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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 Europe...
Context in source publication
Context 1
... on outdoor terraces of restaurants (10.1%; 95% CI: 8.9%-11.4%; Figure 1). While there was low variability by country in the support for not allowing smoking in places where there are minors (support >85% in all countries), greater variability was seen for open stadiums, in which the support varied from 24.4% in Greece to 78.4% in Poland, and for entrances of public buildings, where the support ranged from 20.5% in Spain to 69.4% in Hungary (Table 1). ...Similar publications
Both smoking during pregnancy and secondhand smoke exposure are associated with reduced health outcomes. However, limited consistent evidence exists of risks of secondhand smoke exposure in pregnancy. Currently, inadequate smoking cessation services exist in Irish maternity hospitals. To identify the number of pregnant women smoking during pregnanc...
Citations
... Twelve studies included in this review came from the ITC study, both across multiple countries as well as country-level specific studies, including the general public in Canada [110], France [111] and New Zealand [112]. Seven of these studies were cross-sectional sub-study surveys drawn from the ITC cohort, including comparative surveys across multiple countries [113,114]. ...
Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies ( n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative ( n = 129, 44%) or convenience ( n = 42, 14%) samples. A smaller number of studies used qualitative methods ( n = 60, 20%) such as focus groups ( n = 21, 7%) and interviews ( n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media ( n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention ( n = 124, 42%). Few studies looked solely at physical inactivity ( n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.
... Support to extend smoking bans to outdoor areas has also been evaluated in some countries in Europe, finding that the majority favor banning smoking in outdoor areas. Estimates varied depending on the setting and smoking status, being the highest for children areas (i.e., playgrounds and school grounds; above 80%) and hospitals/healthcare centers (above 70%) (Gallus et al., 2012;Sureda et al., 2015;Fu et al., 2019). ...
Introduction
Secondhand smoke (SHS) causes morbidity and mortality among non-smokers.
Objectives
To investigate SHS presence in outdoor areas from 12 European countries and its association with country-level characteristics.
Methods
Cross-sectional study performed in 2017–2018 within the TackSHS project. We conducted a face-to-face survey on a representative sample of the population aged 15 years and older from 12 European countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain. Out of 11,902 participants, 8,562 were non-smokers. SHS presence was assessed in selected outdoor areas and defined as respondents viewing someone smoking the last time they visited each setting within the last 6 months. A ranking score for outdoor SHS presence was assigned to each country based on the SHS presence in each setting. We used Spearman's correlation (r) and the Chi-squared tests to assess the relationship between SHS presence and country-level characteristics.
Results
Except for children's playgrounds (39.5%; 95% confidence interval, CI: 37.6%–41.3%), more than half of non-smokers reported SHS presence in outdoor areas: schools (52.0%; 95%CI: 50.2%–53.7%), stadia (57.4%; 95%CI: 55.4%–59.4%), parks (67.3%; 95%CI: 66.0%–68.5%), hospitals (67.3%; 95%CI: 65.8%–68.7%), public transport stops (69.9%; 95%CI: 68.6%–71.2%), bar/restaurant terraces (71.4%; 95%CI: 70.2%–72.6%), and beaches (72.8%; 95%CI: 71.4%–74.1%). Residents in Latvia showed the highest overall outdoor SHS presence rank, followed by Greece, and Portugal. Outdoor SHS presence was directly correlated to the country's smoking prevalence (r = 0.64), and inversely correlated to the Tobacco Control Scale 2016 overall score (r = −0.62), the socio-demographic index 2017 (r = −0.56), and Gross Domestic Product per capita 2018 (r = −0.47) (p < 0.001).
Conclusions
SHS presence is high in most outdoor areas in Europe, especially in countries with higher smoking prevalence and lower tobacco control performance. To address outdoor SHS exposure, our findings require considering smoking bans along with other strategies to reduce smoking prevalence.
... Support to extend smoking bans to outdoor areas has also been evaluated in some countries in Europe, finding that the majority favor banning smoking in outdoor areas. Estimates varied depending on the setting and smoking status, being the highest for children areas (i.e., playgrounds and school grounds; above 80%) and hospitals/healthcare centers (above 70%) (Gallus et al., 2012;Sureda et al., 2015;Fu et al., 2019). ...
Introduction
Secondhand smoke (SHS) causes morbidity and mortality among non-smokers.
Objectives
To investigate SHS presence in outdoor areas from 12 European countries and its association with country-level characteristics.
Methods
Cross-sectional study performed in 2017-2018 within the TackSHS project. We conducted a face-to-face survey on a representative sample of the population aged 15 years and older from 12 European countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain. Out of 11,902 participants, 8,562 were non-smokers. SHS presence was assessed in selected outdoor areas and defined as respondents viewing someone smoking the last time they visited each setting within the last 6 months. A ranking score for outdoor SHS presence was assigned to each country based on the SHS presence in each setting. We used Spearman’s correlation (r) and the Chi-squared tests to assess the relationship between SHS presence and country-level characteristics.
Results
Except for children’s playgrounds (39.5%; 95% confidence interval, CI: 37.6%-41.3%), more than half of non-smokers reported SHS presence in outdoor areas: schools (52.0%; 95%CI: 50.2%-53.7%), stadia (57.4%; 95%CI: 55.4%-59.4%), parks (67.3%; 95%CI: 66.0%-68.5%), hospitals (67.3%; 95%CI: 65.8%-68.7%), public transport stops (69.9%; 95%CI: 68.6%-71.2%), bar/restaurant terraces (71.4%; 95%CI: 70.2%-72.6%), and beaches (72.8%; 95%CI: 71.4%-74.1%). Residents in Latvia showed the highest overall outdoor SHS presence rank, followed by Greece, and Portugal. Outdoor SHS presence was directly correlated to the country’s smoking prevalence (r= 0.64), and inversely correlated to the Tobacco Control Scale 2016 overall score (r= -0.62), the socio-demographic index 2017 (r= -0.56), and Gross Domestic Product per capita 2018 (r= -0.47) (p<0.001).
Conclusions
SHS presence is high in most outdoor areas in Europe, especially in countries with higher smoking prevalence and lower tobacco control performance. To address outdoor SHS exposure, our findings require considering smoking bans along with other strategies to reduce smoking prevalence.
... SF car legislation for vehicles carrying minors is expected to be implemented soon in Nordic countries but is also being discussed in Germany and in the Netherlands. Recent research indicates that public support is generally high for SF policies pertaining to child protection (Fu et al., 2018;Kuijpers et al., 2018). In progressive tobacco control countries, such as New Zealand, 92% of people across all sociodemographic groups support SF car legislation if vehicles are carrying children (Li et al., 2016). ...
Background
In the USA and Canada, cars are a major source of secondhand smoke (SHS) exposure among youth. Little is known about the magnitude of this public health problem in European countries. In this report, we study SHS exposure in vehicles among adolescents across 7 member states of the European Union (EU), with a particular focus on socio-economic characteristics and adolescents’ smoking environment.
Methods
Data on self-reported SHS exposure in cars during the past seven days was obtained from the 2016/17 cross-sectional SILNE-R study from 14-17-year old adolescents in EU seven countries (N = 10,481). We applied two multivariate logistic regression models with sociodemographic characteristics and mediating smoking-related factors.
Results
SHS car exposure varied widely across the 7 EU countries: 6% in Finland, 12% in Ireland, 15% in the Netherlands, 19% in Germany, 23% in Portugal, 36% in Belgium and 43% in Italy. Low paternal educational levels were strong correlates of SHS exposure in cars as well as migration background. Other correlates were one’s own smoking status and the relation to the family and peer smoking environment, such as parental smoking, permissive smoking rules at home, and best friends smoking.
Conclusions
In most of these seven countries, a considerable proportion of youth, particularly those from disadvantaged backgrounds, is exposed to SHS in cars. There is a need to ensure adoption and sustained enforcement of smoke-free car legislation. Given the long-term effectiveness of smoke-free car policies, our finding suggests that such policies can contribute towards reducing smoking inequalities.
Key messages
We assessed adolescent secondhand smoke (SHS) exposure in cars in 7 EU countries, which varies widely, ranging from 6% in Finland to 43% in Italy. The findings point to a social gradient, environmental factors in SHS car exposure and call for the rapid implementation of smoke-free car legislation.
... SF car legislation for vehicles carrying minors is expected to be implemented soon in Nordic countries but is also being discussed in Germany and in the Netherlands. Recent research indicates that public support is generally high for SF policies pertaining to child protection (Fu et al., 2018;Kuijpers et al., 2018). In progressive tobacco control countries, such as New Zealand, 92% of people across all sociodemographic groups support SF car legislation if vehicles are carrying children (Li et al., 2016). ...
Background
In the United States and Canada, cars were found to be a major source of harmful secondhand smoke (SHS) exposure among youth. Little is known about the magnitude of this public health problem in European countries. We study SHS exposure in vehicles among adolescents across seven cities of the European Union (EU), with a particular focus on socioeconomic characteristics and smoking in adolescents’ social environment.
Methods
Self-reported survey data on SHS exposure in cars during the past seven days was obtained from the 2016/17 cross-sectional SILNE-R study for 14- to 17-year old adolescents in seven EU cities (N = 10,481). We applied two multivariable logistic regression models with sociodemographic characteristics and mediating smoking-related factors.
Results
SHS exposure in cars varied widely across the seven EU cities: 6% in Tampere (Finland), 12% in Dublin (Ireland), 15% in Amersfoort (the Netherlands), 19% in Hanover (Germany), 23% in Coimbra (Portugal), 36% in Namur (Belgium) and 43% in Latina (Italy). Low paternal (OR 1.65, CI95% 1.38 to 1.98) and maternal (OR 1.40, CI95% 1.16 to 1.68) educational levels and parental migration (OR 1.37, CI95% 1.14 to 1.64) backgrounds were correlated with SHS exposure in cars. Other correlates were one’s own or peer smoking and environmental family factors, such as having at least one parental smoker (OR 4.04, CI95% 3.49 to 4.68) and partial smoking bans at home.
Conclusions
In most of these seven cities, a considerable proportion of youth riding in cars, particularly those from disadvantaged and smoking-permissive backgrounds, is exposed to SHS in cars.
Objectives
To describe the prevalence of school-based tobacco prevention programme exposure among adolescents in low-income and middle-income countries (LMICs) and its association with psychosocial predictors of smoking.
Design
Analysis of pooled cross-sectional data.
Setting
Global Youth Tobacco Survey (GYTS), conducted in 38 LMICs.
Participants
This was a pooled analysis of data involving a total of 132 755 adolescent respondents to GYTS in 38 LMICs across Africa, Europe and Central/South America between 2014 and 2017.
Exposure and outcome measures
The primary independent variable for this study was self-reported exposure to school-based tobacco prevention programmes in the past year. Five psychosocial determinants of smoking were explored as outcomes: perceived addictiveness of nicotine, perceived harm of secondhand smoke exposure, support for restricting cigarette smoking at public indoor locations, support for restricting cigarette smoking at public outdoor areas and self-reported prediction of enjoying cigarette smoking. Multivariable logistic regression models were used to examine the relationship between exposure to school-based tobacco prevention programmes and study outcomes, controlling for sociodemographic and smoking-related characteristics of respondents.
Results
Overall, 59.1% of adolescents in LMICs self-reported exposure to school-based tobacco prevention programmes. The country-specific prevalence of adolescent exposure to school-based tobacco interventions ranged from 24.9% in the Comoros to 99.3% in Turkmenistan. Exposure to school-based tobacco interventions was significantly associated with greater secondhand smoke harm perceptions (adjusted OR (AOR): 1.69; 95% CI: 1.69 to 1.70), perceptions of addictiveness (AOR: 1.37; 95% CI: 1.36 to 1.37) and supporting tobacco use restrictions indoors (AOR: 1.70; 95% CI: 1.69 to 1.70) and outdoors (AOR: 1.59; 95% CI: 1.59 to 1.60). Exposure to school-based tobacco interventions was associated with lower odds of anticipating enjoying cigarette smoking (AOR: 0.76; 95% CI: 0.76 to 0.76).
Conclusion
Exposure to tobacco prevention programmes in schools is suboptimal in LMICs. Given the protective associations described in this study from school-based tobacco prevention programme exposure, it is imperative that national governments implement school-based programmes into ongoing tobacco control measures.
Context
Despite high smoking rates, Armenia and Georgia recently adopted smoke-free policies (2022 and 2018).
Objective
We examined associations between exposure to pro-tobacco media (news opposing smoke-free policies; cigarette, e-cigarette, heated tobacco product [HTP] advertisements) and anti-tobacco media (media, community-based action) and (1) knowledge that the policies applied to alternative tobacco products (ATPs), and (2) support for the policies applying to ATPs and various settings.
Design
We analyzed 2022 survey data.
Setting
Data were from 28 communities in Armenia and Georgia.
Participants
The sample comprised 1468 adults (31.6% past-month smokers).
Methods
We conducted multivariable regressions, controlling for country and sociodemographics.
Results
Participants were knowledgeable that the policy applied to ATPs (79.2%) and supportive of them applying to ATPs and various settings (means = 3.43 and 3.00; 1-4 = strongly support). Greater exposure to anti-tobacco media/community-based action correlated with more likely knowing that the policies applied to ATPs and greater support of the policies applying to various settings; HTP advertisement exposure correlated with less support of the policies applying to various settings. Less exposure to news opposing smoke-free policies and greater exposure to media supporting such policies correlated with greater support of the policies applying to ATPs.
Conclusions
Media and community-based action may promote smoke-free policy knowledge and support. HTP advertisements may uniquely undermine smoke-free policies.
Background: European countries differ considerably in the scope and the extent of their policies to protect people from the harms of secondhand smoke exposure. Public opinion may have a substantial influence on several stages of policy development, implementation, and compliance. For this reason, we aimed to evaluate the population level of support for smoke-free policies and its correlates.
Methods: We used data from the TackSHS Survey (2017-2018), a cross-sectional study with representative samples of the general population aged ≥15 years from 12 European countries. We described the proportion of non-smokers' and smokers' support for the implementation of smoke-free legislation in 14 indoor and outdoor settings and the country-level characteristics associated with it.
Results: In the total sample (n = 11,902), support for smoke-free legislation were the lowest for restaurants/bar patios (non-smokers = 53.0%; smokers = 29.2%) and the highest for workplaces (non-smokers = 78.5%; smokers = 66.5%). In the country-level analysis, the highest support among non-smokers was for workplaces in Bulgaria (93.1%) and the lowest for restaurants/bars patios in Greece (39.4%). Among smokers, the corresponding estimates were for children's playgrounds in Latvia (88.9%) and for cars in Portugal (21%). For most settings, support for smoke-free legislation was directly related with the countries' prevalence of secondhand smoke presence and reported smoking in each setting.
Discussion: Our results show that the majority of European adults (including a large proportion of smokers) are supportive of implementing smoke-free legislation in indoor settings and extending it to selected outdoor settings. Such expressive support can be seen as an opportunity to advance legislation and protect the European population from secondhand smoke exposure.
This study examined use trends of e-cigarette devices types, heated tobacco products (HTPs) and e-liquid nicotine concentrations in England from 2016 to 2020. Data were from a representative repeat cross-sectional survey of adults aged 16 or older. Bayesian logistic regression was used to estimate proportions and 95% credible intervals (CrIs). Of 75,355 participants, 5.3% (weighted = 5.5%) were currently using e-cigarettes or HTPs, with the majority (98.7%) using e-cigarettes. Among e-cigarette users, 53.7% (CrI 52.0–55.1%) used tank devices, 23.7% (22.4–25.1%) mods, 17.3% (16.1–18.4%) pods, and 5.4% (4.7–6.2%) disposables. Tanks were the most widely used device type throughout 2016–2020. Mods were second until 2020, when pods overtook them. Among all e-cigarette/HTP users, prevalence of HTP use remains rare (3.4% in 2016 versus 4.2% in 2020), whereas JUUL use has risen from 3.4% in 2018 to 11.8% in 2020. Across all years, nicotine concentrations of ≤ 6 mg/ml were most widely (41.0%; 39.4–42.4%) and ≥ 20 mg/ml least widely used (4.1%; 3.4–4.9%). Among e-cigarette/HTP users, ex-smokers were more likely than current smokers to use mod and tank e-cigarettes, but less likely to use pods, disposables, JUUL and HTPs. In conclusion, despite growing popularity of pods and HTPs worldwide, refillable tank e-cigarettes remain the most widely used device type in England.
