevalence and quit ratios and their relative changes (between 2006 and 2014) by means of scatter plots and multiple linear regression models. RESULTS In EU27, countries with higher scores in the TCS, which indicates higher tobacco control efforts, have lower prevalence of smokers, higher quit ratios and higher relative decreases in their prevalence rates of smokers over the last decade. The correlation between TCS scores and smoking prevalence (rsp=-0.444; P=0.02) and between the relative changes in smoking prevalence (rsp=-0.415; P=0.03) was negative. A positive correlation was observed between TCS scores and quit ratios (rsp=0.373; P=0.06). The percentage of smoking prevalence explained by all TCS components was 28.9%. CONCLUSION EU27 should continue implementing comprehensive tobacco control policies as they are key for reducing the prevalence of smoking and an increase tobacco cessation rates in their population.
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Affiliation(s)
- Ariadna Feliu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d’Oncologia- ICO, L’Hospitalet de Llobregat, Barcelona, Spain
- Departament of Clinical Sciences, School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L’Hospitalet del Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Luk Joossens
- Association of European Cancer Leagues (ECL), Brussels, Belgium
| | - Geoffrey T Fong
- Department of Psychology, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Constantine I Vardavas
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
- Institute of Public Health, American College of Greece, Athens, Greece
| | - Antoni Baena
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d’Oncologia- ICO, L’Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d’Oncologia- ICO, L’Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d’Oncologia- ICO, L’Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Medicine and Health Scienc School, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d’Oncologia- ICO, L’Hospitalet de Llobregat, Barcelona, Spain
- Departament of Clinical Sciences, School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L’Hospitalet del Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
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13
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Hughes B, Matias J, Griffiths P. Inconsistencies in the assumptions linking punitive sanctions and use of cannabis and new psychoactive substances in Europe. Addiction 2018; 113:2155-2157. [PMID: 29953686 DOI: 10.1111/add.14372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/10/2018] [Accepted: 06/12/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Brendan Hughes
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - João Matias
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
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14
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Bosi S, Gorini G, Tamelli M, Monti C, Storani S, Carreras G, Martini A, Allara E, Angelini P, Faggiano F. A School-Based Peer-Led Smoking Prevention Intervention with Extracurricular Activities: The LILT-LdP Cluster Randomized Controlled Trial Design and Study Population. TUMORI JOURNAL 2018; 99:572-7. [DOI: 10.1177/030089161309900502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Few school programs are effective in preventing adolescents' tobacco smoking initiation. The “Lega contro i Tumori - Luoghi di Prevenzione” is a cluster randomized controlled trial designed to evaluate a school-based peer-led smoking prevention intervention with extracurricular activities for students aged 14–15 years. This paper presents the study design and the baseline characteristics of the study population. Methods and study design Twenty secondary schools located in the Reggio Emilia province took part in the study. Five schools were excluded because they already participated in smoking prevention interventions. The schools were randomized to control or intervention arms. The study population consisted of students attending the first grade. Components of the intervention included 1) the out-of-school “Smoking Prevention Tour” (SPT) at the “Luoghi di Prevenzione” Center, a 4-hour (4 sessions) extracurricular activity; 2) the “Smoke-free Schools” intervention, combining a life–skills-based peer-led intervention at school, an in-depth lesson on one of the SPT sessions, and enforcement surveillance of the school antismoking policy. Tobacco use was studied through a questionnaire administered before and 6 months after the intervention. Results Eleven high schools and 9 vocational secondary schools took part in the study for a total of 2,476 out of 3,050 eligible students (81.2%). The proportions of respondents in high schools and vocational secondary schools were 90.9% and 64.5%, respectively (P <0.001). Intervention and control arms showed a different distribution of gender and school type, whereas no difference was observed in any tobacco-use characteristic. Conclusions This study is one of the few Italian trials to evaluate the effectiveness of a school-based program for preventing smoking initiation.
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Affiliation(s)
- Sandra Bosi
- Lega Italiana per la Lotta contro i Tumori (LILT), Reggio Emilia
| | | | - Marco Tamelli
- Lega Italiana per la Lotta contro i Tumori (LILT), Reggio Emilia
| | | | - Simone Storani
- Lega Italiana per la Lotta contro i Tumori (LILT), Reggio Emilia
| | | | - Andrea Martini
- Cancer Prevention and Research Institute (ISPO), Florence
| | - Elias Allara
- Department of Translational Medicine, Avogadro University, Novara
| | - Paola Angelini
- Public Health Service, Emilia-Romagna Region, Bologna, Italy
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15
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Rathmann K, Pförtner TK, Elgar FJ, Hurrelmann K, Richter M. The Great Recession, Adolescent Smoking, and Smoking Inequalities: What Role Does Youth Unemployment Play in 24 European Countries? Nicotine Tob Res 2018; 19:1284-1291. [PMID: 27794036 DOI: 10.1093/ntr/ntw298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 10/25/2016] [Indexed: 11/14/2022]
Abstract
Introduction Conflicting evidence has been reported on smoking behavior among adults during times of economic downturn. No study has yet investigated young people's smoking and inequalities in smoking during economic recessions. This study examines the association between country-level youth unemployment due to the economic recession and adolescent smoking and smoking inequalities in Europe. Methods The WHO collaborative "Health Behaviour in School-aged Children" study in 2009/2010 included 15-year-old adolescents from 24 European countries (N = 43 093). Socioeconomic position (SEP) was measured by the Family Affluence Scale. Logistic multilevel models were conducted. The absolute rate of youth unemployment in 2010 (during the recession) and the relative change rate in youth unemployment (2005/2006-2009/2010) were regressed on smoking and SEP inequalities in smoking in 2010, respectively. Results Youth unemployment rates were not significantly associated with overall smoking in adolescents. A higher absolute youth unemployment rate in 2010 related to lower likelihoods of smoking among middle (OR: 0.99; 95% CI: 0.98-0.99) and low affluent adolescents (OR: 0.99; 95% CI: 0.98-0.99) compared to high affluent adolescents. In contrast, an increase in youth unemployment (2005/2006-2009/2010) was not associated with overall likelihoods of smoking and inequalities in smoking. Conclusions Our findings indicate that an increase in youth unemployment was not related to smoking and smoking inequalities. However, higher absolute levels of youth unemployment are related to lower likelihoods of smoking in lower SEP adolescents. Thus, smoking among vulnerable groups is more linked to the overall insecure circumstances and the affordability of cigarettes rather than to the economic recession itself. Implications Economic recessions have often led to increases in adult and youth unemployment rates. Conflicting evidence has been reported on smoking behavior among adults during times of economic downturn. This study examines for the first time the impact of the economic recession on young people's smoking and socioeconomic inequalities in smoking. Findings highlight that rather than an increase in youth unemployment, the overall country-level youth unemployment rate is related to young people's tobacco use and particularly to lower odds in smoking among less affluent adolescents across Europe, a finding which is likely to be linked to the affordability of tobacco use.
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Affiliation(s)
- Katharina Rathmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany.,Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences and the Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Frank J Elgar
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
| | | | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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16
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Palladino R, Hone T, Filippidis FT. Changes in support for bans of illicit drugs, tobacco, and alcohol among adolescents and young adults in Europe, 2008-2014. Int J Public Health 2017; 63:23-31. [PMID: 28795205 PMCID: PMC5766717 DOI: 10.1007/s00038-017-1025-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 06/16/2017] [Accepted: 07/01/2017] [Indexed: 11/07/2022] Open
Abstract
Objectives This study assessed the support for bans for tobacco, alcohol, and illicit drugs in adolescents and young adults across the European Union (EU). Methods Data were analysed for the years 2008, 2011, and 2014 for 27 EU member states. 37,253 individuals aged 15–24 years were interviewed ascertaining their support for banning tobacco, alcohol, cannabis, cocaine, heroin, and ecstasy. Changes over time were assessed using multilevel logistic regression. Results Support for banning heroin, ecstasy, and cocaine was constantly greater than 90%, although support fell over time. Support for cannabis ban declined (from 67.6% in 2008 to 53.7% in 2014) as well as support for alcohol ban (from 8.9% in 2008 to 6.9% in 2014) and tobacco ban (from 17.9% in 2008 to 16.5% in 2014). Conclusions Support for banning substances among EU adolescents and young adults varied, with high support for heroin, cocaine, and ecstasy, but less support for banning cannabis, tobacco, and alcohol. There was reduction in support of banning all substances between 2008 and 2014, but this varied substantially between European countries. Electronic supplementary material The online version of this article (doi:10.1007/s00038-017-1025-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raffaele Palladino
- Department of Primary Care and Public Health, Imperial College London, London, UK.
| | - Thomas Hone
- Department of Primary Care and Public Health, Imperial College London, London, UK
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17
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Chow CK, Corsi DJ, Gilmore AB, Kruger A, Igumbor E, Chifamba J, Yang W, Wei L, Iqbal R, Mony P, Gupta R, Vijayakumar K, Mohan V, Kumar R, Rahman O, Yusoff K, Ismail N, Zatonska K, Altuntas Y, Rosengren A, Bahonar A, Yusufali A, Dagenais G, Lear S, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Rangarajan S, Teo K, McKee M, Yusuf S. Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries. BMJ Open 2017; 7:e013817. [PMID: 28363924 PMCID: PMC5387960 DOI: 10.1136/bmjopen-2016-013817] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study examines in a cross-sectional study 'the tobacco control environment' including tobacco policy implementation and its association with quit ratio. SETTING 545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014. PARTICIPANTS Community audits and surveys of adults (35-70 years, n=12 953). PRIMARY AND SECONDARY OUTCOME MEASURES Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models. RESULTS Average tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had >2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (<5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, >80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was >80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). Summary scores of policy implementation, social unacceptability and knowledge were positively and significantly associated with quit ratio and the associations varied by gender, for example, communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5·0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1). CONCLUSIONS This study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and knowledge suggest that different strategies to promoting quitting may need to be implemented in men compared to women.
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Affiliation(s)
- Clara K Chow
- Department of Cardiology, Westmead Hospital and The George Institute, University of Sydney, Camperdown, New South Wales, Australia
- Population Health Research Institute(PHRI), Hamilton, Ontario, Canada
| | - Daniel J Corsi
- Department of Cardiology, Westmead Hospital and The George Institute, University of Sydney, Camperdown, New South Wales, Australia
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Annamarie Kruger
- Faculty of Health Science North, West University Potchefstroom Campus, Potchefstroom, South Africa
| | - Ehimario Igumbor
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Jephat Chifamba
- Physiology Department, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Wang Yang
- National Center for Cardiovascular Diseases, Beijing, China
| | - Li Wei
- National Center for Cardiovascular Diseases Cardiovascular Institute & Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Prem Mony
- Division of Epidemiology & Population Health, St John's Medical College & Research Institute, Bangalore, Karnataka, India
| | - Rajeev Gupta
- Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Krishnapillai Vijayakumar
- Department of Community Medicine, Dr Somervell Memorial CSI Medical College, Karakonam, Thiruvananthapuram, Kerala, India
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - Rajesh Kumar
- PGIMER School of Public Health, Chandigarh, India
| | - Omar Rahman
- Independent University, Bangladesh Bashundhara, Dhaka, Bangladesh
| | - Khalid Yusoff
- Universiti Teknologi MARA Sungai Buloh, Selangor, Malaysia UCSI University, Cheras, Malaysia
| | - Noorhassim Ismail
- Department of Community Health, University Kebangsaan Malaysia Medical Centre, Bangi, Malaysia
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Yuksel Altuntas
- Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey
| | | | - Ahmad Bahonar
- Hypertension Research Center Isfahan Cardiovascular Research Center Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Gilles Dagenais
- Institut universitaire de cardiologie et pneumologie de Québec, Université laval,Quebec, Quebec, Montreal, Canada
| | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica ECLA, Rosario, Argentina
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | | | | | | | - Koon Teo
- Population Health Research Institute(PHRI), Hamilton, Ontario, Canada
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Salim Yusuf
- Population Health Research Institute(PHRI), Hamilton, Ontario, Canada
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18
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Kuipers MAG, Brandhof SD, Monshouwer K, Stronks K, Kunst AE. Impact of laws restricting the sale of tobacco to minors on adolescent smoking and perceived obtainability of cigarettes: an intervention-control pre-post study of 19 European Union countries. Addiction 2017; 112:320-329. [PMID: 27614109 DOI: 10.1111/add.13605] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/03/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022]
Abstract
AIMS To estimate the impact of introducing sales restriction laws in Europe by measuring changes in adolescent smoking prevalence and perceived obtainability of cigarettes over time in countries that have recently introduced sales restriction laws (intervention countries). These countries were compared with countries where such laws were already in force (control countries). The secondary aim was to test whether these trends differed between adolescents of higher and lower socio-economic position (SEP). DESIGN Repeated cross-sectional data were used in a quasi-experimental pre-post design. Intervention countries raised tobacco sales restrictions to 18 years in 2007, 2008 or 2009. Control countries have had sales restrictions of 18 years since at least 2004. SETTING Nineteen European Union (EU) countries in 2007 and 2011. PARTICIPANTS Data of 97 245 15- and 16-year-old adolescents from the 2007 and 2011 European Survey Project on Alcohol and other Drugs (ESPAD) surveys. MEASUREMENTS Dependent variables were smoking status (weekly smoking versus non-smoking or less than weekly smoking) and perceived obtainability of tobacco (easy versus difficult). Key independent variables were time (2007 or 2011), intervention exposure (intervention or control country) and their interaction (time × intervention). Covariates included sex, SEP, the tobacco control scale (TCS), gross domestic product (GDP) and adult smoking prevalence. FINDINGS We did not find a difference in the change in smoking prevalence between intervention and control countries [odds ratio (OR) = 1.00, 95% confidence interval (CI) = 0.93-1.07]. However, sales restrictions were associated with a significantly greater decrease in perceived ease of cigarette obtainability in intervention countries (OR = 0.75, 95% CI = 0.70-0.80). No significant differential effects between high and low SEP adolescents were found (OR = 1.01, 95% CI = 0.81-1.25). CONCLUSION Laws prohibiting the sales of tobacco to minors in Europe do not appear to be associated with a reduction in adolescent smoking rates, but lower the perceived obtainability of cigarettes irrespective of their socio-economic position.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephanie D Brandhof
- Department of Public Health, 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
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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19
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Rozema AD, Mathijssen JJP, Jansen MWJ, van Oers JAM. Schools as smoke-free zones? Barriers and facilitators to the adoption of outdoor school ground smoking bans at secondary schools. Tob Induc Dis 2016; 14:10. [PMID: 27030793 PMCID: PMC4812616 DOI: 10.1186/s12971-016-0076-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background Whereas smoking bans inside secondary school buildings are relatively widespread, a smoking ban for the outdoor school grounds is less common. Therefore, this study investigates why many secondary schools fail to adopt an outdoor school ground smoking ban. The aim is to elucidate the perceived barriers and facilitators of stakeholders at schools without an outdoor school ground smoking ban. Methods Qualitative data were obtained from 60 respondents of 15 secondary schools. Semi-structured interviews were held with various key stakeholders and a thematic approach was used for analysis of the transcripts. Results The perceived barriers and facilitators of the stakeholders fell into four categories: 1) socio-political characteristics (legislation and social norm), 2) school characteristics (policy, decision process, enforcement, resources, workforce conditions, communication and collaboration), 3) individual characteristics (support, knowledge, and target group), and 4) smoking ban characteristics (environmental factors, guideline recommendations, outcome expectations, and evidence). Conclusions These findings highlight the importance of legislation for outdoor smoking bans. Moreover, collaboration, communication and involving stakeholders during an early stage of the process should be stimulated, as this might increase adoption. These results can be applied in future studies on outdoor tobacco control policies; moreover, they may facilitate tobacco control initiatives leading to more smoke-free environments to further protect youth from the harmful effects of tobacco.
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Affiliation(s)
- A D Rozema
- Department Tranzo, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE The Netherlands
| | - J J P Mathijssen
- Department Tranzo, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE The Netherlands
| | - M W J Jansen
- Academic Collaborative Centre for Public Health Limburg, Public Health Service South Limburg (GGD ZL), Geleen, The Netherlands ; Department of Health Services Research, School for Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - J A M van Oers
- Department Tranzo, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE The Netherlands ; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Pförtner TK, Hublet A, Schnohr CW, Rathmann K, Moor I, de Looze M, Baška T, Molcho M, Kannas L, Kunst AE, Richter M. Socioeconomic inequalities in the impact of tobacco control policies on adolescent smoking. A multilevel study in 29 European countries. Addict Behav 2016; 53:58-66. [PMID: 26454551 DOI: 10.1016/j.addbeh.2015.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 09/04/2015] [Accepted: 09/28/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION There are concerns that tobacco control policies may be less effective in reducing smoking among disadvantaged socioeconomic groups and thus may contribute to inequalities in adolescent smoking. This study examines how the association between tobacco control policies and smoking of 15-year-old boys and girls among 29 European countries varies according to socioeconomic group. METHODS Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 comprising 50,338 adolescents aged 15 years from 29 European countries. Multilevel logistic regression analyses were conducted to assess the association of weekly smoking with components of the Tobacco Control Scale (TCS), and to assess whether this association varied according to family affluence (FAS). Analyses were carried out per gender and adjusted for national wealth and general smoking rate. RESULTS For boys, tobacco price was negatively associated with weekly smoking rates. This association did not significantly differ between low and high FAS. Levels of tobacco-dependence treatment were significantly associated with weekly smoking. This association varied between low and high FAS, with higher treatment levels associated with higher probability of smoking only for low FAS boys. For girls, no tobacco policy was significantly associated with weekly smoking, irrespective of the FAS. CONCLUSIONS Results indicated that most tobacco control policies are not clearly related to adolescent weekly smoking across European countries. Only tobacco price seemed to be adequate decreasing smoking prevalence among boys, irrespective of their socioeconomic status.
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Affiliation(s)
- Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany; Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Anne Hublet
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Katharina Rathmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Irene Moor
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Tibor Baška
- Department of Public Health, Jessenius Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Michal Molcho
- Health Promotion Research Centre, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Lasse Kannas
- Department of Health Sciences, University of Jyväskylä, Finland
| | - Anton E Kunst
- Department of Public Health, AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Pförtner TK, Rathmann K, Moor I, Kunst AE, Richter M. [Social inequalities in adolescent smoking: A cross-national perspective of the role of individual and macro-structural factors]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 59:206-16. [PMID: 26631012 DOI: 10.1007/s00103-015-2280-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In an EU-funded project, we examined on the basis of international comparative analyses which factors were associated with and contributed to socioeconomic inequalities in adolescent smoking. This paper presents the results obtained and discusses their implications for policy and research. METHODS Analyses were based on the "Health Behaviour in School-aged Children (HBSC)" study in 2006 and included more than 50,000 adolescents from 37 countries. The focus was on the association between family affluence and weekly smoking (regularly, at least once a week) among adolescents. Explanatory variables at the individual level refer to psychosocial resources and burdens of school, family, and peers. At the country level, national income, various tobacco control policies, and an index of external differentiation of the educational system were used. RESULTS The psychosocial factors of school and family explained many of the inequalities in the smoking behavior of adolescents. In an international comparison, socioeconomic inequalities in smoking were stronger in richer countries. Absolute smoking rates were lower and inequalities in smoking smaller for boys in countries with higher tobacco prices. On the other hand, educational systems with higher degrees of external differentiation showed lower inequalities in smoking beahviour by girls, and relatively higher rates of smoking (for boys and girls). Stronger inequalities in smoking behaviour were demonstrated in countries with a greater range of preventative measures for tobacco dependence (for boys) and with higher levels of government spending on tobacco control (for girls). CONCLUSION Experiences in richer countries revealed that tobacco control needs to be strengthened for socially disadvantaged adolescents. The reduction of smoking prevalence and socioeconomic inequalities in smoking behavior should be based not only on a strengthening of psychosocial resources in the family and at school, but also on an increase in tobacco prices.
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Affiliation(s)
- Timo-Kolja Pförtner
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Universität zu Köln, Eupener Straße 129, 50933, Köln, Deutschland.
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Katharina Rathmann
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Irene Moor
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Anton E Kunst
- Department of Public Health, AMC, University of Amsterdam, Amsterdam, Niederlande
| | - Matthias Richter
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Shi Y, Lenzi M, An R. Cannabis Liberalization and Adolescent Cannabis Use: A Cross-National Study in 38 Countries. PLoS One 2015; 10:e0143562. [PMID: 26605550 PMCID: PMC4659554 DOI: 10.1371/journal.pone.0143562] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/07/2015] [Indexed: 11/19/2022] Open
Abstract
AIMS To assess the associations between types of cannabis control policies at country level and prevalence of adolescent cannabis use. SETTING, PARTICIPANTS AND DESIGN Multilevel logistic regressions were performed on 172,894 adolescents 15 year of age who participated in the 2001/2002, 2005/2006, or 2009/2010 cross-sectional Health Behaviour in School-Aged Children (HBSC) survey in 38 European and North American countries. MEASURES Self-reported cannabis use status was classified into ever use in life time, use in past year, and regular use. Country-level cannabis control policies were categorized into a dichotomous measure (whether or not liberalized) as well as 4 detailed types (full prohibition, depenalization, decriminalization, and partial prohibition). Control variables included individual-level sociodemographic characteristics and country-level economic characteristics. FINDINGS Considerable intra-class correlations (.15-.19) were found at country level. With respect to the dichotomized cannabis control policy, adolescents were more likely to ever use cannabis (odds ratio (OR) = 1.10, p = .001), use in past year (OR = 1.09, p = .007), and use regularly (OR = 1.26, p = .004). Although boys were substantially more likely to use cannabis, the correlation between cannabis liberalization and cannabis use was smaller in boys than in girls. With respect to detailed types of policies, depenalization was associated with higher odds of past-year use (OR = 1.14, p = .013) and regular use (OR = 1.23, p = .038), and partial prohibition was associated with higher odds of regular use (OR = 2.39, p = .016). The correlation between cannabis liberalization and regular use was only significant after the policy had been introduced for more than 5 years. CONCLUSIONS Cannabis liberalization with depenalization and partial prohibition policies was associated with higher levels of regular cannabis use among adolescents. The correlations were heterogeneous between genders and between short- and long-terms.
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Affiliation(s)
- Yuyan Shi
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Michela Lenzi
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Ruopeng An
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
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Kuipers MAG, Monshouwer K, van Laar M, Kunst AE. Tobacco Control and Socioeconomic Inequalities in Adolescent Smoking in Europe. Am J Prev Med 2015; 49:e64-e72. [PMID: 26164833 DOI: 10.1016/j.amepre.2015.04.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The strength of national tobacco control varies by country, but it is unclear how this relates to smoking in adolescents of high and low SES. This study examined the association between tobacco control policies and adolescent smoking and investigated the differences in this association between adolescents of high and low SES. METHODS Data of 90,351 adolescents aged 15-16 years from 13 European countries were obtained from the 2003, 2007, and 2011 European Survey Project on Alcohol and other Drugs databases. Logistic regression analyses were performed in 2014 with a random intercept at the country level and with daily smoking as the outcome. The Tobacco Control Scale was the score for national tobacco control policy. SES was based on parental education. RESULTS In all studied countries, except Portugal, adolescent smoking prevalence rates were highest among low-SES respondents. Stronger tobacco control policies were associated with lower smoking rates in all three survey waves (2003, OR=0.75, 95% CI=0.55, 1.01; 2007, OR=0.84, 95% CI=0.73, 0.98; 2011, OR=0.85, 95% CI=0.74, 0.98). The association was consistently stronger in high-SES than in low-SES individuals, but the difference was not statistically significant. CONCLUSIONS Countries with stronger tobacco control policies tend to have lower smoking rates. We are unable to demonstrate significant socioeconomic inequalities in the effect of tobacco control policies on adolescent smoking.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Public Health, 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
| | - Margriet van Laar
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Verhagen CE, Uitenbroek DG, Schreuders EJ, El Messaoudi S, de Kroon MLA. Does a reduction in alcohol use by Dutch high school students relate to higher use of tobacco and cannabis? BMC Public Health 2015; 15:821. [PMID: 26306998 PMCID: PMC4549080 DOI: 10.1186/s12889-015-2149-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/12/2015] [Indexed: 11/20/2022] Open
Abstract
Background Substance use of adolescents was investigated in a region around Amsterdam, the Netherlands, in the period 2005–2009. The study was intended to find out to what extent behaviour related to different substances are interrelated and how trends develop in different subgroups. Methods Two cross-sectional surveys were conducted among Dutch students in the second and fourth year of secondary school, aged 13-16 [n = 1,854 in 2005; n = 2,088 in 2009] by making use of an online questionnaire including questions about alcohol consumption, tobacco use (smoking behaviour) and cannabis use. Two educational levels were included. Results Decreases in alcohol consumption, tobacco and cannabis use were found between 2005 and 2009. The strongest decline was seen in alcohol consumption. Last month drinking decreased from 61.8 % in 2005 to 36.5 % in 2009. Last month binge drinking decreased from 38.7 % in 2005 to 24.0 % in 2009. Reduced alcohol consumption was found among boys and girls, for all ages and in both educational levels. Changes were strongest among 13-year-olds. Weekly or daily smoking declined between 2005 and 2009 among 13-year-olds, girls and students in the lower schooling level. Last month cannabis use decreased among girls and students in the higher schooling level. In both 2005 and 2009 clustering with alcohol consumption was found for the use of other substances. Conclusions Between 2005 and 2009 alcohol consumption strongly decreased among high school students. This may be due to the national prevention campaign which in the same period highlighted the importance of not drinking before the age of 16. The decrease in smoking and cannabis use between 2005 and 2009 may be due to clustering with alcohol consumption. A reduction in the use of alcohol in adolescence did not lead to replacement by tobacco or cannabis use.
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Affiliation(s)
- Claudia E Verhagen
- Department of Epidemiology & Health Promotion, Public Health Service of Amsterdam, P.O. Box 2200, 1000 CE, Amsterdam, The Netherlands.
| | - Daan G Uitenbroek
- Department of Epidemiology & Health Promotion, Public Health Service of Amsterdam, P.O. Box 2200, 1000 CE, Amsterdam, The Netherlands.
| | - Emilie J Schreuders
- Department of Epidemiology & Health Promotion, Public Health Service of Amsterdam, P.O. Box 2200, 1000 CE, Amsterdam, The Netherlands
| | - Sabah El Messaoudi
- Department of Epidemiology & Health Promotion, Public Health Service of Amsterdam, P.O. Box 2200, 1000 CE, Amsterdam, The Netherlands
| | - Marlou L A de Kroon
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Spivak AL, Monnat SM. Prohibiting juvenile access to tobacco: Violation rates, cigarette sales, and youth smoking. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:851-9. [PMID: 25913107 DOI: 10.1016/j.drugpo.2015.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/12/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Scholars who examine the efficacy of juvenile tobacco sales restrictions, especially the 1992 "Synar Amendment" that led all of fifty U.S. states to enact prohibitions on tobacco sales to minors, are notably divided as to impact on youth smoking. Some researchers claim that such policies have failed and ought to be abandoned (Craig & Boris, 2007; Etter, 2006; Glantz, 2002), while others insist that enforcement has indeed led to reduced tobacco use (DiFranza, 2011b; SAMHSA, 2011). The present study is the first to combine data on Synar violation rates from all states and years available since the amendment's implementation, assessing the connection to national rates of cigarette sales and youth smoking behavior. METHODS Using national data from the United States Substance Abuse and Mental Health Services Administration, the Tobacco Institute, and the Centers for Disease Control's Youth Risk Behavior Surveillance System across all U.S. states between 1996 and 2007, we employ hierarchical linear modeling to examine the connection between retailer Synar violations and youth smoking. RESULTS Controlling for state-level demographic variables, results indicate that retailer violation rates are significantly associated with greater youth smoking prevalence, as well as higher overall cigarette sales. CONCLUSION While critiques of Synar policies are substantive and should be addressed, laws prohibiting the sale of tobacco to juveniles appear to have had some degree of success.
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Pförtner TK, Moor I, Rathmann K, Hublet A, Molcho M, Kunst AE, Richter M. The association between family affluence and smoking among 15-year-old adolescents in 33 European countries, Israel and Canada: the role of national wealth. Addiction 2015; 110:162-73. [PMID: 25220260 DOI: 10.1111/add.12741] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/27/2013] [Accepted: 09/09/2014] [Indexed: 11/27/2022]
Abstract
AIMS To examine the role of national wealth in the association between family affluence and adolescent weekly smoking, early smoking behaviour and weekly smoking among former experimenters. DESIGN AND PARTICIPANTS Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 in 35 countries from Europe and North America that comprises 60 490 students aged 15 years. Multi-level logistic regression was conducted using Markov chain Monte Carlo methods (MCMC) to explore whether associations between family affluence and smoking outcomes were dependent upon national wealth. MEASUREMENT Family Affluence Scale (FAS) as an indicator for the socio-economic position of students. Current weekly smoking behaviour is defined as at least weekly smoking (dichotomous). Early smoking behaviour is measured by smoking more than a first puff before age 13 years (dichotomous). Weekly smoking among former experimenters is restricted to those who had tried a first puff in the past. FINDINGS The logistic multi-level models indicated an association of family affluence with current weekly smoking [odds ratio (OR) = 1.088; 95% credible interval (CrI) = 1.055-1.121, P < 0.001], early smoking behaviour (OR = 1.066; CrI = 1.028-1.104, P < 0.001) and smoking among former experimenters (OR = 1.100; CrI = 1.071-1.130; P < 0.001). Gross domestic product (GDP) per capita was associated positively and significantly with the relationship between family affluence and current weekly smoking (OR = 1.005; CrI = 1.003-1.007; P < 0.001), early smoking behaviour (OR = 1.003; CrI = 1.000-1.005; P = 0.012) and smoking among former experimenters (OR = 1.004; CrI = 1.002-1.006; P < 0.001). The association of family affluence and smoking outcomes was significantly stronger for girls. CONCLUSIONS The difference in smoking prevalence between rich and poor is greater in more affluent countries.
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Affiliation(s)
- Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Medical Faculty, University of Cologne, Cologne, Germany
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Rashid A, Manan AA, Yahya N, Ibrahim L. The support for smoke free policy and how it is influenced by tolerance to smoking - experience of a developing country. PLoS One 2014; 9:e109429. [PMID: 25338116 PMCID: PMC4206272 DOI: 10.1371/journal.pone.0109429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/31/2014] [Indexed: 11/19/2022] Open
Abstract
This cross sectional survey was conducted to determine the support in making Penang UNESCO World Heritage Site (GTWHS) smoke free and to determine the influence of tolerance towards smoking on this support. This is the first phase in making Penang, Malaysia a smoke free state. A multistage sampling process was done to select a sample of respondents to represent the population of GTWHS. Attitude towards smoking was assessed using tolerance as a proxy. A total of 3,268 members of the community participated in the survey. A big majority (n = 2969; 90.9%) of the respondents supported the initiative. Support was lowest among the owners and residents/tenants, higher age groups, the Chinese, men, respondents who had poor knowledge of the places gazetted as smoke free, and respondents with poor knowledge of the health effects on smokers and on passive smokers. The odds (both adjusted and unadjusted) of not supporting the initiative was high among those tolerant to smoking in public areas. Tolerance towards smoking was associated with 80.3% risk of non-support in the respondents who were tolerant to smoking and a 57.2% risk in the population. Health promotion and education concerning the harm of tobacco smoke in Malaysia, which has mainly targeted smokers, must change. Health education concerning the risks of second hand smoke must also be given to non-smokers and efforts should be made to denormalize smoking.
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Affiliation(s)
- Abdul Rashid
- Department of Public Health Medicine, Penang Medical College, Georgetown, Penang, Malaysia
| | - Azizah Ab Manan
- Penang State Health Department, Georgetown, Penang, Malaysia
| | - Noorlia Yahya
- Penang State Health Department, Georgetown, Penang, Malaysia
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Matos EGD, Kraus L, Pabst A, Piontek D. Trends im Substanzkonsum Jugendlicher: Gibt es regionale Unterschiede? SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2014. [DOI: 10.1024/0939-5911.a000307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Fragestellung: Es wurde untersucht, ob auf Bundeslandebene Unterschiede im Alkohol-, Tabak- und Cannabiskonsum Jugendlicher und seiner Zeitverläufe bestehen. Methodik: Daten von 23.997 Jugendlichen aus drei Erhebungswellen (2003; 2007; 2011) der Europäischen Schülerstudie zu Alkohol und anderen Drogen (ESPAD) der 9. und 10. Klasse aus fünf Bundesländern (Bayern, Berlin, Brandenburg, Mecklenburg-Vorpommern, Thüringen) wurden deskriptiv und regressionsanalytisch ausgewertet. Ergebnisse: Länderübergreifend zeigen sich für alle drei Substanzen sinkende Konsumwerte über die Zeit. Für den Cannabiskonsum ist dieser Trend nur bis 2007 zu beobachten. Berlin weist den geringsten Alkohol- und höchsten Cannabiskonsum auf. Der Tabakkonsum ist in Brandenburg und Mecklenburg-Vorpommern am höchsten und zeigt den stärksten Rückgang in Thüringen. Schlussfolgerungen: Trotz einiger Unterschiede in den Konsumprofilen der Bundesländer sind die Trends sehr homogen. Insgesamt betrachtet sind die beobachteten Konsumparameter, die sich im europäischen Vergleich auf hohem bis mittlerem Niveau befinden, rückläufig.
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Affiliation(s)
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm
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Remon J, Molina-Montes E, Majem M, Lianes P, Isla D, Garrido P, Felip E, Viñolas N, de Castro J, Artal A, Sánchez MJ. Lung cancer in women: an overview with special focus on Spanish women. Clin Transl Oncol 2013; 16:517-28. [PMID: 24277573 DOI: 10.1007/s12094-013-1137-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 11/26/2022]
Abstract
Lung cancer incidence is decreasing worldwide among men but rising among women due to recent changes in smoking patterns in both sexes. In Europe, the smoking epidemic has evolved different rates and times, and policy responses to it, vary substantially between countries. Differences in smoking prevalence are much more evident among European women reflecting the heterogeneity in cancer incidence rates. Other factors rather than smoking and linked to sex may increase women's susceptibility to lung cancer, such as genetic predisposition, exposure to sex hormones and molecular features, all of them linked to epidemiologic and clinical characteristics of lung cancer in women. However, biological bases of sex-specific differences are controversial and need further evaluation. This review focuses on the epidemiology and outcome concerning non-small cell lung cancer in women, with emphasis given to the Spanish population.
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Affiliation(s)
- J Remon
- Hospital de Mataró, Carretera de la cirera s/n, 08304, Mataró, Spain,
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Huang SL, Lin IF, Chen CY, Tsai TI. Impact of tobacco control policies on adolescent smoking: findings from the Global Youth Tobacco Survey in Taiwan. Addiction 2013; 108:1829-35. [PMID: 23714267 DOI: 10.1111/add.12259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 01/04/2013] [Accepted: 05/20/2013] [Indexed: 11/30/2022]
Abstract
AIMS To assess the impact of a set of comprehensive tobacco control policies implemented in Taiwan in 2009, including extensive smoke-free policy, advertisement ban, pictorial warning and price increase, on adolescent smoking prevalence. DESIGN Five waves of cross-sectional surveys. SETTING Taiwan, 2004-11. PARTICIPANTS Nationally representative sample of junior high schools aged 13-15 years, in a biennial survey, total sample size 101,100. MEASURES Core questionnaire of the Global Youth Tobacco Survey, including ever smoking, 30-day smoking and number of cigarettes smoked. The magnitude of prevalence change before and after the 2009 policy implementation was quantified by adjusted odds ratios estimated by piecewise logistic regression models. FINDINGS The 30-day smoking prevalence demonstrated an upward trend [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.02-1.10] between 2004 and 2008. Significant decline in 30-day smoking prevalence after the 2009 law implementation was observed (OR = 0.84, 95% CI = 0.71-0.99). Those living in non-city areas demonstrated a greater magnitude of change. In addition to changes in prevalence, we observed some delay in the age starting smoking, reduction in smokers who smoke fewer than one cigarette per day, and decrease in smokers who did not buy cigarettes. The decline in smoking prevalence was contributed primarily by the reduction in experimenters. CONCLUSION The comprehensive tobacco control programme introduced in Taiwan in 2009 was associated with a reduction in adolescent smoking, particularly among those in earlier stages of smoking and those who resided in non-city areas.
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Affiliation(s)
- Song-Lih Huang
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
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Kakuszi B, Bácskai E, Gerevich J, Czobor P. [Teenage and adult pregnancy: different correlations between socio-economic status and smoking]. Orv Hetil 2013; 154:376-81. [PMID: 23461978 DOI: 10.1556/oh.2013.29557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Smoking occurs frequently during pregnancy, thereby putting mother and child at health risks. Low socio-economic status is a risk factor for smoking. AIM To investigate the relationship between smoking and low income in teenage and adult pregnancy, which is an important measure of poor socioeconomic status. METHOD The authors used subject-level data from the US NSDUH database, which contains information on pregnancies and smoking. RESULTS Teenage pregnancy is associated with higher, whereas adult pregnancy with lower prevalence of smoking, compared to the age-matched female population. The association between income and smoking is age-dependent. Among adults there is an inverse relationship (high income -- low-risk of smoking), while in teenage pregnancy smoking increases with income. CONCLUSIONS To investigate in teenage and adult pregnancy the relationship between smoking and low income, which is an important measure of poor socio-economic status. Higher socioeconomic status may be associated with risky behaviour, thereby increasing both the risk of smoking and early pregnancy.
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Affiliation(s)
- Brigitta Kakuszi
- Semmelweis Egyetem, Általános Orvostudományi Kar, Pszichiátriai és Pszichoterápiás Klinika, Budapest.
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Abstract
Evidence of the causal role of marketing in the tobacco epidemic and the advent of the WHO Framework Convention on Tobacco Control have inspired more than half the countries in the world to ban some forms of tobacco marketing. This paper briefly describes the ways in which cigarette marketing is restricted and the tobacco industry's efforts to subvert restrictions. It reviews what is known about the impact of marketing regulations on smoking by adults and adolescents. It also addresses what little is known about the impact of marketing bans in relation to concurrent population-level interventions, such as price controls, anti-tobacco media campaigns and smoke-free laws. Point of sale is the least regulated channel and research is needed to address the immediate and long-term consequences of policies to ban retail advertising and pack displays. Comprehensive marketing restrictions require a global ban on all forms of promotion, elimination of packaging and price as marketing tools, and limitations on the quantity, type and location of tobacco retailers.
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Affiliation(s)
- Lisa Henriksen
- Stanford University School of Medicine, Palo Alto, CA 94304, USA.
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Levin KA, Kirby J, Currie C. Adolescent risk behaviours and mealtime routines: does family meal frequency alter the association between family structure and risk behaviour? HEALTH EDUCATION RESEARCH 2012; 27:24-35. [PMID: 21900407 DOI: 10.1093/her/cyr084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Family structure is associated with a range of adolescent risk behaviours, with those living in both parent families generally faring best. This study describes the association between family structure and adolescent risk behaviours and assesses the role of the family meal. Data from the 2006 Health Behaviour in School-Aged Children survey were modelled using Multilevel Binomial modelling for six risk behaviour outcomes. Significantly more children from 'both parent' families ate a family meal every day and fewer 'hardly ever or never' did. Family structure was associated with boys' and girls' smoking, drinking, cannabis use and having sex and with girls' fighting. Frequency of eating a family meal was associated with a reduced likelihood of all risk behaviours among girls and all but fighting and having sex among boys. Eating a family meal regularly nullified the association between family structure and drinking alcohol for boys and girls and cannabis use for boys and reduced the effect size of alternative family structures on boys having sex and smoking. The family meal, associated with a reduced likelihood of many adolescent risk behaviours, reduces or eliminates the association with family structure and may therefore help to overcome inequalities in adolescent risk behaviours.
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Affiliation(s)
- Kate A Levin
- Child and Adolescent Health Research Unit, The Moray House School of Education, University of Edinburgh, St Leonard's Land, Edinburgh EH8 8AQ, UK.
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Katsiki N, Hatzitolios AI, Mikhailidis DP. Passive Smoking: The Democratic Right of Nonsmokers to Survive. Angiology 2011; 62:520-2. [DOI: 10.1177/0003319711402986] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Niki Katsiki
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital campus, University College London Medical School, University College London (UCL), London, UK
- First Propedeutic Department of Internal Medicine, Vascular Risk Factors and Smoking Cessation Clinics, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos I. Hatzitolios
- First Propedeutic Department of Internal Medicine, Vascular Risk Factors and Smoking Cessation Clinics, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital campus, University College London Medical School, University College London (UCL), London, UK
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Martínez-Sánchez JM, Fernández E, Fu M, Gallus S, Martínez C, Sureda X, La Vecchia C, Clancy L. Smoking behaviour, involuntary smoking, attitudes towards smoke-free legislations, and tobacco control activities in the European Union. PLoS One 2010; 5:e13881. [PMID: 21079729 PMCID: PMC2975630 DOI: 10.1371/journal.pone.0013881] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 10/08/2010] [Indexed: 11/18/2022] Open
Abstract
Background 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). Methods/Principal Findings Ecologic study in the EU27. We used data from the TCS in 2007 and from the Eurobarometer on Tobacco Survey in 2008. We analysed the relations between the TCS and prevalence of smoking, self-reported exposure to SHS (home and work), and attitudes towards smoking bans by means of scatter plots and Spearman rank-correlation coefficients (rsp). Among the EU27, smoking prevalence varied from 22.6% in Slovenia to 42.1% in Greece. Austria was the country with the lowest TCS score (35) and the UK had the highest one (93). The correlation between smoking prevalence and TCS score was negative (rsp = −0.42, p = 0.03) and the correlation between TCS score and support to smoking bans in all workplaces was positive (rsp = 0.47, p = 0.01 in restaurants; rsp = 0.5, p = 0.008 in bars, pubs, and clubs; and rsp = 0.31, p = 0.12 in other indoor workplaces). The correlation between TCS score and self-reported exposure to SHS was negative, but statistically non-significant. Conclusions/Significance Countries with a higher score in the TCS have higher support towards smoking bans in all workplaces (including restaurants, bars, pubs and clubs, and other indoor workplaces). TCS scores were strongly, but not statistically, associated with a lower prevalence of smokers and a lower self-reported exposure to SHS.
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Affiliation(s)
- Jose M. Martínez-Sánchez
- Tobacco Control Unit, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
| | - Marcela Fu
- Tobacco Control Unit, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvano Gallus
- Department of Epidemiology, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
| | - Cristina Martínez
- Tobacco Control Unit, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xisca Sureda
- Tobacco Control Unit, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carlo La Vecchia
- Department of Epidemiology, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
- Department of Occupational Medicine, School of Medicine, University of Milan, Milan, Italy
| | - Luke Clancy
- Tobacco Free Research Institute, Dublin, Ireland
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Nelson JP. What is learned from longitudinal studies of advertising and youth drinking and smoking? A critical assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:870-926. [PMID: 20617009 PMCID: PMC2872298 DOI: 10.3390/ijerph7030870] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 02/20/2010] [Accepted: 02/28/2010] [Indexed: 12/23/2022]
Abstract
This paper assesses the methodology employed in longitudinal studies of advertising and youth drinking and smoking behaviors. These studies often are given a causal interpretation in the psychology and public health literatures. Four issues are examined from the perspective of econometrics. First, specification and validation of empirical models. Second, empirical issues associated with measures of advertising receptivity and exposure. Third, potential endogeneity of receptivity and exposure variables. Fourth, sample selection bias in baseline and follow-up surveys. Longitudinal studies reviewed include 20 studies of youth drinking and 26 studies of youth smoking. Substantial shortcomings are found in the studies, which preclude a causal interpretation.
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Affiliation(s)
- Jon P Nelson
- Department of Economics, Pennsylvania State University, University Park, PA 16802, USA.
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