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Due to the continued detrimental effects of tobacco use, a growing number of countries are embracing the idea of tobacco endgame, meaning ending the tobacco epidemic instead of controlling it. This narrative review aims to synthesize and update the evidence from earlier scientific reviews on effective tobacco endgame measures, as well as to assess their integration to current national strategies among European countries with official tobacco endgame goals. The synthesis of the prior scientific literature found most evidence on product-focused and some evidence for supply-focused policies. Little evidence was detected for user- and institutional-focused measures. An update for the tobacco-free generation measure showed uncertainty in reducing smoking prevalence, especially for adolescents' reactions to age-restrictive laws. All the countries that established a tobacco endgame strategy have included product standards in their measures, predominantly based on European Union regulations on conventional tobacco products, yet standards above this level and considering other products were also common. Cessation measures were given strong emphasis in strategies, yet none of the countries linked these to specific endgame measures. Despite commonly mentioning vulnerable groups, such as youth and pregnant women, adoption of measures to reduce tobacco use among these groups was scarce. Lastly, the decline in tobacco use seems to be modest, implying challenges in meeting the endgame goals. To meet these goals, European countries should reinforce the implementation of known effective tobacco control measures such as tax increases. Furthermore, new innovative strategies and measures to meet the objective of an endgame should be explored., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2024 Ruokolainen O. et al.)

Introduction: To assess the feasibility of developing World Health Organization (WHO) European Region countries' goals and measures in line with tobacco endgame objectives, information on the current tobacco control context and capacity is needed. The aim of this study was to assess the implementation of the Framework Convention on Tobacco Control (WHO FCTC) and MPOWER measures in the region., Methods: In this cross-sectional study we used data from the WHO FCTC implementation reports and MPOWER from 2020 in 53 WHO European Region countries. Six domains (i.e. capacity, taxation and price policies, other national key regulations, public awareness raising and communication, tobacco use cessation, and monitoring) were formed. Subsequently, available indicators under these domains were scored and the level of implementation was computed for each country. Mann-Whitney tests were carried out to compare the scores between the group of countries with and without official endgame goals., Results: Overall, implementation of the WHO FCTC with the selected indicators at the country level ranged from 28% to 86%, and of MPOWER from 31% to 96%. Full implementation was achieved by 28% of WHO FCTC Parties in the region in taxation and price policies, 12% in public awareness raising and communication, and 42% in monitoring. In capacity, tobacco use cessation and other national key regulations, none of the Parties in the region reached full implementation. Overall median WHO FCTC scores were significantly higher in countries with official endgame goals than in those without (p<0.001)., Conclusions: There is unequal implementation of both WHO FCTC and MPOWER measures among WHO European Region countries. MPOWER and WHO FCTC provide all the measures for the necessary first steps, followed by innovative measures, to accomplish tobacco endgame goals., Competing Interests: The authors have each completed and submitted an ICMJE form for Disclosure of Potential Conflicts of Interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. A. González Marrón, C. Lidón-Moyano, H. Pérez-Martín, O. Ruokolainen, T. Laatikainen and H. Ollila, report that since the initial planning of the work received support by the European Union’s Health Program (2014-2020) under grant agreement N°101035968. H. Koprivnikar, J. Tisza, Z. Cselkó, A. Lambrou, E. Papachristou, M. Vasic, R. Guignard, S. Schoretsaniti and V. Nguyen-Thanh report that since the initial planning of the work their institution received support by European Commission for the Joint action on tobacco control 2 (JATC 2). In addition, M. Mulcahy reports that since the initial planning of the work he received support from the Health Service Executive, Ireland and the Joint action on tobacco control 2 (JATC 2). He also reports that in the past 36 months he received grants, consulting fees, support for attending meetings and travels and receipt of equipment/ materials from the Health Service Executive, Ireland and the Joint action on tobacco control 2 (JATC 2). H. Koprivnikar reports that in the past 36 months she received payment from the Medical Faculty, University of Ljubljana, for lecture to pediatric residents and from Slovene Medical Chamber for lecture to health professionals. E. Nunes reports that since the initial planing of the work she received support from European Commission and from General Directorate of Health, Ministry of Health, Portugal. M. Karekla reports that since the initial planning of the work she received support from Horizon Europe (no payments made to her or her institution). She also reports that in the past 36 months she received support from Horizon Europe for attending meetings of this group and that she is the immediate past president of the Association for Contextual Behavior Science. R. Guignard and V. Nguyen-Thanh report that in past 36 months they received support from the European Commission for travel and accommodation to the JATC 2 consortium meeting in Madrid, Spain, in April 2023., (© 2023 González-Marrón A. et al.)

Introduction: This paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings., Methods: We conducted a qualitative review of published peer reviewed and grey literature., Results: There is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quit-smoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high., Conclusions: There have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes., Competing Interests: The authors declare that they have no competing interests, financial or otherwise, related to the current work. S. Papadakis reports grants from Global Bridges (Pfizer Education and Change), outside the submitted work. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest., (© 2019 Diamanti A.)

The objective of the present survey was to assess the extent and socio-economic determinants of population exposure to secondhand smoke (SHS) in Greece in 2011. The national household survey Hellas Health IV was conducted in October 2011. SHS exposure was based on self-reported exposure within home, workplace and public places. Thirty-three per cent of the respondents reported living in a smoke-free home. Smokers (p < 0.001) and single individuals (p < 0.017) were less likely to prohibit smoking at home. SHS exposure at work, in restaurants and in bars/clubs/cafes was frequently mentioned by 41.6, 84.2 and 90.5%, respectively. SHS exposure in a bar/club/cafe was noted more among single individuals (p = 0.004) and those aged 18-34 years (p = 0.007). Inhabitants of rural areas were more likely to report someone smoking indoors in all the above venues. Public health education and effective enforcement of the nationwide smoke-free legislation are imperative.

Objectives: The objective of the present study was to explore the trends in the intention to quit smoking among adults in Greece between 2006 and 2011, a period characterized by financial instability and newly endorsed tobacco control initiatives., Methods: Trend analysis of 3 representative national and cross-sectional surveys, 'Hellas Health I' (2006), "Hellas Health III" (2010) and Hellas Health IV (2011)., Results: Since 2006, the intention to quit smoking has significantly increased among both genders (33.3% [in 2006] to 42.4% [in 2011], p=0.002), among respondents aged >54years (26.9% [in 2006] to 45.1% [in 2011], p=0.019) and among residents of rural areas (26.4% [in 2006] to 46.7% [in 2011], p=0.001). Both highest (32.1% [in 2006] to 49.4% [in 2011], p=0.036) and lowest (31.7% to 46.0%, p=0.021) socioeconomic (SE) strata showed an increase in the proportion of smokers who intend to quit. However, in 2011, quit attempts were more frequent (35.3%, p=0.009) in smokers of high socioeconomic status. Moreover, smoking prevalence has significantly decreased (43.1% [in 2006] to 38.1% [in 2011], p=0.023), mainly among men (52.4% to 45.7%, p=0.037), respondents of low socioeconomic status (38.9% to 29.4%, p=0.008) and residents of urban areas (45.2% to 37.9%, p=0.005)., Conclusions: Over the past 5years and possibly as a combined result of the implemented tobacco control policies and austerity measures, the intention to quit smoking has increased among all SE strata, however actual quit attempts were higher among those less disadvantaged. Further effort should be made to support quit attempts, especially among vulnerable populations., (© 2013 Elsevier Ltd. All rights reserved.)

Compliance with laws making certain environments smoke free has focused mainly on smokers' behavior, while the role of non-smokers has scarcely been investigated. Our cross-sectional study interviewed 4043 adults (2037 smokers and 2006 non-smokers) in the general population of Greece during April 2009. Non-smokers reported that they would actively work for compliance with the law. The non-smokers were older, more educated (odds ratio, OR 1.4), and were more likely to be annoyed by the smell of environmental tobacco smoke (OR 2.4) or report that it irritates their eyes (OR 1.8). Policymakers should evaluate how non-smokers could actively support smoke-free laws through reporting of violations using media campaigns that inform them of their rights, and other measures.