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Vitzthum K, Cerci D. A Qualitative Investigation of Staff Feedback on an Online Learning Module on Smoking Cessation in a German Healthcare Company. Healthcare (Basel) 2023; 11:1774. [PMID: 37372892 PMCID: PMC10298186 DOI: 10.3390/healthcare11121774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Quitting smoking is a powerful way for patients to improve their own wellbeing and to significantly reduce the risk of health problems. Evidence shows that health professionals can effectively intervene in order to prevent and stop tobacco smoking in their patients. Online learning modules have proved to be effective in terms of transferring knowledge and skills. In an urban community hospital setting in Germany, a novel e-learning course for staff on the treatment of tobacco dependence was implemented in 2021. In this study, we analyzed free-text feedback of participants completing this online module in order to examine the feasibility and acceptance of this new format. We were able to reach a reasonable proportion of staff. Our qualitative analysis showed that most feedback was positive and described the module as well-designed and helpful. Some staff, however, expressed extremely negative views and did not see smoking cessation support as essential to their role in healthcare. We argue that in order to achieve a shift in attitude in healthcare staff, a change in German policy is required which includes the creation of smoke-free environments and the adherence to smoke-free policies on hospital sites. Furthermore, the provision of smoking cessation support in line with the WHO Framework Convention on Tobacco Control and a true understanding of the role of all healthcare professionals in promoting health of patients and staff will be essential.
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Affiliation(s)
- Karin Vitzthum
- Institut für Tabakentwöhnung und Raucherprävention, Vivantes Netzwerk für Gesundheit GmbH, 13407 Berlin, Germany
| | - Deniz Cerci
- Klinik für Forensische Psychiatrie, Universitätsmedizin Rostock, 18147 Rostock, Germany
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2
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Cerci D. Attitudes of staff towards smoke-free environments in psychiatric hospitals in Germany. Tob Induc Dis 2022; 20:76. [PMID: 36118555 PMCID: PMC9443077 DOI: 10.18332/tid/152252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smoke-free environments have already been successfully introduced in hospitals world-wide. But despite convincing evidence of their success, many countries still struggle to make the necessary changes. Not only is the smoking prevalence higher amongst people with mental health problems and staff working in psychiatric units, but employees in psychiatry often resist the implementation of smoke-free policies. This study explores staff attitudes towards smoke-free environments in psychiatric hospitals in Germany and tries to identify barriers and opportunities for implementation. METHODS This cross-sectional online survey was carried out at eight psychiatric units of the state-owned healthcare company Vivantes Netzwerk für Gesundheit GmbH in Berlin, Germany, in 2019. A total of 448 members of staff were surveyed on their views towards creating a smoke-free environment in their workplace. RESULTS Psychiatric staff present contradictory attitudes towards implementing smoke-free regulations. On the one hand, a majority recognizes the need for smoke-free environments as they promote physical well-being of staff and patients. On the other hand, a majority opposes comprehensive restrictions like a complete smoking ban. Smokers are more likely than non-smokers to resist restrictive measures and show a tendency to only support those measures which they deem unlikely to affect their own smoking habits. CONCLUSIONS The contradictory attitudes towards implementing smoke-free regulations present an entry point to elicit behavior change and a shift in attitudes, for example in staff training on smoke-free environments. Staff who smoke, in particular, should be motivated to reflect on the contradiction that is presented by their private smoking behavior and their role as healthcare professionals.
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Affiliation(s)
- Deniz Cerci
- Klinik fur Forensische Psychiatrie, Universitatsmedizin Rostock, Rostock, Deutschland
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3
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Prabandari YS, Bintoro BS, Purwanta P. A Comprehensive Tobacco Control Policy Program in a Mining Industry in Indonesia: Did It Work? Front Public Health 2022; 10:853862. [PMID: 35400041 PMCID: PMC8987008 DOI: 10.3389/fpubh.2022.853862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background Risk factor controls, including smoking cessation and prevention, impact health costs. This study aimed to describe the Kaltim Prima Coal (KPC), one of Indonesia's largest coal mining operations, comprehensive tobacco control policy program in 2015 and its impact on smoking behavior among the employees. Method A survey among 404 employees was conducted to assess the impact of the smoke-free KPC programs. In addition to the descriptive analysis, logistic regression was used to measure the association of intention to the smoking behavior change and the association between intention and the determinants using the Theory of Planned Behavior in 102 smokers. Results A series of tobacco control programs: advocacy, health education, brief interventions for smoking cessation, peer counselor training, media campaigns, and policy regulations were implemented. About 95.5% of the respondents attended the KPC Smoke-Free 2015 programs, and 97.8% reported they already knew that KPC is a total smoke-free area. Nearly 50% of the respondents expressed that the staff complied with the rules and no longer smoked in KPC. Majority of smokers (76.6%) reduced their consumption, and 5.6% of them quit smoking. Among smokers, we found that attitude toward smoking cessation, subjective norm, and perceived control for quitting were related to the intention to stop smoking. Conclusions The KPC smoke-free policy has been comprehensively implemented. Regulations on smoking and tobacco controls should be maintained, and monitoring should be consistently done. Media campaigns on the regulations and the availability of trained peer educators for smoking cessation help need to be applied continuously.
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Affiliation(s)
- Yayi S. Prabandari
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bagas S. Bintoro
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Purwanta Purwanta
- Department of Mental Health and Community Health Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Howse E, Cullerton K, Grunseit A, Bohn-Goldbaum E, Bauman A, Freeman B. Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods. Health Res Policy Syst 2022; 20:26. [PMID: 35246170 PMCID: PMC8895540 DOI: 10.1186/s12961-022-00829-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
Abstract
Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.
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Affiliation(s)
- Eloise Howse
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia. .,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Katherine Cullerton
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Anne Grunseit
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Erika Bohn-Goldbaum
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Becky Freeman
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Nogueira SO, Fernández E, Driezen P, Fu M, Tigova O, Castellano Y, Mons U, Herbeć A, Kyriakos CN, Demjén T, Trofor AC, Przewoźniak K, Katsaounou PA, Vardavas CI, Fong GT. Secondhand smoke exposure in European countries with different smoke-free legislation. Findings from the EUREST-PLUS ITC Europe Surveys. Nicotine Tob Res 2021; 24:85-92. [PMID: 34387341 DOI: 10.1093/ntr/ntab157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/12/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Exposure to secondhand smoke (SHS) poses serious and extensive health and economic-related consequences to European society and worldwide. Smoking bans are a key measure to reducing SHS exposure but have been implemented with varying levels of success. We assessed changes in the prevalence of self-reported SHS exposure and smoking behaviour in public places among smokers in six European countries and the influence of the country's type of smoking ban (partial or total ban) on such exposure and smoking behaviour. METHODS The EUREST-PLUS ITC Europe Surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, and Spain in 2016 (Wave 1, n=6,011) and 2018 (Wave 2, n=6,027). We used generalised estimating equations models to assess changes between Waves 1 and 2 and to test the interaction between the type of smoking ban and 1) self-reported SHS exposure, 2) self-reported smoking in public places. RESULTS A significant decrease in self-reported SHS exposure was observed in workplaces, from 19.1% in 2016 to 14.0% in 2018 (-5.1%; 95% CI: -8.0%;-2.2%). Self-reported smoking did not change significantly inside bars (22.7% in W2), restaurants (13.2% in W2) and discos/nightclubs (34.0% in W2). SHS exposure in public places was significantly less likely (OR=0.35; 95% CI: 0.26-0.47) in the countries with total bans as compared to those countries with partial bans. CONCLUSION The inverse association between smoking in public places and smoking bans indicates an opportunity for strengthening smoke-free legislation and protecting bystanders from exposure to SHS in public places.
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Affiliation(s)
- Sarah O Nogueira
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases, Madrid, Spain
| | - Esteve Fernández
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases, Madrid, Spain
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Marcela Fu
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases, Madrid, Spain
| | - Olena Tigova
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain.,Consortium for Biomedical Research in Respiratory Diseases, Madrid, Spain
| | - Yolanda Castellano
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Spain.,Consortium for Biomedical Research in Respiratory Diseases, Madrid, Spain
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center, Heidelberg, Germany.,Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne Cologne, Germany
| | - Aleksandra Herbeć
- Health Promotion Foundation, Warsaw, Poland.,Centre for Behaviour Change, Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Christina N Kyriakos
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.,European Network on Smoking and Tobacco Prevention, Brussels, Belgium
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania.,Aer Pur Romania, Bucharest, Romania
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland.,Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Collegium Civitas, Warsaw, Poland
| | - Paraskevi A Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantine I Vardavas
- European Network on Smoking and Tobacco Prevention, Brussels, Belgium.,European Respiratory Society, Lausanne, Switzerland.,Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
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Charalampous P, Pallari E, Tyrovolas S, Middleton N, Economou M, Devleesschauwer B, Haagsma JA. Burden of non-communicable diseases in Cyprus, 1990-2017: findings from the Global Burden of Disease 2017 study. Arch Public Health 2021; 79:138. [PMID: 34325736 PMCID: PMC8320095 DOI: 10.1186/s13690-021-00655-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) accounted for over 90% of all deaths in the Cypriot population, in 2018. However, a detailed and comprehensive overview of the impact of NCDs on population health of Cyprus over the period of 1990 to 2017, expressed in disability-adjusted life years (DALYs), is currently not available. Knowledge about the drivers of changes in NCD DALYs over time is paramount to identify priorities for the prevention of NCDs in Cyprus and guide evidence-based decision making. The objectives of this paper were to: 1) assess the burden of NCDs in terms of years of life lost (YLLs), years lived with disability (YLDs), and DALYs in Cyprus in 2017, and 2) identify changes in the burden of NCDs in Cyprus over the 28-year period and assess the main drivers of these changes. METHODS We performed a secondary database descriptive study using the Global Burden of Disease (GBD) 2017 results on NCDs for Cyprus from 1990 to 2017. We calculated the percentage change of age-standardized DALY rates between 1990 and 2017 and decomposed these time trends to assess the causes of death and disability that were the main drivers of change. RESULTS In Cyprus in 2017, 83% (15,129 DALYs per 100,000; 12,809 to 17,707 95%UI) of total DALYs were due to NCDs. The major contributors to NCD DALYs were cardiovascular diseases (16.5%), neoplasms (16.3%), and musculoskeletal disorders (15.6%). Between 1990 and 2017, age-standardized NCD DALY rates decreased by 23%. For both males and females, the largest decreases in DALY rates were observed in ischemic heart disease and stroke. For Cypriot males, the largest increases in DALY rates were observed for pancreatic cancer, drug use disorders, and acne vulgaris, whereas for Cypriot females these were for acne vulgaris, psoriasis and eating disorders. CONCLUSION Despite a decrease in the burden of NCDs over the period from 1990 to 2017, NCDs are still a major public health challenge. Implementation of interventions and early detection screening programmes of modifiable NCD risk factors are needed to reduce occurrence and exacerbation of leading causes of NCDs in the Cypriot population.
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Affiliation(s)
- Periklis Charalampous
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Elena Pallari
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
- Health Services Research Center, Strovolos, Nicosia, Cyprus
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Nicos Middleton
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Mary Economou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Bommelé J, Troelstra S, Walters BH, Willemsen M. Does support for smoke-free outdoor spaces increase after implementation?: A case study of a Dutch research center's smoke-free campus transition. Tob Prev Cessat 2020; 6:67. [PMID: 33336119 PMCID: PMC7737562 DOI: 10.18332/tpc/129647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Policymakers may sometimes be reluctant to develop policies for smoke-free outdoor spaces due to concerns about public reaction. In this study, we investigated the support for a smoke-free campus before and after the campus of a Dutch research institute became smoke-free. METHODS We conducted two surveys among employees to measure the level of support for a smoke-free campus. The first survey (n=129) was conducted 3 months before and the second 13 months after the implementation of a smoke-free campus policy (n=134). RESULTS More employees supported the smoke-free campus after (82.1%) than before (64.3%) implementation (OR=2.55; 95% CI: 1.39–4.70; p=0.003). In addition, more employees (75.4%) employees believed it is important to have a smoke-free campus than was the situation before (56.6%) the implementation (OR=2.28; 95% CI: 1.31–3.97; p=0.004). CONCLUSIONS This case study adds to the knowledge that support for a smoke-free campus increases after implementation of a smoke-free policy. This may encourage other organizations or local governments to create policies for smoke-free outdoor spaces.
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Affiliation(s)
- Jeroen Bommelé
- Trimbos Institute, The Netherlands Expertise Centre for Tobacco Control, Utrecht, the Netherlands
| | - Sigrid Troelstra
- Trimbos Institute, The Netherlands Expertise Centre for Tobacco Control, Utrecht, the Netherlands
| | - Bethany Hipple Walters
- Trimbos Institute, The Netherlands Expertise Centre for Tobacco Control, Utrecht, the Netherlands.,Massachusetts General Hospital, Boston, United States
| | - Marc Willemsen
- Trimbos Institute, The Netherlands Expertise Centre for Tobacco Control, Utrecht, the Netherlands.,Department of Health Promotion, University of Maastricht, Maastricht, the Netherlands
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Sansone G, Fong GT, Meng G, Craig LV, Xu SS, Quah ACK, Ouimet J, Mochizuki Y, Yoshimi I, Tabuchi T. Secondhand Smoke Exposure in Public Places and Support for Smoke-Free Laws in Japan: Findings from the 2018 ITC Japan Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E979. [PMID: 32033243 PMCID: PMC7037123 DOI: 10.3390/ijerph17030979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/15/2020] [Accepted: 02/01/2020] [Indexed: 12/14/2022]
Abstract
Comprehensive smoke-free policies such as those called for by the WHO FCTC are the only way to protect the public effectively from the harms of secondhand smoke (SHS), yet Japan has been slow to implement this important health measure. This study examines baseline levels of smoking and SHS exposure in public places and support for smoking bans in Japan prior to the implementation of the 2018 national smoke-free law. Data are from the International Tobacco Control (ITC) Japan Wave 1 Survey (Feb-Mar 2018), a web survey of adult cigarette smokers, heated tobacco product users, dual users, and non-users (total N = 4684). Measures included prevalence of smoking (whether respondents noticed people smoking inside restaurants and bars at their last visit, and workplaces in the last month), and support for complete smoking bans in these venues. Smoking prevalence in each venue was high overall in 2018 (49% of workplaces, 55% of restaurants, and 83% of bars), even higher than in China, the country with the greatest toll of SHS. Support for complete smoking bans was very high overall (81% for workplaces, 78% for restaurants, and 65% for bars). Non-users were less likely to be exposed to SHS and had higher support for smoking bans than tobacco users. These findings point to the ineffectiveness of partial smoke-free laws in Japan and reinforce the call for comprehensive smoke-free laws, which even smokers would support at higher levels than in many other ITC countries.
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Affiliation(s)
- Genevieve Sansone
- Department of Psychology, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (L.V.C.); (S.S.X.); (A.C.K.Q.); (J.O.)
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (L.V.C.); (S.S.X.); (A.C.K.Q.); (J.O.)
- Ontario Institute for Cancer Research, 661 University Ave Suite 510, Toronto, ON M5G 0A3, Canada
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (L.V.C.); (S.S.X.); (A.C.K.Q.); (J.O.)
| | - Lorraine V. Craig
- Department of Psychology, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (L.V.C.); (S.S.X.); (A.C.K.Q.); (J.O.)
| | - Steve S. Xu
- Department of Psychology, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (L.V.C.); (S.S.X.); (A.C.K.Q.); (J.O.)
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (L.V.C.); (S.S.X.); (A.C.K.Q.); (J.O.)
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (L.V.C.); (S.S.X.); (A.C.K.Q.); (J.O.)
| | - Yumiko Mochizuki
- Japan Cancer Society, 13th Floor, Yurakucho Center Bldg. 2-5-1, Yurakucho, Chiyoda-ku, Tokyo 100-0006, Japan;
| | - Itsuro Yoshimi
- Division of Tobacco Policy Research, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Chome-1-69 Otemae, Chuo Ward, Osaka 541-8567, Japan;
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Sansone G, Fong GT, Yan M, Meng G, Craig L, Xu SS, Quah ACK, Wu C, Feng G, Jiang Y. Secondhand smoke exposure and support for smoke-free policies in cities and rural areas of China from 2009 to 2015: a population-based cohort study (the ITC China Survey). BMJ Open 2019; 9:e031891. [PMID: 31831539 PMCID: PMC6924814 DOI: 10.1136/bmjopen-2019-031891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To examine trends in smoking prevalence in key venues (workplaces, restaurants, bars) and in public support for comprehensive smoke-free laws, with comparisons between cities and rural areas in China. DESIGN Data are from Waves 3-5 (2009-2015) of the International Tobacco Control (ITC) China Survey, a cohort survey of smokers and non-smokers. Logistic regression analyses employing generalised estimating equations assessed changes in smoking prevalence and support for smoke-free laws over time; specific tests assessed whether partial smoking bans implemented in three cities between Waves 3 and 4 had greater impact. SETTING Face-to-face surveys were conducted in seven cities (Beijing, Changsha, Guangzhou, Kunming, Shanghai, Shenyang and Yinchuan) and five rural areas (Changzhi, Huzhou, Tongren, Yichun and Xining). PARTICIPANTS In each survey location at each wave, a representative sample of approximately 800 smokers and 200 non-smokers (aged 18+) were selected using a multistage cluster sampling design. MAIN OUTCOME MEASURES Prevalence of smoking (whether respondents noticed smoking inside restaurants, bars and workplaces); smoking rules inside these venues; and support for complete smoking bans in these venues. RESULTS Although smoking prevalence decreased and support increased over time, neither trend was greater in cities that implemented partial smoke-free laws. Smoking was higher in rural than urban workplaces (62% vs 44%, p<0.01), but was equally high in all restaurants and bars. There were generally no differences in secondhand smoke (SHS) exposure between smokers and non-smokers except in rural workplaces (74% vs 58%, p<0.05). Support for comprehensive bans was equally high across locations. CONCLUSIONS Partial laws have had no effect on reducing SHS in China. There is an urgent need for comprehensive smoke-free laws to protect the public from exposure to deadly tobacco smoke in both urban and rural areas. The high support among Chinese smokers for such a law demonstrates that public support is not a barrier for action.
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Affiliation(s)
- Genevieve Sansone
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - 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
| | - Mi Yan
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Steve S Xu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Changbao Wu
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Guoze Feng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Jiang
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
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Wei Y, Borland R, Zheng P, Fu H, Wang F, He J, Feng Y. Evaluation of the Effectiveness of Comprehensive Smoke-Free Legislation in Indoor Public Places in Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16204019. [PMID: 31640111 PMCID: PMC6843952 DOI: 10.3390/ijerph16204019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/08/2019] [Accepted: 10/18/2019] [Indexed: 11/16/2022]
Abstract
This study evaluated compliance with the comprehensive smoke-free law in public indoor places introduced in Shanghai in March 2017. Observations and PM2.5 monitoring over 30 min intervals in 8 types of the venue were conducted three times: within a month before implementation and 3- and 12-months post implementation. Observations of evidence of smoking decreased from 66.2% before legislation to 52.8% three months after (p = 0.002) and 49.7% one year after (p < 0.001). The density of lit cigarettes also reduced significantly after implementation (p < 0.001). When adjusting for outdoor, indoor PM2.5 levels were significantly lower after the legislation, but only by a small amount (three months later: −0.27, p = 0.08; one year later: −0.12; p = 0.03). Evidence of compliance was weakest in farmer’s markets and bars, and smoking in male toilets did not change significantly. The reduction in smoking was affected by the management performance of their obligations. The comprehensive smoke-free law led to modest reductions in smoking and PM2.5 levels as a result, but from levels suggesting quite high levels of pre-compliance. However, compliance was limited in some areas, suggesting more effort is required on management to gain better compliance in some places like farmer’s markets, bars, and toilets.
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Affiliation(s)
- Yanxia Wei
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Ron Borland
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne 3010, Australia.
| | - Pinpin Zheng
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Hua Fu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Fan Wang
- Department of Politics, East China Normal University, Shanghai 200241, China.
| | - Jingyi He
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Yitian Feng
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China.
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Hafez AY, Gonzalez M, Kulik MC, Vijayaraghavan M, Glantz SA. Uneven Access to Smoke-Free Laws and Policies and Its Effect on Health Equity in the United States: 2000-2019. Am J Public Health 2019; 109:1568-1575. [PMID: 31536405 DOI: 10.2105/ajph.2019.305289] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tobacco control measures have played an important role in the reduction of the cigarette smoking prevalence among US adults.However, although overall smoking prevalence has declined, it remains high among many subpopulations that are disproportionately burdened by tobacco use, resulting in tobacco-related health disparities. Slow diffusion of smoke-free laws to rural regions, particularly in the South and Southeast, and uneven adoption of voluntary policies in single-family homes and multiunit housing are key policy variables associated with the disproportionate burden of tobacco-related health disparities in these subpopulations.Developing policies that expand the reach of comprehensive smoke-free laws not only will facilitate the decline in smoking prevalence among subpopulations disproportionately burdened by tobacco use but will also decrease exposure to secondhand smoke and further reduce tobacco-caused health disparities in the United States.
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Affiliation(s)
- Amy Y Hafez
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Mariaelena Gonzalez
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Margarete C Kulik
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Maya Vijayaraghavan
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Stanton A Glantz
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
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Ranabhat CL, Kim CB, Park MB, Jakovljevic M(M. Situation, Impacts, and Future Challenges of Tobacco Control Policies for Youth: An Explorative Systematic Policy Review. Front Pharmacol 2019; 10:981. [PMID: 31551784 PMCID: PMC6745506 DOI: 10.3389/fphar.2019.00981] [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] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/31/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Tobacco use in youths is a major public health challenge globally, and approaches to the challenge have not been sufficiently addressed. The existing policies for tobacco control are not well specified by age. Objective: Our study aims to systematically investigate existing tobacco control policies, potential impacts, and national and international challenges to control tobacco use targeting the youth. Data sources: We used the statistics of the Global Youth Tobacco Survey (GYTS), studies, and approaches of tobacco control policies targeting youth. Considering country, continent, age, and significance, PubMed, Health Inter-Network Access to Research Initiative (HINARI), Scopus, the Cochrane Library, Google, and Google Scholar were searched. The related keywords were tobacco control, youth, smoking, smoking reduction policies, prevalence of tobacco use in youth, classification of tobacco control policies, incentives to prevent young people from using tobacco, WHO Framework Convention on Tobacco Control (FTCT), etc. The search strategy was by timeline, specific and popular policies, reliability, significance, and applicability. Results: We found 122 studies related to this topic. There were 25 studies focusing on situation, significance, and theoretical aspects of tobacco control policies associated with youth; 41 studies on national population polices and challenges; and 7 studies for global challenges to overcome the youth tobacco epidemic. All national policies have been guided by WHO-MPOWER strategies. Increases in tobacco tax, warning signs on packaging, restriction of tobacco product advertisements, national law to discourage young people, and peer-based approaches to quit tobacco are popular policies. Smuggling of tobacco products by youth and ignorance of smokeless tobacco control approach are major challenges. Limitation: Our study was flexible for the standard age of youth and we were not able to include all countries in the world and most of the studies focused on smoking control rather than all smokeless tobaccos. Conclusion: The policies of tobacco control adopted by many countries are based on the WHO Framework Convention on Tobacco Control but not necessarily focused on youth. Due to the physical and economic burden of tobacco consumption by youth, this is a high priority that needs to be addressed. Youth-focused creative policies are necessary, and more priority must be given to tobacco prevention in youth. Tobacco control should be a social, public health, and quality-of-life concern rather than a business and trade issue. Implication of key findings: There is limited research on how and in what ways tobacco control policies reach young people and their engagement with these policies from physical, physiological, and psychological aspects. Analysis of these aspects, popular polices practiced in different countries, and creative strategies support the need to review current practices and future ways to discourage youth from tobacco use.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Policy Research Institute, Kathmandu, Nepal
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
- Manmohan Memorial Institute of Health Science, Kathmandu, Nepal
- Department of Gerontology, Pai Chai University, Daejeon, South Korea
| | - Chun-Bae Kim
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Myung Bae Park
- Department of Gerontology, Pai Chai University, Daejeon, South Korea
| | - Mihajlo (Michael) Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Division of Health Economics, Lund University, Lund, Sweden
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van Beek KNJ, Kuipers MAG, Lignac O, Kunst AE. Smoking in bars in eight European countries in 2010 and 2016: an observational comparative study. Eur J Public Health 2019; 29:159-163. [PMID: 29982399 DOI: 10.1093/eurpub/cky111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Most European countries established laws against smoking in public places. We aimed to describe the prevalence of smoking in bars in 2010 and 2016 in eight European countries and to characterise those bars in which smoking still occurred in 2016. Methods Smoking in bars was studied in 16 cities in 8 European countries (Austria, Belgium, Czech Republic, Denmark, England, France, Germany and the Netherlands). In 2010, 96 bars were visited. In 2016, 51 bars were revisited and 45 new bars were visited. Smoking indoors and characteristics of bars, terrace and customers were observed using a standard observation template. Associations between bar characteristics and smoking were analyzed using logistic regression. Results Overall prevalence of in-bar smoking was 39.6% in 2010 and 34.4% in 2016. Prevalence in bars covered by smoke-free legislation decreased from 24.2 to 13.0% between 2010 and 2016 whereas prevalence in bars where smoking was legally allowed increased from 73.3 to 88.9%. In-bar smoking almost exclusively occurred in countries with partial smoke-free legislation compared with more comprehensive legislation. Smoking was more prevalent in bars for locals, with a counter for drinks, slot-machines, no outside seating and no food service. Size of the bar, comfort of the terrace and the presence of cigarette vending machines were not associated with in-bar smoking. Conclusions Whereas comprehensive smoke-free legislation resulted in high compliance, smoking increased in bars in countries with partial or no smoke-free legislation. This study confirms that comprehensive smoke-free legislation is needed to protect customers and personnel against second-hand-smoke exposure in all bars.
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Affiliation(s)
- Kolja N J van Beek
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - Mirte A G Kuipers
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - Onno Lignac
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
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Chung-Hall J, Craig L, Gravely S, Sansone N, Fong GT. Impact of the WHO FCTC over the first decade: a global evidence review prepared for the Impact Assessment Expert Group. Tob Control 2019; 28:s119-s128. [PMID: 29880598 PMCID: PMC6589489 DOI: 10.1136/tobaccocontrol-2018-054389] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present findings of a narrative review on the implementation and effectiveness of 17 Articles of the WHO Framework Convention on Tobacco Control (FCTC) during the Treaty's first decade. DATA SOURCES Published reports on global FCTC implementation; searches of four databases through June 2016; hand-search of publications/online resources; tobacco control experts. STUDY SELECTION WHO Convention Secretariat global progress reports (2010, 2012, 2014); 2015 WHO report on the global tobacco epidemic; studies of social, behavioural, health, economic and/or environmental impacts of FCTC policies. DATA EXTRACTION Progress in the implementation of 17 FCTC Articles was categorised (higher/intermediate/lower) by consensus. 128 studies were independently selected by multiple authors in consultation with experts. DATA SYNTHESIS Implementation was highest for smoke-free laws, health warnings and education campaigns, youth access laws, and reporting/information exchange, and lowest for measures to counter industry interference, regulate tobacco product contents, promote alternative livelihoods and protect health/environment. Price/tax increases, comprehensive smoking and marketing bans, health warnings, and cessation treatment are associated with decreased tobacco consumption/health risks and increased quitting. Mass media campaigns and youth access laws prevent smoking initiation, decrease prevalence and promote cessation. There were few studies on the effectiveness of policies in several domains, including measures to prevent industry interference and regulate tobacco product contents. CONCLUSIONS The FCTC has increased the implementation of measures across several policy domains, and these implementations have resulted in measurable impacts on tobacco consumption, prevalence and other outcomes. However, FCTC implementation must be accelerated, and Parties need to meet all their Treaty obligations and consider measures that exceed minimum requirements.
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Affiliation(s)
- Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Natalie Sansone
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Chyderiotis S, Beck F, Andler R, Hitchman SC, Benmarhnia T. How to reduce biases coming from a before and after design: the impact of the 2007-08 French smoking ban policy. Eur J Public Health 2019; 29:372-377. [PMID: 30203020 DOI: 10.1093/eurpub/cky160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Smoke-free laws aim at protecting against second-hand smoke and at contributing to change smoking behaviors. Impact evaluation studies can help understand to what extent they reach their goals. Simple before and after designs are often used but cannot isolate the effect of the policy of interest. METHODS The short-term impact of the French smoking ban (2007-08) on smoking behavior outcomes was evaluated among smokers with data from the ITC project. We first conducted a before and after design on the French sample. Second, we added the UK (excluding Scotland) as a control group and finally used external pre-policy data from national surveys to control for bias arising from pre-policy trends. RESULTS After one year post-implementation, the smoking ban led to a decrease in seeing people smoking in bars, restaurants and workplaces [estimated risk ratios (RR) of 8.81 IC95% (5.34-14.71), 2.02 (1.79-2.31) and 1.24 (1.16-1.33), respectively], as well as an increase in support for the smoke-free policy, but only in bars and restaurants [RR of 1.35 (1.15-1.61) and 1.25 (1.16-1.35)], respectively. No impact was found on smoking behaviors and on having a strict no smoking policy at home. The simple before and after design systematically overestimated the smoking ban's impact [e.g. RR of 29.9 (20.06-44.56) for observed smoking in bar, compared to 13.21 (7.78-22.42) with the control group, and 8.81 (5.34-14.71) with the correction from external data]. CONCLUSION When data are lacking to conduct quasi-experimental designs for impact evaluation, the use of external data could help understand and correct pre-policy trends.
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Affiliation(s)
| | - Francois Beck
- National Institute of Statistics and Economic Studies (INSEE), Paris, France.,CESP, Faculté de médecine, Université Paris Sud, Faculté de médecine UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | | | | | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, Scripps Institution of Oceanography, University of California, San Diego, CA, USA
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Fu M, Castellano Y, Tigova O, Mons U, Agar T, Kyriakos CN, Quah ACK, Fong GT, Trofor AC, Przewoźniak K, Zatoński WA, Demjén T, Tountas Y, Vardavas CI, Fernández E. Correlates of the support for smoke-free policies among smokers: A cross-sectional study in six European countries of the EUREST-PLUS ITC EUROPE SURVEYS. Tob Induc Dis 2019; 16:A17. [PMID: 31516471 PMCID: PMC6661849 DOI: 10.18332/tid/103918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION This report describes the support for smoke-free policies in different settings among smokers in six European countries and the relationship between their opinions about the places where smoking should be banned and their beliefs about the harms of secondhand smoke to non-smokers. METHODS A cross-sectional survey (the ITC 6 European Country Survey, part of the EUREST-PLUS Project) was conducted using nationally representative samples of adult smokers in Germany, Greece, Hungary, Poland, Romania and Spain (n=6011). We describe the prevalence of agreement and support for smoke-free policies in different settings according to sociodemographics, smoking characteristics and beliefs about the danger of secondhand smoke to non-smokers. RESULTS There was high agreement with smoking regulations in cars with preschool children and in schoolyards of primary/secondary schools (>90% overall) and low agreement with banning smoking in outdoor terraces of bars/pubs (8.6%; 95%CI: 7.5%-9.8%) and restaurants (10.1%; 95%CI: 8.9%-11.4%). The highest support for complete smoking bans inside public places came from smokers in Poland, among women, people aged ≥25 years, who had low nicotine dependence, and who tried to quit smoking in the last 12 months. About 78% of participants agreed that tobacco smoke is dangerous to non-smokers, ranging from 63.1% in Hungary to 88.3% in Romania; the highest agreement was noted among women, the 25-54 age groups, those with higher education, low cigarette dependence, and those who tried to quit in the last 12 months. The support for complete smoking bans in public places was consistently higher among smokers who agreed that secondhand smoke is dangerous to non-smokers. CONCLUSIONS Smokers in six European countries declared strong support for smoke-free policies in indoor settings and in settings with minors but low support in outdoor settings, particularly leisure facilities. More education is needed to increase the awareness about the potential exposure to secondhand smoke in specific outdoor areas.
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Affiliation(s)
- Marcela Fu
- Catalan Institute of Oncology (ICO), Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- University of Barcelona (UB), Barcelona, Spain
| | - Yolanda Castellano
- Catalan Institute of Oncology (ICO), Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Olena Tigova
- Catalan Institute of Oncology (ICO), Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Agar
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
| | - Christina N. Kyriakos
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
| | - Anne C. K. Quah
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
| | - Geoffrey T. Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research (OICR), Toronto, Canada
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi (UMF Iasi), Iasi, Romania
- Aer Pur Romania (APR), Bucharest, Romania
| | - Krzysztof Przewoźniak
- Health Promotion Foundation (HPF), Warsaw, Poland
- Maria Skłodowska-Curie Institute ‒ Oncology Center (MSCI), Warsaw, Poland
| | - Witold A. Zatoński
- Health Promotion Foundation (HPF), Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences (PSWZ), Kalisz, Poland
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
| | - Esteve Fernández
- Catalan Institute of Oncology (ICO), Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- University of Barcelona (UB), Barcelona, Spain
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17
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Fong GT, Thompson ME, Boudreau C, Bécuwe N, Driezen P, Agar TK, Quah ACK, Zatoński WA, Przewoźniak K, Mons U, Demjén T, Tountas Y, Trofor AC, Fernández E, McNeill A, Willemsen M, Vardavas CI. The Conceptual Model and Methods of Wave 1 (2016) of the EUREST-PLUS ITC 6 European Countries Survey. Tob Induc Dis 2018; 16:A3. [PMID: 31516459 PMCID: PMC6659555 DOI: 10.18332/tid/99881] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 11/24/2022] Open
Abstract
Population-level interventions represent the only real approach for combatting the tobacco epidemic. There is thus great importance in conducting rigorous evaluation studies of tobacco control policies and regulations such as those arising from the WHO Framework Convention on Tobacco Control (FCTC) and the European Union's 2014 Tobacco Products Directive (TPD). The ITC 6 European Countries Survey, a component of the Horizon 2020 Project entitled European Regulatory Science on Tobacco: Policy Implementation to Reduce Lung Disease (EUREST-PLUS), was created to evaluate and impact of the TPD in six EU Member States: Germany, Greece, Hungary, Poland, Romania, and Spain. In each country, a cohort survey of a representative national sample of 1000 smokers was conducted. This paper describes the conceptual model, methodology, and initial survey statistics of Wave 1 of the ITC 6E Survey, which was conducted June-September 2016. The ITC 6E Survey's conceptual model, methodology, and survey instrument, were based on the broader 29-country ITC Project cohort studies, which have been conducted since 2002. The commonality of methods and measures allow a strong potential for cross-country comparisons between the 6 EU countries of the ITC 6E Project and 3 other EU countries (England, France, The Netherlands) in the ITC Project, as well as the broader set of ITC countries outside the EU.
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Affiliation(s)
- Geoffrey T. Fong
- University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | | | | | | | | | | | | | - Witold A. Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO) and Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, University of Barcelona, Catalonia, Spain
| | - Ann McNeill
- Addictions Department, King’s College London, London, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, King’s College London, London, United Kingdom
| | | | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
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Hutchinson SG, van Schayck CP, Muris JWM, Feron FJM, Dompeling E. Recruiting families for an intervention study to prevent second-hand smoke exposure in children. BMC Pediatr 2018; 18:19. [PMID: 29386032 PMCID: PMC5793411 DOI: 10.1186/s12887-018-0983-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/04/2018] [Indexed: 11/20/2022] Open
Abstract
Background We evaluated the effectiveness of different recruitment strategies used in a study aimed at eliminating/reducing second-hand smoke (SHS) exposure in Dutch children 0–13 years of age with a high risk of asthma. Methods The different strategies include: 1) questionnaires distributed via home addresses, physicians or schools of the children; 2) cohorts from other paediatric studies; 3) physicians working in the paediatric field (family physicians, paediatricians and Youth Health Care (YHC) physicians); and 4) advertisements in a local newsletter, at child-care facilities, and day-care centres. Results More than 42,782 families were approached to take part in the screening of which 3663 could be assessed for eligibility. Of these responders, 196 families met the inclusion criteria for the study. However, only 58 (one third) could be randomised in the trial, mainly because of no interest or time of the parents. The results showed that recruiting families who expose their children to SHS exposure is very challenging, which may be explained by lack of ‘recognition’ or awareness that SHS occurs in homes. The presence of asthma in the family, respiratory symptoms in the children, and even incentives did not increase parental motivation for participation in the study. Conclusions The recruitment process for an intervention program addressing SHS exposure in children was considerably more challenging and time consuming than anticipated. Barriers at both a parents level and a doctor’s level can be discriminated. Electronic supplementary material The online version of this article (10.1186/s12887-018-0983-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sasha G Hutchinson
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+) / CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Constant P van Schayck
- Department of Family Medicine, MUMC+ / CAPHRI, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, MUMC+ / CAPHRI, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Frans J M Feron
- Department of Social Medicine, MUMC+ / CAPHRI, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Edward Dompeling
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+) / CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.
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Gravely S, Nyamurungi KN, Kabwama SN, Okello G, Robertson L, Heng KKC, Ndikum AE, Oginni AS, Rusatira JC, Kakoulides S, Huffman MD, Yusuf S, Bianco E. Knowledge, opinions and compliance related to the 100% smoke-free law in hospitality venues in Kampala, Uganda: cross-sectional results from the KOMPLY Project. BMJ Open 2018; 8:e017601. [PMID: 29306880 PMCID: PMC5780705 DOI: 10.1136/bmjopen-2017-017601] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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
OBJECTIVE This study evaluated knowledge, opinions and compliance related to Uganda's comprehensive smoke-free law among hospitality venues in Kampala Uganda. DESIGN This multi-method study presents cross-sectional findings of the extent of compliance in the early phase of Uganda's comprehensive smoke-free law (2 months postimplementation; pre-enforcement). SETTING Bars, pubs and restaurants in Kampala Uganda. PROCEDURE AND PARTICIPANTS A two-stage stratified cluster sampling procedure was used to select hospitality sites stratified by all five divisions in Kampala. A total of 222 establishments were selected for the study. One hospitality representative from each of the visited sites agreed to take part in a face-to-face administered questionnaire. A subsample of hospitality venues were randomly selected for tobacco air quality testing (n=108). Data were collected between June and August 2016. OUTCOME MEASURES Knowledge and opinions of the smoke-free law among hospitality venue staff and owners. The level of compliance with the smoke-free law in hospitality venues through: (1) systematic objective observations (eg, active smoking, the presence of designated smoking areas, 'no smoking' signage) and (2) air quality by measuring the levels of tobacco particulate matter (PM2.5) in both indoor and outdoor venues. RESULTS Active smoking was observed in 18% of venues, 31% had visible 'no smoking' signage and 47% had visible cigarette remains. Among interviewed respondents, 57% agreed that they had not been adequately informed about the smoke-free law; however, 90% were supportive of the ban. Nearly all respondents (97%) agreed that the law will protect workers' health, but 32% believed that the law would cause financial losses at their establishment. Indoor PM2.5 levels were hazardous (267.6 µg/m3) in venues that allowed smoking and moderate (29.6 µg/m3) in smoke-free establishments. CONCLUSIONS In the early phase of Uganda's smoke-free law, the level of compliance in hospitality venues settings in Kampala was suboptimal. Civil society and the media have strong potential to inform and educate the hospitality industry and smokers of the benefits and requirements of the smoke-free law.
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Affiliation(s)
- Shannon Gravely
- International Tobacco Control Policy Evaluation (ITC)Project, Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Steven Ndugwa Kabwama
- School of Public Health, Makerere University, Kampala, Uganda
- Mental Health and Substance Abuse, Ministry of Health, Kampala, Uganda
| | - Gabriel Okello
- Respiratory Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Lindsay Robertson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Achiri Elvis Ndikum
- Association for the Promotion of Youth Leadership, Advocacy and Volunteerism (APYLAV), Yaounde, Cameroon
| | | | | | | | - Mark D Huffman
- Department of Preventive Medicine and Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Salim Yusuf
- Department of Medicine and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Eduardo Bianco
- Centro de Investigación para la Epidemia del Tabaquismo, Montevideo, Uruguay
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Kennedy RD, Grant A, Spires M, Cohen JE. Point-of-Sale Tobacco Advertising and Display Bans: Policy Evaluation Study in Five Russian Cities. JMIR Public Health Surveill 2017; 3:e52. [PMID: 28811269 PMCID: PMC5575420 DOI: 10.2196/publichealth.6069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 01/27/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022] Open
Abstract
Background The tobacco industry uses point-of-sale (POS) advertising, promotion, and product display to increase consumption of its products among current users, to attract new consumers, and to encourage former customers to resume tobacco use. As part of a comprehensive tobacco control effort, Russia—having one of the highest tobacco use prevalence rates in the world—enacted legislation that banned tobacco POS advertising, effective November 15, 2013, and banned the display of tobacco and the sale of cigarettes in kiosks, effective June 1, 2014. Objective The objective of the study was to evaluate the implementation of the national law by assessing the state of POS advertising, promotion, and product display, and sales in kiosks across Russia. Methods Two waves of observations were conducted to measure compliance with the POS restrictions: wave 1 took place in April-May 2014 after the advertising ban was in effect and again in August-September 2014 after the display ban and elimination of tobacco sales in kiosks came into effect. Observations were conducted by local trained staff that traveled to 5 populous cities in different regions of Russia (Moscow, St. Petersburg, Kazan, Ekaterinburg, and Novosibirsk). Staff followed a published POS evaluation protocol and used mobile phones to collect data. Observations were conducted in a roughly equal number of supermarket chains, convenience stores, and kiosks. Observed items included advertising at POS, product displays, and cigarette sales in kiosks. Results Observations were made in 780 venues in wave 1 and in 779 revisited venues in wave 2. In wave 1, approximately a third of supermarkets and convenience stores (34.2%, 184/538) were advertising cigarettes using light boxes, and over half of observed venues (54.3%, 292/538) had signage such as banners or shelf liners that used colors or images related to cigarette brands. Product displays were common in wave 1. In wave 2, compliance with advertising restrictions was very good: there were virtually no light boxes (1.0%, 5/489); banners or shelf liners were observed in 30.5% (149/489) of supermarkets/convenience stores; approximately 7.4% (36/489) of venues were still displaying products in a powerwall. In wave 2, 41.3% (100/242) of kiosks continued to sell tobacco. Conclusions Russia’s compliance with POS bans was excellent. Remaining compliance issues are largely with the use of cigarette brand colors or images used in banners or shelf liners; this type of infraction is more difficult to enforce as inspectors need to be deeply familiar with tobacco industry products and marketing practices. A sizable proportion of kiosks continue to sell tobacco post restrictions.
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Affiliation(s)
- Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ashley Grant
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mark Spires
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Hummel K, Willemsen MC, de Vries H, Monshouwer K, Nagelhout GE. Social Acceptance of Smoking Restrictions During 10 Years of Policy Implementation, Reversal, and Reenactment in the Netherlands: Findings From a National Population Survey. Nicotine Tob Res 2016; 19:231-238. [PMID: 27613933 DOI: 10.1093/ntr/ntw169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/27/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Little is known about the extent to which smoking restrictions are socially accepted in a country such as the Netherlands where smoking restrictions have been implemented and reversed several times. The current study assessed trends as well as factors associated with two indicators of social acceptance of smoking restrictions in the Netherlands: acceptance of smoking in public places and implementation of home smoking bans. METHODS We used data from the Dutch Continuous Survey of Smoking Habits (DCSSH) between 2005 and 2014 (n = 182826). The DCSSH is a national population survey with a cross-sectional design in which respondents aged 15 years and older are surveyed weekly. RESULTS Acceptance of smoking in public places decreased for six out of eight included venues, with the largest decrease for smoking in restaurants. The decrease in acceptance was larger among younger respondents and smokers. Smoking on terraces was an exception: decrease in acceptance there was larger among older respondents and ex-smokers. Implementation of home smoking bans increased over time. Having implemented a home smoking ban was associated with being male, being younger, having a high socioeconomic status, and being ex- or never smoker. CONCLUSIONS Social acceptance of smoking restrictions has increased in the Netherlands, despite a suboptimal implementation process of smoking restrictions. However, there is still potential for improvement as acceptance of smoking is still quite high for some public venues like bars. It is important to strengthen smoking restrictions in order to further denormalize smoking in the Netherlands. IMPLICATIONS We examined the extent to which smoking restrictions are socially accepted in the Netherlands where smoking restrictions have been implemented and reversed several times. Acceptance of smoking in public places decreased and implementation of home smoking bans increased between 2005 and 2014. Social acceptance of smoking restrictions increased in the Netherlands despite a suboptimal implementation process of smoking restrictions. However, acceptance of smoking in bars remains relatively high.
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Affiliation(s)
- Karin Hummel
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Karin Monshouwer
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Gera E Nagelhout
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands.,Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, The Netherlands
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Liang LA, Weber A, Herr C, Hendrowarsito L, Meyer N, Bolte G, Nennstiel-Ratzel U, Kolb S. Children’s exposure to second-hand smoke before and after the smoking ban in Bavaria—a multiple cross-sectional study. Eur J Public Health 2016; 26:969-974. [DOI: 10.1093/eurpub/ckw099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Monson E, Arsenault N. Effects of Enactment of Legislative (Public) Smoking Bans on Voluntary Home Smoking Restrictions: A Review. Nicotine Tob Res 2016; 19:141-148. [PMID: 27613902 DOI: 10.1093/ntr/ntw171] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 06/30/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The positive effects of worldwide increases in enactment of legislative bans on smoking in public areas have been well documented. Relatively little is known about the effects of such bans on voluntary home smoking behavior. Meanwhile, private spaces, such as homes, have replaced public spaces as the primary milieu of secondhand smoke exposure. METHODS A systematic search of peer-reviewed articles was conducted using multiple databases including Cochrane Library, Cinahl, Embase, Global Health, Health Star, Joanna Briggs, MEDLINE, PsycINFO, PAIS International, PubMed, and Web of Science. We examined peer-reviewed studies that considered the impact of legislation-based public smoking bans on enactment of private home smoking restrictions. RESULTS Sixteen articles published between 2002 and 2014 were identified and included. Our results suggest overall positive effects post-legislative ban with the majority of studies demonstrating significant increases in home smoking restrictions. Studies focusing on smoking and nonsmoking samples as well as child populations are discussed in depth. CONCLUSIONS Existing evidence indicates an overall significant positive effect post-legislative ban on voluntary home smoking restrictions. While disentangling these effects over space and time remains a challenge, scientific research has converged in dispelling any notion of significant displacement of smoking into the home. Policy makers, especially those in countries without existing public smoking legislation, can rest assured that these types of bans contribute to the minimization of tobacco-related harm. IMPLICATIONS Findings converge in dispelling notions of displacement of smoking into the home as a consequence of legislative bans that prohibit smoking in public spaces. Evidence from the studies reviewed suggests that through their influence on social norms, legislative bans on smoking in public places may encourage citizens to establish voluntary home smoking restrictions, thus decreasing harm related to secondhand smoke.
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Affiliation(s)
- Eva Monson
- Department of Psychiatry, McGill University, Montreal, QC, Canada; .,Department of Sociology and Anthropology, Concordia University, Montreal, QC, Canada
| | - Nicole Arsenault
- Department of Sociology and Anthropology, Concordia University, Montreal, QC, Canada
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Barnoya J, Monzon JC, Briz P, Navas-Acien A. Compliance to the smoke-free law in Guatemala 5-years after implementation. BMC Public Health 2016; 16:318. [PMID: 27138959 PMCID: PMC4852414 DOI: 10.1186/s12889-016-2960-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoke-free environments decrease smoking prevalence and consequently the incidence of heart disease and lung cancer. Due to issues related to poor enforcement, scant data is currently available from low/middle income countries on the long-term compliance to smoke-free laws. In 2006, high levels of secondhand smoke (SHS) were found in bars and restaurants in Guatemala City. Six months after a smoking ban was implemented in 2009, levels significantly decreased. However, in 2010, poor law compliance was observed. Therefore, we sought to assess long-term compliance to the ban using SHS measurements. METHODS In 2014 we assessed SHS exposure using airborne nicotine monitors in bars (n = 9) and restaurants (n = 12) for 7 days using the same protocol as in 2006 and in 2009. Nicotine was measured using gas-chromatography (μg/m(3)) and compared to levels pre- (2006) and post-ban (2009). Employees responded to a survey about SHS exposure, perceived economic impact of the ban and customers' electronic cigarette use. In addition, we estimated the fines that could have been collected for each law infringement. RESULTS Most (71 %) venues still have a smoking section, violating the law. The percentage of samples with detectable nicotine concentrations was 100, 85 and 43 % in 2006, 2009 and 2014, respectively. In bars, median (25(th) and 75(th) percentiles) nicotine concentrations were 4.58 μg/m(3) (1.71, 6.45) in 2006, 0.28 (0.17, 0.66) in 2009, and 0.59 (0.01, 1.45) in 2014. In restaurants, the corresponding medians were 0.58 μg/m(3) (0.44, 0.71), 0.04 (0.01, 0.11), and 0.01 (0.01, 0.09). Support for the law continues to be high (88 %) among bar and restaurant employees. Most employees report no economic impact of the law and that a high proportion of customers (78 %) use e-cigarettes. A total of US$50,012 could have been collected in fines. CONCLUSIONS Long-term compliance to the smoking ban in Guatemala is decreasing. Additional research that evaluates the determinants of non-compliance is needed and could also contribute to improve enforcement and implementation of the smoke-free law in Guatemala.
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Affiliation(s)
- Joaquín Barnoya
- Research Department, Cardiovascular Surgery Unit of Guatemala, 9th Avenue, 8-00, Zone 11, 01011, Guatemala City, Guatemala. .,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO, 63110, USA.
| | - Jose C Monzon
- Research Department, Cardiovascular Surgery Unit of Guatemala, 9th Avenue, 8-00, Zone 11, 01011, Guatemala City, Guatemala
| | - Paulina Briz
- Research Department, Cardiovascular Surgery Unit of Guatemala, 9th Avenue, 8-00, Zone 11, 01011, Guatemala City, Guatemala
| | - Ana Navas-Acien
- Department of Environmental Health Sciences and Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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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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Yang T, Jiang S, Barnett R, Oliffe JL, Wu D, Yang X, Yu L, Cottrell RR. Who smokes in smoke-free public places in China? Findings from a 21 city survey. HEALTH EDUCATION RESEARCH 2016; 31:36-47. [PMID: 26546594 PMCID: PMC4883029 DOI: 10.1093/her/cyv054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/16/2015] [Indexed: 05/30/2023]
Abstract
Efforts toward controlling secondhand smoke in public places have been made throughout China. However, in contrast to the western world, significant challenges remain for effectively implementing smoke-free regulations. This study explores individual and regional factors which influence smoking in smoke-free public places. Participants included 16 866 urban residents, who were identified through multi-stage sampling conducted in 21 Chinese cities. The reported smoking prevalence in smoke-free public places was 41.2%. Of those who smoked in smoke-free public places, 45.9% had been advised to stop smoking. Participants stated that no-smoking warnings/signs with 'please' in the statement had a better likelihood of gaining compliance and preventing smoking in public spaces. Multilevel logistic regression analysis showed that ethnicity, education, occupation, type of smoking, age of smoking initiation, smoking situation, stress, household smoking restrictions and city population were all associated with smoking in smoke-free public places. Interestingly local smoke-free regulations were not associated with smoking in public places. The findings underscore that efforts to restrict smoking in public places in China should emphasize strong enforcement, while simultaneously raising public awareness of the perils of second hand smoke.
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Affiliation(s)
- Tingzhong Yang
- Center for Tobacco Control Research, Zhejiang University, School of Medicine, Hangzhou 310058, China,
| | - Shuhan Jiang
- Center for Tobacco Control Research, Zhejiang University, School of Medicine, Hangzhou 310058, China
| | - Ross Barnett
- Department of Geography, University of Canterbury, Private Bag 4800, Christchurch, New Zealand
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Dan Wu
- Center for Tobacco Control Research, Zhejiang University, School of Medicine, Hangzhou 310058, China
| | - Xiaozhao Yang
- Department of Sociology, Purdue University, West Lafayette, IN 47907, USA and
| | - Lingwei Yu
- Center for Tobacco Control Research, Zhejiang University, School of Medicine, Hangzhou 310058, China
| | - Randall R Cottrell
- Public Health Studies Program, School of Health and Applied Human Sciences, University of North Carolina, Wilmington, NC 28403, USA
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Secondhand smoke exposure, indoor smoking bans and smoking-related knowledge in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12835-47. [PMID: 25514143 PMCID: PMC4276649 DOI: 10.3390/ijerph111212835] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 11/16/2022]
Abstract
Although previous studies have provided strong evidence that Chinese individuals are exposed to secondhand smoke (SHS) and lack knowledge of its harmful effects, there has not been an in-depth exploration of the variability in exposure and knowledge by geographic region, occupation, and socioeconomic status. The objectives of this study were to examine: (1) the demographic factors associated with the level of knowledge of the harmful effects of smoking; (2) the factors related to implementation of in-home and workplace smoking bans; and (3) geographic differences in being exposed to SHS in government buildings, healthcare facilities, restaurants, public transportations, and schools. We used data from the 2010 Global Adult Tobacco Survey-China. Chi-square tests were used for statistical analysis. The results suggested that among Chinese citizens age 15 years and older, there is poor knowledge of the harmful effects of tobacco, and knowledge varies with region and socioeconomic status. Over three-quarters of the households had no smoking restrictions, and a large percentage of workers reported working in places with no smoking ban. In public places, exposure to SHS was high, particularly in rural areas and in the Southwest. These results suggest Chinese individuals are not well informed of smoking and SHS associated risks and are regularly exposed to SHS at home, work and public places.
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Rennen E, Nagelhout GE, van den Putte B, Janssen E, Mons U, Guignard R, Beck F, de Vries H, Thrasher JF, Willemsen MC. Associations between tobacco control policy awareness, social acceptability of smoking and smoking cessation. Findings from the International Tobacco Control (ITC) Europe Surveys. HEALTH EDUCATION RESEARCH 2014; 29:72-82. [PMID: 23861478 PMCID: PMC3894664 DOI: 10.1093/her/cyt073] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This study examined whether awareness of tobacco control policies was associated with social unacceptability of smoking and whether social unacceptability had an effect on smoking cessation in three European countries. Representative samples (n = 3865) of adult smokers in France, the Netherlands and Germany were used from two survey waves of the longitudinal International Tobacco Control Europe Surveys. Associations were examined of aspects of social unacceptability of smoking (i.e. feeling uncomfortable, important people disapproval and societal disapproval) with tobacco policy awareness (i.e. awareness of warning labels, anti-tobacco information and smoking restrictions at work) and smoking cessation. Only the positive association of awareness of anti-tobacco information with feeling uncomfortable about smoking was significant in each of the three countries. Important people disapproval predicted whether smokers attempted to quit, although this did not reach significance in the French and German samples in multivariate analyses. Our findings suggest that anti-tobacco information campaigns about the dangers of second-hand smoke in France and about smoking cessation in the Netherlands and Germany might have reduced the social acceptability of smoking in these countries. However, campaigns that influence the perceived disapproval of smoking by important people may be needed to ultimately increase attempts to quit smoking.
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Affiliation(s)
- Els Rennen
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Gera E. Nagelhout
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
- *Correspondence to: G. Nagelhout. E-mail:
| | - Bas van den Putte
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Eva Janssen
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Ute Mons
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Romain Guignard
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - François Beck
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - James F. Thrasher
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Marc C. Willemsen
- Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
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