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1. Evidence-Based Post-Ban Research to Inform Effective Menthol Cigarette Bans in the United States and Other Jurisdictions.

Author

Erinoso, Olufemi, Brown, Jennifer L, Glasser, Allison M, Gravely, Shannon, Fong, Geoffrey T, Chung-Hall, Janet, Kyriakos, Christina N, Liber, Alex C, Craig, Lorraine V, White, Augustus M, Rose, Shyanika W, Smiley, Sabrina L, Zeller, Mitch, Leischow, Scott, Ayo-Yusuf, Olalekan, Cohen, Joanna E, and Ashley, David L

Subjects
POOR communities, ELECTRONIC cigarettes, TOBACCO products, SMOKE prevention, ELECTRONIC commerce
Published
2024
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2. Use of Menthol Cigarettes and Accessories Among Youth Who Smoked After the Menthol Cigarette Ban in England and Canada, 2021: Implications for Health Equity.

Author

Kyriakos, Christina N., Filippidis, Filippos T., East, Katherine A., Reid, Jessica L., Driezen, Pete, and Hammond, David

Subjects
*MENTHOL, *CIGARETTES, *HEALTH equity, *YOUNG adults, *SMOKING
Abstract

Introduction: This study examined menthol cigarette use among youth who smoked, after menthol cigarette bans were implemented in England (May 2020) and Canada (October 2017). Aims and Methods: Cross-sectional data come from 2021 ITC Youth Tobacco and Vaping Survey respondents aged 16-19 who smoked in the past 30 d in England (N = 715) and Canada (N = 419). Adjusted logistic regression models, estimated separately for each country, examined sociodemographic correlates of usually smoking menthol cigarettes (reporting currently most often smoking menthol cigarettes) overall, and by past 30-d use of any menthol accessories (e.g., filters, capsules). Youth reported the cigarette variety they smoked most often, coded as menthol or nonmenthol. Results: Almost no youth who smoked in the past 30 d reported most often smoking a cigarette variety coded as menthol. However, 34.5% (95% CI: 30.4% to 38.9%) of youth who smoke in England and 30.9% (26.0%-36.3%) in Canada reported usually smoking menthol cigarettes, with greater odds of use among those identifying as black, or other race/ethnicity, respectively, compared to white in England (60.0%, aOR = 3.08, p = .001; 47.4%, aOR = 2.27, p = .011) and Canada (43.6%, aOR = 2.44, p = .046; 51.2%, aOR = 2.92, p = .001). Among those who reported usually smoking menthol cigarettes in England (N = 223) and Canada (N = 108), 71.7% (64.0%-78.2%) and 51.5% (41.1%-61.7%) reported using menthol accessories. Conclusions: After menthol cigarette bans in England and Canada, approximately one-third of youth who smoked reported usually smoking menthol cigarettes, with disproportionately higher use among those identifying as black and other race/ethnicity. Menthol accessories accounted for most menthol cigarette use. Closing regulatory loopholes is critical to advancing public health equity. Implications: Use of menthol cigarette accessories (eg, filters, cards, capsules) among youth who smoked was prevalent after implementation of menthol cigarette bans in England and Canada, and there was disproportionately higher use among those who identified as black and any other race/ethnicity. Efforts are therefore required to close regulatory loopholes of menthol cigarette bans. Findings further support countries, such as the United States, proposing menthol cigarette bans which extend coverage to accessories. More comprehensive menthol bans that also restrict accessories are likely to be more effective in reducing flavored tobacco use among young people and in advancing health equity. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Impact of the European Union's menthol cigarette ban on smoking cessation outcomes: longitudinal findings from the 2020--2021 ITC Netherlands Surveys.

Author

Kyriakos, Christina N., Driezen, Pete, Fong, Geoffrey, Hall, Janet Chung, Hyland, Andrew, Willemsen, Cloé Geboers Anne C. K. Quah Marc C., and Filippidis, Filippos T.

Subjects
SMOKING cessation -- Law & legislation, GOVERNMENT policy -- Law & legislation, SMOKING cessation, TOBACCO, MINTS (Plants), RESEARCH funding, MULTIPLE regression analysis, DESCRIPTIVE statistics, STRUCTURAL equation modeling, LONGITUDINAL method, PRE-tests & post-tests, ODDS ratio, TOBACCO products, HEALTH outcome assessment, CONFIDENCE intervals, COMPARATIVE studies
Published
2024
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8. Smokers’ support for the ban on sale of slim cigarettes in six European countries: findings from the EUREST-PLUS ITC Europe Surveys

Author

Mechili, Enkeleint A., primary, Przewoźniak, Krzysztof, additional, Driezen, Pete, additional, Kyriakos, Christina N, additional, Girvalaki, Charis, additional, Mons, Ute, additional, Quah, Anne CK, additional, Fernández, Esteve, additional, Trofor, Antigona C, additional, Demjén, Tibor, additional, Katsaounou, Paraskevi A, additional, Zatoński, Witold, additional, Fong, Geoffrey T, additional, and Vardavas, Constantine I, additional

Published
2023
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14. Smokers’ support for the ban on sale of slim cigarettes in six European countries: findings from the EUREST-PLUS ITC Europe Surveys

Author

Mechili, Enkeleint A., primary, Przewoźniak, Krzysztof, additional, Driezen, Pete, additional, Kyriakos, Christina N, additional, Girvalaki, Charis, additional, Mons, Ute, additional, Quah, Anne CK, additional, Fernández, Esteve, additional, Trofor, Antigona C, additional, Demjén, Tibor, additional, Katsaounou, Paraskevi A, additional, Zatoński, Witold, additional, Fong, Geoffrey T, additional, and Vardavas, Constantine I, additional

Published
2022
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16. Secondhand Smoke Exposure in European Countries With Different Smoke-Free Legislation: Findings From the EUREST-PLUS ITC Europe Surveys

Author

Nogueira, Sarah O., Fernandez, Esteve, Driezen, Pete, Fu, Marcela, Tigova, Olena, Castellano, Yolanda, Mons, Ute, Herbec, Aleksandra, Kyriakos, Christina N., Demjen, Tibor, Trofor, Antigona C., Przewozniak, Krzysztof, Katsaounou, Paraskevi A., Vardavas, Constantine, I, Fong, Geoffrey T., Nogueira, Sarah O., Fernandez, Esteve, Driezen, Pete, Fu, Marcela, Tigova, Olena, Castellano, Yolanda, Mons, Ute, Herbec, Aleksandra, Kyriakos, Christina N., Demjen, Tibor, Trofor, Antigona C., Przewozniak, Krzysztof, Katsaounou, Paraskevi A., Vardavas, Constantine, I, and Fong, Geoffrey T.

Abstract

Introduction: 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 behavior 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 behavior. Aims and 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 = 6011) and 2018 (Wave 2, n = 6027). We used generalized 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 several 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 Wave 2), restaurants (13.2% in Wave 2) and discos/nightclubs (34.0% in W2). SHS exposure in public places was significantly less likely (adjusted odds ratio = 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.

Published
2022

17. Marketing of flavour capsule cigarettes: a systematic review.

Author

Kyriakos, Christina N., Zatoński, Mateusz Zygmunt, and Filippidis, Filippos T.

Subjects
FLAVORING essences, MEDICAL information storage & retrieval systems, MIDDLE-income countries, SYSTEMATIC reviews, MARKETING, ADVERTISING, LOW-income countries, COMMERCIAL product evaluation, RESEARCH funding, TOBACCO products, MEDLINE, CONTENT analysis
Published
2023
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19. Secondhand Smoke Exposure in European Countries With Different Smoke-Free Legislation: Findings From the EUREST-PLUS ITC Europe Surveys

Author

Nogueira, Sarah O. Fernandez, Esteve Driezen, Pete Fu, Marcela Tigova, Olena Castellano, Yolanda Mons, Ute and Herbec, Aleksandra Kyriakos, Christina N. Demjen, Tibor and Trofor, Antigona C. Przewozniak, Krzysztof Katsaounou, Paraskevi A. Vardavas, I, Constantine Fong, Geoffrey T. EUREST-PLUS Consortium

Abstract

Introduction: 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 behavior 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 behavior. Aims and 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 = 6011) and 2018 (Wave 2, n = 6027). We used generalized 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 several 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 Wave 2), restaurants (13.2% in Wave 2) and discos/nightclubs (34.0% in W2). SHS exposure in public places was significantly less likely (adjusted odds ratio = 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.

Published
2022

22. Beyond the European Union Tobacco Products Directive: smokers' and recent quitters' support for further tobacco control measures (2016-2018).

Author

Nogueira, Sarah O., Driezen, Pete, Fu, Marcela, Hitchman, Sara C., Tigova, Olena, Castellano, Yolanda, Kyriakos, Christina N., Zatoński, Mateusz Zygmunt, Mons, Ute, Quah, Anne C. K., Demjén, Tibor, Trofor, Antigona Carmen, Przewozniak, Krzysztof, Katsaounou, Paraskevi, Fong, Geoffrey, Vardavas, Constantine I., and Fernández, Esteve

Subjects
HEALTH policy, SMOKING cessation, SOCIAL support, CONSUMER attitudes, HUMAN services programs, DESCRIPTIVE statistics, TOBACCO products, SMOKING
Published
2022
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23. Global market trends of flavor capsule cigarettes and menthol (non-capsule) cigarettes: An ecological analysis using commercial data across 78 countries, 2010-2020.

Author

Kyriakos, Christina N., Qi, Dickson, Chang, Kiara, Laverty, Anthony A., and Filippidis, Filippos T.

Subjects
*FLAVORING essences, *CONFIDENCE intervals, *MULTIVARIATE analysis, *REGRESSION analysis, *ECOLOGICAL research, *TOBACCO products
Abstract

INTRODUCTION This study describes market trends of flavor capsule cigarettes (FCCs) and menthol (non-capsule) cigarettes (MNCCs) across 78 countries from 2010 to 2020 and examines country-level factors associated with market shares of these products. METHODS Market share and retail volume data came from the Euromonitor Passport database and country-level data came from the World Health Organization (WHO), World Bank, and International Monetary Fund. Multivariable linear fixed effects panel regression analyses were conducted to evaluate the relationship between predictor variables and the market shares of menthol (non-capsule) cigarettes and flavor capsule cigarettes. RESULTS The overall market share (i.e. the percentage retail volume out of total retail volume of all cigarette types) increased from 0.23% in 2010 to 4.5% in 2020 for FCCs and decreased from 5.0% to 3.8% for MNCCs. Market shares of FCCs grew most rapidly in the Americas region and among upper middle-income countries. Market shares of MNCCs remained stable across most regions and were highest in the Western Pacific and Africa regions. The overall market share of FCCs was positively associated with the unemployment rate (β=0.28; 95% CI: 0.12-0.44, p=0.001), and inversely associated with the percent of the population aged 15-29 years (β=-0.57, 95% CI: -0.98 -- -0.15, p=0.008), percent of urban population (β=-0.88; 95% CI: -1.28 -- -0.48, p<0.001), GDP PPP per capita (β= -0.13; 95% CI: -0.24 -- -0.03, p=0.015), and age-standardized prevalence of cigarette smoking (β=-0.93; 95% CI: -1.38 -- -0.49, p<0.001). In contrast, the overall market share of MNCCs was positively associated with urbanicity (β=0.24; 95% CI: 0.08-0.40, p=0.003), and negatively associated with the unemployment rate (β=-0.09; 95% CI: -0.17 -- -0.02, p=0.014). CONCLUSIONS Global sales of flavor capsule cigarettes grew substantially in the last decade, surpassing menthol (non-capsule) cigarettes, which also continued to be high in many regions. There is a need for increased efforts to address flavors and novel tobacco products, features that are known to appeal to youth. [ABSTRACT FROM AUTHOR]

Published
2022
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24. Smokers’ support for the ban on sale of slim cigarettes in six European countries: findings from the EUREST-PLUS ITC Europe surveys

Author

Mechili, Enkeleint A., primary, Przewoźniak, Krzysztof, additional, Driezen, Pete, additional, Kyriakos, Christina N, additional, Girvalaki, Charis, additional, Mons, Ute, additional, Quah, Anne CK, additional, Fernández, Esteve, additional, Trofor, Antigona C, additional, Demjén, Tibor, additional, Katsaounou, Paraskevi A, additional, Zatoński, Witold, additional, Fong, Geoffrey T, additional, and Vardavas, Constantine I, additional

Published
2021
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26. 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

Author

Aleyan, Sarah, Driezen, Pete, Kyriakos, Christina N., Thompson, Mary E., Balmford, James, Demjén, Tibor, Fernández, Esteve, Mons, Ute, Tountas, Yannis, Janik-Koncewicz, Kinga, Zatonski, Witold, Trofor, Antigona C., Vardavas, Constantine I., Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., EUREST-PLUS consortium, Aleyan, Sarah, Driezen, Pete, Kyriakos, Christina N., Thompson, Mary E., Balmford, James, Demjén, Tibor, Fernández, Esteve, Mons, Ute, Tountas, Yannis, Janik-Koncewicz, Kinga, Zatonski, Witold, Trofor, Antigona C., Vardavas, Constantine I., Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., and EUREST-PLUS consortium

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; N¼9547) and 2 (2018; N¼9724) 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.

Published
2020

27. 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

Author

Vardavas, Constantine I., Kyriakos, Christina N., Driezen, Pete, Girvalaki, Charis, Nikitara, Katerina, Filippidis, Filippos T., Fernández, Esteve, Mons, Ute, Przewozniak, Krzysztof, Trofor, Antigona C., Demjén, Tibor, Katsaounou, Paraskevi A., Zatonski, Witold, Willemsen, Marc, Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Petroulia, Ioanna, Tzavara, Chara, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., EUREST-PLUS consortium, Vardavas, Constantine I., Kyriakos, Christina N., Driezen, Pete, Girvalaki, Charis, Nikitara, Katerina, Filippidis, Filippos T., Fernández, Esteve, Mons, Ute, Przewozniak, Krzysztof, Trofor, Antigona C., Demjén, Tibor, Katsaounou, Paraskevi A., Zatonski, Witold, Willemsen, Marc, Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Petroulia, Ioanna, Tzavara, Chara, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., and EUREST-PLUS consortium

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.

Published
2020

28. 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

Author

Papadakis, Sophia, Katsaounou, Paraskevi, Kyriakos, Christina N., Balmford, James, Tzavara, Chara, Girvalaki, Charis, Driezen, Pete, Filippidis, Filippos T., Herbec, Aleksandra, Hummel, Karin, Mcneill, Ann, Mons, Ute, Fernández, Esteve, Fu, Marcela, Trofor, Antigona C., Demjén, Tibor, Zatonski, Witold A., Willemsen, Marc, Fong, Geoffrey T., Vardavas, Constantine I., Glahn, Andrea, Nguyen, Dominick, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Igoumenaki, Chryssi, Nikitara, Katerina, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Piroska A., Castellano, Yolanda, Nogueira, Sarah O., Tigova, Olena, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Gratziou, Christina, Peleki, Theodosia, Petroulia, Ioanna, De Vries, Hein, Nagelhout, Gera E., EUREST-PLUS consortium, Papadakis, Sophia, Katsaounou, Paraskevi, Kyriakos, Christina N., Balmford, James, Tzavara, Chara, Girvalaki, Charis, Driezen, Pete, Filippidis, Filippos T., Herbec, Aleksandra, Hummel, Karin, Mcneill, Ann, Mons, Ute, Fernández, Esteve, Fu, Marcela, Trofor, Antigona C., Demjén, Tibor, Zatonski, Witold A., Willemsen, Marc, Fong, Geoffrey T., Vardavas, Constantine I., Glahn, Andrea, Nguyen, Dominick, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Igoumenaki, Chryssi, Nikitara, Katerina, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Piroska A., Castellano, Yolanda, Nogueira, Sarah O., Tigova, Olena, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Gratziou, Christina, Peleki, Theodosia, Petroulia, Ioanna, De Vries, Hein, Nagelhout, Gera E., and EUREST-PLUS consortium

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 ¼ 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 ¼ 1.66, 95%CI ¼ 1.08–2.56). In the cross-sectional analysis, having an intention to quit was associated with seeing EC use in public (OR ¼ 1.37, 95%CI ¼ 1.04–1.81) and reporting fewer than three close friends smoke (OR ¼ 0.59, 95%CI ¼ 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.

Published
2020

29. Transitions from and to roll-your-own tobacco, perceptions and health beliefs among smokers: findings from the EUREST-PLUS ITC Europe Surveys

Author

Filippidis, Filippos T., Driezen, Pete, Kyriakos, Christina N., Katsaounou, Paraskevi, Petroulia, Ioanna, Girvalaki, Charis, Fu, Marcela, Fernández, Esteve, Mons, Ute, Trofor, Antigona C., Demjén, Tibor, Przewozniak, Krzysztof, Zatonski, Witold A., Fong, Geoffrey T., Tountas, Yannis, Vardavas, Constantine I., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Gratziou, Christina, Peleki, Theodosia, Tzavara, Chara, Eremia, Marius, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., EUREST-PLUS consortium, Filippidis, Filippos T., Driezen, Pete, Kyriakos, Christina N., Katsaounou, Paraskevi, Petroulia, Ioanna, Girvalaki, Charis, Fu, Marcela, Fernández, Esteve, Mons, Ute, Trofor, Antigona C., Demjén, Tibor, Przewozniak, Krzysztof, Zatonski, Witold A., Fong, Geoffrey T., Tountas, Yannis, Vardavas, Constantine I., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Gratziou, Christina, Peleki, Theodosia, Tzavara, Chara, Eremia, Marius, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., and EUREST-PLUS consortium

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 ¼ 6011 smokers) and in 2018 (n ¼ 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.

Published
2020

30. Awareness and use of heated tobacco products among adult smokers in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys

Author

Nogueira, Sarah O., Tigova, Olena, Driezen, Pete, Fu, Marcela, Kyriakos, Christina N., Zatonski, Mateusz, Mons, Ute, Quah, Anne C.K., Demjén, Tibor, Trofor, Antigona C., Przewozniak, Krzysztof, Katsaounou, Paraskevi A., Fong, Geoffrey T., Vardavas, Constantine I., Fernández, Esteve, Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Petroulia, Ioanna, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., EUREST-PLUS consortium, Nogueira, Sarah O., Tigova, Olena, Driezen, Pete, Fu, Marcela, Kyriakos, Christina N., Zatonski, Mateusz, Mons, Ute, Quah, Anne C.K., Demjén, Tibor, Trofor, Antigona C., Przewozniak, Krzysztof, Katsaounou, Paraskevi A., Fong, Geoffrey T., Vardavas, Constantine I., Fernández, Esteve, Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Petroulia, Ioanna, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., and EUREST-PLUS consortium

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 ¼ 6011) and 2018 (N ¼ 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.

Published
2020

31. Support for e-cigarette policies among smokers in seven European countries: longitudinal findings from the 2016–18 EUREST-PLUS ITC Europe Surveys

Author

Chung-Hall, Janet, Meng, Gang, Kyriakos, Christina N., Craig, Lorraine V., Balmford, James, Demjén, Tibor, Fernández, Esteve, Mons, Ute, Tountas, Yannis, Janik-Koncewicz, Kinga, Zatonski, Witold, Trofor, Antigona C., Vardavas, Constantine I., Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., EUREST-PLUS consortium, Chung-Hall, Janet, Meng, Gang, Kyriakos, Christina N., Craig, Lorraine V., Balmford, James, Demjén, Tibor, Fernández, Esteve, Mons, Ute, Tountas, Yannis, Janik-Koncewicz, Kinga, Zatonski, Witold, Trofor, Antigona C., Vardavas, Constantine I., Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., and EUREST-PLUS consortium

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 ¼ 9547; just after TPD) and 2018 (n ¼ 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.

Published
2020

32. Effectiveness of tobacco warning labels before and after implementation of the European Tobacco Products Directive—findings from the longitudinal EUREST-PLUS ITC Europe surveys

Author

Gravely, Shannon, Driezen, Pete, Kyriakos, Christina N., Thompson, Mary E., Balmford, James, Demjén, Tibor, Fernández, Esteve, Mons, Ute, Tountas, Yannis, Janik-Koncewicz, Kinga, Zatonski, Witold, Trofor, Antigona C., Vardavas, Constantine I., Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., EUREST-PLUS consortium, Gravely, Shannon, Driezen, Pete, Kyriakos, Christina N., Thompson, Mary E., Balmford, James, Demjén, Tibor, Fernández, Esteve, Mons, Ute, Tountas, Yannis, Janik-Koncewicz, Kinga, Zatonski, Witold, Trofor, Antigona C., Vardavas, Constantine I., Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., and EUREST-PLUS consortium

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 ¼ 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. .........................................................................................................

Published
2020

33. Do smokers want to protect non-smokers from the harms of second-hand smoke in cars? Findings from the EUREST-PLUS ITC Europe Surveys

Author

Nogueira, Sarah O., Tigova, Olena, Driezen, Pete, Fu, Marcela, Kyriakos, Christina N., Zatonski, Mateusz, Mons, Ute, Quah, Anne C.K., Demjén, Tibor, Trofor, Antigona C., Przewozniak, Krzysztof, Katsaounou, Paraskevi A., Fong, Geoffrey T., Vardavas, Constantine I., Fernández, Esteve, Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Peleki, Theodosia, Petroulia, Ioanna, Tzavara, Chara, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., EUREST-PLUS consortium, Nogueira, Sarah O., Tigova, Olena, Driezen, Pete, Fu, Marcela, Kyriakos, Christina N., Zatonski, Mateusz, Mons, Ute, Quah, Anne C.K., Demjén, Tibor, Trofor, Antigona C., Przewozniak, Krzysztof, Katsaounou, Paraskevi A., Fong, Geoffrey T., Vardavas, Constantine I., Fernández, Esteve, Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Peleki, Theodosia, Petroulia, Ioanna, Tzavara, Chara, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., and EUREST-PLUS consortium

Abstract

Background: There is currently no comprehensive legislation protecting non-smokers and children from secondhand 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 ¼ 6011) and Wave 2 (2018, n ¼ 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.

Published
2020

34. 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

Author

Vardavas, Constantine I., Kyriakos, Christina N., Driezen, Pete, Girvalaki, Charis, Nikitara, Katerina, Filippidis, Filippos T., Fernández, Esteve, Mons, Ute, Przewozniak, Krzysztof, Trofor, Antigona C., Demjén, Tibor, Katsaounou, Paraskevi A., Zatonski, Witold, Willemsen, Marc, Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Petroulia, Ioanna, Tzavara, Chara, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., EUREST-PLUS consortium, Vardavas, Constantine I., Kyriakos, Christina N., Driezen, Pete, Girvalaki, Charis, Nikitara, Katerina, Filippidis, Filippos T., Fernández, Esteve, Mons, Ute, Przewozniak, Krzysztof, Trofor, Antigona C., Demjén, Tibor, Katsaounou, Paraskevi A., Zatonski, Witold, Willemsen, Marc, Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Tountas, Yannis, Behrakis, Panagiotis, Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Petroulia, Ioanna, Tzavara, Chara, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., and EUREST-PLUS consortium

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 ¼ 5597) and recent quitters (n ¼ 412). Adjusted logistic regression analyses were restricted to the subset of current smokers (n ¼ 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.

Published
2020

35. 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

Author

Gravely, Shannon, Driezen, Pete, Kyriakos, Christina N., Thompson, Mary E., Balmford, James, Demjén, Tibor, Fernández, Esteve, Mons, Ute, Tountas, Yannis, Janik-Koncewicz, Kinga, Zatonski, Witold, Trofor, Antigona C., Vardavas, Constantine I., Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., EUREST-PLUS consortium, Gravely, Shannon, Driezen, Pete, Kyriakos, Christina N., Thompson, Mary E., Balmford, James, Demjén, Tibor, Fernández, Esteve, Mons, Ute, Tountas, Yannis, Janik-Koncewicz, Kinga, Zatonski, Witold, Trofor, Antigona C., Vardavas, Constantine I., Fong, Geoffrey T., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Bécuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Rivière, Oscar, Kiss, Judit, Kovacs, Anna Piroska, Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Filippidis, Filippos T., Gratziou, Christina, Katsaounou, Paraskevi, Peleki, Theodosia, Willemsen, Marc, De Vries, Hein, Hummel, Karin, Nagelhout, Gera E., and EUREST-PLUS consortium

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.

Published
2020

36. Perceptions, Predictors of and Motivation for Quitting among Smokers from Six European Countries from 2016 to 2018: Findings from EUREST-PLUS ITC Europe Surveys

Author

Girvalaki, Charis, Filippidis, Filippos T., Kyriakos, Christina N., Driezen, Pete, Herbec, Aleksandra, Mons, Ute, Papadakis, Sophia, Mechili, Enkeleint A., Katsaounou, Paraskevi A., Przewozniak, Krzysztof, Fernandez, Esteve, Trofor, Antigona C., Demjen, Tibor, Fong, Geoffrey T., Vardavas, Constantine, I, Girvalaki, Charis, Filippidis, Filippos T., Kyriakos, Christina N., Driezen, Pete, Herbec, Aleksandra, Mons, Ute, Papadakis, Sophia, Mechili, Enkeleint A., Katsaounou, Paraskevi A., Przewozniak, Krzysztof, Fernandez, Esteve, Trofor, Antigona C., Demjen, Tibor, Fong, Geoffrey T., and Vardavas, Constantine, I

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.

Published
2020

37. Beyond the European Union Tobacco Products Directive: smokers’ and recent quitters’ support for further tobacco control measures (2016–2018)

Author

Nogueira, Sarah O, primary, Driezen, Pete, additional, Fu, Marcela, additional, Hitchman, Sara C, additional, Tigova, Olena, additional, Castellano, Yolanda, additional, Kyriakos, Christina N, additional, Zatoński, Mateusz Zygmunt, additional, Mons, Ute, additional, Quah, Anne C K, additional, Demjén, Tibor, additional, Trofor, Antigona Carmen, additional, Przewozniak, Krzysztof, additional, Katsaounou, Paraskevi, additional, Fong, Geoffrey, additional, Vardavas, Constantine I, additional, and Fernández, Esteve, additional

Published
2021
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38. Secondhand Smoke Exposure in European Countries With Different Smoke-Free Legislation: Findings From the EUREST-PLUS ITC Europe Surveys.

Author

Nogueira, Sarah O, Fernández, Esteve, Driezen, Pete, Fu, Marcela, Tigova, Olena, Castellano, Yolanda, Mons, Ute, Herbeć, Aleksandra, Kyriakos, Christina N, Demjén, Tibor, Trofor, Antigona C, Przewoźniak, Krzysztof, Katsaounou, Paraskevi A, Vardavas, Constantine I, Fong, Geoffrey T, Consortium, EUREST-PLUS, and EUREST-PLUS Consortium

Subjects
RESEARCH, RESTAURANTS, RESEARCH methodology, ARTHRITIS Impact Measurement Scales, EVALUATION research, COMPARATIVE studies, RESEARCH funding, QUESTIONNAIRES, PASSIVE smoking
Abstract

Introduction: 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 behavior 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 behavior.Aims and 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 = 6011) and 2018 (Wave 2, n = 6027). We used generalized 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 several 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 Wave 2), restaurants (13.2% in Wave 2) and discos/nightclubs (34.0% in W2). SHS exposure in public places was significantly less likely (adjusted odds ratio = 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.Implications: Prevalence of smokers engaging in and being exposed to smoking in public places varied by type of smoke-free legislation across six European Union countries in our study; those with total smoke bans reported significantly less exposure to SHS than those with partial or no bans. Our results indicate room for improvement, not only to decrease the prevalence of exposure to SHS in Europe but also to diminish the variability between countries through common, more restrictive smoke-free legislation, and importantly, strong and sustained enforcement. [ABSTRACT FROM AUTHOR]

Published
2022
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39. Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases: Findings from the EUREST-PLUS ITC Europe Surveys

Author

Hedman, Linnea, Katsaounou, Paraskevi A., Filippidis, Filippos T., Ravara, Sofia B., Lindberg, Anne, Janson, Christer, Gratziou, Christina, Rohde, Gernot, Kyriakos, Christina N., Mons, Ute, Fernandez, Esteve, Trofor, Antigona C., Demjen, Tibor, Przewozniak, Krzysztof, Tountas, Yannis, Fong, Geoffrey T., Vardavas, Constantine I., Glahn, Andrea, Nguyen, Dominick, Nikitara, Katerina, Radu-Loghin, Cornel, Starchenko, Polina, Tsatsakis, Aristidis, Girvalaki, Charis, Igoumenaki, Chryssi, Papadakis, Sophia, Papathanasaki, Aikaterini, Tzatzarakis, Manolis, Vardavas, Alexander I., Becuwe, Nicolas, Deaconu, Lavinia, Goudet, Sophie, Hanley, Christopher, Riviere, Oscar, Kiss, Judit, Kovacs, Piroska A., Castellano, Yolanda, Fu, Marcela, Nogueira, Sarah O., Tigova, Olena, McNeill, Ann, East, Katherine, Hitchman, Sara C., Kahnert, Sarah, Behrakis, Panagiotis, Katsaounou, Paraskevi, Peleki, Theodosia, Petroulia, Ioanna, Tzavara, Chara, Eremia, Marius, Lotrean, Lucia, Mihaltan, Florin, Asano, Tamaki, Cichon, Claudia, Far, Amy, Genton, Celine, Jessner, Melanie, Lindberg, Ann, Maguire, Beth, Ravara, Sofia, Vaccaro, Valerie, Ward, Brian, Willemsen, Marc, de Vries, Hein, Hummel, Karin, Nagelhout, Gera E., Zatonski, Witold A., Herbec, Aleksandra, Janik-Koncewicz, Kinga, Zatonski, Mateusz, Agar, Thomas K., Driezen, Pete, Gravely, Shannon, Quah, Anne C. K., and Thompson, Mary E.

Subjects
Respiratory diseases, medicine.medical_specialty, Health (social science), medicine.medical_treatment, Medicine (miscellaneous), quitting smoking, Smoking cessation, Quit smoking, Malalties de l'aparell respiratori, 03 medical and health sciences, 0302 clinical medicine, DEPENDENCE, Tractament del tabaquisme, COPD, Malalties cròniques, Medicine, CESSATION ADVICE, 030212 general & internal medicine, tobacco smoking, Beroendelära, Psychiatry, Public, Environmental & Occupational Health, TOBACCO, Science & Technology, business.industry, Substance Abuse, Public Health, Environmental and Occupational Health, 1103 Clinical Sciences, Public Health, Global Health, Social Medicine and Epidemiology, medicine.disease, smoking cessation, 3. Good health, Substance abuse, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Chronic disease, 030228 respiratory system, Chronic diseases, behavior and behavior mechanisms, EUREST-PLUS consortium, business, Life Sciences & Biomedicine, chronic disease, Research Paper, Chronic Obstructive Pulmonary Disease (COPD)
Abstract

INTRODUCTION Having a chronic disease either caused or worsened by tobacco smoking does not always translate into quitting smoking. Although smoking cessation is one of the most cost-effective medical interventions, it remains poorly implemented in healthcare settings. The aim was to examine whether smokers with chronic and respiratory diseases were more likely to receive support to quit smoking by a healthcare provider or make a quit attempt than smokers without these diseases. METHODS This population-based study included a sample of 6011 adult smokers in six European countries. The participants were interviewed face-to-face and asked questions on sociodemographic characteristics, current diagnoses for chronic diseases, healthcare visits in the last 12 months and, if so, whether they had received any support to quit smoking. Questions on smoking behavior included nicotine dependence, motivation to quit smoking and quit attempts in the last 12 months. The results are presented as weighted percentages with 95% confidence intervals (CI) and as adjusted odds ratios with 95% CI based on logistic regression analyses. RESULTS Smokers with chronic respiratory disease, those aged 55 years and older, as well as those with one or more chronic diseases were more likely to receive smoking cessation advice from a healthcare professional. Making a quit attempt in the last year was related to younger age, high educational level, higher motivation to quit, lower nicotine dependence and having received advice to quit from a healthcare professional but not with having chronic diseases. There were significant differences between countries with smokers in Romania consistently reporting more support to quit as well as quit attempts. CONCLUSIONS Although smokers with respiratory disease did indeed receive smoking cessation support more often than smokers without disease, many smokers did not receive any advice or support to quit during a healthcare visit. Supplement 2.

Published
2019
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40. Prevalence and correlates of different smoking bans in homes and cars among smokers in six countries of the EUREST-PLUS ITC Europe Surveys

Author

Fu, Marcela, Castellano, Yolanda, Tigova, Olena, Kyriakos, Christina N., Fong, Geoffrey T., Mons, Ute, Zatoński, Witold A., Agar, Thomas K., Quah, Anne C. K., Trofor, Antigona C., Demjén, Tibor, Przewoźniak, Krzysztof, Tountas, Yannis, Vardavas, Constantine I., and Fernández, Esteve

Subjects
Europe, voluntary smoke-free regulation, smokers, private settings, WHO FCTC, Research Paper
Abstract

INTRODUCTION Second-hand smoke exposure has decreased in a number of countries due to widespread smoke-free legislation in public places, but exposure is still present in private settings like homes and cars. Our objective was to describe to what extent smokers implement smoking rules in these settings in six European Union (EU) Member States (MS). METHODS A cross-sectional survey was conducted with a nationally representative sample of adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (ITC six European countries survey, part of the EUREST-PLUS Project). We analysed data from 6011 smokers regarding smoking rules in their homes and in cars with children (no rules, partial ban, total ban). We described the prevalence of smoking rules by EU MS and several sociodemographic and smoking characteristics using prevalence ratios (PR) and 95% confidence intervals (CI) derived from Poisson regression models. \ RESULTS In homes, 26.5% had a total smoking ban (from 13.1% in Spain to 35.5% in Hungary), 44.7% had a partial ban (from 41.3% in Spain to 49.9% in Greece), and 28.8% had no-smoking rules (from 20.2% in Romania to 45.6% in Spain). Prevalence of no-smoking rules in cars with children was 16.2% (from 11.2% in Germany to 20.4% in Spain). The correlates of not restricting smoking in homes and cars included: low education (PR=1.51; 95%CI: 1.20-1.90 and PR=1.55; 95%CI: 1.09-2.20), smoking >30 cigarettes daily (PR=1.53; 95%CI: 1.10-2.14 and PR=2.66; 95%CI: 1.40-5.05) and no attempts to quit ever (PR=1.18; 95%CI: 1.06-1.31 and PR=1.28; 95%CI: 1.06-1.54). CONCLUSIONS Among smokers in six EU MS, no-smoking rules were more prevalent in homes than in cars with children. Whilst awareness about the health effects of exposure to tobacco smoke on children seemed to be high, more research is needed to better understand the factors that promote private smoke-free environments.

Published
2019

41. Attitudes towards tobacco control policies among smokers of menthol, other flavored and unflavored cigarettes: Findings from the EUREST-PLUS ITC Europe Surveys

Author

Przewozniak, Krzysztof Zatonski, Mateusz Herbec, Aleksandra and Zatonski, Witold Janik-Koncewicz, Kinga Mons, Ute Fong, Geoffrey T. Quah, Anne C. K. Driezen, Pete Demjen, Tibor and Tountas, Yannis Trofor, Antigona C. Fernandez, Esteve and McNeill, Ann Willemsen, Marc Hummel, Karin Kyriakos, Christina N. Vardavas, Constantine I. EUREST-PLUS Consortium

Published
2019

42. Price differentials of tobacco products: A cross-sectional analysis of 79 countries from the six WHO regions.

Author

Kyriakos, Christina N., Ahmad, Aulia, Chang, Kiara, and Filippidis, Filippos T.

Subjects
*TAXATION, *SMOKING cessation, *CROSS-sectional method, *POPULATION geography, *COMPARATIVE studies, *COST analysis, *DESCRIPTIVE statistics, *GOVERNMENT policy, *TOBACCO products
Abstract

INTRODUCTION Increased taxation is one of the most effective tobacco control measures. Price differentials across tobacco product types may undermine the effectiveness of taxation policies by providing the option to switch to cheaper products rather than to quit. The aim of this study was to use commercial data to compare prices and price differentials of both cigarette and non-cigarette products across countries from all geographical regions. METHODS We analyzed 6920 price data points (i.e. product brands) from Euromonitor Passport 2016 for 12 types of tobacco products across 79 countries from the six WHO regions: Africa (n=5), Eastern Mediterranean (n=6), Europe (n=39), the Americas (n=15), South-East Asia (n=3), and Western Pacific (n=12). For each product and country, a price differential was computed as the percentage of minimum price to the median. RESULTS Median cigarette prices (US$) were highest in Western Pacific countries (4.00; range: 0.80-16.20) and European countries (3.80; range: 0.80-14.00), but lowest in African countries (2.00; range: 0.80-2.20). The medians of cigarette price differentials were largest in the Eastern Mediterranean (48.33%) and African regions (50.00%), but smallest in Europe (82.35%). Pipe tobacco and fine-cut tobacco were generally less expensive than cigarettes while cigars were the most expensive. However, there were wide variations in prices and price differentials across regions and tobacco products. CONCLUSIONS We found substantial variations in prices and price differentials between countries and world regions across tobacco products, likely reflecting differences in taxation policies and structures. Findings identify types of tobacco products in specific geographical regions where price differentials are highest, thereby highlighting areas where taxation policies need improvement, for example through implementing specific excise taxes. [ABSTRACT FROM AUTHOR]

Published
2021
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43. Extent and correlates of self-reported exposure to tobacco advertising, promotion, and sponsorship in smokers:Findings from the EUREST-PLUS ITC Europe Surveys Tobacco marketing exposure – findings from ITC Europe

Author

Kahnert, Sarah, Demjén, Tibor, Tountas, Yannis, Trofor, Antigona, Przewoźniak, Krzysztof, Zatónski, Witold A, Fernández, Esteve, McNeill, Ann Denise, Willemsen, Marc, Kyriakos, Christina N., Fong, Geoffrey T, Vardavas, Constantine, and Mons, Ute

Subjects
TAPS, Advertising bans, EUROPE, Tobacco marketing, Tobacco sponsorship, Tobacco advertising, Tobacco promotion
Abstract

Introduction: Tobacco advertising, promotion, and sponsorship (TAPS) are known to promote tobacco consumption and to discourage smoking cessation. Consequently, comprehensive TAPS bans are effective measures to reduce smoking. The objective of this study was to investigate to what extent smokers are exposed to TAPS in general, and in various media and localities, in different European countries.Methods: A Cross-sectional analysis of national representative samples of adult smokers in 2016 from Germany, Greece, Hungary, Poland, Romania, and Spain (EUREST-PLUS Project, n=6,011), as well as England (n=3,503) and the Netherlands (n=1,213) (ITC Europe Surveys) was conducted. Prevalence of self-reported TAPS exposure is reported by country, and socio-economic correlates were investigated using logistic regression models.Results: Self-reported exposure to TAPS varied widely among the countries, from 15.4 % in Hungary to 69.2 % in the Netherlands. In most countries, tobacco advertising was most commonly seen at the point of sale, and rarely noticed in mass media. The multivariate analysis revealed some variation in exposure to TAPS by sociodemographic factors. Age showed the greatest consistency across countries with younger smokers (18–24-year-olds) being more likely to notice TAPS than older smokers.Conclusions: TAPS exposure tended to be higher in countries with less restrictive regulation but was also reported in countries with more comprehensive bans, although at lower levels. The findings indicate the need for a comprehensive ban on TAPS to avoid a shift of marketing efforts to less regulated channels, and for stronger enforcement of existing bans.

Published
2018
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44. 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

Author

Fu, Marcela Castellano, Yolanda Tigova, Olena Mons, Ute and Agar, Thomas Kyriakos, Christina N. Quah, Anne C. K. Fong, Geoffrey T. Trofor, Antigona C. Przewozniak, Krzysztof and Zatonski, Witold A. Demjen, Tibor Tountas, Yannis Vardavas, Constantine I. Fernandez, Esteve Glahn, Andrea Nguyen, Dominick Nikitara, Katerina Radu-Loghin, Cornel Starchenko, Polina Tsatsakis, Aristidis Girvalaki, Charis Igoumenaki, Chryssi Papadakis, Sophia Papathanasaki, Aikaterini and Tzatzarakis, Manolis Vardavas, Alexander I. Becuwe, Nicolas and Deaconu, Lavinia Goudet, Sophie Hanley, Christopher Riviere, Oscar Kiss, Judit Kovacs, Piroska A. Nogueira, Sarah O. and McNeill, Ann East, Katherine Hitchman, Sara C. Kahnert, Sarah Behrakis, Panagiotis Filippidis, Filippos T. Gratziou, Christina Katsaounou, Paraskevi Peleki, Theodosia Petroulia, Ioanna Tzavara, Chara Eremia, Marius Lotrean, Lucia and Mihaltan, Florin Rohde, Gernot Asano, Tamaki Cichon, Claudia and Far, Amy Genton, Celine Jessner, Melanie Hedman, Linnea and Janson, Christer Lindberg, Ann Maguire, Beth Ravara, Sofia Vaccaro, Valerie Ward, Brian Willemsen, Marc de Vries, Hein Hummel, Karin Nagelhout, Gera E. Herbec, Aleksandra Janik-Koncewicz, Kinga Zatonski, Mateusz Agar, Thomas K. Driezen, Pete Gravely, Shannon Thompson, Mary E. and EUREST-PLUS Consortium

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.

Published
2018

45. Undesirable events during electronic cigarette use prior to the implementation of Article 20 of the European Union Tobacco Products Directive: Findings from the EUREST-PLUS ITC Europe Surveys

Author

Kyriakos, Christina N. Filippidis, Filippos T. Hitchman, Sara and Girvalaki, Charis Tzavara, Chara Demjen, Tibor and Fernandez, Esteve Mons, Ute Trofor, Antigona Tountas, Yannis and Zatonski, Mateusz Zatonski, Witold A. Fong, Geoffrey T. and Vardavas, Constantine I. EUREST-PLUS Consortium

Published
2018

46. Quitting behaviors and cessation assistance used among smokers with anxiety or depression: Findings among six countries of the EUREST-PLUS ITC Europe Surveys

Author

Petroulia, Ioanna Kyriakos, Christina N. Papadakis, Sophia and Tzavara, Chara Filippidis, Filippos T. Girvalaki, Charis and Peleki, Theodosia Katsaounou, Paraskevi McNeill, Ann Mons, Ute Fernandez, Esteve Demjen, Tibor Trofor, Antigona and Herbec, Aleksandra Zatonski, Witold Tountas, Yannis Fong, Geoffrey T. Vardavas, Constantine I. EUREST-PLUS Consortium

Published
2018

47. Smoking in public places in six European countries: Findings from the EUREST-PLUS ITC Europe Survey

Author

Fu, Marcela Castellano, Yolanda Tigova, Olena Mons, Ute and Agar, Thomas Kyriakos, Christina N. Trofor, Antigona C. and Quah, Anne C. K. Fong, Geoffrey T. Przewozniak, Krzysztof and Zatonski, Witold A. Demjen, Tibor Tountas, Yannis Vardavas, Constantine I. Fernandez, Esteve Glahn, Andrea Nguyen, Dominick Nikitara, Katerina Radu-Loghin, Cornel Starchenko, Polina Tsatsakis, Aristidis Girvalaki, Charis Igoumenaki, Chryssi Papadakis, Sophia Papathanasaki, Aikaterini and Tzatzarakis, Manolis Vardavas, Alexander I. Becuwe, Nicolas and Deaconu, Lavinia Goudet, Sophie Hanley, Christopher Riviere, Oscar Kiss, Judit Kovacs, Piroska A. Nogueira, Sarah O. and McNeill, Ann East, Katherine Hitchman, Sara C. Kahnert, Sarah Behrakis, Panagiotis Filippidis, Filippos T. Gratziou, Christina Katsaounou, Paraskevi Peleki, Theodosia Petroulia, Ioanna Tzavara, Chara Eremia, Marius Lotrean, Lucia and Mihaltan, Florin Rohde, Gernot Asano, Tamaki Cichon, Claudia and Far, Amy Genton, Celine Jessner, Melanie Hedman, Linnea and Janson, Christer Lindberg, Ann Maguire, Beth Ravara, Sofia Vaccaro, Valerie Ward, Brian Willemsen, Marc de Vries, Hein Hummel, Karin Nagelhout, Gera E. Herbec, Aleksandra Janik-Koncewicz, Kinga Zatonski, Mateusz Agar, Thomas K. Driezen, Pete Gravely, Shannon Thompson, Mary E. and EUREST-PLUS Consortium

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 smokefree regulations, especially in leisure facilities.

Published
2018

48. Discrepancies in reported versus measured nicotine content of e-cigarette refill liquids across nine European countries before and after the implementation of the EU Tobacco Products Directive

Author

Girvalaki, Charis, primary, Tzatzarakis, Manolis, additional, Vardavas, Alexander, additional, Kyriakos, Christina N., additional, Nikitara, Katerina, additional, Stivaktakis, Polychronis, additional, Tsatsakis, Aristidis, additional, and Vardavas, Constantine, additional

Published
2019
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50. H2020 funding for respiratory research: scaling up for the prevention and treatment of lung diseases

Author

Vardavas, Constantine I., primary, Kyriakos, Christina N., additional, Fernández, Esteve, additional, Bamidis, Panagiotis, additional, Siddiqi, Kamran, additional, Chavannes, Niels H., additional, van der Kleij, R.M.J.J., additional, Parker, Gary, additional, Radu-Loghin, Cornel, additional, Ward, Brian, additional, and Berkouk, Karim, additional

Published
2019
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