E-cigarette experimentation and support for tobacco control policies in the European Union

Abstract Background Second-hand smoke (SHS) is still an important public health problem. With joining the Framework Convention on Tobacco Control (FCTC), all parties acknowledged the health risks of SHS and agreed to implement policies to protect their populations from SHS in public places. The aim of this study was to explore the SHS exposure in restaurants and bars as well as its associations with smoke-free legislation in the European Union. Methods Data of Eurobarometer surveys 2014 and 2017 were used to estimate prevalence of SHS exposure. We also extracted data on individual confounders such as smoking status, gender, sex, age and information on social economic status. Additionally, we collected data on country specific data on smoking regulations in restaurants and bars from the Tobacco Control Scale to analyse associations with SHS exposure using multilevel logistic regression. Smoking regulations were categorized into the following three categories: partial ban, comprehensive ban with minor exceptions, and complete ban. Results Preliminary results on the prevalence of SHS in restaurants showed a decrease from 11.8% (95% confidence intervals (CI) 11.2-12.5) in 2014 to 8.8% (95% CI 8.3-9.3) in 2017. The crude multilevel model controlling only for smoking prevalence resulted in an odds ratio of 0.39 (95% CI 0.19-0.77) for comprehensive ban with minor exceptions and 0.28 (95% CI 0.16-0.50) for complete ban versus partial ban. Odds ratios remained at significant levels when controlling for all available confounders. Conclusions Between 2014 and 2017, SHS exposure in restaurants decreased significantly. Furthermore, strong associations with smoking regulations were observed suggesting a high compliance. Many tobacco control policies have been introduced during the last years but several countries need to strengthen their smoke-free tobacco control policies to further reduce SHS exposure preventing death, disease and disability. Key messages SHS exposure remains a significant public health challenge. The implementation of effective measures could be strengthened through a convergence of tobacco control strategies and policies among European Union member states.

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Are smokers “hardening” or rather “softening”? An ecological and multilevel analysis across 28 European Union countries

European Respiratory Journal ◽

10.1183/13993003.00596-2019 ◽

2019 ◽

Vol 54 (3) ◽

pp. 1900596 ◽

Cited By ~ 5

Author(s):

Ariadna Feliu ◽

Esteve Fernandez ◽

Cristina Martinez ◽

Filippos T. Filippidis

Keyword(s):

European Union ◽

Tobacco Control ◽

Fixed Effects ◽

Smoking Prevalence ◽

The European Union ◽

Control Policies ◽

Tobacco Control Policies ◽

Hardcore Smokers ◽

Over Time ◽

The Eu

BackgroundTobacco control policies can reduce smoking prevalence. These measures may be less effective where smoking prevalence has significantly declined, as the remaining smokers have “hardened”. Our aim was to empirically evaluate the “hardening hypothesis” at the population level in the European Union (EU) and explore factors associated with hardcore smoking.MethodsWe conducted two separate analyses in the EU using data on smoking from the Eurobarometer surveys (2009–2017, n=112 745). 1) A panel-data fixed-effects linear regression to investigate changes over time in the percentage of hardcore smokers in relation to standardised smoking prevalence at the country level. 2) A multilevel logistic regression analysis with hardcore (daily smokers, ≥15 cigarettes per day who have not attempted to quit in the last 12 months) or light (<5 cigarettes per day) smoking as the dependent variable and time as the main independent variable, controlling for individual and ecological variables.ResultsWe studied 29 010 current smokers (43.8% hardcore smokers and 14.7% light smokers). The prevalence of hardcore smoking among adult smokers increased by 0.55 (95% CI 0.14–0.96) percentage points per each additional percentage point in the overall smoking prevalence. The odds of being a hardcore smoker increased over time and were higher in middle-aged males and people with financial difficulties, while the odds of being a light smoker significantly declined among females.ConclusionThis study does not support the “hardening hypothesis” in the EU between 2009 and 2017, but suggests a softening of the smoking population. Existing tobacco control policies are likely to be suitable to further decrease smoking prevalence in Europe.

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