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Casswell S, Randerson S, Parker K, Huckle T. Using the International Alcohol Control (IAC) policy index to assess effects of legislative change in Aotearoa New Zealand. BMC Public Health 2024; 24:1563. [PMID: 38858663 PMCID: PMC11165747 DOI: 10.1186/s12889-024-18992-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The IAC Policy Index was developed to allow comparison in alcohol policy between countries and within countries over time including in low resource settings. It measures four effective alcohol policies and takes into account stringency of regulation and the actual impact on the alcohol environment, such as trading hours and prices paid. This framework was used to assess policy in Aotearoa New Zealand in a time period covering two relevant legislative changes. This is the first study to use an alcohol policy index to assess and describe legislative change within country. METHODS Data to calculate the IAC Policy Index was collected for 2013 and 2022. Stringency of policy was assessed from legislative statutes and impacts of policy on the alcohol environment from administrative data and specifically designed data collection. RESULTS The overall IAC Policy Index score improved over the time period. The scores for the separate policy areas reflected the legislative changes as hypothesised, but also independent changes in impact, given ecological changes including reduced enforcement of drink driving countermeasures and increased exposure to marketing in digital channels. The IAC Policy index reflects the changes in policy status observed in Aotearoa, NZ. DISCUSSION The IAC Policy Index provided a useful framework to assess and describe change in alcohol legislation contextualised by other influences on policy impact over time within a country. The results indicated the value of assessing stringency and impact separately as these moved independently. CONCLUSIONS The IAC Alcohol Policy Index, measuring both stringency and actual impact on the alcohol environment with a focus on only the most effective alcohol policies provides meaningful insights into within-country policy strength over time. The IAC Policy Index used over time can communicate to policy makers successes and gaps in alcohol policy.
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Affiliation(s)
- Sally Casswell
- SHORE & Whariki Research Centre, College of Health, Massey University, PO Box 6137, Victoria Street West, Auckland, 1142, New Zealand.
| | - Steve Randerson
- SHORE & Whariki Research Centre, College of Health, Massey University, PO Box 6137, Victoria Street West, Auckland, 1142, New Zealand
| | - Karl Parker
- SHORE & Whariki Research Centre, College of Health, Massey University, PO Box 6137, Victoria Street West, Auckland, 1142, New Zealand
| | - Taisia Huckle
- SHORE & Whariki Research Centre, College of Health, Massey University, PO Box 6137, Victoria Street West, Auckland, 1142, New Zealand
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Ponce-Hernández DJ, Martínez-Regalado JA, Reynales-Shigematsu LM, Calderón-Villarreal A, Regidor E, Herrero L, Sordo L. Correlation between tobacco control policies and tobacco prevention in Mexico: a sub-national analysis. J Public Health Policy 2024; 45:378-392. [PMID: 38575787 DOI: 10.1057/s41271-024-00473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 04/06/2024]
Abstract
This study aims to determinate the correlation between tobacco control policies (TCP) and the prevalence of tobacco use in the 32 Mexican states during the 2016-2017 period. This is an ecological study that measured TCP by the Tobacco Control Scale (TCS) which assigns a score (0-100) based on the level of these component's implementation: price, prohibition in public spaces, expenditures of public information campaigns, publicity prohibitions, health warnings, and treatments. We analyzed the associations between the TCS scores and prevalence of tobacco use extracted from the National Survey of Drug, Alcohol and Tobacco Consumption using Spearman correlations. Prevalence of daily smokers is negatively correlated with global TCS scores for adolescents (p = 0.026). Price showed similar negative correlations with daily prevalence in adolescents (p = 0.003), adults (p = 0.040), men (p < 0.006), and women (p = 0.040). Many Mexican states need to improve on tobacco control policies, especially targeting a key population: adolescents.
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Affiliation(s)
- Delta Jeazul Ponce-Hernández
- Department of Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, P/ Ramón y Cajal s/n, 28040, Madrid, Spain
| | | | - Luz Myriam Reynales-Shigematsu
- Department of Tobacco Prevention and Control, Population Research Center, Instituto Nacional de Salud Publica de Mexico, Mexico City, Mexico
| | - Alhelí Calderón-Villarreal
- University of California, San Diego (UCSD), La Jolla, USA
- San Diego State University (SDSU), San Diego, USA
| | - Enrique Regidor
- Department of Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, P/ Ramón y Cajal s/n, 28040, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Health Research Institute, Hospital Clínico de San Carlos (IdISSC), Madrid, Spain
| | | | - Luis Sordo
- Department of Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, P/ Ramón y Cajal s/n, 28040, Madrid, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Health Research Institute, Hospital Clínico de San Carlos (IdISSC), Madrid, Spain.
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Hebbar PB, Bhojani U, van Schayck O, Babu G, Dsouza V, Nagelhout GE. Shifting the gaze on implementation: examining the association between the implementation of tobacco control laws and prevalence of tobacco using data from a nationally representative survey. BMC Public Health 2023; 23:1971. [PMID: 37821863 PMCID: PMC10568881 DOI: 10.1186/s12889-023-16780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/15/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Tobacco use and the associated health burden is a cause of concern in India and globally. Despite several tobacco control policies in place, their sub-optimal and variable implementation across Indian states has remained a concern. Studies evaluating the real-world implementation of policies such as Cigarettes and Other Tobacco Products (COTPA) or National Tobacco Control Program (NTCP) in India and its association with reductions in tobacco use are limited. In this paper, we analyse data from a nationally representative survey to examine how policy implementation is associated with the tobacco use prevalence in India. METHODS We analysed data from the Global Adult Tobacco Survey (GATS 2016-17) India using multivariable logistic regression. The dependent variables were the use of smoked tobacco, smokeless tobacco, and tobacco in any form. The independent variables were proxies of implementation of the COTPA and the NTCP. We followed a step-wise backward elimination technique to reach the best fit models. RESULTS People exposed to no-smoking signages had lower odds of using tobacco (OR = 0.70, p < 0.001). People exposed to second-hand smoke (OR = 1.51, p < 0.001) and tobacco product advertisements (OR = 1.23, p < 0.001) had greater odds of using tobacco. Exposure to tobacco advertisements was associated with higher odds of using smokeless tobacco (OR = 1.23, p < 0.001), and smoked (OR = 1.33, p < 0.001) forms of tobacco. CONCLUSION We find significant association between the implementation of tobacco control laws/programs and tobacco use in India. Our findings highlight the potential that policy implementation holds in reducing population-level tobacco use thus drawing attention towards the implementation phase of policies. The findings have implications on prioritising enforcement of specific tobacco control measures such as smokefree laws, modifying COTPA signages to encompass all tobacco products including against smokeless tobacco use and strengthening indirect advertising restrictions. Future research could focus on developing and validating predictors specific to policy implementation to support policy evaluation efforts.
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Affiliation(s)
- Pragati B Hebbar
- Institute of Public Health Bengaluru, Bangalore, Karnataka, India.
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands.
| | - Upendra Bhojani
- Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Onno van Schayck
- Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Giridhara Babu
- Epidemiology, IIPH-H, Bangalore Campus, Public Health Foundation of India, IIPH-H, Bangalore, Karnataka, India
| | - Vivek Dsouza
- Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Gera E Nagelhout
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
- IVO Research Institute, The Hague, The Netherlands
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Henderson E, Rodriguez Guerrero LA, Continente X, Fernández E, Tigova O, Cortés-Francisco N, Semple S, Dobson R, Tzortzi A, Vyzikidou VK, Gorini G, Geshanova G, Mons U, Przewozniak K, Precioso J, Brad R, López MJ. Measurement of airborne nicotine, as a marker of secondhand smoke exposure, in homes with residents who smoke in 9 European countries. ENVIRONMENTAL RESEARCH 2023; 219:115118. [PMID: 36566961 DOI: 10.1016/j.envres.2022.115118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Smoke-free policies are effective in preventing secondhand smoke (SHS) exposure, but their adoption at home remains largely voluntary. This study aimed to quantify SHS exposure in homes with residents who smoke in Europe according to households' characteristics, tobacco consumption habits, and national contextual factors. METHODS Cross-sectional study (March 2017-September 2018) based on measurements of air nicotine inside 162 homes with residents who smoke from nine European countries. We installed passive samplers for seven consecutive days to monitor nicotine concentrations. Through self-administered questionnaires, we collected sociodemographic information and the number of individuals who smoke, smoking rules, frequency, location, and quantity of tobacco use in households. Country-level factors included the overall score in the Tobacco Control Scale 2016, the smoking prevalence, and self-reported SHS exposure prevalence. Nicotine concentrations were analyzed as continuous and dichotomous variables, categorized based on the limit of quantification of 0.02 μg/m3. RESULTS Overall, median nicotine concentration was 0.85 μg/m3 (interquartile range (IQR):0.15-4.42), and there was nicotine presence in 93% of homes. Participants reported that smoking was not permitted in approximately 20% of households, 40% had two or more residents who smoked, and in 79% residents had smoked inside during the week of sampling. We found higher nicotine concentrations in homes: with smell of tobacco smoke inside (1.45 μg/m3 IQR: 0.32-6.34), where smoking was allowed (1.60 μg/m3 IQR: 0.68-7.63), with two or more residents who smoked (2.42 μg/m3 IQR: 0.58-11.0), with more than 40 cigarettes smoked (2.92 μg/m3 IQR: 0.97-10.61), and where two or more residents smoked inside (4.02 μg/m3 IQR: 1.58-11.74). Household nicotine concentrations were significantly higher in countries with higher national smoking prevalence and self-reported SHS exposure prevalence (p < 0.05). CONCLUSIONS SHS concentrations in homes with individuals who smoke were approximately twenty times higher in homes that allowed smoking compared to those reporting smoke-free household rules. Evidence-based interventions promoting smoke-free homes should be implemented in combination with strengthening other MPOWER measures.
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Affiliation(s)
- Elisabet Henderson
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain
| | | | - Xavier Continente
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Center for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Esteve Fernández
- Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Spain; Universitat de Barcelona, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Olena Tigova
- Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Spain; Universitat de Barcelona, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain
| | - Nuria Cortés-Francisco
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Anna Tzortzi
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou str., Athens, 10557, Greece
| | - Vergina K Vyzikidou
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou str., Athens, 10557, Greece
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Via Cosimo il Vecchio, 2, 50139, Florence, Italy
| | - Gergana Geshanova
- Smoke-free Life Coalition, Slivnitsa Blvd, 257, 1202, Sofia, Bulgaria
| | - Ute Mons
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50923, Cologne, Germany; Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, 280, 69120, Heidelberg, Germany
| | - Krzysztof Przewozniak
- Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena, 5, 02-781, Warsaw, Poland; The Foundation Smart Health - Health in 3D, Makolągwy 24, 02-811, Warsaw, Poland; Collegium Civitas, 1 Defilad Square, 00-901, Warsaw, Poland
| | - José Precioso
- Research Center in Child Studies, University of Minho, 4710-057, Braga, Portugal
| | - Ramona Brad
- Healthy Romania Generation 2035 Association, Bucharest, Romania
| | - Maria J López
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Center for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 282029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut (DCEXS), Doctor Aiguader, 88, 08003, Barcelona, Spain.
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Blanchette JG, Pacula RL, Smart R, Lira MC, Pessar SC, Naimi TS. The Cannabis Policy Scale: A New Research and Surveillance Tool for U.S. States. J Stud Alcohol Drugs 2022; 83:829-838. [PMID: 36484580 PMCID: PMC9756403 DOI: 10.15288/jsad.21-00462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/03/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Rapid shifts toward cannabis liberalization in the United States have created immense policy variability that is challenging to measure. We developed composite measures to characterize the restrictiveness of U.S. state cannabis policy environments. METHOD Nine panelists, consisting of four research team members and five expert policy consultants, nominated distinct cannabis policies pertaining to cannabis prohibition, medicalization, and legalization for recreational use. For each of the 17 nominated policies, panelists developed implementation ratings and rated each policy's relative efficacy for reducing excessive cannabis use by adults, youth use, and impaired driving. Cannabis Policy Scale scores were then calculated for each state-year for all 50 states from 1999 to 2019 by weighting policies by their efficacy and implementation ratings, and then summing over policies. RESULTS Median Cannabis Policy Scale scores remained stable until 2008, when they started declining (representing policy liberalization), with steeper declines after 2012. In 2019, state Cannabis Policy Scale scores targeting excessive use among the general population ranged from 29.6 to 66.7 for recreational cannabis legalization states, and from 72.4 to 93.4 for medical cannabis legalization states. Cannabis Policy Scale scores using youth-specific and driving-specific efficacy ratings showed similar trends. CONCLUSIONS The Cannabis Policy Scale reflects trends toward liberalization of cannabis policy in many U.S. states. Even within crude policy phenotypes (e.g., medical cannabis programs), Cannabis Policy Scale scores varied considerably between states and over time. The Cannabis Policy Scale is a new measure that can add nuance to cannabis policy research and help assess cannabis policy-outcome relationships.
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Affiliation(s)
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | | | | | - Seema Choksy Pessar
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | - Timothy S. Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
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Feliu A, Martinez C, Peruga A, Joossens L, Bianco E, Cornejo M, Nogueira SO, Fernández E. Tool to monitor tobacco control policy implementation: the Tobacco Control Scale in Latin America. Adaptation process and pilot study. Tob Control 2022; 31:642-648. [PMID: 34031228 DOI: 10.1136/tobaccocontrol-2020-056395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Monitoring tobacco control policy implementation is one of the keys for tobacco consumption reduction in Latin America (LA). This study reports on the adaptation of the Tobacco Control Scale (TCS) for use in LA countries and the level of tobacco control policy implementation in this region according to the scale. METHODS Ecological cross-sectional survey. The questionnaire to measure tobacco control policies was a translated (into Spanish and Portuguese) and adapted version of the last TCS as used in Europe. The resulting TCS-LA maintains the same structure as the original TCS, with eight policy domains and 100 points (pts) as maximum score; however, four policy domains were adapted because the exact same rationale could not be applied. At least two non-governmental tobacco control experts were contacted per country to answer the TCS-LA. RESULTS Informants from 17 out of 18 countries completed the questionnaire. Using the TCS-LA, Panama (70 pts), Uruguay (68 pts) and Ecuador (61 pts) exhibited the strongest tobacco control policies, while Guatemala (32 pts), Bolivia (30 pts) and Dominican Republic (29 pts) have implemented a lower number of tobacco control policies. Eight countries reached 50% of the TCS-LA total possible score, indicating a relatively good implementation level of tobacco control policies. CONCLUSIONS Panama, Uruguay and Ecuador are the tobacco control policy leaders in LA; however, tobacco control in the region has room for improvement since nine countries have a total score under 50 pts. The TCS is a feasible and adaptable tool to monitor tobacco control in other WHO regions beyond Europe.
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Affiliation(s)
- Ariadna Feliu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Cristina Martinez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94118, USA
| | - Armando Peruga
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Center for Epidemiology and Health Policies, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Las Condes, Región Metropolitana de Santiago, Chile
| | | | - Eduardo Bianco
- Regional Coordinator for the Americas, Framework Convention Alliance (FCA), Montevideo, Uruguay
| | - Marco Cornejo
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Institute for Research in Dental Sciences, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Sarah O Nogueira
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
- Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
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Been JV, Laverty AA, Tsampi A, Filippidis FT. European progress in working towards a tobacco-free generation. Eur J Pediatr 2021; 180:3423-3431. [PMID: 34032890 PMCID: PMC8589739 DOI: 10.1007/s00431-021-04116-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Abstract
Children have the right to grow up free from the hazards associated with tobacco smoking. Tobacco smoke exposure can have detrimental effects on children's health and development, from before birth and beyond. As a result of effective tobacco control policies, European smoking rates are steadily decreasing among adults, as is the proportion of adolescents taking up smoking. Substantial variation however exists between countries, both in terms of smoking rates and regarding implementation, comprehensiveness and enforcement of policies to address smoking and second-hand smoke exposure. This is important because comprehensive tobacco control policies such as smoke-free legislation and tobacco taxation have extensively been shown to carry clear health benefits for both adults and children. Additional policies such as increasing the legal age to buy tobacco, reducing the number of outlets selling tobacco, banning tobacco display and advertising at the point-of-sale, and introducing plain packaging for tobacco products can help reduce smoking initiation by youth. At societal level, health professionals can play an important role in advocating for stronger policy measures, whereas they also clearly have a duty to address smoking and tobacco smoke exposure at the patient level. This includes providing cessation advise and referring to effective cessation services.Conclusion: Framing of tobacco exposure as a child right's issue and of comprehensive tobacco control as a tool to work towards the ultimate goal of reaching a tobacco-free generation can help accelerate European progress to curb the tobacco epidemic. What is Known: • Tobacco exposure is associated with a range of adverse health effects among babies and children. • Comprehensive tobacco control policies helped bring down smoking rates in Europe and benefit child health. What is New: • Protecting the rights and health of children provides a strong starting point for tobacco control advocacy. • The tobacco-free generation concept helps policy-makers set clear goals for protecting future generations from tobacco-associated harms.
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Affiliation(s)
- Jasper V Been
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands.
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands.
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Aikaterini Tsampi
- Department of Transboundary Legal Studies, Faculty of Law, University of Groningen, Groningen, Netherlands
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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Gallus S, Lugo A, Stival C, Cerrai S, Clancy L, Filippidis FT, Gorini G, Lopez MJ, López-Nicolás Á, Molinaro S, Odone A, Soriano JB, Tigova O, VAN DEN Brandt PA, Vardavas CI, Fernandez E. Electronic cigarette use in 12 European countries. Results from the TackSHS survey. J Epidemiol 2021. [PMID: 34776500 PMCID: PMC10165220 DOI: 10.2188/jea.je20210329] [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] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited data on electronic cigarette prevalence, patterns and settings of use are available from several European countries. METHODS Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). Overall, 11,876 participants, representative of the population aged ≥15 years in each country, provided information on electronic cigarette. RESULTS 2.4% (95% confidence interval, CI: 2.2-2.7) of the subjects (2.5% among men and 2.4% among women; 0.4% among never, 4.4% among current- and 6.5% among ex-smokers) reported current use of electronic cigarette, ranging from 0.6% in Spain to 7.2% in England. Of the 272 electronic cigarette users, 52.6% were dual users (i.e., users of both electronic and conventional cigarettes) and 58.8% used liquids with nicotine. In all, 65.1% reported using electronic cigarette in at least one indoor setting where smoking is forbidden, in particular in workplaces (34.9%), and bars and restaurants (41.5%). Multivariable logistic regression analysis showed that electronic cigarette use was lower among older individuals (p for trend <0.001) and higher among individuals with high level of education (p for trend 0.040). Participants from countries with higher tobacco cigarette prices more frequently reported electronic cigarette use (odds ratio 3.62; 95% CI: 1.80-7.30). CONCLUSIONS Considering the whole adult population of these 12 European countries, more than 8.3 million people use electronic cigarettes. The majority of users also smoked conventional cigarettes, used electronic cigarettes with nicotine and consumed electronic cigarettes in smoke-free indoor areas.
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Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
| | - Chiara Stival
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
| | - Sonia Cerrai
- Epidemiology and Health Research Lab, Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR)
| | | | | | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO)
| | - Maria José Lopez
- Agència de Salut Pública de Barcelona.,Departament de Ciències Experimentals i de la Salut (DCEXS), Universitat Pompeu Fabra.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP).,Sant Pau Institute of Biomedical Research (IIB Sant Pau)
| | | | - Sabrina Molinaro
- Epidemiology and Health Research Lab, Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR)
| | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia
| | - Joan B Soriano
- Hospital Universitario La Princesa (IISP).,Consortium for Biomedical Research in Respiratory Diseases (CIBERES)
| | - Olena Tigova
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES).,Tobacco Control Research Group, Epidemiology and Public Health Research Programme, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL.,Tobacco Control Unit, WHO collaborating center on tobacco control, Institut Català d'Oncologia-ICO.,School of Medicine and Health Sciences, Campus of Bellvitge, Universitat de Barcelona
| | - Piet A VAN DEN Brandt
- Maastricht University Medical Centre, GROW- School for Oncology and Developmental Biology, Department of Epidemiology.,Maastricht University Medical Centre, CAPHRI- School for Public Health and Primary Care, Department of Epidemiology
| | | | - Esteve Fernandez
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES).,Tobacco Control Research Group, Epidemiology and Public Health Research Programme, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL.,Tobacco Control Unit, WHO collaborating center on tobacco control, Institut Català d'Oncologia-ICO.,School of Medicine and Health Sciences, Campus of Bellvitge, Universitat de Barcelona
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9
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Shah A, Britton J, Bogdanovica I. Developing a novel e-cigarette regulatory and policy control scale: results from the European Union. DRUGS (ABINGDON, ENGLAND) 2021; 29:719-725. [PMID: 36483003 PMCID: PMC9721402 DOI: 10.1080/09687637.2021.1959520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/12/2021] [Accepted: 07/18/2021] [Indexed: 06/06/2023]
Abstract
Background E-cigarette regulations vary considerably between countries though a standard approach for comparing regulatory frameworks does not exist. Additionally, there is no evidence on whether regulatory variations are associated with differences in e-cigarette use and smoking cessation. This study aims to develop a regulatory scale to measure and compare e-cigarette regulations between European Union countries and investigate whether scores are associated with e-cigarette use and smoking cessation. Methods Data from a range of sources, such as ECigIntelligence, were used to develop a scale and score countries in the respective areas of e-cigarette scale. We used correlation analysis to investigate association between scale scores and e-cigarettes market, e-cigarette prevalence and use of e-cigarettes for smoking cessation. Results An e-cigarette scale consisting of 10 domains was developed. Our analysis suggests that higher e-cigarette scale scores were associated with significantly greater use of e-cigarettes within countries, and greater increases in the prevalence of former smoking smokers between 2014 and 2017. Conclusions Whilst further work is needed to develop the scale in line with rapidly changing regulatory landscape and product development, the current findings suggest that countries that have implemented e-cigarette regulations might be more successful in obtaining public health gains such as increase in the proportion of former smokers compared to countries where e-cigarette market and sales is not regulated.
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Affiliation(s)
- Ajay Shah
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - John Britton
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Ilze Bogdanovica
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
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10
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The association between tobacco control policy implementation and country-level socioeconomic factors in 31 European countries. Sci Rep 2021; 11:8912. [PMID: 33903637 PMCID: PMC8076295 DOI: 10.1038/s41598-021-88194-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/25/2021] [Indexed: 11/08/2022] Open
Abstract
European countries have made significant progress in implementing tobacco control policies to reduce tobacco use; however, whether socioeconomic status (SES) of a country may influence the implementation of such policies is unknown. The aim of this study is to assess the association between country-level SES and the implementation level of tobacco control policies in 31 European countries. An ecological study using data from Eurostat, Human Development Reports on several SES indicators and the Tobacco Control Scale (TCS) of 2016 was conducted to measure country-level tobacco control policies. We analysed the relationship between SES indicators and the TCS by means of scatter-plots and Spearman's rank correlation coefficients (rsp) and multivariable linear regression analysis. In Europe, no statistically significant association was found between SES factors and the level of implementation of tobacco control policies. Only public spending on tobacco control was associated with all SES factors, except for Gini Index (an income inequality index). The strongest associations of TCS scores for this policy domain were found with the Human Development Index (rsp = 0.586; p < 0.001) and the Gross Domestic Product per capita (in Euros) (rsp = 0.562; p = 0.001). The adjusted linear regression model showed an association of tobacco control policy implementation with countries' geographical location (Western Europe, β = - 15.7; p = 0.009, compared to Northern Europe). In conclusion, no association was found between SES factors and the level of implementation of tobacco control policies in 31 European countries; policymakers should be aware that tobacco control policies could be successfully implemented despite socioeconomic constraints, especially when these policies are of low cost and cost-effective (i.e., smoke-free bans and taxation).
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