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Sassano M, Mariani M, Pastorino R, Ricciardi W, La Vecchia C, Boccia S. Association of national smoke-free policies with per-capita cigarette consumption and acute myocardial infarction mortality in Europe. J Epidemiol Community Health 2024; 78:388-394. [PMID: 38485217 PMCID: PMC11103332 DOI: 10.1136/jech-2023-220746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/03/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Evidence on the association between smoke-free policies and per-capita cigarette consumption and mortality due to acute myocardial infarction (AMI) in Europe is limited. Hence, we aimed to assess this association and to evaluate which factors influence it. METHODS We performed an interrupted time series analysis, including 27 member states of the European Union and the UK, on per-capita cigarette consumption and AMI mortality.A multivariate meta-regression was used to assess the potential influence of other factors on the observed associations. RESULTS Around half of the smoke-free policies introduced were associated with a level or slope change, or both, of per-capita cigarette consumption and AMI mortality (17 of 35). As for cigarette consumption, the strongest level reduction was observed for the smoking ban issued in 2010 in Poland (rate ratio (RR): 0.47; 95% CI: 0.41, 0.53). Instead, the largest level reduction of AMI mortality was observed for the intervention introduced in 2012 in Bulgaria (RR: 0.38; 95% CI: 0.34, 0.42).Policies issued more recently or by countries with a lower human development index were found to be associated with a larger decrease in per-capita cigarette consumption. In addition, smoking bans applying to bars had a stronger inverse association with both cigarette consumption and AMI mortality. CONCLUSIONS The results of our study suggest that smoke-free policies are effective at reducing per-capita cigarette consumption and AMI mortality. It is extremely important to monitor and register data on tobacco, its prevalence and consumption to be able to tackle its health effects with concerted efforts.
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Affiliation(s)
- Michele Sassano
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Mariani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Jarlstrup NS, Thygesen LC, Pisinger C, Vestbo J, Grønbæk M, Tolstrup JS. Trends in smoking-related diseases by socioeconomic position following a national smoking ban in 2007: a nationwide study in the Danish population. BMC Public Health 2023; 23:1648. [PMID: 37641031 PMCID: PMC10463393 DOI: 10.1186/s12889-023-16456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND National comprehensive smoke-free legislation has been found to decrease the incidence of several smoking-related diseases. In 2007, Denmark introduced a national smoking ban, which banned smoking indoor in workplaces and public places, although only partial restrictions were applied in certain settings. We examined the impact of the smoking ban on smoking-related diseases and whether this differed across socioeconomic groups. METHODS Interrupted time series analyses of nationwide register data were performed using Poisson regression models to examine the differential impact of the smoking ban on monthly incidence rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers from 2002 to 2015. Immediate changes in incidence rates after the smoking ban and long-term changes in disease trends were estimated by comparing data from the pre- and post-ban period. Models were stratified by socioeconomic position. RESULTS Overall, we found neither immediate changes in rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers following the smoking ban nor long-term post-ban changes in disease trends as compared to before the ban. Results did not differ across socioeconomic groups. A pronounced socioeconomic gradient in incidence rates was observed for all outcomes both before and after the smoking ban. CONCLUSION The national smoking ban was not associated with a lower incidence of smoking-related diseases in the post-ban period compared to pre-ban levels and no differences between socioeconomic groups were observed. Future tobacco control in Denmark should consider which measures most effectively target the low socioeconomic groups to decrease the current strong socioeconomic inequality in health.
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Affiliation(s)
- Nanna Schneekloth Jarlstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Jørgen Vestbo
- University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
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DeCicca P, Kenkel D, Lovenheim MF. The Economics of Tobacco Regulation: A Comprehensive Review. JOURNAL OF ECONOMIC LITERATURE 2022; 60:883-970. [PMID: 37075070 PMCID: PMC10072869 DOI: 10.1257/jel.20201482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Tobacco regulation has been a major component of health policy in the developed world since the UK Royal College of Physicians' and the US Surgeon General's reports in the 1960s. Such regulation, which has intensified in the past two decades, includes cigarette taxation, place-based smoking bans in areas ranging from bars and restaurants to workplaces, and regulations designed to make tobacco products less desirable. More recently, the availability of alternative products, most notably e-cigarettes, has increased dramatically, and these products are just starting to be regulated. Despite an extensive body of research on tobacco regulations, there remains substantial debate regarding their effectiveness, and ultimately, their impact on economic welfare. We provide the first comprehensive review of the state of research in the economics of tobacco regulation in two decades.
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Foster B, Ledgerwood DM, Struble CA, Fodor MC, Jordan P, Krishnan AC, Turner B, Pearson C, Twiner MJ, Levy PD. Public Housing Resident Perspectives on Smoking, Barriers for Smoking Cessation, and Changes in Smoking Mandates. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221092814. [PMID: 35403482 PMCID: PMC9006371 DOI: 10.1177/00469580221092814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Individuals from low-income groups report disproportionate rates of cigarette use, secondhand smoke (SHS) exposure with increased morbidity and mortality. Smoking bans in public housing have been enacted in attempt to reduce tobacco use and SHS exposure among lower income individuals. This study investigated the support needs of tobacco users living in two public housing complexes in Detroit, Michigan (USA), including their perspectives on smoking, resources and barriers for smoking cessation, and the impact of policy changes. Methods This is a mixed-methods study, using a qualitative focus groups approach and a short survey, public housing residents interview data was analyzed to explore themes related to smoking-related issues. Specifically, six themes were assessed across four focus groups: (1) Quitting Smoking, (2) Current Smoking Cessation Resources, (3) Legal Mandates, (4) Education and Perceptions of Smoking, (5) Community Needs and Barriers, and (6) Medical Experiences. Results There were 59 participants; the majority (39/42, 93%) of smokers reported at least one quit attempt. During the focus groups, several participants indicated a desire to quit smoking but reported barriers to smoking cessation, such as lack of access to medications, social triggers to continue smoking, and socioeconomic stressors. A number of suggestions were provided to improve smoking cessation resources, including support groups, graphic images of smoking-related diseased tissue, and better communication with health care providers. Conclusions These findings demonstrate smoking bans in two public housing complexes can be effective yet are dependent upon a complex set of issues, including numerous barriers to care.
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Affiliation(s)
- Bethany Foster
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
- Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - David M. Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Cara A. Struble
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Marina C. Fodor
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Parada Jordan
- Office of Community Engaged Research, Wayne State University, Detroit, MI, USA
| | - Abhinav C. Krishnan
- Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
- Department of Physiology, Wayne State University, Detroit, MI, USA
| | - Beverly Turner
- Office of Community Engaged Research, Wayne State University, Detroit, MI, USA
| | | | - Michael J. Twiner
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
- Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
- Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
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Pulido J, Molist G, Vallejo F, Jiménez-Mejías E, Hoyos J, Regidor E, Barrio G. No effect of the Penalty Point System on road traffic accident mortality among men with a high socioeconomic status in Spain. ACCIDENT; ANALYSIS AND PREVENTION 2021; 156:106154. [PMID: 33933718 DOI: 10.1016/j.aap.2021.106154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to assess the effect of the Penalty Point System (PPS) on road traffic accident mortality by gender and socioeconomic status. We conducted a nationwide prospective study covering adult people living in Spain on November 2001. They were followed up until 30 Nov 2007 to determine vital status and cause of death. An interrupted time-series analysis was used to assess whether PPS (explanatory variable) had both immediate and long-term effect on the rates of road traffic accident mortality (RTAMs) separately by gender. Subjects were classified by socioeconomic status (low and high) using two indicators: educational attainment (up to lower secondary education; upper secondary education or more) and occupation (manual and non-manual workers). We performed several segmented Poisson regression models, controlling for trend, seasonality, 2004 road safety measures and fuel consumption as proxy for traffic exposure. Among men, we found a decrease on the RTAMs immediately after PPS in those with low educational level (16.2 %, IC95 %: 6.1 %-25.2 %) and manual workers (16.3 %, IC95 %: 2.8 %-27.8 %), and a non-significant increase among those with high education level and non-manual workers (6.2 % and 1.8 %). Among women, there were no significant differences in the immediate effect of PPS by socioeconomic status. We did not identify significant trend changes between pre-PPS and post-PPS periods in any socioeconomic group. In a context of downward trend of traffic mortality, the PPS implementation led to an immediate reduction on death rates only among men with a low socioeconomic status.
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Affiliation(s)
- J Pulido
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain; National School of Public Health, Institute of Health Carlos III, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - G Molist
- Granollers General Hospital, Research and Innovation Area, Granollers, Barcelona, Spain
| | - F Vallejo
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - E Jiménez-Mejías
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Biosanitary Research Institute (Ibs Granada), Granada, Spain
| | - J Hoyos
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - E Regidor
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - G Barrio
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Anyanwu PE, Craig P, Katikireddi SV, Green MJ. Impact of UK Tobacco Control Policies on Inequalities in Youth Smoking Uptake: A Natural Experiment Study. Nicotine Tob Res 2020; 22:1973-1980. [PMID: 32469404 PMCID: PMC7593354 DOI: 10.1093/ntr/ntaa101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 05/26/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION UK countries implemented smoke-free public places legislation and increased the legal age for tobacco purchase from 16 to 18 years between 2006 and 2008. We evaluated the immediate and long-term impacts of these UK policy changes on youth smoking uptake and inequalities therein. AIMS AND METHODS We studied 74 960 person-years of longitudinal data from 14 992 youths (aged 11-15 years) in annual UK household surveys between 1994 and 2016. Discrete-time event history analyses examined whether changes in rates of youth smoking transitions (initiation, experimentation, and escalation to daily smoking or quitting) or their inequalities (by parental education) were associated with policy implementation. Parallel analyses examined smoke-free legislation and the change in legal age. We interpret the results as a combined effect of the two pieces of legislation as their implementation dates were too close to identify separate effects. Models were adjusted for sex, age, UK country, historical year, tobacco taxation, and e-cigarette prevalence, with multiple imputation for missing data. RESULTS For both policies, smoking initiation reduced following implementation (change in legal age odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.55 to 0.81; smoke-free legislation OR: 0.68; 95% CI: 0.56 to 0.82), while inequalities in initiation narrowed over subsequent years. The legal age change was associated with annual increases in progression from initiation to occasional smoking (OR: 1.26; 95% CI: 1.07 to 1.50) and a reduction in quitting following implementation (OR: 0.57; 95% CI: 0.35 to 0.94). Similar effects were observed for smoke-free legislation but CIs overlapped the null. CONCLUSIONS Policies such as these may be highly effective in preventing and reducing socioeconomic inequalities in youth smoking initiation. IMPLICATIONS UK implementation of smoke-free legislation and an increase in the legal age for tobacco purchase from 16 to 18 years were associated with an immediate reduction in smoking initiation and a narrowing of inequalities in initiation over subsequent years. While the policies were associated with reductions in the initiation, progression to occasional smoking increased and quitting decreased following the legislation.
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Affiliation(s)
- Philip Emeka Anyanwu
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK,Global Digital Health Unit, School of Public Health, Imperial College London, London, UK,Corresponding Author: Philip Emeka Anyanwu, PhD, Global Digital Health Unit, School of Public Health, Imperial College London, Room 350, Reynolds Building, Charing Cross Campus, London W6 8RP, UK. Telephone: +44-(0)-207-594-2756; E-mail:
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael James Green
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Christian WJ, Walker CJ, Huang B, Hahn EJ. Effect of Local Smoke-Free Ordinances on Smoking Prevalence in Kentucky, 2002-2009. South Med J 2019; 112:369-375. [PMID: 31282965 PMCID: PMC6687407 DOI: 10.14423/smj.0000000000001000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Many local communities in Kentucky, a state with one of the highest smoking prevalence rates in the United States, have enacted smoke-free ordinances that prohibit smoking in workplaces and enclosed buildings open to the public. Research has shown that such ordinances are clearly beneficial for public health, but their influence on smoking prevalence in the populations they cover remains unclear. This study explores the effect of local smoke-free ordinances on smoking prevalence in Kentucky. METHODS We used a database of smoke-free ordinances maintained by the Kentucky Center for Smoke-Free Policy, Kentucky Behavioral Risk Factor Surveillance System survey data, and US Census data. We estimated the proportion of Kentucky adults living in counties with smoke-free ordinances of varying strength; examined bivariate associations between smoke-free ordinances and smoking prevalence; and fit regression models that adjusted for various county-level demographic, socioeconomic, and geographic factors. RESULTS Smoking prevalence was approximately 5% lower in counties with smoke-free ordinances, even after adjusting for other relevant factors, including a trend in decreasing prevalence throughout the study region. There was a slight dose-response effect related to the strength of smoke-free ordinances after adjustment for these covariates. Smoke-free ordinances appear to have a modest effect on smoking prevalence across the span of several years. CONCLUSIONS Findings demonstrate that although smoking prevalence fell throughout the state during the study period, counties with smoke-free ordinances experienced a greater decline. Future research should examine the strength of smoke-free ordinances in greater detail to better understand their influence on smoking prevalence.
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Affiliation(s)
- W Jay Christian
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Courtney J Walker
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Bin Huang
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Ellen J Hahn
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
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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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Coppo A, Baldissera S, Migliardi A, Minardi V, Quarchioni E, Ferrante G, Dal Molin A, Faggiano F. Quit attempts and smoking cessation in Italian adults (25-64 years): factors associated with attempts and successes. Eur J Public Health 2018; 27:717-722. [PMID: 28108591 DOI: 10.1093/eurpub/ckw262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Over the past 50 years there was a substantial decrease in the prevalence of smoking in Italy. The objective of this work is to describe attempts to quit and cessation success in Italian smokers. Methods A surveillance on health-related behaviors (PASSI) was conducted in 2007-13 on a sample of 203 610 Italian adults 25-64 years of age. An analysis of smokers' characteristics and behaviors was performed, focusing on attempts to quit and quit success. Data from national surveys (ISTAT) from 1983 to 2013 (Italian adults, 25-64 years of age, 1983: 46 634; 1987: 40 915; 1990: 36 622; 2000: 77 531; 2005: 71 032; 2013: 64 205) were used to explore if a cessation trend in Italy exists. Results Smokers who quit in the previous year and were still abstinent when interviewed increased from 1990 to 2013. In the years 2011-13, 38% of people who had smoked in the last 12 months reported at least a quit attempt during the same period and 7% were still abstinent when interviewed. An association of successful recent quit attempts with higher educational level, absence of economic difficulties and younger age was found. In the years 2007-13, the great majority tried to stop unaided. Having received assistance from a cessation program did not increase the probability of enduring abstinence. Conclusions In Italy interventions to drive more smokers to quit should be focused in particular on disadvantaged groups. Initiatives have to be studied not only to incentive more smokers to try to quit, but also to maintain abstinence over time.
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Affiliation(s)
- Alessandro Coppo
- Department of Translational Medicine, Avogadro University, Novara, Italy
| | - Sandro Baldissera
- Surveillance and Health Promotion, National Centre of Epidemiology, Rome, Italy
| | | | - Valentina Minardi
- Surveillance and Health Promotion, National Centre of Epidemiology, Rome, Italy
| | - Elisa Quarchioni
- Surveillance and Health Promotion, National Centre of Epidemiology, Rome, Italy
| | - Gianluigi Ferrante
- Surveillance and Health Promotion, National Centre of Epidemiology, Rome, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, Avogadro University, Novara, Italy
| | - Fabrizio Faggiano
- Department of Translational Medicine, Avogadro University, Novara, Italy
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Fleischer NL, Lozano P, Wu YH, Hardin JW, Meng G, Liese AD, Fong GT, Thrasher JF. Disentangling the roles of point-of-sale ban, tobacco retailer density and proximity on cessation and relapse among a cohort of smokers: findings from ITC Canada Survey. Tob Control 2018. [PMID: 29519935 DOI: 10.1136/tobaccocontrol-2017-054081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine how point-of-sale (POS) display bans, tobacco retailer density and tobacco retailer proximity were associated with smoking cessation and relapse in a cohort of smokers in Canada, where provincial POS bans were implemented differentially over time from 2004 to 2010. METHODS Data from the 2005 to 2011 administrations of the International Tobacco Control (ITC) Canada Survey, a nationally representative cohort of adult smokers, were linked via residential geocoding with tobacco retailer data to derive for each smoker a measure of retailer density and proximity. An indicator variable identified whether the smoker's province banned POS displays at the time of the interview. Outcomes included cessation for at least 1 month at follow-up among smokers from the previous wave and relapse at follow-up among smokers who had quit at the previous wave. Logistic generalised estimating equation models were used to determine the relationship between living in a province with a POS display ban, tobacco retailer density and tobacco retailer proximity with cessation (n=4388) and relapse (n=866). RESULTS Provincial POS display bans were not associated with cessation. In adjusted models, POS display bans were associated with lower odds of relapse which strengthened after adjusting for retailer density and proximity, although results were not statistically significant (OR 0.66, 95% CI 0.41 to 1.07, p=0.089). Neither tobacco retailer density nor proximity was associated with cessation or relapse. CONCLUSIONS Banning POS retail displays shows promise as an additional tool to prevent relapse, although these results need to be confirmed in larger longitudinal studies.
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Affiliation(s)
- Nancy L Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Paula Lozano
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Yun-Hsuan Wu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James W Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
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11
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Sandoval JL, Leão T, Cullati S, Theler JM, Joost S, Humair JP, Gaspoz JM, Guessous I. Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation: a cross-sectional population-based study in Geneva, Switzerland (1995-2014). Tob Control 2018; 27:663-669. [PMID: 29374093 DOI: 10.1136/tobaccocontrol-2017-053986] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Smoking bans were suggested to reduce smoking prevalence and increase quit ratio but their equity impact remains unclear. We aimed to characterise the socioeconomic status (SES)-related inequalities in smoking prevalence and quit ratio before and after the implementation of a public smoking ban. METHODS We included data from 17 544 participants in the population-based cross-sectional Bus Santé study in Geneva, Switzerland, between 1995 and 2014. We considered educational attainment (primary, secondary and tertiary) as a SES indicator. Outcomes were smoking prevalence (proportion of current smokers) and quit ratio (ex-smokers to ever-smokers ratio). We used segmented linear regression to assess the overall impact of smoking ban on outcome trends. We calculated the relative (RII) and slope (SII, absolute difference) indexes of inequality, quantifying disparities between educational groups in outcomes overall (1995-2014), before and after ban implementation (November 2009). RESULTS Least educated participants displayed higher smoking prevalence (RII=2.04, P<0.001; SII=0.15, P<0.001) and lower quit ratio (RII=0.73, P<0.001; SII=-0.18, P<0.001). As in other studies, smoking ban implementation coincided with a temporary reduction of smoking prevalence (P=0.003) and increase in quit ratio (P=0.02), with a progressive return to preban levels. Inequalities increased (P<0.05) in relative terms for smoking prevalence (RIIbefore=1.84, P<0.001 and RIIafter=3.01, P<0.001) and absolute terms for both outcomes (smoking prevalence: SIIbefore=0.14, P<0.001 and SIIafter=0.19, P<0.001; quit ratio: SIIbefore=-0.15, P<0.001 and SIIafter=-0.27, P<0.001). CONCLUSIONS Implementation of a public smoking ban coincided with a short-lived decrease in smoking prevalence and increase in quit ratio but also with a widening in SES inequalities in smoking-related outcomes.
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Affiliation(s)
- José Luis Sandoval
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Stéphane Cullati
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.,Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
| | - Jean-Marc Theler
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Joost
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Geographical Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jean-Paul Humair
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Michel Gaspoz
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Ambulatory and Community Medicine, University of Lausanne, Lausanne, Switzerland
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12
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Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion. Arch Phys Med Rehabil 2017; 98:1941-1947. [PMID: 28483657 DOI: 10.1016/j.apmr.2017.03.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain. DESIGN Single-blind case series. SETTING Three outpatient physical therapy clinics. PARTICIPANTS Patients with shoulder pain and limited AROM (N=69). INTERVENTION Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder. MAIN OUTCOME MEASURES We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy. RESULTS There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°. CONCLUSIONS A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects.
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13
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Hu Y, van Lenthe FJ, Hoffmann R, van Hedel K, Mackenbach JP. Assessing the impact of natural policy experiments on socioeconomic inequalities in health: how to apply commonly used quantitative analytical methods? BMC Med Res Methodol 2017; 17:68. [PMID: 28427353 PMCID: PMC5397741 DOI: 10.1186/s12874-017-0317-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The scientific evidence-base for policies to tackle health inequalities is limited. Natural policy experiments (NPE) have drawn increasing attention as a means to evaluating the effects of policies on health. Several analytical methods can be used to evaluate the outcomes of NPEs in terms of average population health, but it is unclear whether they can also be used to assess the outcomes of NPEs in terms of health inequalities. The aim of this study therefore was to assess whether, and to demonstrate how, a number of commonly used analytical methods for the evaluation of NPEs can be applied to quantify the effect of policies on health inequalities. METHODS We identified seven quantitative analytical methods for the evaluation of NPEs: regression adjustment, propensity score matching, difference-in-differences analysis, fixed effects analysis, instrumental variable analysis, regression discontinuity and interrupted time-series. We assessed whether these methods can be used to quantify the effect of policies on the magnitude of health inequalities either by conducting a stratified analysis or by including an interaction term, and illustrated both approaches in a fictitious numerical example. RESULTS All seven methods can be used to quantify the equity impact of policies on absolute and relative inequalities in health by conducting an analysis stratified by socioeconomic position, and all but one (propensity score matching) can be used to quantify equity impacts by inclusion of an interaction term between socioeconomic position and policy exposure. CONCLUSION Methods commonly used in economics and econometrics for the evaluation of NPEs can also be applied to assess the equity impact of policies, and our illustrations provide guidance on how to do this appropriately. The low external validity of results from instrumental variable analysis and regression discontinuity makes these methods less desirable for assessing policy effects on population-level health inequalities. Increased use of the methods in social epidemiology will help to build an evidence base to support policy making in the area of health inequalities.
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Affiliation(s)
- Yannan Hu
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | | | - Rasmus Hoffmann
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
- European University Institute, Florence, Italy
| | - Karen van Hedel
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
- Max Planck Institute for Demographic Research, Rostock, Germany
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14
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Katikireddi SV, Der G, Roberts C, Haw S. Has Childhood Smoking Reduced Following Smoke-Free Public Places Legislation? A Segmented Regression Analysis of Cross-Sectional UK School-Based Surveys. Nicotine Tob Res 2016; 18:1670-4. [PMID: 26911840 PMCID: PMC4902887 DOI: 10.1093/ntr/ntw018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/05/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoke-free legislation has been a great success for tobacco control but its impact on smoking uptake remains under-explored. We investigated if trends in smoking uptake amongst adolescents differed before and after the introduction of smoke-free legislation in the United Kingdom. METHODS Prevalence estimates for regular smoking were obtained from representative school-based surveys for the four countries of the United Kingdom. Post-intervention status was represented using a dummy variable and to allow for a change in trend, the number of years since implementation was included. To estimate the association between smoke-free legislation and adolescent smoking, the percentage of regular smokers was modeled using linear regression adjusted for trends over time and country. All models were stratified by age (13 and 15 years) and sex. RESULTS For 15-year-old girls, the implementation of smoke-free legislation in the United Kingdom was associated with a 4.3% reduction in the prevalence of regular smoking (P = .029). In addition, regular smoking fell by an additional 1.5% per annum post-legislation in this group (P = .005). Among 13-year-old girls, there was a reduction of 2.8% in regular smoking (P = .051), with no evidence of a change in trend post-legislation. Smaller and nonsignificant reductions in regular smoking were observed for 15- and 13-year-old boys (P = .175 and P = .113, respectively). CONCLUSIONS Smoke-free legislation may help reduce smoking uptake amongst teenagers, with stronger evidence for an association seen in females. Further research that analyses longitudinal data across more countries is required. IMPLICATIONS Previous research has established that smoke-free legislation has led to many improvements in population health, including reductions in heart attack, stroke, and asthma. However, the impacts of smoke-free legislation on the rates of smoking amongst children have been less investigated. Analysis of repeated cross-sectional surveys across the four countries of the United Kingdom shows smoke-free legislation may be associated with a reduction in regular smoking among school-aged children. If this association is causal, comprehensive smoke-free legislation could help prevent future generations from taking up smoking.
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Affiliation(s)
| | - Geoff Der
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Chris Roberts
- Social Research and Information Division, Welsh Government, Cardiff, UK
| | - Sally Haw
- School of Health Sciences, University of Stirling, Stirling, UK
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15
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Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2016; 2:CD005992. [PMID: 26842828 PMCID: PMC6486282 DOI: 10.1002/14651858.cd005992.pub3] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and the smoking behaviour of those populations they affect. Since the first version of this review in 2010, more countries have introduced national smoking legislation banning indoor smoking. OBJECTIVES To assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL and reference lists of included studies. We also checked websites of various organisations. Date of most recent search; February 2015. SELECTION CRITERIA We considered studies that reported legislative smoking bans affecting populations. The minimum standard was having an indoor smoking ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. Our search included a broad range of research designs including: randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before-and-after studies, interrupted time series as defined by the Cochrane Effective Practice and Organisation of Care Group, and uncontrolled pre- and post-ban data. DATA COLLECTION AND ANALYSIS One author extracted characteristics and content of the interventions, participants, outcomes and methods of the included studies and a second author checked the details. We extracted health and smoking behaviour outcomes. We did not attempt a meta-analysis due to the heterogeneity in design and content of the studies included. We evaluated the studies using qualitative narrative synthesis. MAIN RESULTS There are 77 studies included in this updated review. We retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes randomized controlled trials. Thirty-six studies used an interrupted time series study design, 23 studies use a controlled before-and-after design and 18 studies are before-and-after studies with no control group; six of these studies use a cohort design. Seventy-two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking-related diseases. A number of the studies report multiple health outcomes. There is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking-related illnesses. Effects on respiratory and perinatal health were less consistent. We found 24 studies evaluating the impact of national smoke-free legislation on smoking behaviour. Evidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long-term change in existing trends in prevalence. AUTHORS' CONCLUSIONS Since the first version of this review was published, the current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in SHS for countries and their populations. The clearest evidence is observed in reduced admissions for acute coronary syndrome. There is evidence of reduced mortality from smoking-related illnesses at a national level. There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption.
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Affiliation(s)
- Kate Frazer
- University College DublinSchool of Nursing, Midwifery & Health SystemsHealth Sciences CentreBelfieldDublin 4Ireland
| | - Joanne E Callinan
- Milford Care CentreLibrary & Information Service, Education, Research & Quality DepartmentPlassey Park RoadCastletroyLimerickIreland000
| | - Jack McHugh
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
| | - Susan van Baarsel
- University College DublinSchool of Medicine and Medical ScienceDublinIreland
| | - Anna Clarke
- National Immunisation OfficeManor StreetDublin 7Ireland
| | - Kirsten Doherty
- Education and Research CentreDepartment of Preventive Medicine and Health PromotionSt Vincent's University HospitalElm ParkDublin 4Ireland
| | - Cecily Kelleher
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
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16
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Regidor E, Pascual C, Giráldez-García C, Galindo S, Martínez D, Kunst AE. Impact of tobacco prices and smoke-free policy on smoking cessation, by gender and educational group: Spain, 1993–2012. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1215-21. [DOI: 10.1016/j.drugpo.2015.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
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17
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Estimating the Smoking Ban Effects on Smoking Prevalence, Quitting and Cigarette Consumption in a Population Study of Apprentices in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9523-35. [PMID: 26287220 PMCID: PMC4555295 DOI: 10.3390/ijerph120809523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 11/24/2022]
Abstract
Objectives: We evaluated the effects of the Italian 2005 smoking ban in public places on the prevalence of smoking, quitting and cigarette consumption of young workers. Data and Methods: The dataset was obtained from non-computerized registers of medical examinations for a population of workers with apprenticeship contracts residing in the province of Viterbo, Italy, in the period 1996–2007. To estimate the effects of the ban, a segmented regression approach was used, exploiting the discontinuity introduced by the application of the law on apprentices’ smoking behavior. Results: It is estimated that the Italian smoking ban generally had no effect on smoking prevalence, quitting ratio, or cigarette consumption of apprentices. However, when the estimates were applied to subpopulations, significant effects were found: −1% in smoking prevalence, +2% in quitting, and −3% in smoking intensity of apprentices with at least a diploma.
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18
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Bosdriesz JR, Willemsen MC, Stronks K, Kunst AE. Socioeconomic inequalities in smoking cessation in 11 European countries from 1987 to 2012. J Epidemiol Community Health 2015; 69:886-92. [PMID: 25841241 DOI: 10.1136/jech-2014-205171] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/13/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND During the 1990s, inequalities in smoking prevalence by socioeconomic status (SES) have widened in Europe. Since then, many tobacco control policies have been implemented. Yet, European overviews of recent trends in smoking inequalities are lacking. This paper aims to provide an overview of long-term trends of socioeconomic inequalities in smoking cessation in Europe. METHODS We used data for 11 countries taken from Eurobarometer surveys from 1987 to 1995 and 2002-2012, with a total study sample of 63 737 respondents. We performed multilevel logistic regression to model associations of the quit ratio (proportion former smokers of ever smokers) with SES, measured by education and occupation separately, with adjustments for age, sex and time. RESULTS We found a significant, positive association for education and occupation with the quit ratio. The strength of the association decreased slightly from 1987 to 1995 and increased again from 2002 to 2012. Inequalities increased between the two periods in most countries and decreased in only one country. While in 1987-1995, the quit ratio increased among all SES groups and most strongly among the low SES group, in 2002-2012 it increased only among the high-education group (OR=1.38, 95% CI 1.02 to 1.87), and non-manual occupation group (OR=1.59, 95% CI 1.19 to 2.12). CONCLUSIONS Socioeconomic inequalities in smoking cessation rates have strongly increased since the 1990s and during the 2000s. This suggests that the tobacco control policies implemented during the 2000s have not been able to counter the trend in increasing inequalities.
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Affiliation(s)
- Jizzo R Bosdriesz
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands Alliance Smokefree Holland, The Hague, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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19
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Klumbiene J, Sakyte E, Petkeviciene J, Prattala R, Kunst AE. The effect of tobacco control policy on smoking cessation in relation to gender, age and education in Lithuania, 1994-2010. BMC Public Health 2015; 15:181. [PMID: 25886060 PMCID: PMC4349467 DOI: 10.1186/s12889-015-1525-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 02/12/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the association between tobacco control policies and trends in smoking cessation according to gender, age and educational level in Lithuania in 1994-2010. METHODS The data were obtained from nine cross-sectional postal surveys conducted biennially within the framework of Finbalt Health Monitor project during 1994-2010. Each survey was based on a nationally representative random sample drawn from the National population register. The sample consisted of 3000 citizens aged 20-64 in 1994-2008 surveys and 4000 in the 2010 survey. In total, 17161 individuals participated in all surveys. The development of tobacco control policy in Lithuania was assessed using the Tobacco Control Scale (TCS). The association of the TCS scores with short-term and long-term quitting according to gender, age and education was examined using logistic regression analysis with control for secular trends. RESULTS Over the last two decades, a large improvement in the development of tobacco control policy has been achieved in Lithuania. At the same time, this progress was associated with the increase in smoking cessation. A significant increase in both short-term and long-term quit ratios was found among people aged 20-44. An increase by 10 points on the TCS was associated with 17% increase in the odds of short-term quitting and with 15% increase in the odds of long-term quitting. The association between tobacco control policies and long-term quitting was stronger among younger than older people. No differential effect of tobacco control policies on smoking cessation was found in relation to gender and educational level. CONCLUSIONS The improvement in Lithuanian tobacco control policies was associated with an increase in smoking cessation in long-term perspective. These policies have not only benefitted highly educated groups, but lower educated groups as well. Nonetheless, further development of comprehensive tobacco control policies is needed in order to decrease social inequalities in smoking cessation.
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Affiliation(s)
- Jurate Klumbiene
- Public Health Faculty, Lithuanian University of Health Sciences, Siaures av. 57, LT-49264, Kaunas, Lithuania.
| | - Edita Sakyte
- Public Health Faculty, Lithuanian University of Health Sciences, Siaures av. 57, LT-49264, Kaunas, Lithuania.
| | - Janina Petkeviciene
- Public Health Faculty, Lithuanian University of Health Sciences, Siaures av. 57, LT-49264, Kaunas, Lithuania.
| | - Ritva Prattala
- National Institute for Health and Welfare, Helsinki, Finland.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
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20
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Bosdriesz JR, Nagelhout GE, Stronks K, Willemsen MC, Kunst AE. The Association Between Tobacco Control Policy and Educational Inequalities in Smoking Cessation in the Netherlands from 1988 Through 2011. Nicotine Tob Res 2015; 17:1369-76. [DOI: 10.1093/ntr/ntv004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 12/29/2014] [Indexed: 11/13/2022]
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Kuipers MAG, Nagelhout GE, Willemsen MC, Kunst AE. Widening educational inequalities in adolescent smoking following national tobacco control policies in the Netherlands in 2003: a time-series analysis. Addiction 2014; 109:1750-9. [PMID: 24895015 DOI: 10.1111/add.12637] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/14/2014] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In 2003, the Netherlands introduced tobacco control policies, including bans on tobacco sales to minors, advertising and sponsoring and tobacco sales in government institutions. We examined the extent to which these policies were associated with a change in educational inequalities in adolescent smoking. DESIGN Repeated cross-sectional survey. SETTING The Netherlands, 1992-2011. PARTICIPANTS A total of 43 527 14-19-year-old adolescents. MEASUREMENTS Data were obtained from the national Youth Smoking Monitor. We used logistic regression analyses to model the immediate change in daily smoking prevalence in 2003, the trends and the changes in trends. Models included interactions between educational level (high versus low, based on the educational track of the respondent) and, respectively, period (after versus before 2003), time and time × period. FINDINGS Before 2003 the smoking trend declined slightly, and the decline was comparable for students of both high and low educational levels. Immediately after tobacco policies were introduced, daily smoking prevalence dropped for the total population [regression coefficient (β) = -0.340, 95% confidence interval (CI) = -0.445; -0.236]. This drop was larger for high educational level compared to low educational level (β interaction = -0.400, 95% CI = -0.623; -0.176). After 2003, trends in educational inequalities in smoking stabilized. CONCLUSIONS Following the introduction of new tobacco control policies in the Netherlands in 2003, smoking prevalence rates decreased among adolescents of both higher and lower educational levels. However, socio-economic inequalities in adolescent smoking increased.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands
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22
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Wakefield MA, Coomber K, Durkin SJ, Scollo M, Bayly M, Spittal MJ, Simpson JA, Hill D. Time series analysis of the impact of tobacco control policies on smoking prevalence among Australian adults, 2001-2011. Bull World Health Organ 2014; 92:413-22. [PMID: 24940015 PMCID: PMC4047797 DOI: 10.2471/blt.13.118448] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 12/08/2013] [Accepted: 12/15/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the impact of tobacco control policies and mass media campaigns on smoking prevalence in Australian adults. METHODS Data for calculating the average monthly prevalence of smoking between January 2001 and June 2011 were obtained via structured interviews of randomly sampled adults aged 18 years or older from Australia's five largest capital cities (monthly mean number of adults interviewed: 2375). The influence on smoking prevalence was estimated for increased tobacco taxes; strengthened smoke-free laws; increased monthly population exposure to televised tobacco control mass media campaigns and pharmaceutical company advertising for nicotine replacement therapy (NRT), using gross ratings points; monthly sales of NRT, bupropion and varenicline; and introduction of graphic health warnings on cigarette packs. Autoregressive integrated moving average (ARIMA) models were used to examine the influence of these interventions on smoking prevalence. FINDINGS The mean smoking prevalence for the study period was 19.9% (standard deviation: 2.0%), with a drop from 23.6% (in January 2001) to 17.3% (in June 2011). The best-fitting model showed that stronger smoke-free laws, tobacco price increases and greater exposure to mass media campaigns independently explained 76% of the decrease in smoking prevalence from February 2002 to June 2011. CONCLUSION Increased tobacco taxation, more comprehensive smoke-free laws and increased investment in mass media campaigns played a substantial role in reducing smoking prevalence among Australian adults between 2001 and 2011.
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Affiliation(s)
- Melanie A Wakefield
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Kerri Coomber
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Sarah J Durkin
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Michelle Scollo
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Megan Bayly
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Matthew J Spittal
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - Julie A Simpson
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
| | - David Hill
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
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Smoking ban policies in Italy and the potential impact of the so-called Sirchia Law: state of the art after eight years. BIOMED RESEARCH INTERNATIONAL 2014; 2014:293219. [PMID: 24955353 PMCID: PMC4052100 DOI: 10.1155/2014/293219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the present work is to describe the state of the art of tobacco habits in Italy, eight years after the law was introduced. METHODS Time series analyses, based on estimates of smoking prevalence/consumption derived from the openly available data of national surveys performed during the 2001-2013 period, were performed. Data have been expressed in percentage of smokers and daily cigarettes consumption. Time changes are expressed as expected annual percentage change (EAPC). RESULTS Over time, the percentage of Italian smokers shows a constant and statistically significant decrease (from 28.9% in 2001 to 20.6% in 2013, EAPC = -2.6%, and P < 0.001). Regarding data stratified by gender, we found a stronger reduction among men (EAPC = -2.9%, P < 0.001) than in women (EAPC = -2.5%, P < 0.001). Similarly, the consumption of tobacco smoking, measured as the number of daily cigarettes smoked, registered a downward trend (P < 0.001). No join point (time point when a significant trend change is detected) resulted from the trend analysis. CONCLUSIONS Data show a constant decrease of tobacco consumption in Italy, with no join point related to the introduction of the banning law. These findings require to reflect on the priorities of the smoking banning policies that may be focused on other intervention activities such as to increase the price of cigarettes.
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Brown T, Platt S, Amos A. Equity impact of population-level interventions and policies to reduce smoking in adults: a systematic review. Drug Alcohol Depend 2014; 138:7-16. [PMID: 24674707 DOI: 10.1016/j.drugalcdep.2014.03.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/21/2014] [Accepted: 03/02/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS There is strong evidence about which tobacco control policies reduce smoking. However, their equity impact is uncertain. The aim was to assess the effectiveness of population-level interventions/policies to reduce socioeconomic inequalities in adult smoking. METHODS Systematic review of studies of population-level interventions/policies reporting smoking-related outcomes in adults of lower compared to higher socioeconomic status (SES). References were screened and independently checked. Studies were quality assessed. Results are presented in a narrative synthesis. Equity impact was assessed as: positive (reduced inequality), neutral (no difference by SES), negative (increased inequality), mixed (equity impact varied) or unclear. RESULTS 117 studies of 130 interventions/policies were included: smokefree (44); price/tax (27); mass media campaigns (30); advertising controls (9); cessation support (9); settings-based interventions (7); multiple policies (4). The distribution of equity effects was: 33 positive, 36 neutral, 38 negative, 6 mixed, 17 unclear. Most neutral equity studies benefited all SES groups. Fourteen price/tax studies were equity positive. Voluntary, regional and partial smokefree policies were more likely to be equity negative than national, comprehensive smokefree policies. Mass media campaigns had inconsistent equity effects. Cigarette marketing controls were equity positive or neutral. Targeted national smoking cessation services can be equity positive by achieving higher reach among low SES, compensating for lower quit rates. CONCLUSIONS Few studies have assessed the equity impact of tobacco control policy/interventions. Price/tax increases had the most consistent positive equity impact. More research is needed to strengthen the evidence-base for reducing smoking inequalities and to develop effective equity-orientated tobacco control strategies.
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Affiliation(s)
- Tamara Brown
- UK Centre for Tobacco Control Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Stephen Platt
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Amanda Amos
- UK Centre for Tobacco Control Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK.
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Chang FC, Sung HY, Zhu SH, Chiou ST. Impact of the 2009 Taiwan tobacco hazards prevention act on smoking cessation. Addiction 2014; 109:140-6. [PMID: 24033589 DOI: 10.1111/add.12344] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/01/2013] [Accepted: 08/19/2013] [Indexed: 12/01/2022]
Abstract
AIMS In January 2009, the government of Taiwan amended the 1997 Tobacco Hazards Prevention Act by extending smoke-free areas to include almost all enclosed work-places and public places, adding graphic health warnings to cigarette packages, totally banning tobacco advertisements, promotion and sponsorship and increasing tobacco taxes. This study examined the impact of the 2009 amended Act on smoking cessation in Taiwan. DESIGN Taiwan Adult Tobacco Surveys 2007 and 2010, each with a nationally representative sample of adults aged 18 years and older (n = 16 588, and n = 16 295, respectively). PARTICIPANTS All recent active smokers (current smokers plus former smokers who quit smoking within the past 12 months) were used for the analyses (n = 3783 in 2007, and n = 2777 in 2010). MEASUREMENTS Quit attempt rate and annual cessation rate (defined as having succeeded in quitting for at least 3 months) among recent active smokers were compared between the pre-Act (2007) and post-Act (2010) periods. FINDINGS The quit attempt rate increased significantly from 39.4% in 2007 to 42.9% in 2010. The annual cessation rate increased significantly from 7.1 to 8.9%. A multivariate analysis, controlling for demographic characteristics, showed that the implementation of the 2009 Act was associated with an increase in the quit attempt rate [odds ratio (OR) = 1.14; 95% confidence interval (CI) = 1.03-1.25] and the annual cessation rate (OR = 1.28; 95% CI = 1.08-1.53). CONCLUSIONS The comprehensive tobacco control programme introduced in 2009 in Taiwan, which combined smoke-free legislation with a tobacco tax increase, graphic health warning labels and a total ban on tobacco advertisements, was associated with increases in quit attempt rate and annual cessation rate.
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Azagba S, Asbridge M. The association between smoking bans and nicotine dependence: a longitudinal analysis of current smokers in Canada. Addict Behav 2013; 38:2817-20. [PMID: 24018223 DOI: 10.1016/j.addbeh.2013.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/16/2013] [Accepted: 08/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND While a substantial body of research has examined the effects of smoking bans on smoking behavior, little is known about the relationship between smoking bans and nicotine dependence. The objective of this study was to examine whether home and workplace smoking bans are associated with reduced nicotine dependence among continuing smokers. METHODS We used longitudinal data of 1073 adult daily smokers from the Canadian National Population Health Survey (2004-2010). Generalized estimating equations were used to examine the association between smoking bans and nicotine dependence. RESULTS Smokers living in homes where smoking is restricted were less likely to be nicotine dependent (OR=0.40, 95% CI=0.32-0.50) than smokers living in homes with no such smoking restriction. Workplace smoking policies had no significant association with nicotine dependence (complete ban: OR=0.79, 95% CI=0.56-1.11; partial ban: OR=0.82, 95% CI=0.57-1.16). There was some evidence that workplace smoking bans were significantly associated with nicotine dependence when single items of the Fagerstrom test were considered. CONCLUSIONS This paper demonstrates that the presence of a home smoking ban was associated with lower nicotine dependence among continuing smokers. The relationship of workplace bans with nicotine dependence was less clear and was contingent on the measure of nicotine dependence employed. These findings further confirm the importance of bans on smoking in the home, workplace, and other public places on reducing tobacco-related harms.
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Affiliation(s)
- Sunday Azagba
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada.
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Verbiest MEA, Chavannes NH, Crone MR, Nielen MMJ, Segaar D, Korevaar JC, Assendelft WJJ. An increase in primary care prescriptions of stop-smoking medication as a result of health insurance coverage in the Netherlands: population based study. Addiction 2013; 108:2183-92. [PMID: 23819654 DOI: 10.1111/add.12289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/07/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
AIMS To examine the impact of two national tobacco control interventions in the past decade on (dispensed) prescriptions of stop-smoking medication. DESIGN Ecological study with interrupted time-series analyses of quarterly data points of three nation-wide representative databases. SETTING The Netherlands 2001-2012, with the introduction of the guideline for smoking cessation care for general practitioners (GP) in 2007 and full insurance coverage for smoking cessation treatment in 2011. PARTICIPANTS GPs, pharmacists and people in the general population aged 15 years and older. MEASUREMENTS Time-series plots were inspected visually and segmented regression analyses were performed to estimate the change in level and slope of (dispensed) prescriptions of stop-smoking medication and smoking prevalence in the years preceding and after the tobacco control interventions. FINDINGS No measurable effects of the GP guideline on (dispensed) prescriptions were observed. Shortly after the start of health insurance coverage, an estimated increase in primary care prescriptions of 6.3 per 1000 smokers [95% confidence interval (CI) = 2.9-9.8; P = 0.001] and 17.3 dispensed items per 1000 smokers (95% CI = 12.5-22.0; P < 0.000) was accompanied by a sudden drop in smoking prevalence of 2.9% (95% CI = 4.6-1.1; P = 0.002) in the first quarter of 2011. Immediately after the coverage abolition, smoking prevalence increased by 1.2% (95% CI = 0.5-2.8; P = 0.156) and dispensed prescription rates decreased with 21.6 per 1000 smokers (95% CI = 26.0-17.2; P < 0.000). CONCLUSIONS Full health insurance coverage for smoking cessation treatment in the Netherlands was accompanied by a significant increase in the number of (dispensed) prescriptions of stop-smoking medication and a decrease in smoking prevalence.
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Affiliation(s)
- Marjolein E A Verbiest
- Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, the Netherlands
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Abstract
Smoking is prevalent across Europe, but the severity and stage of the smoking epidemic, and policy responses to it, vary substantially between countries. Much progress is now being made in prohibition of paid-for advertising and in promotion of smoke-free policies, but mass media campaigns are widely underused, provision of services for smokers trying to quit is generally poor, and price policies are undermined by licit and illicit cheap supplies. Monitoring of prevalence is inadequate in many countries, as is investment in research and capacity to address this largest avoidable cause of death and disability across Europe. However, grounds for optimism are provided by progress in implementation of the WHO Framework Convention on Tobacco Control, and in the development of a new generation of nicotine-containing devices that could enable more widespread adoption of harm-reduction strategies. The effect of commercial vested interests has been and remains a major barrier to progress.
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Affiliation(s)
- John Britton
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
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Pieroni L, Chiavarini M, Minelli L, Salmasi L. The role of anti-smoking legislation on cigarette and alcohol consumption habits in Italy. Health Policy 2013; 111:116-26. [PMID: 23642788 DOI: 10.1016/j.healthpol.2013.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 03/30/2013] [Accepted: 04/02/2013] [Indexed: 11/18/2022]
Abstract
The short-term effects of public smoking bans on individual smoking and drinking habits were investigated in this paper. In 2005, a smoking ban was introduced in Italy, and we exploited this exogenous variation to measure the effect on both smoking participation and intensity and the indirect effect on alcohol consumption. Using data from the Everyday Life Aspects survey, for the period 2001-2007, we show that the introduction of smoke-free legislation in Italy significantly affected smoking behavior. We also document significant indirect effects on alcohol consumption for the main alcoholic beverage categories. A robustness analysis is also performed, to test the extent to which unobservable variables may bias our estimated parameters. Our results are then used to perform a cost-effectiveness analysis of the anti-smoking legislation in Italy.
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Affiliation(s)
- Luca Pieroni
- Department of Economics, Finance and Statistics, University of Perugia, via Pascoli 20, 06123 Perugia, Italy.
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