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Marou V, Vardavas CI, Aslanoglou K, Nikitara K, Plyta Z, Leonardi-Bee J, Atkins K, Condell O, Lamb F, Suk JE. The impact of conflict on infectious disease: a systematic literature review. Confl Health 2024; 18:27. [PMID: 38584269 PMCID: PMC11000310 DOI: 10.1186/s13031-023-00568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/28/2023] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Conflict situations, armed or not, have been associated with emergence and transmission of infectious diseases. This review aims to identify the pathways through which infectious diseases emerge within conflict situations and to outline appropriate infectious disease preparedness and response strategies. METHODS A systematic review was performed representing published evidence from January 2000 to October 2023. Ovid Medline and Embase were utilised to obtain literature on infectious diseases in any conflict settings. The systematic review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis). No geographical restrictions were imposed. FINDINGS Our review identified 51 studies covering AIDS, Hepatitis B, Tuberculosis, Cholera, Coronavirus 2, Ebola, Poliomyelitis, Malaria, Leishmaniasis, Measles, Diphtheria, Dengue and Acute Bacterial Meningitis within conflict settings in Europe, Middle East, Asia, and Africa since October 2023. Key factors contributing to disease emergence and transmission in conflict situations included population displacement, destruction of vital infrastructure, reduction in functioning healthcare systems and healthcare personnel, disruption of disease control programmes (including reduced surveillance, diagnostic delays, and interrupted vaccinations), reduced access by healthcare providers to populations within areas of active conflict, increased population vulnerability due to limited access to healthcare services, and disruptions in the supply chain of safe water, food, and medication. To mitigate these infectious disease risks reported preparedness and response strategies included both disease-specific intervention strategies as well as broader concepts such as the education of conflict-affected populations through infectious disease awareness programmes, investing in and enabling health care in locations with displaced populations, intensifying immunisation campaigns, and ensuring political commitment and intersectoral collaborations between governments and international organisations. CONCLUSION Conflict plays a direct and indirect role in the transmission and propagation of infectious diseases. The findings from this review can assist decision-makers in the development of evidence-based preparedness and response strategies for the timely and effective containment of infectious disease outbreaks in conflict zones and amongst conflict-driven displaced populations. FUNDING European Centre for Disease Prevention and Control under specific contract No. 22 ECD.13,154 within Framework contract ECDC/2019/001 Lot 1B.
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Affiliation(s)
- Valia Marou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | | | - Zinovia Plyta
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kirsty Atkins
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Orla Condell
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Favelle Lamb
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden.
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Agaku IT, Sulentic R, Dragicevic A, Njie G, Jones CK, Odani S, Tsafa T, Gwar J, Vardavas CI, Ayo-Yusuf O. Gender differences in use of cigarette and non-cigarette tobacco products among adolescents aged 13-15 years in 20 African countries. Tob Induc Dis 2024; 22:TID-22-20. [PMID: 38259662 PMCID: PMC10801700 DOI: 10.18332/tid/169753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/10/2023] [Accepted: 07/18/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Examining gender differences in youth tobacco use is important as it aligns tobacco control within the context of broader human development goals seeking to eliminate gender inequalities. In this study, we examined gender differences in adolescent use of cigarettes, smokeless tobacco, shisha, and e-cigarettes in Africa. METHODS This was a cross-sectional study using data from the Global Youth Tobacco Survey. Our analytical sample comprised 56442 adolescents aged 13-15 years from 20 African countries. Weighted, country-specific prevalence estimates were computed overall and by gender. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to examine whether correlates of tobacco use differed between boys and girls. RESULTS Ever cigarette smoking prevalence was significantly higher among boys than girls in 16 of the 20 countries, but a significantly higher percentage of girls reported earlier age of cigarette smoking initiation than boys within pooled analysis. Some of the largest gender differences in current cigarette smoking were seen in Algeria (12.2% vs 0.8%, boys and girls, respectively), Mauritius (21.2% vs 6.6%), and Madagascar (15.0% vs 4.1%). Current use of e-cigarettes, shisha, and smokeless tobacco was generally comparable between boys and girls where data existed. Among girls, higher levels of reported exposure to tobacco advertisement were positively associated with shisha smoking whereas perceived tobacco harm was inversely associated with current cigarette and shisha smoking. Among boys, perceived social acceptability of smoking at parties was associated with an increased likelihood of cigarette smoking (APR=2.27; 95% Cl: 1.20-4.30). CONCLUSIONS The prevalence of cigarette smoking among boys was higher than that of girls in many countries. However, girls who smoke tend to start at an earlier age than boys. Differential gender patterns of cigarette and non-cigarette tobacco product use among youth may have implications for future disease burden. As the tobacco control landscape evolves, tobacco prevention efforts should focus on all tobacco products, not just cigarettes.
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Affiliation(s)
- Israel T. Agaku
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Rose Sulentic
- Centers for Disease Control and Prevention Foundation, Atlanta, United States
| | - Adriana Dragicevic
- Centers for Disease Control and Prevention Foundation, Atlanta, United States
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Gibril Njie
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Candace K. Jones
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Satomi Odani
- Osaka International Cancer Institute, Cancer Control Center, Osaka, Japan
| | - Tina Tsafa
- Department of Mass Communication, Benue State University, Makurdi, Nigeria
| | - Joy Gwar
- Department of Clinical Psychology, Federal Medical Centre Makurdi, Makurdi, Nigeria
| | - Constantine I. Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States
| | - Olalekan Ayo-Yusuf
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Mechili EA, Przewoźniak K, Driezen P, Kyriakos CN, Girvalaki C, Mons U, Quah ACK, Fernández E, Trofor AC, Demjén T, Katsaounou PA, Zatoński W, Fong GT, Vardavas CI. Smokers' support for the ban on sale of slim cigarettes in six European countries: findings from the EUREST-PLUS ITC Europe Surveys. Open Res Eur 2023; 1:52. [PMID: 37645112 PMCID: PMC10446023 DOI: 10.12688/openreseurope.13405.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 08/31/2023]
Abstract
Background: Efforts to regulate tobacco products and reduce consumption in the European Union (EU) include the European Tobacco Products Directive (TPD), which went into force in May 2016. Despite the initial discussion to include a ban on sale of slim cigarettes, it was excluded in the final TPD. The main goal of this study was to examine support for a ban on slim cigarettes among smokers in six European Countries. Methods: Data from the 2018 (Wave 2) International Tobacco Control Policy Evaluation Project 6 European Country (ITC 6E) EUREST-PLUS project survey, a cross sectional study of adult smokers (n=5592) from Germany, Greece, Hungary, Poland, Romania, and Spain, was analysed. Descriptive statistics were used to estimate support for a ban on slim cigarettes by sociodemographic characteristics and smoking behaviors. Logistic regression analysis was used to examine factors associated with support for a ban on slim cigarettes and perceptions of harm. Results: Support for a ban on slims varied across countries, with highest support in Romania (33.8%), and lowest in Greece (18.0%). Female smokers (OR=0.78; 95%CI=0.67-0.91, daily smokers (OR=0.68; 95%CI=0.47-0.97), menthol smokers (OR=0.55; 95%CI=0.36-0.86), and smokers who did not have plans to quit within next six months (OR=0.45; 95%CI=0.36-0.56) had significantly lower odds of supporting a ban on slim cigarettes. Overall, 21% of smokers perceived slim cigarettes as less harmful than regular cigarettes. Conclusions: Support for a ban of slim cigarettes was relatively low among smokers, while misperceptions that slim cigarettes are less harmful is high, particularly among countries where slim cigarette use is more prevalent. Findings support a ban on slim cigarettes to reduce misperceptions around slim cigarettes being less harmful.
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Affiliation(s)
- Enkeleint A. Mechili
- Department of Health Care, Faculty of Health,, University of Vlora, Vlora, 9401, Albania
- European Network for Smoking and Tobacco Prevention, Chausse d'lxelles 144, Brussels, 1050, Belgium
- School of Medicine, University of Crete, Voutes, Heraklion, 71409, Greece
| | - Krzysztof Przewoźniak
- Maria Skłodowska-Curie National Research Institute of Oncology, 15B Wawelska Street, Warsaw, 02-034, Poland
- Health Promotion Foundation, Mszczonowska, Nadarzyn, 05-830, Poland
- Collegium Civitas, plac Defilad 1, Warsaw, 00-901, Poland
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
- School of Public Health Sciences, University of Waterloo, University Avenue West 200, Waterloo, Ontario, N2L 3G1, Canada
| | - Christina N Kyriakos
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, 310 Reynolds Building, St. Dunstan's Road, London, W6 9RP, UK
| | - Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Chausse d'lxelles 144, Brussels, 1050, Belgium
- School of Medicine, University of Crete, Voutes, Heraklion, 71409, Greece
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany
- Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, Cologne, 50937, Germany
| | - Anne CK Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), Av Gran Via De L’Hospitalet 199-203, L’Hospitalet de Llobregat, Catalonia, 08908, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Av Gran Via De L’Hospitalet 199-203, L’Hospitalet de Llobregat, Catalonia, 08908, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia, 08908, Spain
- Center for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Madrid, 28029, Spain
| | - Antigona C Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Strada Universității 16, Iași, 700115, Romania
- AerPur Romania, Street Argentina 35 Sector 1, Bucharest, 011753, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Fiumei 18/B IB IV LPH I 2, Budapest, 1044, Hungary
| | - Paraskevi A Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Ipsilantou 45-47, Athens, 10676, Greece
| | - Witold Zatoński
- Health Promotion Foundation, Mszczonowska, Nadarzyn, 05-830, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Nowy Świat 4 st, Kalisz, 62-800, Poland
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
- School of Public Health Sciences, University of Waterloo, University Avenue West 200, Waterloo, Ontario, N2L 3G1, Canada
- Ontario Institute for Cancer Research, 661 University Avenue, Toronto, Ontario, M5G 0A3, Canada
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Chausse d'lxelles 144, Brussels, 1050, Belgium
- School of Medicine, University of Crete, Voutes, Heraklion, 71409, Greece
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Fu M, Castellano Y, Tigova O, Driezen P, Thompson ME, Kaai SC, Quah ACK, Fong GT, Vardavas CI, Fernández E. ITC EUREST-PLUS Spain: protocol of a prospective longitudinal study of smokers in Spain. Gac Sanit 2023; 37:102307. [PMID: 37247520 DOI: 10.1016/j.gaceta.2023.102307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The ITC EUREST-PLUS Spain Survey is a longitudinal study of a representative sample of Spanish adult (≥18 years old) smokers. This protocol describes the methods of the 2021 follow-up survey. METHOD The ITC EUREST-PLUS Survey, a prospective cohort study of a representative sample of smokers in six European countries, was conducted in 2016 (baseline) and 2018 (waves 1 and 2). The 2021 ITC EUREST-PLUS Spain Survey is a continuation of the Spanish cohort with a new interview in 2021 (wave 3). Lost participants were replaced with new smokers recruited using the same multi-stage sampling design. This latest follow-up aims to examine current patterns and transitions of tobacco use and to evaluate the impact of new tobacco-related policies. COMMENTS The ITC EUREST-PLUS Spain Survey will provide recent information about the impact of tobacco control policies on smoking behaviour.
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Affiliation(s)
- Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme; Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Spain.
| | - Yolanda Castellano
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme; Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Spain; Department of Odontostomatology, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme; Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan C Kaai
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- 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 Sciences, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece; Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, United States of America
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology, WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme; Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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5
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Vardavas CI, Nikitara K, Aslanoglou K, Kamekis A, Puttige Ramesh N, Symvoulakis E, Agaku I, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Deogan C, Suk JE. Systematic review of outbreaks of COVID-19 within households in the European region when the child is the index case. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001718. [PMID: 36649374 PMCID: PMC9835947 DOI: 10.1136/bmjpo-2022-001718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings. METHODS This literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of SARS-CoV-2 within household settings. The inclusion criteria were based on the Population, Exposure, Outcome framework for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with paediatric index cases 1-17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either an SAR or the probability of onward infection (outcome). RESULTS Of 1819 studies originally identified, 19 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 15 studies, while there was no evidence of secondary transmission from children to other household members in one study. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings. CONCLUSIONS SARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece.,Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Katerina Nikitara
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Aslanoglou
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Apostolos Kamekis
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Nithya Puttige Ramesh
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Israel Agaku
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,CIBER Respiratory Diseases (CIBERES), Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
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Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R, Leonardi-Bee J, Fernandez E, Carnicer-Pont D, Vestbo J, Semenza JC, Deogan C, Suk JE, Kramarz P, Lamb F, Penttinen P. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. Eur Respir Rev 2022; 31:220098. [PMID: 36323422 PMCID: PMC9724816 DOI: 10.1183/16000617.0098-2022] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. METHODS We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients. FINDINGS We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease. INTERPRETATION The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Dolors Carnicer-Pont
- Catalan Institute of Oncology, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), Barcelona, Spain
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Piotr Kramarz
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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7
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Nogueira SO, Driezen P, Fu M, Hitchman SC, Tigova O, Castellano Y, Kyriakos CN, Zatoński MZ, Mons U, Quah ACK, Demjén T, Trofor AC, Przewozniak K, Katsaounou P, Fong G, Vardavas CI, Fernández E. Beyond the European Union Tobacco Products Directive: smokers' and recent quitters' support for further tobacco control measures (2016-2018). Tob Control 2022; 31:765-769. [PMID: 33727255 DOI: 10.1136/tobaccocontrol-2020-056177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Several measures recommended by the WHO Framework Convention on Tobacco Control have not been implemented in the European Union, despite changes in the legislation such as the Tobacco Products Directive (TPD). This study aims to understand smokers' and recent quitters' levels of support for tobacco control measures that go beyond the TPD during and after its implementation. METHODS Data from wave 1 (2016, n=6011) and wave 2 (2018, n=6027) of the EUREST-PLUS International Tobacco Control Policy Evaluation Project Six European Countries Survey, a cohort of adult smokers in Germany, Greece, Hungary, Poland, Romania, Spain were used to estimate the level of support for seven different tobacco control measures, overall and by country. RESULTS In 2018, the highest support was for implementing measures to further regulate tobacco products (50.5%) and for holding tobacco companies accountable for the harm caused by smoking (48.8%). Additionally, in 2018, 40% of smokers and recent quitters supported a total ban on cigarettes and other tobacco products within ten years, if assistance to quit smoking is provided. Overall, support for tobacco control measures among smokers and recent quitters after the implementation of the TPD remained stable over time. CONCLUSION There is considerable support among smokers and recent quitters for tobacco control measures that go beyond the current measures implemented. A significant percentage of smokers would support a ban on tobacco products in the future if the government provided assistance to quit smoking. This highlights the importance of implementing measures to increase smoking cessation in conjunction with other policies.
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Affiliation(s)
- Sarah O Nogueira
- Tobacco Control Unit, Cancer Epidemiology and Prevention Programme, Institut Catala d' Oncologia (ICO), L'Hospitalet de Llobregat, Catalunya, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Catalunya, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Programme (EPIBELL), Institut d'Investigació Biomèdica Mèdica (IDIBELL), Barcelona, Catalonia, Spain
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Marcela Fu
- Tobacco Control Unit, Cancer Epidemiology and Prevention Programme, Institut Catala d' Oncologia (ICO), L'Hospitalet de Llobregat, Catalunya, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Catalunya, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Programme (EPIBELL), Institut d'Investigació Biomèdica Mèdica (IDIBELL), Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Sara C Hitchman
- Department of Addictions, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Olena Tigova
- Tobacco Control Unit, Cancer Epidemiology and Prevention Programme, Institut Catala d' Oncologia (ICO), L'Hospitalet de Llobregat, Catalunya, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Catalunya, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Programme (EPIBELL), Institut d'Investigació Biomèdica Mèdica (IDIBELL), Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Cancer Epidemiology and Prevention Programme, Institut Catala d' Oncologia (ICO), L'Hospitalet de Llobregat, Catalunya, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Catalunya, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Programme (EPIBELL), Institut d'Investigació Biomèdica Mèdica (IDIBELL), Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Christina N Kyriakos
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, London, UK
- European Network for Smoking and Tobacco Prevention, Brussels, Brussels, Belgium
| | - Mateusz Zygmunt Zatoński
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
- Health Promotion Foundation, Warsaw, Poland
- Institute - European Observatory of Health Inequalities, Calisia University, Kalisz, Poland
| | - Ute Mons
- Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Centre, Heidelberg, Germany
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Antigona Carmen Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Krzysztof Przewozniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
| | - Paraskevi Katsaounou
- Pulmonary and Critical Care Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Geoffrey 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
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Brussels, Belgium
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Epidemiology and Prevention Programme, Institut Catala d' Oncologia (ICO), L'Hospitalet de Llobregat, Catalunya, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Catalunya, Spain
- Tobacco Control Research Group, Epidemiology and Public Health Programme (EPIBELL), Institut d'Investigació Biomèdica Mèdica (IDIBELL), Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
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8
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Havermans A, Mallock N, Zervas E, Caillé-Garnier S, Mansuy T, Michel C, Pennings JLA, Schulz T, Schwarze PE, Solimini R, Tassin JP, Vardavas CI, Merino M, Pauwels CGGM, van Nierop LE, Lambré C, Bolling AK. Review of industry reports on EU priority tobacco additives part A: Main outcomes and conclusions. Tob Prev Cessat 2022; 8:27. [PMID: 35860504 PMCID: PMC9255285 DOI: 10.18332/tpc/151529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Abstract
The European Union Tobacco Products Directive (EU TPD) mandates enhanced reporting obligations for tobacco manufacturers regarding 15 priority additives. Within the Joint Action on Tobacco Control (JATC), a review panel of independent experts was appointed for the scientific evaluation of the additive reports submitted by a consortium of 12 tobacco manufacturers. As required by the TPD, the reports were evaluated based on their comprehensiveness, methodology and conclusions. In addition, we evaluated the chemical, toxicological, addictive, inhalation facilitating and flavoring properties of the priority additives based on the submitted reports, supplemented by the panel's expert knowledge and some independent literature. The industry concluded that none of the additives is associated with concern. Due to significant methodological limitations, we question the scientific validity of these conclusions and conclude that they are not warranted. Our review demonstrates that many issues regarding toxicity, addictiveness and attractiveness of the additives have not been sufficiently addressed, and therefore concerns remain. For example, menthol facilitates inhalation by activation of the cooling receptor TRPM8. The addition of sorbitol and guar gum leads to a significant increase of aldehydes that may contribute to toxicity and addictiveness. Titanium dioxide particles (aerodynamic diameter <10 µm) are legally classified as carcinogenic when inhaled. For diacetyl no report was provided. Overall, the industry reports were not comprehensive, and the information presented provides an insufficient basis for the regulation of most additives. We, therefore, advise MS to consider alternative approaches such as the precautionary principle.
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Affiliation(s)
- Anne Havermans
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nadja Mallock
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - Efthimios Zervas
- Hellenic Thoracic Society, Athens, Greece.,School of Applied Arts and Sustainable Design, Hellenic Open University, Athens, Greece
| | | | - Thibault Mansuy
- French Agency for Food, Environmental and Occupational Health and Safety, Paris, France
| | - Cécile Michel
- French Agency for Food, Environmental and Occupational Health and Safety, Paris, France
| | - Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Thomas Schulz
- German Federal Institute for Risk Assessment, Berlin, Germany
| | | | | | | | | | - Miguel Merino
- Andalusia Agency For Agriculture and Fisheries Development, Seville, Spain
| | - Charlotte G G M Pauwels
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Lotte E van Nierop
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Claude Lambré
- National Institute of Health and Medical Research, Paris, France
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9
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El Asmar ML, Laverty AA, Vardavas CI, Filippidis FT. How do Europeans quit using tobacco, e-cigarettes and heated tobacco products? A cross-sectional analysis in 28 European countries. BMJ Open 2022; 12:e059068. [PMID: 35487758 PMCID: PMC9058771 DOI: 10.1136/bmjopen-2021-059068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES While smoking tobacco remains a substantial cause of harm in Europe, novel products such as electronic cigarettes or e-cigarettes (ECs) and heated tobacco products (HTPs) have entered the market recently. While debate still persists over the role of these novel products, they are now in widespread use. This study aimed to explore the prevalence and methods of attempts to quit EC and HTP. SETTING We analysed the 2020 Eurobarometer survey, which collected data in 28 European countries. PARTICIPANTS A representative sample of individuals residing in these countries aged ≥15 years. PRIMARY AND SECONDARY OUTCOME MEASURES Multilevel regression analyses were performed to assess differences in quit attempts and cessation methods among tobacco smokers and exclusive EC/HTP users separately. RESULTS 51.1% of current tobacco smokers and 27.1% of exclusive EC or HTP users reported having ever made a quit attempt. The majority of former and current smokers (75.8%) who made a quit attempt did so unassisted, with 28.8% reporting at least one attempt using a cessation aid. The most popular cessation aids were nicotine replacement therapy or other medication (13.4%) and ECs (11.3%). 58.8% of exclusive EC or HTP users who had made a quit attempt did so unassisted, with 39.5% reporting the use of a cessation aid. CONCLUSION Most EC and HTP users in Europe try to quit unassisted, although more of them report the use of a cessation aid compared with tobacco smokers. Cessation support services should take into consideration the increasing numbers of users of EC and HTP who may be trying to quit.
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Affiliation(s)
- Marie Line El Asmar
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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10
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Carnicer-Pont D, Tigova O, Havermans A, Remue E, Ferech M, Vejdovszky K, Solimini R, Gallus S, Nunes E, Lange CC, Gomez-Chacon C, Ruiz-Dominguez F, Behrakis P, Vardavas CI, Fernandez E. Tobacco products in the European Union Common Entry Gate (EU-CEG): A tool for monitoring the EU tobacco products directive. Tob Prev Cessat 2022; 8:10. [PMID: 35330752 PMCID: PMC8889498 DOI: 10.18332/tpc/145501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/10/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Under the European Union (EU) Tobacco Products Directive (2014/40/EU) (TPD), manufacturers and importers of tobacco products are required to report information to the European Commission (EC) and Member States (MS) on products intended to be placed on the market. We describe the distribution of notifications to the EU Common Entry Gate (EU-CEG) and identify key fields for improvement on reporting cigarettes or roll-your-own (RYO) tobacco. METHODS A cross-sectional analysis of secondary data reported in the EU-CEG was conducted for tobacco products notified within EU-CEG between June 2016 and October 2019 for 12 EU MS. Analysis of compliance to specific regulations for priority additives that refer to cigarettes and RYO was conducted for 10 EU countries. RESULTS Overall, 39170 tobacco products were notified. This included 16762 (42.8%) notifications of cigars, followed by cigarettes 11242 (28.7 %), waterpipes 3291 (8.4%), cigarillos (n=1783), pipe (n=1715), RYO (n=1635), chewing tobacco (n=1021), novel tobacco products (n=839), herbal products for smoking (n=535), other (n=258), nasal (n=74) and oral tobacco (n=15). In cigarettes and RYO tobacco products, the proportion of ingredients notified in all countries that contained an unknown Chemical Abstract Services (CAS) number was 3.8% and 2.1%, respectively. The proportion of underreporting flagging of priority additives ranged from 15.9% in Malta to 41.3% in Lithuania, the mean proportion of underreporting of the variable 'priority additive' for the 10 countries together was 24.7%. CONCLUSIONS In the EU-CEG data base, for the period of analysis, a significant number of product notifications took place while large variations in the number of types of tobacco products notified across EU countries was noted. The timely monitoring of these data is needed so that products non-compliant within the EU-CEG system are assessed.
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Affiliation(s)
- Dolors Carnicer-Pont
- Cancer Prevention and Control Programme, Cancer Epidemiology and Prevention Department, Catalan Institute of Oncology, Barcelona, Spain.,Tobacco Control Research Group, Epidemiology and Public Health Programme, Bellvitge Biomedical Research Institute, Barcelona, Spain.,School of Medicine and Clinical Sciences, University of Barcelona, Barcelona, Spain.,Centre for Biomedical Research Network, CIBERES, Madrid, Spain
| | - Olena Tigova
- Cancer Prevention and Control Programme, Cancer Epidemiology and Prevention Department, Catalan Institute of Oncology, Barcelona, Spain.,Tobacco Control Research Group, Epidemiology and Public Health Programme, Bellvitge Biomedical Research Institute, Barcelona, Spain.,School of Medicine and Clinical Sciences, University of Barcelona, Barcelona, Spain.,Centre for Biomedical Research Network, CIBERES, Madrid, Spain
| | - Anne Havermans
- Centre for Health Protection, National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands
| | - Eline Remue
- Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Matus Ferech
- Tobacco Control Team, DG SANTE B2, Cross-border Healthcare and Tobacco Control, Brussels, Belgium
| | | | - Renata Solimini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Emilia Nunes
- Department of Health, Ministry of Health, Lisbon, Portugal
| | - Carl C Lange
- The Danish Safety Technology Authority, Copenhagen, Denmark
| | - Cristina Gomez-Chacon
- Tobacco Prevention and Control Unit, Deputy Direction of Promotion, Prevention and Quality, General Direction of Public Health, Ministry of Health, Madrid, Spain
| | - Francisco Ruiz-Dominguez
- General Directorate of Public Health and Pharmaceutical Management, Regional Ministry of Health and Families of Andalusia, Sevilla, Spain
| | | | | | - Esteve Fernandez
- Cancer Prevention and Control Programme, Cancer Epidemiology and Prevention Department, Catalan Institute of Oncology, Barcelona, Spain.,Tobacco Control Research Group, Epidemiology and Public Health Programme, Bellvitge Biomedical Research Institute, Barcelona, Spain.,School of Medicine and Clinical Sciences, University of Barcelona, Barcelona, Spain.,Centre for Biomedical Research Network, CIBERES, Madrid, Spain
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11
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Abstract
Efforts to reduce the toll of tobacco-related morbidity and mortality in the European Union are spearheaded by the Tobacco Products Directive (TPD), a legal act implemented during 2016-2021, with the overall aim to reduce tobacco consumption by 2% in Europe. Within this time frame, several core tobacco control measures were implemented, the impact of which is outlined within this manuscript. Key successful legislative actions implemented in this time frame led to greater availability of information and further regulation of additives, the banning of mentholated cigarettes, enhanced pictorial package warnings and a regulatory framework for e-cigarettes. While repeated cross-sectional data indicated a 12.5% relative reduction in smoking prevalence after implementation of the TPD, the differential regulation of cigarettes and roll-your-own tobacco compared with other products, such as cigarillos, e-cigarettes and heated tobacco products, may have also led to product displacement. Moreover, as the TPD could not keep up with the ever-changing nicotine product landscape, further adaptations may be needed.
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12
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Pénzes M, Solimini R, Dominguez FMR, Joó T, Vardavas CI, Behrakis P. Recommendations for treating electronic cigarette and heated tobacco product dependence. Tob Prev Cessat 2021; 7:67. [PMID: 34805624 PMCID: PMC8573535 DOI: 10.18332/tpc/142961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Melinda Pénzes
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Renata Solimini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Francisco M Ruiz Dominguez
- Regional Ministry of Health and Families of Andalusia, Directorate General of Public Health and Pharmaceutical Management, Seville, Spain
| | - Tamás Joó
- Health Services Management Training Centre, Faculty of Health and Public Administration, Semmelweis University, Budapest, Hungary
| | | | - Panagiotis Behrakis
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece.,Institute of Public Health, The American College of Greece, Athens, Greece.,Athens Medical Center, Athens, Greece
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Laverty AA, Vardavas CI, Filippidis FT. Prevalence and reasons for use of Heated Tobacco Products (HTP) in Europe: an analysis of Eurobarometer data in 28 countries. Lancet Reg Health Eur 2021; 8:100159. [PMID: 34557853 PMCID: PMC8454644 DOI: 10.1016/j.lanepe.2021.100159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Heated Tobacco Products (HTP) are a relatively new class of tobacco products, with limited data on usage patterns. We assessed the prevalence and reasons for use among persons aged ≥15 years in 27 European Union member states and the United Kingdom·. METHODS The 2020 Eurobarometer (93·2) survey was analysed (n=28,300, aged ≥15). Multi-level regression analyses assessed socio-demographic differences in use while separate analyses investigated reasons for starting to use HTP. Results are presented as adjusted Odds Ratios (aOR) and weighted percentages with 95% Confidence Intervals (95%CI). FINDINGS Overall, 6·5% (95% CI 6·1;7·0) of participants had ever used a HTP. 1·3% (1·1%;1·5%) of participants were current users of HTP, and 0·7% (0·6% to 0·9%) daily users. Current and former tobacco smokers were more likely than never tobacco smokers to use HTP (aOR 36·3 (22·9;57·5), and 7·3 (4·3;12·3) respectively. Youth aged 15-24 years of age were substantially more likely to report use, e.g. aOR for ever use=7·77 (6·56;9·21) compared to those aged ≥55 years. 51·3% of ever HTP users reported at least weekly concurrent use of combustible tobacco. Among those who reported ever use of HTP, but not e-cigarettes, the most popular reason for use was the perception that HTP are less harmful than smoking tobacco (39·5%), followed by use by friends (28·4%) and stopping or reducing smoking (28·2%). INTERPRETATION Considerable numbers of people in the EU have ever used HTP, although current and daily use remains low. Current use is more common among younger people, and current and former smokers. FUNDING None.
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Affiliation(s)
- Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom
| | - Constantine I. Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, MA, USA
- School of Medicine, University of Crete, Greece
| | - Filippos T. Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Aleyan S, Driezen P, McNeill A, McDermott M, Kahnert S, Kyriakos CN, Mons U, Fernández E, Trofor AC, Zatoński M, Demjén T, Katsaounou PA, Przewoźniak K, Balmford J, Filippidis FT, Fong GT, Vardavas CI, Hitchman SC. Evaluating the impact of introducing standardized packaging with larger health-warning labels in England: findings from adult smokers within the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2021; 30:iii91-iii97. [PMID: 32918815 DOI: 10.1093/eurpub/ckaa053] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The European (EU) Tobacco Product Directive (TPD) was implemented in May 2016 to regulate the design and labelling of cigarettes and roll-your-own tobacco. At the same time, the UK introduced standardized packaging measures, whereas Germany, Greece, Hungary, Poland, Romania and Spain did not. This study examines the impact of introducing standardized packaging in England using a quasi-experimental design. METHODS Data from adult smokers in Waves 1 (2016; N=9547) and 2 (2018; N=9724) from the International Tobacco Control Policy Evaluation surveys (England) and EUREST-PLUS surveys (Germany, Greece, Hungary, Poland, Romania and Spain) were used. Generalized estimating equations were used to estimate changes in pack/brand appeal, salience of health-warning labels (HWLs) and perceived relative harm of different brands in England (where larger HWLs and standardized packaging were implemented), vs. each EU country (where only larger HWLs were implemented). RESULTS There was an increase in the percentage of respondents from Germany, Hungary and Poland reporting they did not like the look of the pack (4.7%, 9.6%, and 14.2%, respectively), but the largest increase was in England (41.0%). Moreover, there was a statistically significant increase in the salience of HWLs in Hungary, Poland and Romania (17.0%, 13.9%, and 15.3%, respectively), but the largest increase was in England (27.6%). Few differences were observed in cross-country comparisons of the perceived relative harm of different brands. CONCLUSIONS Findings suggest that standardized packaging reduces pack appeal and enhances the salience of HWLs over and above the effects of larger HWLs. Findings provide additional evidence and support for incorporating standardized packaging into the EU TPD.
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Affiliation(s)
- Sarah Aleyan
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Pete Driezen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), UK
| | - Máirtín McDermott
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah Kahnert
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa', Iasi, Romania.,Aer Pur Romania, Bucharest, Romania
| | - Mateusz Zatoński
- Health Promotion Foundation, Warsaw, Poland.,Department for Health, Tobacco Control Research Group, University of Bath, Bath, UK.,European Observatory of Health Inequalities, President Stanislaw Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Paraskevi A Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,European Respiratory Society, Lausanne, Switzerland
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland.,Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Collegium Civitas, Warsaw, Poland
| | - James Balmford
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg im Breisgau, Germany
| | - Filippos T Filippidis
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,European Respiratory Society, Lausanne, Switzerland.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Geoffrey T Fong
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Department of Psychology, University of Waterloo, Waterloo, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece.,European Respiratory Society, Lausanne, Switzerland
| | - Sara C Hitchman
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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17
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Vardavas CI, Kyriakos CN, Driezen P, Girvalaki C, Nikitara K, Filippidis FT, Fernández E, Mons U, Przewoźniak K, Trofor AC, Demjén T, Katsaounou PA, Zatoński W, Willemsen M, Fong GT. Transitions in product use during the implementation of the European Tobacco Products Directive: cohort study findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2021; 30:iii10-iii17. [PMID: 32918817 DOI: 10.1093/eurpub/ckaa023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The emergence of new types of tobacco and tobacco-related products on the European Union (EU) market has precipitated the possibility for both poly-tobacco use and transitions between products. In the EU, the regulatory environment has shifted with the implementation of the European Tobacco Products Directive (TPD) in May 2016, which may influence consumer transitions between products. METHODS The aim of this paper was to examine trends and transitions in tobacco products from 2016 to 2018 -before and after implementation of the TPD in the EU. Data come from Wave 1 (pre-TPD) and Wave 2 (post-TPD) of the EUREST-PLUS ITC Six European Country Survey, a cohort study of adults who at the time of recruitment were smokers from six EU countries- Germany, Greece, Hungary, Poland, Romania, and Spain. D (N = 3195). Bivariate and logistic regression analyses of weighted data was conducted using SAS-callable SUDAAN. RESULTS Overall, among those who smoked factory-made cigarettes (FM) only at Wave 1, 4.3% switched to roll-your-own tobacco (RYO) only. Among RYO only users at Wave 1, 17.0% switched to FM only, however compared to all other countries, respondents from Hungary had the highest percentage of FM only users at Wave 1 switch to RYO only at Wave 2 (18.0%). CONCLUSIONS The most prominent transition overall was from smoking RYO exclusively at Wave 1 to smoking FM tobacco exclusively at Wave 2, however this varied across countries. As the tobacco control regulatory environment of the EU develops, it is important to continue to monitor transitions between types of products, as well as trends in cessation.
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Affiliation(s)
- Constantine I Vardavas
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece.,European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,European Respiratory Society, Lausanne, Switzerland
| | - Christina N Kyriakos
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece.,European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Charis Girvalaki
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece.,European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Filippos T Filippidis
- European Respiratory Society, Lausanne, Switzerland.,Department of Primary Care and Public Health, Imperial College, London, UK.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.,School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Ute Mons
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland.,Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland.,Collegium Civitas, Warsaw, Poland
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania.,Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Paraskevi A Katsaounou
- European Respiratory Society, Lausanne, Switzerland.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Witold Zatoński
- Health Promotion Foundation, Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Marc Willemsen
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
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18
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Gravely S, Driezen P, Kyriakos CN, Thompson ME, Balmford J, Demjén T, Fernández E, Mons U, Tountas Y, Janik-Koncewicz K, Zatoński W, Trofor AC, Vardavas CI, Fong GT. European adult smokers' perceptions of the harmfulness of e-cigarettes relative to combustible cigarettes: cohort findings from the 2016 and 2018 EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2021; 30:iii38-iii45. [PMID: 32191332 PMCID: PMC7526777 DOI: 10.1093/eurpub/ckz215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This study presents perceptions of the harmfulness of electronic cigarettes (e-cigarettes) relative to combustible cigarettes among smokers from six European Union (EU) countries, prior to the implementation of the EU Tobacco Products Directive (TPD), and 2 years post-TPD. Methods Data were drawn from the EUREST-PLUS ITC Europe Surveys, a cohort study of adult smokers (≥18 years) from Germany, Greece, Hungary, Poland, Romania and Spain. Data were collected in 2016 (pre-TPD: N = 6011) and 2018 (post-TPD: N = 6027). Weighted generalized estimating equations were used to estimate perceptions of the harmfulness of e-cigarettes compared to combustible cigarettes (less harmful, equally harmful, more harmful or ‘don’t know’). Results In 2016, among respondents who were aware of e-cigarettes (72.2%), 28.6% reported that they perceived e-cigarettes to be less harmful than cigarettes (range 22.0% in Spain to 34.1% in Hungary). In 2018, 72.2% of respondents were aware of e-cigarettes, of whom 28.4% reported perceiving that e-cigarettes are less harmful. The majority of respondents perceived e-cigarettes to be equally or more harmful than cigarettes in both 2016 (58.5%) and 2018 (61.8%, P > 0.05). Overall, there were no significant changes in the perceptions that e-cigarettes are less, equally or more harmful than cigarettes, but ‘don’t know’ responses significantly decreased from 12.9% to 9.8% (P = 0.036). The only significant change within countries was a decrease in ‘don’t know’ responses in Spain (19.3–9.4%, P = .001). Conclusions The majority of respondents in these six EU countries perceived e-cigarettes to be equally or more harmful than combustible cigarettes.
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Affiliation(s)
| | | | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,University of Crete, Heraklion, Greece
| | | | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.,School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yannis Tountas
- National and Kapodistrian University of Athens, Athens, Greece
| | - Kinga Janik-Koncewicz
- Health Promotion Foundation, Warsaw, Poland.,European Observatory of Health Inequalities, President Stanislaw Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Witold Zatoński
- Health Promotion Foundation, Warsaw, Poland.,European Observatory of Health Inequalities, President Stanislaw Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T.Popa', Iasi, Romania.,Aer Pur Romania, Bucharest, Romania
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,University of Crete, Heraklion, Greece
| | - Geoffrey T Fong
- University of Waterloo, Waterloo, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
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19
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Tretyakova MO, Vardavas AI, Vardavas CI, Iatrou EI, Stivaktakis PD, Burykina TI, Mezhuev YO, Tsatsakis AM, Golokhvast KS. Effects of coal microparticles on marine organisms: A review. Toxicol Rep 2021; 8:1207-1219. [PMID: 34189057 PMCID: PMC8220176 DOI: 10.1016/j.toxrep.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Coal dust is a source of pollution not only for atmospheric air but also for the marine environment. In places of storage and handling of coal near water bodies, visible pollution of the water area can be observed. Coal, despite its natural origin, can be referred to as anthropogenic sources of pollution. If coal microparticles enter the marine environment, it may cause both physical and toxic effects on organisms. The purpose of this review is to assess the stage of knowledge of the impact of coal particles on marine organisms, to identify the main factors affecting them, and to define advanced research directions. The results presented in the review have shown that coal dust in seawater is generally not an inert substance for marine organisms, and there is a need for further study of the impact of coal dust particles on marine ecosystems.
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Affiliation(s)
- M O Tretyakova
- Far Eastern Federal University, Vladivostok, Russian Federation
| | - A I Vardavas
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - C I Vardavas
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - E I Iatrou
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - P D Stivaktakis
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - T I Burykina
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Y O Mezhuev
- Mendeleev University of Chemical Technology of Russia, 125047, Moscow, Russian Federation
| | - A M Tsatsakis
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - K S Golokhvast
- Far Eastern Federal University, Vladivostok, Russian Federation.,Pacific Institute of Geography FEB RAS, Vladivostok, Russian Federation.,Siberian Federal Scientific Center for Agrobiotechnology RAS, Krasnoobsk, Russian Federation
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20
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Markina ZV, Orlova TY, Vasyanovich YA, Vardavas AI, Stivaktakis PD, Vardavas CI, Kokkinakis MN, Rezaee R, Ozcagli E, Golokhvast KS. Porphyridium purpureum microalga physiological and ultrastructural changes under copper intoxication. Toxicol Rep 2021; 8:988-993. [PMID: 34026563 PMCID: PMC8131853 DOI: 10.1016/j.toxrep.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022] Open
Abstract
The number of cells did not differ significantly at Cu 50 and 100 μg/L compared to the control, whereas Cu 150 μg/L inhibited population growth. The fluorescence of chlorophyll a increased following exposure to Cu 100 μg/L and fluorescence of phycoerythrin enhanced by Cu 150 μg/L. The content of ROS increased with increasing Cu concentration in a dose-dependent manner. The population size structure was also changed by Cu as the number of cells sized 4−6 μm increased in the presence of Cu, especially with Cu 150 μg/L.
The present work assessed the effect of copper (Cu) on cell dynamics and structure of the microalga Porphyridium purpureum (Rhodophyta, Bangiophycidae). Ultrastructure of the microalga was investigated and fluorescence of chlorophyll a and phycoerythrin, and content of reactive oxygen species (ROS) were estimated by flow cytometry. The number of cells did not show statistically significant differences at concentrations of 50 and 100 μg/L of Cu compared to the control, whereas 150 μg/L of Cu inhibited population growth. The fluorescence of chlorophyll a increased following exposure to Cu 100 μg/L and fluorescence of phycoerythrin enhanced by Cu 150 μg/L. There was no alteration in the above indicators at other concentrations. The content of ROS increased with increasing Cu concentration in a dose-dependent manner. The population size structure was also changed by Cu as the number of cells sized 4–6 μm was increased in the presence of Cu, especially with Cu 150 μg/L. Changes in the topography of thylakoids grew larger with Cu concentration.
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Affiliation(s)
- Zhanna V Markina
- A.V. Zhirmunsky Institute of Marine Biology, National Scientific Center of Marine Biology, Vladivostok, 690041, Russia
| | - Tatyana Yu Orlova
- A.V. Zhirmunsky Institute of Marine Biology, National Scientific Center of Marine Biology, Vladivostok, 690041, Russia
| | | | - Alexander I Vardavas
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | | | | | - Manolis N Kokkinakis
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece.,Hellenic Mediterranean University, Department of Nutrition and Dietetics, Heraklion, Greece
| | - Ramin Rezaee
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eren Ozcagli
- Istanbul University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 34116, Beyazıt, Istanbul, Turkey
| | - Kirill S Golokhvast
- Far Eastern Federal University, Vladivostok, 690950 Russia.,Pacific Geografical Institite FEB RAS, Vladivostok, 690014, Russia.,N.I. Vavilov All-Russian Research Institute of Plant Genetic Resources, Saint Petersburg, Russia.,Siberian Federal Scientific Center of Agrobiotechnology RAS, Krasnoobsk, Russia
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21
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Vardavas CI, Girvalaki C, Odani S, Nikitara K, de Vries I, van Riel A, van Sommeren-de Potter I, Grass JN, Grassi MC, Deim S, Balázs A, Fosztó S, Schiel H, Arif T, Eronen AK, Alonso AA, Menor JLC, Arrieta RM, Babić Ž, Turk R, Vardavas AI, Tsatsakis A. Profile of incidental exposures to e-cigarette liquids in Europe, 2018-2019. Hum Exp Toxicol 2020; 40:1045-1050. [PMID: 33272061 DOI: 10.1177/0960327120975828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Following the implementation of the European Union Tobacco Product Directive (EU TPD) regulations on e-cigarette products in 2016, we assessed the current profile of e-cigarette liquid exposure incidents and their associated health outcomes. METHODS De-identified data were received from poison centers in eight EU Member States (Sweden, the Netherlands, Italy, Hungary Austria, Finland, Spain and Croatia) reporting on e-cigarette liquid exposure incidents between August 2018 to December 2019. Descriptive analysis was conducted to present incident characteristics and health outcomes. Chi-square tests and multivariable logistic regression analysis were used to test associations. RESULTS Of the 223 e-liquid exposure incidents recorded by poison centers in multiple EU MS, 64.7% of the cases were unintentional exposures, ranging from 48.4% among adults aged ≥19 years to 100.0% among children aged 0-5 years (p < 0.05). The most frequent route of exposure was ingestion (73.5%) while55.2% experienced any clinical symptoms, including nausea (16.6%), vomiting (11.1%), and dizziness (9.0%). 57.8% of the cases were treated at the residence or on-site. CONCLUSION Further monitoring is warranted, using uniform reporting requirements, to ensure the continued compliance to the EU TPD and assess its long-term impact on related incident characteristics.
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Affiliation(s)
- Constantine I Vardavas
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Charis Girvalaki
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Satomi Odani
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Katerina Nikitara
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Irma de Vries
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antoinette van Riel
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Maria Caterina Grassi
- Clinical Toxicology-Poison Control Centre and Drug Dependence Unit, Policlinico Umberto I-"Sapienza University of Rome", Rome, Italy
| | - Szilvia Deim
- National Public Health Center, Department for Chemical Safety and Competent Authority, Unit for Health Toxicological Information Service and Notification, Hungary
| | - Andrea Balázs
- National Public Health Center, Department for Chemical Safety and Competent Authority, Unit for Health Toxicological Information Service and Notification, Hungary
| | - Szabolcs Fosztó
- National Public Health Center, Department for Chemical Safety and Competent Authority, Unit for Health Toxicological Information Service and Notification, Hungary
| | | | - Tara Arif
- Poisons Information Centre, Vienna, Austria
| | | | | | | | | | - Željka Babić
- Croatian Poison Control Centre at Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Rajka Turk
- Croatian Poison Control Centre at Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Alexander I Vardavas
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Aristidis Tsatsakis
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
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22
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Girvalaki C, Filippidis FT, Kyriakos CN, Driezen P, Herbeć A, Mons U, Papadakis S, Mechili EA, Katsaounou PA, Przewoźniak K, Fernández E, Trofor AC, Demjén T, Fong GT, Vardavas CI. Perceptions, Predictors of and Motivation for Quitting among Smokers from Six European Countries from 2016 to 2018: Findings from EUREST-PLUS ITC Europe Surveys. Int J Environ Res Public Health 2020; 17:E6263. [PMID: 32872132 PMCID: PMC7504326 DOI: 10.3390/ijerph17176263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/23/2022]
Abstract
The European Tobacco Products Directive (TPD) was introduced in 2016 in an effort to decrease prevalence of smoking and increase cessation in the European Union (EU). This study aimed to explore quitting behaviours, motivation, reasons and perceptions about quitting, as well as predictors (reported before the TPD implementation) associated with post-TPD quit status. A cohort study was conducted involving adult smokers from six EU countries (n = 3195). Data collection occurred pre-(Wave 1; 2016) and post-(Wave 2; 2018) TPD implementation. Bivariate and logistic regression analyses of weighted data were conducted. Within this cohort sample, 415 (13.0%) respondents reported quitting at Wave 2. Predictors of quitting were moderate or high education, fewer cigarettes smoked per day at baseline, a past quit attempt, lower level of perceived addiction, plans for quitting and the presence of a smoking-related comorbidity. Health concerns, price of cigarettes and being a good example for children were among the most important reasons that predicted being a quitter at Wave 2. Our findings show that the factors influencing decisions about quitting may be shared among European countries. European policy and the revised version of TPD could emphasise these factors through health warnings and/or campaigns and other policies.
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Affiliation(s)
- Charis Girvalaki
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, Imperial College, London W6 8RP, UK;
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, 10561 Athens, Greece;
| | - Christina N. Kyriakos
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Aleksandra Herbeć
- Health Promotion Foundation, 00 764 Warsaw, Poland; (A.H.); (K.P.); (G.T.F.)
- Centre for Behaviour Change, Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
- Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
| | - Sophia Papadakis
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, and Faculty of Medicine, University of Ottawa, Ottawa, ON K1Y 4W7, Canada
| | - Enkeleint A. Mechili
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
- Department of Health Care, Faculty of Public Health, University of Vlora, 9401 Vlora, Albania
| | - Paraskevi A. Katsaounou
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, 10561 Athens, Greece;
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, 00 764 Warsaw, Poland; (A.H.); (K.P.); (G.T.F.)
- Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Collegium Civitas, 00-901 Warsaw, Poland
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), 08908 L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain;
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, 08908 L’Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), 28029 Madrid, Spain
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, 700115 Iasi, Romania;
- Aer Pur Romania, 052034 Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, 1044 Budapest, Hungary;
| | - Geoffrey T. Fong
- Health Promotion Foundation, 00 764 Warsaw, Poland; (A.H.); (K.P.); (G.T.F.)
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| | - Constantine I. Vardavas
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
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23
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Bahdila D, Aldosari M, Abdullah A, Nelson JL, Hegazi F, Badamia R, Alhazmi H, Chandel T, Odani S, Vardavas CI, Agaku IT. Cocaine, polysubstance abuse, and oral health outcomes, NHANES 2009 to 2014. J Periodontol 2020; 91:1039-1048. [PMID: 31919844 DOI: 10.1002/jper.19-0509] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/20/2019] [Accepted: 12/04/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cocaine is the second most abused illicit drug in the United States. To date, no study has examined the association between cocaine use and oral health with a nationally representative sample. Our study examined the association between cocaine use-singly and with other substances-and oral health outcomes, including periodontitis and untreated caries, among US adults. METHODS Data for 11,753 individuals, aged ≥30 years, who completed a periodontal examination, in the 2009 to 2014 National Health and Nutrition Examination Survey (NHANES) were analyzed. Descriptive analyses and multivariable binary logistic regression analyses were conducted on weighted data. RESULTS Overall, 17% (20.5 million) of US adults aged ≥30 years had ever used cocaine, with higher likelihood seen among males, non-Hispanic whites, and those living in poverty. Current cocaine use prevalence was 2.6% (3.2 million). By number of co-used substances, the odds of having any periodontitis were higher among cocaine users who consumed ≥3 other substances (adjusted OR = 2.47; 95% CI = 1.15 to 5.30) when compared with solely cocaine users. By type of substance co-used, odds of having untreated caries were greater among those reporting cigarettes (adjusted OR = 1.94; 95% CI = 1.21 to 3.11) or methamphetamine (adjusted OR = 5.40; 95% CI = 1.92 to 15.14) usage. Odds of any periodontitis were higher among those reported ancillary cigarette use (adjusted OR = 2.84; 95% CI = 1.60 to 5.04) compared with cocaine-only users. CONCLUSIONS In addition to a positive association between periodontal disease, dental caries, and cocaine use, select co-usage elevated the risk of oral disease. Patients should be screened for and counseled regarding substance abuse to facilitate a successful quit.
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Affiliation(s)
- Dania Bahdila
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Preventive Dental Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muath Aldosari
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Abeer Abdullah
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Preventive Dental Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jevae L Nelson
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Fahad Hegazi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Riddhi Badamia
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Hesham Alhazmi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Preventive Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Tejasvita Chandel
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Satomi Odani
- The National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Constantine I Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Israel T Agaku
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
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24
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Kyriakos CN, Driezen P, Girvalaki C, Hitchman SC, Filippidis FT, Gravely S, Balmford J, Nikitara K, Mons U, Fernández E, Przewoźniak K, Trofor AC, Demjén T, Zatoński W, Tountas Y, Fong GT, Vardavas CI. Awareness and correlates of noticing changes to cigarette packaging design after implementation of the European Tobacco Products Directive: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii98-iii107. [PMID: 32918819 PMCID: PMC7526785 DOI: 10.1093/eurpub/ckaa057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The European Tobacco Products Directive (TPD), which went into effect in May 2016, regulates packaging design and labelling of cigarettes and roll-your-own (RYO) tobacco. The aim of the current study was to examine whether smokers and recent quitters in six European Union (EU) countries (Germany, Greece, Hungary, Poland, Romania and Spain) reported noticing TPD-related changes to packaging, and correlates of noticing these changes. METHODS Cross-sectional data from the Wave 2 of the ITC 6 European Country Survey in 2018 after implementation of the TPD. Bivariate analyses included adult smokers (n = 5597) and recent quitters (n = 412). Adjusted logistic regression analyses were restricted to the subset of current smokers (n = 5597) and conducted using SAS-callable SUDAAN. RESULTS Over half of smokers (58.2%) and 30% of quitters noticed at least one of five types of TPD-related pack changes. Over one-quarter of all respondents noticed changes to health warnings (30.0%), standardized openings (27.7%), minimum pack unit size (27.9%), and the removal of tar, nicotine and carbon monoxide information (26.7%) on packaging. Cross-country differences were observed across all measures, with noticing all pack changes markedly lower in Spain than the other countries. Correlates of noticing specific pack changes included sociodemographic characteristics, smoking behaviours and related to packaging. CONCLUSIONS This is one of the first cross-country studies to examine the extent to which TPD changes to cigarette and RYO tobacco packaging are being noticed by smokers and recent quitters. Findings indicate that the majority of smokers noticed at least one type of pack change, but this varied across countries and sub-populations.
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Affiliation(s)
- Christina N Kyriakos
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Charis Girvalaki
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | - Filippos T Filippidis
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Witold Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanislaw, Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Yannis Tountas
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Geoffrey T Fong
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- Department of Psychology, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Constantine I Vardavas
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
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25
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Zatoński M, Herbeć A, Zatoński W, Janik-Koncewicz K, Driezen P, Demjén T, Fernández E, Fong GT, Quah ACK, Kyriakos CN, McNeill A, Willemsen M, Mons U, Tountas Y, Trofor AC, Vardavas CI, Przewoźniak K. Cessation behaviours among smokers of menthol and flavoured cigarettes following the implementation of the EU Tobacco Products Directive: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii34-iii37. [PMID: 32918816 PMCID: PMC7526784 DOI: 10.1093/eurpub/ckaa050] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The European Tobacco Products Directive (TPD) introduced a ban on characterizing flavours in cigarettes (2016), including menthol (2020). The longitudinal data analysis of the EUREST-PLUS International Tobacco Control (ITC) Project Europe Surveys (n = 16 534; Wave 1 in 2016 and Wave 2 in 2018) found significant but small declines in the weighted prevalence of menthol (by 0.94%; P = 0.041) and other flavoured cigarette use (by 1.32%; P < 0.001) following the 2016 TPD. The declines tended to be driven primarily by the menthol and flavoured cigarette (MFC) smokers switching to unflavoured tobacco. Cigarette consumption declined between waves, but there were no statistically significant difference in decline between MFC and unflavoured tobacco smokers on smoking and cessation behaviours between the waves.
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Affiliation(s)
- Mateusz Zatoński
- Health Promotion Foundation, Warsaw, Poland
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
- European Observatory of Health Inequalities, President Stanislaw, Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Aleksandra Herbeć
- Health Promotion Foundation, Warsaw, Poland
- Centre for Behaviour Change, Clinical, Educational and Health Psychology, University College London, UK
| | - Witold Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanislaw, Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Kinga Janik-Koncewicz
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanislaw, Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Esteve Fernández
- Cancer Epidemiology and Prevention Department, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Christina N Kyriakos
- Ontario Institute for Cancer Research, Toronto, Canada
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Marc Willemsen
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Ute Mons
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany
| | - Yannis Tountas
- Center for Health Services Research, School of Medicine, 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
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- School of Medicine, University of Crete (UoC), Heraklion, Greece
- European Respiratory Society, Lausanne, Switzerland
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
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26
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Nikitara K, Girvalaki C, Kyriakos CN, Driezen P, Filippidis FT, Kahnert S, Hitchman SC, Mons U, Fernández E, Trofor AC, Przewoźniak K, Demjén T, Katsaounou PA, Zatoński W, Fong GT, Vardavas CI. Changes in electronic cigarette use and label awareness among smokers before and after the European Tobacco Products Directive implementation in six European countries: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii62-iii67. [PMID: 32918814 DOI: 10.1093/eurpub/ckaa081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Article 20 of the European Tobacco Product Directive (TPD), which went into effect in May 2016, regulates electronic cigarettes (e-cigarettes) in the European Union (EU). The aim of this study was to evaluate changes in e-cigarette use, design attributes of the products used and awareness of e-cigarette labelling and packaging among smokers from six EU Member States (MS) before and after TPD implementation. METHODS Data come from Wave 1 (2016, pre-TPD) and Wave 2 (2018, post-TPD) of the ITC Six European Country Survey among a sample of smokers and recent quitters who use e-cigarettes from six EU MS. Weighted logistic generalized estimating equations regression models were estimated to test the change in binary outcomes between Waves 1 and 2 using SAS-callable SUDAAN. RESULTS In 2018, current daily/weekly e-cigarette use among adult smokers was just over 2%, but this varied from the highest in Greece (4%) to lowest in Poland (1.2%). From Waves 1 to 2, there was a significant increase in respondents reporting noticing and reading health and product safety information on leaflets inside e-cigarette packaging (8.39-11.62%, P < 0.001). There were no significant changes between waves of respondents reporting noticing or reading warning labels on e-cigarette packages/vials. CONCLUSIONS e-cigarette use among smokers in these six EU countries is low. Although reported noticing and reading leaflets included in the packaging of e-cigarettes increased significantly from before to after the TPD, there was no significant change in reported noticing and reading of warning labels. Findings indicate the importance of continued monitoring of TPD provisions around e-cigarettes.
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Affiliation(s)
- Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, Imperial College London, London, UK.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sarah Kahnert
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany
| | | | - Ute Mons
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.,School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania.,AerPur Romania, Bucharest, Romania
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland.,Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Collegium Civitas, Warsaw, Poland
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Paraskevi A Katsaounou
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Witold Zatoński
- Health Promotion Foundation, Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
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27
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Chung-Hall J, Fong GT, Meng G, Craig LV, McNeill A, Hitchman SC, Fernández E, Mons U, Trofor AC, Przewoźniak K, Zatoński WA, Demjén T, Katsaounou PA, Kyriakos CN, Vardavas CI. Support for e-cigarette policies among smokers in seven European countries: longitudinal findings from the 2016-18 EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii68-iii77. [PMID: 32918824 DOI: 10.1093/eurpub/ckaa085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The 2016 European Tobacco Products Directive (TPD) required Member States (MS) to implement new regulations for electronic cigarettes (ECs). We conducted a longitudinal study to assess changes over 2 years in smokers' support for EC policies and identify predictors of support in seven European countries after TPD implementation. METHODS Prospective cohort surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, Spain and England in 2016 (n = 9547; just after TPD) and 2018 (n = 10 287; 2 years after TPD). Multivariable logistic regression models employing generalized estimating equations assessed changes in support for four EC policies, and tested for country differences and strength of key predictors of support. RESULTS Banning EC use in smoke-free places was supported by 53.1% in 2016 and 54.6% in 2018 with a significant increase in Greece (51.7-66.0%) and a decrease in Spain (60.1-48.6%). Restricting EC/e-liquid nicotine content was supported by 52.2 and 47.4% in 2016 and 2018, respectively, with a significant decrease in England (54.2-46.5%) and Romania (52.5-41.0%). An EC promotion ban was supported by 41.1 and 40.2%. A flavour ban was supported by 33.3% and 32.3% with a significant increase in Hungary (34.3-43.3%). Support was generally higher in Poland, Hungary and Greece vs. England. Support was lower among dual and EC-only users, and low-income smokers. CONCLUSIONS Smokers in all countries strongly supported banning EC use in smoke-free places and restricting nicotine content after TPD implementation, with no clear trends for changes in policy support.
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Affiliation(s)
- Janet Chung-Hall
- 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
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine V Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Ann McNeill
- Department of Addictions, King's College London, London, UK
| | | | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.,School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Lasi, Romania.,Aer Pur Romania, Bucharest, Romania
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland.,Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Collegium Civitas, Warsaw, Poland
| | - Witold A Zatoński
- Health Promotion Foundation, Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Paraskevi A Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
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28
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Kahnert S, Driezen P, Balmford J, Kyriakos CN, Demjén T, Fernández E, Katsaounou PA, Trofor AC, Przewoźniak K, Zatoński WA, Fong GT, Vardavas CI, Mons U. Impact of the Tobacco Products Directive on self-reported exposure to e-cigarette advertising, promotion and sponsorship in smokers-findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii55-iii61. [PMID: 32918820 PMCID: PMC7526780 DOI: 10.1093/eurpub/ckaa055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advertising, promotion and sponsorship of electronic cigarettes (ECAPS) have increased in recent years. Since May 2016, the Tobacco Products Directive 2014/40/EU (TPD2) prohibits ECAPS in various advertising channels, including media that have cross-border effects. The objective of this study was to investigate changes in exposure to ECAPS in a cohort of smokers from six European Union member states after implementation of TPD2. METHODS Self-reported exposure to ECAPS overall and in various media and localities was examined over two International Tobacco Control Policy Evaluation survey waves (2016 and 2018) in a cohort of 6011 adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (EUREST-PLUS Project) using longitudinal generalized estimating equations models. RESULTS Self-reported ECAPS exposure at both timepoints varied between countries and across examined advertising channels. Overall, there was a significant increase in ECAPS exposure [adjusted odds ratio (aOR): 1.25, 95% CI: 1.09-1.44]. Between waves, no consistent patterns of change in ECAPS exposure across countries and different media were observed. Generally, ECAPS exposure tended to decline in some channels regulated by TPD2, particularly on television and radio, while exposure tended to increase in some unregulated channels, such as at points of sale. CONCLUSIONS The findings suggest that the TPD2 was generally effective in reducing ECAPS in regulated channels. Nonetheless, further research is warranted to evaluate its role in reducing ECAPS exposure, possibly by triangulation with additional sources of data.
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Affiliation(s)
- Sarah Kahnert
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Esteve Fernández
- Department of Cancer Epidemiology and Prevention, Catalan Institute of Oncology (ICO), Barcelona, Spain
- Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Paraskevi A Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
- European Respiratory Society, Lausanne, Switzerland
| | - Antigona C Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’, 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
| | - Witold A Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
- European Respiratory Society, Lausanne, Switzerland
| | - Ute Mons
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Papadakis S, Katsaounou P, Kyriakos CN, Balmford J, Tzavara C, Girvalaki C, Driezen P, Filippidis FT, Herbeć A, Hummel K, McNeill A, Mons U, Fernández E, Fu M, Trofor AC, Demjén T, Zatoński WA, Willemsen M, Fong GT, Vardavas CI. Quitting behaviours and cessation methods used in eight European Countries in 2018: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii26-iii33. [PMID: 32918825 PMCID: PMC7526775 DOI: 10.1093/eurpub/ckaa082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We examined quit attempts, use of cessation assistance, quitting beliefs and intentions among smokers who participated in the 2018 International Tobacco Control (ITC) Europe Surveys in eight European Union Member States (England, Germany, Greece, Hungary, the Netherlands, Poland, Romania and Spain). METHODS Cross-sectional data from 11 543 smokers were collected from Wave 2 of the ITC Six European Country (6E) Survey (Germany, Greece, Hungary, Poland, Romania and Spain-2018), the ITC Netherlands Survey (the Netherlands-late 2017) and the Four Countries Smoking and Vaping (4CV1) Survey (England-2018). Logistic regression was used to examine associations between smokers' characteristics and recent quit attempts. RESULTS Quit attempts in the past 12 months were more frequently reported by respondents in the Netherlands (33.0%) and England (29.3%) and least frequently in Hungary (11.5%), Greece (14.7%), Poland (16.7%) and Germany (16.7%). With the exception of England (35.9%), the majority (56-84%) of recent quit attempts was unaided. Making a quit attempt was associated with younger age, higher education and income, having a smoking-related illness and living in England. In all countries, the majority of continuing smokers did not intend to quit in the next 6 months, had moderate to high levels of nicotine dependence and perceived quitting to be difficult. CONCLUSIONS Apart from England and the Netherlands, smokers made few quit attempts in the past year and had low intentions to quit in the near future. The use of cessation assistance was sub-optimal. There is a need to examine approaches to supporting quitting among the significant proportion of tobacco users in Europe and increase the use of cessation support as part of quit attempts.
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Affiliation(s)
- Sophia Papadakis
- School of Medicine, University of Crete (UoC), Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paraskevi Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina N Kyriakos
- School of Medicine, University of Crete (UoC), Heraklion, Greece
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Chara Tzavara
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Girvalaki
- School of Medicine, University of Crete (UoC), Heraklion, Greece
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
| | - Filippos T Filippidis
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Aleksandra Herbeć
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Tobacco and Alcohol Research Group, University College London, London, UK
| | - Karin Hummel
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Ann McNeill
- Department of Addictions, King’s College London, London, UK
| | - Ute Mons
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat (Barcelona), Catalonia
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Catalonia
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat (Barcelona), Catalonia
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Catalonia
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Antigona C Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Witold A Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Marc Willemsen
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - 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, Toronto, Canada
| | - Constantine I Vardavas
- School of Medicine, University of Crete (UoC), Heraklion, Greece
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
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30
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Nogueira SO, Tigova O, Driezen P, Fu M, Kyriakos CN, Zatoński M, Mons U, Quah ACK, Demjén T, Trofor AC, Przewoźniak K, Katsaounou PA, Fong GT, Vardavas CI, Fernández E. Do smokers want to protect non-smokers from the harms of second-hand smoke in cars? Findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii108-iii112. [PMID: 32918821 DOI: 10.1093/eurpub/ckaa056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is currently no comprehensive legislation protecting non-smokers and children from second-hand smoke (SHS) exposure in private cars at the European Union (EU) level. This study aims to assess smokers' support for smoke-free cars legislation in six EU countries. METHODS Data come from the EUREST-PLUS ITC Europe Surveys: Wave 1 (2016, n = 6011) and Wave 2 (2018, n = 6027) conducted in Germany, Greece, Hungary, Poland, Romania and Spain. Support for smoke-free cars carrying pre-school children and non-smokers and voluntary implementation of smoke-free cars were assessed among adult smokers. Generalized estimating equations models were used to assess changes in support between waves. RESULTS In 2018, 96.3% [95% confidence interval (CI) 95.4-97.0%] of the overall sample supported smoke-free legislation for cars carrying pre-school children, representing an increase of 2.4 percentage points in comparison to 2016. Smoke-free legislation for cars transporting non-smokers was supported by 85.2% (95% CI 83.1-87.1%) of smokers' in 2016 and 90.2% (95% CI 88.6-91.7%) in 2018. Among smokers who owned cars, there was a significant 7.2 percentage points increase in voluntary implementation of smoke-free cars carrying children from 2016 (60.7%, 95% CI 57.2-64.0%) to 2018 (67.9%, 95% CI 65.1-70.5%). All sociodemographic groups of smokers reported support higher than 80% in 2018. CONCLUSION The vast majority of smokers in all six EU countries support smoke-free legislation for cars carrying pre-school children and non-smokers. This almost universal support across countries and sociodemographic groups is a clear indicator of a window of opportunity for the introduction of comprehensive legislation to protect non-smokers and children from SHS exposure in cars.
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Affiliation(s)
- Sarah O Nogueira
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Olena Tigova
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Pete Driezen
- Department of Psychology, University of Waterloo (UW), Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,School of Medicine, University of Crete (UoC), Heraklion, Greece
| | - Mateusz Zatoński
- Health Promotion Foundation (HPF), Warsaw, Poland.,Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK.,European Observatory of Health Inequalities, President Stanislaw, Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Ute Mons
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany
| | - Anne C K Quah
- Department of Psychology, University of Waterloo (UW), Waterloo, Canada
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), 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 (HPF), Warsaw, Poland.,Maria Skłodowska-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 (UoA), Athens, Greece.,European Respiratory Society, Lausanne, Switzerland
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo (UW), Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,School of Medicine, University of Crete (UoC), Heraklion, Greece
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
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31
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Filippidis FT, Driezen P, Kyriakos CN, Katsaounou P, Petroulia I, Girvalaki C, Fu M, Fernández E, Mons U, Trofor AC, Demjén T, Przewoźniak K, Zatoński WA, Fong GT, Tountas Y, Vardavas CI. Transitions from and to roll-your-own tobacco, perceptions and health beliefs among smokers: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii18-iii25. [PMID: 32267933 PMCID: PMC7526787 DOI: 10.1093/eurpub/ckz214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of roll-your-own tobacco (RYO) in Europe has been increasing. The aim of this study was to investigate transitions between factory-made (FM) cigarettes and RYO in a longitudinal sample of European smokers, and their perceptions of relative harmfulness and knowledge of health effects. METHODS We used data collected from the EUREST-PLUS ITC 6 European Country (6E) Surveys in 2016 (n = 6011 smokers) and in 2018 (n = 6027) in Germany, Greece, Hungary, Poland, Romania and Spain. A total of 3195 cohort respondents were interviewed in both years. Use of RYO and FM, knowledge of health effects of smoking as well as perceptions about RYO were assessed. We used logistic regression models to explore sociodemographic correlates of transitions from one product to the other, of perceptions and knowledge related to smoking health effects. RESULTS Approximately 7.4% of exclusive FM smokers transitioned to RYO and 29.5% of exclusive RYO smokers transitioned to FM cigarettes from 2016 to 2018. RYO use in 2018 was more frequent among smokers of low education and income, but none of these factors were associated with transitions. Most RYO smokers perceived RYO as cheaper than FM and 21.7% of them considered RYO to be less harmful than FM. Knowledge of the health effects of smoking was not associated with type of product smoked. CONCLUSIONS RYO is popular among European smokers; its lower cost seems to be a major factor for RYO users; reasons for transitions to and from RYO are less clear and need to be further investigated.
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Affiliation(s)
- Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - Paraskevi Katsaounou
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Petroulia
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Girvalaki
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat (Barcelona), Catalonia
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Catalonia
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat (Barcelona), Catalonia
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Catalonia
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antigona C Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
| | - Witold A Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Yannis Tountas
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
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Maria Lotrean L, Trofor A, Radu-Loghin C, Eremia M, Mihaltan F, Driezen P, Kyriakos CN, Mons U, Demjén T, Fernández E, Katsaounou PA, Przewoźniak K, Filippidis FT, Gravely S, Fong GT, Vardavas CI. Awareness and use of heated tobacco products among adult smokers in six European countries: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii78-iii83. [PMID: 32918826 PMCID: PMC7526786 DOI: 10.1093/eurpub/ckz228] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The study assessed awareness and use of heated tobacco products (HTPs) and factors that influenced these issues among cigarette smokers from six European countries in 2016 (Wave 1) and 2018 (Wave 2). METHODS A survey was conducted among a nationally representative sample of cigarette smokers aged 18 years or older from Germany, Greece, Hungary, Poland, Romania and Spain in 2016 (N = 6011) and 2018 (N = 6027; 53% of smokers from the previous wave were retained, regardless of smoking status and dropouts were replaced by a replenishment sample of smokers). Data were collected through face-to-face interviews. Estimates were produced using weighted data. The study presents the cross-sectional results. RESULTS Awareness of HTPs increased from 8% to 17% between the two waves. At Wave 1, 1.1% of the smokers declared having used HTPs at least once during their lifetime; and at Wave 2, this increased to 1.9% (around 1% or less in four countries, except for Greece and Romania where it was around 4%). Factors associated with HTPs use among those who had ever heard about these products at Wave 1 were country of residence, being a daily cigarette smoker and ever use of electronic cigarettes. At Wave 2, ever use of HTPs was significantly higher among those who had tried to quit smoking combustible cigarettes in the last 12 months, had tried electronic cigarettes during lifetime and perceived HTPs as less dangerous than combustible cigarettes; the country of residence was also associated with HTPs use. CONCLUSION This study offers insights into the behaviours and perceptions of European adult smokers regarding HTPs, an important emerging issue in the field of tobacco control.
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Affiliation(s)
- Lucia Maria Lotrean
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- AerPur Romania, Bucuresti, Romania
| | - Antigona Trofor
- AerPur Romania, Bucuresti, Romania
- University of Medicine and Pharmacy, “Grigore T.Popa”, Iasi, Romania
| | | | | | - Florin Mihaltan
- AerPur Romania, Bucuresti, Romania
- University of Medicine and Pharmacy “Carol Davilla”, Bucharest, Romania
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Department of School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Laboratory of Toxicology, School of Medicine, University of Crete, Greece
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Germany
| | | | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat (Barcelona), Catalonia, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Paraskevi A Katsaounou
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Skłodowska Curie Institute, Oncology Center, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
| | - Filippos T Filippidis
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Department of School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Laboratory of Toxicology, School of Medicine, University of Crete, Greece
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33
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Vardavas CI, Kyriakos CN, McNeill A, Fong GT. Evaluating the impact of the Tobacco Products Directive within the context of the FCTC in Europe-findings from the EUREST-PLUS ITC Europe Surveys: introductory Commentary. Eur J Public Health 2020; 30:iii1-iii3. [PMID: 32918823 PMCID: PMC7526776 DOI: 10.1093/eurpub/ckaa110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Ann McNeill
- Department of Addictions, King’s College London, London, UK
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
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Kahnert S, Driezen P, Balmford J, Kyriakos CN, Aleyan S, Hitchman SC, Nogueira S, Demjén T, Fernández E, Katsaounou PA, Trofor AC, Przewoźniak K, Zatoński WA, Fong GT, Vardavas CI, Mons U. Effectiveness of tobacco warning labels before and after implementation of the European Tobacco Products Directive-findings from the longitudinal EUREST-PLUS ITC Europe surveys. Eur J Public Health 2020; 30:iii84-iii90. [PMID: 32918822 PMCID: PMC7526774 DOI: 10.1093/eurpub/ckaa039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tobacco product packaging is a key part of marketing efforts to make tobacco use appealing. In contrast, large, prominent health warnings are intended to inform individuals about the risks of smoking. In the European Union, since May 2016, the Tobacco Products Directive 2014/40/EU (TPD2) requires tobacco product packages to carry combined health warnings consisting of a picture, a text warning and information on stop smoking services, covering 65% of the front and back of the packages. METHODS Key measures of warning label effectiveness (salience, cognitive reactions and behavioural reaction) before and after implementation of the TPD2, determinants of warning labels' effectiveness and country differences were examined in a longitudinal sample of 6011 adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (EUREST-PLUS Project) using longitudinal Generalized Estimating Equations (GEE) models. RESULTS In the pooled sample, the warning labels' effectiveness increased significantly over time in terms of salience (adjusted OR = 1.18; 95% CI: 1.03-1.35), while cognitive and behavioural reactions did not show clear increases. Generally, among women, more highly educated smokers and less addicted smokers, the effectiveness of warning labels tended to be higher. CONCLUSION We found an increase in salience, but no clear increases for cognitive and behavioural reactions to the new warning labels as required by the TPD2. While it is likely that our study underestimated the impact of the new pictorial warning labels, it provides evidence that health messages on tobacco packaging are more salient when supported by large pictures.
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Affiliation(s)
- Sarah Kahnert
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Sarah Aleyan
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
| | - Sara C Hitchman
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
| | - Sarah Nogueira
- Cancer Epidemiology and Prevention Department, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Esteve Fernández
- Cancer Epidemiology and Prevention Department, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Paraskevi A Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
- European Respiratory Society, Lausanne, Switzerland
| | - 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
| | - Witold A Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - 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
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
- European Respiratory Society, Lausanne, Switzerland
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
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McDermott MS, East KA, Hitchman SC, McNeill A, Tountas Y, Demjén T, Fernández E, Mons U, Trofor AC, Herbeć A, Janik-Koncewicz K, Fong GT, Vardavas CI. Social norms for e-cigarettes and smoking: associations with initiation of e-cigarette use, intentions to quit smoking and quit attempts: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii46-iii54. [PMID: 32918818 DOI: 10.1093/eurpub/ckaa014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Social norms have received little attention in relation to electronic cigarettes (EC). The current study examine social norms for EC use and smoking tobacco, and their associations with (i) initiation of EC use, (ii) intention to quit smoking and (iii) attempts to quit smoking. METHODS Cross-sectional and longitudinal data analysis from Waves 1 and 2 of the ITC 6 European Country Survey and corresponding waves from England (the ITC Four Country Smoking and Vaping Survey). Current smokers at baseline, who heard of ECs and provided data at both waves were included (n = 3702). Complex samples logistic regression examined associations between the outcomes and descriptive (seeing EC use in public, close friends using ECs/smoking) and injunctive (public approves of ECs/smoking) norms, adjusting for country, demographics, EC use and heaviness of smoking. RESULTS In longitudinal analyses, seeing EC use in public at least some days was the only social norm that predicted initiation of EC use between waves (OR = 1.66, 95%CI = 1.08-2.56). In the cross-sectional analysis, having an intention to quit was associated with seeing EC use in public (OR = 1.37, 95%CI = 1.04-1.81) and reporting fewer than three close friends smoke (OR = 0.59, 95%CI = 0.44-0.80). There was no association between any social norm and making a quit attempt between waves. CONCLUSIONS Initiation of EC use is predicted by seeing EC use in public, which was also associated with greater intention to quit smoking. Friends' smoking was associated with lower intention to quit. These findings may allay concerns that increased visibility of ECs is renormalizing smoking amongst current smokers.
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Affiliation(s)
| | - Katherine A East
- National Addiction Centre, King's College London, London, UK.,Shaping Public Health Policies to Reduce Inequalities and Harm (SPECTRUM), Nottingham, UK
| | - Sara C Hitchman
- National Addiction Centre, King's College London, London, UK.,Shaping Public Health Policies to Reduce Inequalities and Harm (SPECTRUM), Nottingham, UK
| | - Ann McNeill
- National Addiction Centre, King's College London, London, UK.,Shaping Public Health Policies to Reduce Inequalities and Harm (SPECTRUM), Nottingham, UK
| | - Yannis Tountas
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain.,School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Ute Mons
- German Cancer Research Center (DKFZ), Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany
| | - Antigona C Trofor
- Aer Pur Romania, Bucharest, Romania.,University of Medicine and Pharmacy 'Grigore T.Popa', Iasi, Romania
| | - Aleksandra Herbeć
- Health Promotion Foundation (HPF), Warsaw, Poland.,UCL Tobacco and Alcohol Research Group, London, UK
| | | | - Geoffrey T Fong
- Departments of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I Vardavas
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,Laboratory of Toxicology, School of Medicine, University of Crete (UoC), Heraklion, Greece.,European Respiratory Society, Lausanne, Switzerland
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Girvalaki C, Mechili EA, Papadakis S, Nikitara K, Demin A, Trofor A, Lila A, Harutyunyan A, Saliaj A, Dimitrievska D, Lozano FR, Bakh-Turidze G, Ayesta J, Przewozniak K, Cattaruzza MS, Zdraveska M, Lovše M, Kilibarda B, Stoyka O, Behrakis P, Bizel P, Starchenko P, Spahija S, Radu-Loghin C, Vardavas CI. Current practices and perceived barriers to tobacco-treatment delivery among healthcare professionals from 15 European countries. The EPACTT Plus project. Tob Prev Cessat 2020; 6:6. [PMID: 32548343 PMCID: PMC7291907 DOI: 10.18332/tpc/115033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The latest evidence-based Guidelines for Treating Tobacco Dependence highlight the significant role of healthcare professionals in supporting smokers interested to quit. This study aimed to identify the current practices of healthcare professionals in Europe and perceived barriers in delivering tobacco treatment to their patients who smoke. METHODS In the context of EPACTT-Plus, collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine) worked for the development of an accredited eLearning course on Tobacco Treatment Delivery available at http://elearning-ensp.eu/. In total, 444 healthcare professionals from the wider European region successfully completed the course from December 2018 to July 2019. Cross-sectional data were collected online on healthcare professionals’ current practices and perceived barriers in introducing tobacco-dependence treatment into their daily clinical life. RESULTS At registration, 41.2% of the participants reported having asked their patients if they smoked. Advise to quit smoking was offered by 47.1% of the participants, while 29.5% reported offering assistance to their patients who smoked in order to quit. From the total number of participants, 39.9% regarded the lack of patient compliance as a significant barrier. Other key barriers were lack of: interest from the patients (37.4%), healthcare professionals training (33.1%), community resources to refer patients (31.5%), and adequate time during their everyday clinical life (29.7%). CONCLUSIONS The identification of current practices and significant barriers is important to build evidence-based guidelines and training programs (online and/or live) that will improve the performance of healthcare professionals in offering tobacco-dependence treatment for their patients who smoke.
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Affiliation(s)
- Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Enkeleint A Mechili
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece.,Department of Healthcare, Faculty of Health, University of Vlora, Vlore, Albania
| | - Sophia Papadakis
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Andrey Demin
- Institute of Leadership and Healthcare Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Antigona Trofor
- University of Medicine and Pharmacy 'Grigore T.Popa', Iasi, Romania.,AER PUR Romania, Bucharest, Romania
| | - Arben Lila
- Kosovo Advocacy and Development Center, Prishtina, Kosovo
| | - Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Aurela Saliaj
- Department of Healthcare, Faculty of Health, University of Vlora, Vlore, Albania
| | | | - Francisco Rodriguez Lozano
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Comité Nacional de Prevención del Tabaquismo, Madrid, Spain
| | | | | | - Krzysztof Przewozniak
- Foundation 'Smart Health - Health in 3D', Warsaw, Poland.,Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Sofia Cattaruzza
- Department of Public Health & Infectious Diseases, Sapienza University, Rome, Italy.,SITAB, Società Italiana di Tabaccologia, Rome, Italy
| | | | - Mihaela Lovše
- Slovenian Coalition for Tobacco Control, Ljubljana, Slovenia
| | | | | | - Panagiotis Behrakis
- George D. Behrakis Research Laboratory, Athens, Greece.,Hellenic Cancer Society, Athens, Greece
| | | | - Polina Starchenko
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | | | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Medical School, University of Crete, Heraklion, Greece
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Girvalaki C, Papadakis S, Mechili EA, Nikitara K, Demin A, Trofor AC, Lila A, Harutyunyan A, Saliaj A, Dimitrievska D, Lozano FR, Bakhturidze G, Ayesta J, Przewoźniak K, Cattaruzza MS, Zdraveska M, Lovše M, Kilibarda B, Stoyka O, Behrakis P, Bizel P, Starchenko P, Spahija S, Radu-Loghin C, Vardavas CI. Impact of the ENSP eLearning platform on improving knowledge, attitudes and self-efficacy for treating tobacco dependence: An assessment across 15 European countries. Tob Induc Dis 2020; 18:40. [PMID: 32435174 PMCID: PMC7233524 DOI: 10.18332/tid/120188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals' knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines. METHODS We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019. RESULTS Healthcare professionals' self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals' self-efficacy in delivering tobacco treatment interventions (p<0.001) were also documented. Significant improvements were documented in intentions to address tobacco use as a priority, document tobacco use, offer support, provide brief counselling, give written material, discuss available medication, prescribe medication, schedule dedicated appointment to develop a quit plan, and be persistent in addressing tobacco use with the patients (all p<0.001). CONCLUSIONS An evidence-based digital intervention can be effective in improving knowledge, attitudes, self-efficacy and intentions on future delivery of tobacco-treatment interventions.
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Affiliation(s)
- Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
| | - Sophia Papadakis
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Enkeleint A. Mechili
- Medical School, University of Crete, Heraklion, Greece
- Department of Health Care, Faculty of Public Health, University ‘Ismail Qemali’ Vlore, Vlora, Albania
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
| | - Andrey Demin
- Institute of Leadership and Healthcare Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- AER PUR Romania, Bucharest, Romania
| | - Arben Lila
- Kosovo Advocacy and Development Center, Pristina, Kosovo
| | - Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Aurela Saliaj
- Department of Health Care, Faculty of Public Health, University ‘Ismail Qemali’ Vlore, Vlora, Albania
| | | | - Francisco Rodriguez Lozano
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Comité Nacional de Prevención del Tabaquismo, Madrid, Spain
| | | | | | - Krzysztof Przewoźniak
- Foundation ‘Smart Health – Health in 3D’, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Sofia Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
- Società Italiana di Tabaccologia (SITAB), Rome, Italy
| | | | - Mihaela Lovše
- Slovenian Coalition for Public Health, Environment and Tobacco Control, Maribor, Slovenia
| | - Biljana Kilibarda
- Institute of Public Health of Serbia ‘Dr Milan Jovanović Batut’, Belgrade, Serbia
| | | | - Panagiotis Behrakis
- George D. Behrakis Research Laboratory, Athens, Greece
- Hellenic Cancer Society, Athens, Greece
| | | | - Polina Starchenko
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | | | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
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Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis 2020. [PMID: 32206052 DOI: 10.18332/tid/119324,] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Constantine I Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States.,School of Medicine, University of Crete, Heraklion, Greece
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Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis 2020. [PMID: 32206052 DOI: 10.18332/tid/119324;] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Constantine I Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States.,School of Medicine, University of Crete, Heraklion, Greece
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Abstract
COVID-19 is a coronavirus outbreak that initially appeared in Wuhan, Hubei Province, China, in December 2019, but it has already evolved into a pandemic spreading rapidly worldwide1,2. As of 18 March 2020, a total number of 194909 cases of COVID-19 have been reported, including 7876 deaths, the majority of which have been reported in China (3242) and Italy (2505)3. However, as the pandemic is still unfortunately under progression, there are limited data with regard to the clinical characteristics of the patients as well as to their prognostic factors4. Smoking, to date, has been assumed to be possibly associated with adverse disease prognosis, as extensive evidence has highlighted the negative impact of tobacco use on lung health and its causal association with a plethora of respiratory diseases5. Smoking is also detrimental to the immune system and its responsiveness to infections, making smokers more vulnerable to infectious diseases6. Previous studies have shown that smokers are twice more likely than non-smokers to contract influenza and have more severe symptoms, while smokers were also noted to have higher mortality in the previous MERS-CoV outbreak7,8. Given the gap in the evidence, we conducted a systematic review of studies on COVID-19 that included information on patients’ smoking status to evaluate the association between smoking and COVID-19 outcomes including the severity of the disease, the need for mechanical ventilation, the need for intensive care unit (ICU) hospitalization and death. The literature search was conducted on 17 March 2020, using two databases (PubMed, ScienceDirect), with the search terms: [‘smoking’ OR ‘tobacco’ OR ‘risk factors’ OR ‘smoker*’] AND [‘COVID-19’ OR ‘COVID 19’ OR ‘novel coronavirus’ OR ‘sars cov-2’ OR ‘sars cov 2’] and included studies published in 2019 and 2020. Further inclusion criteria were that the studies were in English and referred to humans. We also searched the reference lists of the studies included. A total of 71 studies were retrieved through the search, of which 66 were excluded after full-text screening, leaving five studies that were included. All of the studies were conducted in China, four in Wuhan and one across provinces in mainland China. The populations in all studies were patients with COVID-19, and the sample size ranged from 41 to 1099 patients. With regard to the study design, retrospective and prospective methods were used, and the timeframe of all five studies covered the first two months of the COVID-19 pandemic (December 2019, January 2020). Specifically, Zhou et al.9 studied the epidemiological characteristics of 191 individuals infected with COVID-19, without, however, reporting in more detail the mortality risk factors and the clinical outcomes of the disease. Among the 191 patients, there were 54 deaths, while 137 survived. Among those that died, 9% were current smokers compared to 4% among those that survived, with no statistically significant difference between the smoking rates of survivors and non-survivors (p=0.21) with regard to mortality from COVID-19. Similarly, Zhang et al.10 presented clinical characteristics of 140 patients with COVID-19. The results showed that among severe patients (n=58), 3.4% were current smokers and 6.9% were former smokers, in contrast to non-severe patients (n=82) among which 0% were current smokers and 3.7% were former smokers , leading to an OR of 2.23; (95% CI: 0.65–7.63; p=0.2). Huang et al.11 studied the epidemiological characteristics of COVID-19 among 41 patients. In this study, none of those who needed to be admitted to an ICU (n=13) was a current smoker. In contrast, three patients from the non-ICU group were current smokers, with no statistically significant difference between the two groups of patients (p=0.31), albeit the small sample size of the study. The largest study population of 1099 patients with COVID-19 was provided by Guan et al.12 from multiple regions of mainland China. Descriptive results on the smoking status of patients were provided for the 1099 patients, of which 173 had severe symptoms, and 926 had non-severe symptoms. Among the patients with severe symptoms, 16.9% were current smokers and 5.2% were former smokers, in contrast to patients with non-severe symptoms where 11.8% were current smokers and 1.3% were former smokers. Additionally, in the group of patients that either needed mechanical ventilation, admission to an ICU or died, 25.5% were current smokers and 7.6% were former smokers. In contrast, in the group of patients that did not have these adverse outcomes, only 11.8% were current smokers and 1.6% were former smokers. No statistical analysis for evaluating the association between the severity of the disease outcome and smoking status was conducted in that study. Finally, Liu et al.13 found among their population of 78 patients with COVID-19 that the adverse outcome group had a significantly higher proportion of patients with a history of smoking (27.3%) than the group that showed improvement or stabilization (3.0%), with this difference statistically significant at the p=0.018 level. In their multivariate logistic regression analysis, the history of smoking was a risk factor of disease progression (OR=14.28; 95% CI: 1.58–25.00; p= 0.018). We identified five studies that reported data on the smoking status of patients infected with COVID-19. Notably, in the largest study that assessed severity, there were higher percentages of current and former smokers among patients that needed ICU support, mechanical ventilation or who had died, and a higher percentage of smokers among the severe cases12. However, from their published data we can calculate that the smokers were 1.4 times more likely (RR=1.4, 95% CI: 0.98–2.00) to have severe symptoms of COVID-19 and approximately 2.4 times more likely to be admitted to an ICU, need mechanical ventilation or die compared to non-smokers (RR=2.4, 95% CI: 1.43–4.04). In conclusion, although further research is warranted as the weight of the evidence increases, with the limited available data, and although the above results are unadjusted for other factors that may impact disease progression, smoking is most likely associated with the negative progression and adverse outcomes of COVID-19.
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Affiliation(s)
- Constantine I Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States.,School of Medicine, University of Crete, Heraklion, Greece
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Cheung CMM, Vardavas CI, Filippidis FT. Factors associated with abstinence after a recent smoking cessation attempt across 28 European Union member states. Tob Prev Cessat 2020; 7:5. [PMID: 33511319 PMCID: PMC7831377 DOI: 10.18332/tpc/132123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION There is a lack of information regarding factors associated with successful smoking cessation on a population and European Union (EU)-wide level. Our study seeks to explore individual and country-level factors associated with abstinence after a recent smoking cessation attempt across the EU. METHODS We obtained data from the March 2017 Special Eurobarometer 87.1 (n=27901). Regression analysis was performed on a subset of 1472 individuals who made quit attempts in the past 12 months. Sociodemographic, policy and country-level factors were assessed using logistic regression among smokers and ex-smokers who attempted to quit approximately 12 months before the survey date. We defined and examined the Cessation Ratio (ratio of number of recent quitters to those who did not succeed) across 28 EU Member States. RESULTS In all, 14.9% (n=1018) of current smokers and 8.80% (n=454) of ex-smokers attempted to quit in approximately the last 12 months (n=1472). Cessation Ratios ranged from 0.182 (95% CI: 0.045–0.319) in Estonia to 1.060 (95% CI: 0.262–1.860) in Sweden. There is a quadratic, U-shaped relationship between odds of quitting and smoking prevalence. The lowest odds of cessation were observed at a prevalence of 26.3%, with higher odds of cessation observed above and below this point. Respondents who reported financial difficulties were less likely to quit (AOR=0.66; 95% CI: 0.52–0.83). There was no association of likelihood of success with other sociodemographic factors or the Tobacco Control Scale treatment score. CONCLUSIONS These findings highlight a need for exploring reasons behind the variation in likelihood of abstinence following a recent quit attempt, in order to design policies targeted at population groups or countries that need greater support.
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Affiliation(s)
- Chung-Mei M Cheung
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Filippidis FT, Jawad M, Vardavas CI. Trends and Correlates of Waterpipe use in the European Union: Analysis of Selected Eurobarometer Surveys (2009-2017). Nicotine Tob Res 2020; 21:469-474. [PMID: 29145647 DOI: 10.1093/ntr/ntx255] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/13/2017] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The aim of this study was to assess the trends and correlates of waterpipe use between 2009 and 2017 in the 28 European Union (EU) member states. METHODS We analyzed data from wave 72.3 (2009, n = 27788); wave 77.1 (2012, n = 26751); wave 82.4 (2014, n = 27801); and wave 87.1 (2017, n = 27901) of the Eurobarometer survey. Representative samples of EU residents aged ≥15 years were asked to report ever use of waterpipe. Regular waterpipe use, i.e., at least once a month was also assessed in 2017. Associations of ever and current use with sociodemographic factors were assessed with multilevel logistic regression. RESULTS The prevalence of ever waterpipe use in the EU increased from 11.6% in 2009 to 16.3% in 2014 before dropping to 12.9% in 2017, but there was wide variation between EU member states, ranging from 2.3% (Croatia, 2009) to 41.7% (Latvia, 2017). Regular waterpipe use was highest in Austria (3.6%), Latvia (2.5%) and Belgium (2.0%) in 2017. Respondents aged 15-24 years were 11.43 times more likely (95% confidence interval [CI] = 10.71 to 12.21) to have ever used waterpipe compared to those 55 years and older. Regular and ever waterpipe use were also more likely among current and former cigarette smokers. Males (adjusted odds ratio [aOR] = 1.64; 95% CI = 1.58 to 1.70) and those living in urban areas (aOR = 1.36; 95% CI = 1.30 to 1.42) were more likely to have ever used waterpipe. CONCLUSION A substantial proportion of EU citizens, especially young men, have tried waterpipe. Regular use is relatively limited, but more systematic surveillance is required to monitor trends across the EU. IMPLICATIONS Data on waterpipe use in the European Union are scarce. The prevalence of ever waterpipe use in the EU increased from 11.6% in 2009 to 16.3% in 2014 before dropping to 12.9% in 2017, with wide variation between EU member states. Males, those living in urban areas, younger respondents, and current or former cigarette smokers were more likely to be ever or regular users of waterpipe.
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Affiliation(s)
- Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Mohammed Jawad
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Constantine I Vardavas
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Greece.,European Network for Smoking and Tobacco Prevention (ENSP), Belgium
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Petroulia I, Kyriakos CN, Papadakis S, Tzavara C, Filippidis FT, Girvalaki C, Peleki T, Katsaounou P, McNeill A, Mons U, Fernández E, Demjén T, Trofor AC, Herbeć A, Zatoński WA, Tountas Y, Fong GT, Vardavas CI. Corrigendum: Patterns of tobacco use, quit attempts, readiness to quit and self-efficacy among smokers with anxiety or depression: Findings among six countries of the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2020; 17:83. [PMID: 31889945 PMCID: PMC6897046 DOI: 10.18332/tid/114415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 11/24/2022] Open
Abstract
[This corrects the article DOI: 10.18332/tid/98965.].
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Affiliation(s)
- Ioanna Petroulia
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Christina N Kyriakos
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,University of Crete (UoC), Heraklion, Greece
| | - Sophia Papadakis
- University of Crete (UoC), Heraklion, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Chara Tzavara
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Filippos T Filippidis
- National and Kapodistrian University of Athens (UoA), Athens, Greece.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Theodosia Peleki
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | | | - Ann McNeill
- King's College London (KCL), London, United Kingdom
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), and Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain.,School of Medicine and Health Sciences, Universitat de Barcelona, Catalonia, Spain
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania.,Aer Pur Romania, Bucharest, Romania
| | | | - Witold A Zatoński
- Health Promotion Foundation (HPF), Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo (UW), Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I Vardavas
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,University of Crete (UoC), Heraklion, Greece
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Herbeć A, Zatoński M, Zatoński WA, Janik-Koncewicz K, Mons U, Fong GT, Quah ACK, Driezen P, Demjén T, Tountas Y, Trofor AC, Fernández E, McNeill A, Willemsen M, Vardavas CI, Przewoźniak K. Dependence, plans to quit, quitting self-efficacy and past cessation behaviours among menthol and other flavoured cigarette users in Europe: The EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2019; 16:A19. [PMID: 34671234 PMCID: PMC8525627 DOI: 10.18332/tid/111356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study characterises smoking and cessation-related behaviours among menthol and other flavoured cigarette users in Europe prior to the implementation of the European Tobacco Products Directive (TPD) ban on the sale of flavoured cigarettes. METHODS An analysis of cross-sectional data from the 2016 EUREST-PLUS ITC Europe Surveys was conducted among a sample of 10760 adult smokers from eight European Union Member States. Respondents were classified as menthol, other flavoured, unflavoured, or no usual flavour cigarette users and compared on smoking and cessation behaviours and characteristics. Data were analysed in SPSS Complex Samples Package using bivariate and multivariate regression analyses adjusted for sociodemographic characteristics, dependence, and country. RESULTS In bivariate analyses, cigarette flavour was significantly associated with all outcomes (p<0.001). After adjusting for sociodemographic characteristics, these associations attenuated but remained significant and in the same direction for dependence, self-efficacy, plans to quit, past quit attempts, and ever e-cigarette use. In fully adjusted models, compared to smokers of non-flavoured cigarettes, menthol smokers were less likely to smoke daily (AOR=0.47, 95% CI: 0.32-0.71), smoke within 30 min of waking (0.52,0.43-0.64), consider themselves addicted (0.74,0.59-0.94), and more likely to have ever used e-cigarettes (1.26,1.00-1.57); other flavoured cigarette smokers were less likely to smoke daily (0.33,0.15-0.77), and have higher self-efficacy (1.82,1.20-2.77); no usual flavour smokers were less likely to smoke daily (0.34,0.22-0.51), smoke within 30 min of waking (0.66,0.55-0.80), consider themselves addicted (0.65,0.52-0.78), have ever made a quit attempt (0.69,0.58-0.84), have ever used e-cigarettes (0.66,0.54-0.82), and had higher self-efficacy (1.46,1.19-1.80). CONCLUSIONS Smokers of different cigarette flavours in Europe differ on smoking and cessation characteristics. The lower dependence of menthol cigarette smokers could lead to greater success rates if quit attempts are made, however cross-country differences in smoking behaviours and quitting intentions could lead to the TPD ban on cigarette flavours having differential impact if not accompanied by additional measures, such as smoking cessation support.
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Affiliation(s)
- Aleksandra Herbeć
- Health Promotion Foundation (HPF), Warsaw, Poland.,Department of Behavioural Science and Health, University College London, London, United Kingdom.,Centre for Behaviour Change, Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Mateusz Zatoński
- Health Promotion Foundation (HPF), Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland.,Tobacco Control Research Group, Department for Health, University of Bath, Bath, United Kingdom
| | - Witold A Zatoński
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland.,Health Promotion Foundation (HPF), Warsaw, Poland
| | | | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo (UW), Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo (UW), Waterloo, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo (UW), Waterloo, Canada
| | - 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 Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain.,School of Medicine and Health Sciences, University of Barcelona, Catalonia, Spain
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, London, United Kingdom.,National Addiction Centre, King's College London, London, United Kingdom
| | - Marc Willemsen
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,University of Crete (UoC), Heraklion, Greece
| | - Krzysztof Przewoźniak
- Maria Skłodowska-Curie Institute - Oncology Center, Warsaw, Poland.,Health Promotion Foundation (HPF), Warsaw, Poland
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Girvalaki C, Vardavas A, Tzatzarakis M, Kyriakos CN, Nikitara K, Tsatsakis AM, Vardavas CI. Compliance of e-cigarette refill liquids with regulations on labelling, packaging and technical design characteristics in nine European member states. Tob Control 2019; 29:531-536. [PMID: 31519795 DOI: 10.1136/tobaccocontrol-2019-055061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate electronic cigarette (e-cigarette) product compliance with European regulations (Tobacco Products Directive (TPD), Implementing Decisions), with a focus on labelling/packaging practices and technical design/safety features. METHODS Before the implementation of the TPD, in early 2016, we randomly selected e-cigarette refill liquids from the five top-selling companies in France, Poland, Germany, Netherlands, UK, Spain, Romania, Hungary and Greece. Identical products were purchased after the implementation of the TPD (early 2018) and assessment of compliance was performed on self-matched samples (n=107) using a prospective cohort design. Compliance with the Classification, Labelling and Packaging (CLP) regulations was also evaluated. RESULTS Following the implementation of the TPD, improvements were noted with regards to the existence of text-only warnings (32.7% pre vs 86.0% post, p<0.001), child-resistant fastenings (93.3% pre vs 100.0% post, p=0.016), tamper-proof vials (58.9% pre vs 86.9%, post p<0.001) and maximum refill volume ≤10 mL in vials (86.9% pre vs 94.4% post, p=0.008). Lower compliance was noted with regards to the inclusion of a leaflet (26.2% pre vs 53.3% post, p<0.001), refilling instructions (28.0% pre vs 51.4% post, p<0.001) and health warnings on the box, vial or leaflet (32.7% pre vs 86.0%, p<0.001). Overall, 86.0% of products had a warning label in the post-TPD phase in comparison to 32.7% of products before the implementation of the TPD (p<0.001). Compliance with the CLP regulations, also increased in the post TPD follow-up phase. CONCLUSIONS This is the first study to evaluate the level of implementation of the e-cigarette regulations in nine EU member states. Our results indicate that refill liquids had substantial but not full compliance in most of the characteristics evaluated. Further effort is needed to ensure complete compliance.
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Affiliation(s)
- Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
| | - Alexander Vardavas
- Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
| | - Manolis Tzatzarakis
- Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
| | - Christina N Kyriakos
- Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium .,Laboratory of Toxicology, University of Crete School of Medicine, Heraklion, Greece
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Vardavas CI, Kyriakos CN, Fernández E, Bamidis P, Siddiqi K, Chavannes NH, van der Kleij R, Parker G, Radu-Loghin C, Ward B, Berkouk K. H2020 funding for respiratory research: scaling up for the prevention and treatment of lung diseases. Eur Respir J 2019; 54:54/3/1901417. [DOI: 10.1183/13993003.01417-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 02/02/2023]
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Tsiaoussis J, Antoniou MN, Koliarakis I, Mesnage R, Vardavas CI, Izotov BN, Psaroulaki A, Tsatsakis A. Effects of single and combined toxic exposures on the gut microbiome: Current knowledge and future directions. Toxicol Lett 2019; 312:72-97. [PMID: 31034867 DOI: 10.1016/j.toxlet.2019.04.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 12/12/2022]
Abstract
Human populations are chronically exposed to mixtures of toxic chemicals. Predicting the health effects of these mixtures require a large amount of information on the mode of action of their components. Xenobiotic metabolism by bacteria inhabiting the gastrointestinal tract has a major influence on human health. Our review aims to explore the literature for studies looking to characterize the different modes of action and outcomes of major chemical pollutants, and some components of cosmetics and food additives, on gut microbial communities in order to facilitate an estimation of their potential mixture effects. We identified good evidence that exposure to heavy metals, pesticides, nanoparticles, polycyclic aromatic hydrocarbons, dioxins, furans, polychlorinated biphenyls, and non-caloric artificial sweeteners affect the gut microbiome and which is associated with the development of metabolic, malignant, inflammatory, or immune diseases. Answering the question 'Who is there?' is not sufficient to define the mode of action of a toxicant in predictive modeling of mixture effects. Therefore, we recommend that new studies focus to simulate real-life exposure to diverse chemicals (toxicants, cosmetic/food additives), including as mixtures, and which combine metagenomics, metatranscriptomics and metabolomic analytical methods achieving in that way a comprehensive evaluation of effects on human health.
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Affiliation(s)
- John Tsiaoussis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion, Greece
| | - Michael N Antoniou
- Gene Expression and Therapy Group, King's College London, Faculty of Life Sciences & Medicine, Department of Medical and Molecular Genetics, 8th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Ioannis Koliarakis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion, Greece
| | - Robin Mesnage
- Gene Expression and Therapy Group, King's College London, Faculty of Life Sciences & Medicine, Department of Medical and Molecular Genetics, 8th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Constantine I Vardavas
- Laboratory of Toxicology, Medical School, University of Crete, Voutes, 71409 Heraklion, Crete, Greece
| | - Boris N Izotov
- Department of Analytical, Toxicology, Pharmaceutical Chemistry and Pharmacognosy, Sechenov University, 119991 Moscow, Russia
| | - Anna Psaroulaki
- Department of Clinical Microbiology and Microbial Pathogenesis, Medical School, University of Crete, 71110 Heraklion, Greece
| | - Aristidis Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, Voutes, 71409 Heraklion, Crete, Greece; Department of Analytical, Toxicology, Pharmaceutical Chemistry and Pharmacognosy, Sechenov University, 119991 Moscow, Russia.
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Fu M, Castellano Y, Tigova O, Mons U, Agar T, Kyriakos CN, Trofor AC, Quah ACK, Fong GT, Przewoźniak K, Zatoński WA, Demjén T, Tountas Y, Vardavas CI, Fernández E. Smoking in public places in six European countries: Findings from the EUREST-PLUS ITC Europe Survey. Tob Induc Dis 2019; 16:A18. [PMID: 34671233 PMCID: PMC8525624 DOI: 10.18332/tid/104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Surveillance of tobacco consumption in public places is an important measure to evaluate the impact of tobacco control interventions over time. The objective of this study was to estimate the prevalence of smoking as seen by smokers and their smoking behaviour in public places, in six European countries. METHODS We used baseline data of the International Tobacco Control Six European countries (ITC 6E) Survey, part of the EUREST-PLUS Project, conducted in 2016 in national representative samples of about 1000 adult smokers aged 18 years and older in Germany, Greece, Hungary, Poland, Romania and Spain. For each setting (workplaces, restaurants, bars/pubs and discos) participants were asked whether they had seen someone smoking during their last visit there and whether they too had smoked there. We report the overall and by-country weighted prevalence of seeing someone smoking and the smokers' own smoking behaviour at each setting. We also assess the relationship between seeing someone smoking and smoking themselves at these settings. RESULTS The prevalence of smoking as seen by smokers was 18.8% at workplaces, with high variability among countries (from 4.7% in Hungary to 40.8% in Greece). Among smokers visiting leisure facilities in the last year, during their last visit 22.7% had seen someone smoking inside restaurants and 12.2% had smoked themselves there, while for bars/pubs the corresponding prevalences were 33.9% and 20.4%, and inside discos 44.8% and 34.8%. CONCLUSIONS Smoking is still prevalent at leisure facilities, particularly at discos in Europe, with high variability among countries. More extensive awareness campaigns and stricter enforcement are needed to increase the compliance of smoke-free regulations, especially in leisure facilities.
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Affiliation(s)
- Marcela Fu
- Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,University of Barcelona (UB), Barcelona, Spain
| | - Yolanda Castellano
- Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Olena Tigova
- Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Agar
- University of Waterloo (UW), Waterloo, Canada
| | - Christina N Kyriakos
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,University of Crete (UoC), Heraklion, Greece
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi (UMF Iasi), Iasi, Romania.,Aer Pur Romania (APR), Bucharest, Romania
| | | | - Geoffrey T Fong
- University of Waterloo (UW), Waterloo, Canada.,Ontario Institute for Cancer Research (OICR), Toronto, Canada
| | - 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 on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,University of Crete (UoC), Heraklion, Greece
| | - Esteve Fernández
- Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,University of Barcelona (UB), Barcelona, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Demjén T, Kiss J, Kovács PA, Mons U, Kahnert S, Driezen P, Kyriakos CN, Zatoński M, Przewoźniak K, Fu M, Fernández E, McNeill A, Willemsen M, Tountas Y, Trofor AC, Fong GT, Vardavas CI. The purchase sources of and price paid for cigarettes in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2019; 16:A16. [PMID: 31516470 PMCID: PMC6661972 DOI: 10.18332/tid/100413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/09/2018] [Accepted: 11/29/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tobacco tax policies have been proven to be effective in reducing tobacco consumption, but their impact can be mitigated through price-minimizing behaviours among smokers. This study explored the purchase sources of tobacco products and the price paid for tobacco products in six EU member states. METHODS Data from Wave 1 of the EUREST-PLUS ITC Europe Survey collected from nationally representative samples of adult smokers in Germany, Greece, Hungary, Poland, Romania and Spain (ITC 6E Survey) were used. The ITC 6E Survey sample, conducted in 2016, randomly sampled 6011 adult cigarette smokers aged 18 years or older. Information on purchase sources of tobacco was examined by country. The difference in reported purchase price by purchase location (store vs non-store/other) was analysed using linear regression for each country. RESULTS Tobacco purchasing patterns and sources varied widely between countries. Non-store/other purchases were very rare in Hungary (0.1%) while these types of purchases were more common in Germany (5.1%) and Poland (8.6%). Reported prices of one standard pack of 20 cigarettes were highest in Germany (4.80€) and lowest in Hungary (2.45€). While non-store purchases were only made by a minority of smokers (>10% in all countries), the price differential was considerable between store and non-store/other sources, up to 2€ per pack in Greece and in Germany. CONCLUSIONS The results suggest a huge variation of purchasing sources and price differentials between store and non-store purchasing sources across the six EU member states examined. While the cross-sectional data precludes any causal inference, supply chain control through licensing as introduced in Hungary and the lack of such measures in the other countries might nevertheless be a plausible explanation for the large differences in the frequency of non-store purchases observed in this study.
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Affiliation(s)
- Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Judit Kiss
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | | | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sarah Kahnert
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Pete Driezen
- Department of Psychology, 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
| | - Mateusz Zatoński
- Health Promotion Foundation (HPF), Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Krzysztof Przewoźniak
- Health Promotion Foundation (HPF), Warsaw, Poland
- Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland
| | - Marcela Fu
- Catalan Institute of Oncology (ICO), University of Barcelona, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Esteve Fernández
- Catalan Institute of Oncology (ICO), University of Barcelona, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, King’s College London (KCL), London, United Kingdom
| | - Marc Willemsen
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
- Netherlands Expertise Center for Tobacco Control (Trimbos Institute), Utrecht, the Netherlands
| | - 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
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
- School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
| | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
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