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Background and AimsThe addictive potential of electronic cigarettes (e-cigarettes) remains to be fully understood. We identified patterns and correlates of perceived addiction to e-cigarettes and perceived addictiveness of e-cigarettes relative to tobacco cigarettes (relative addictiveness) in dual users as well as exclusive e-cigarette users. Design, Setting and ParticipantsObservational study using cross-sectional survey data from England (2016) from the International Tobacco Control Project (ITC) Four Country Smoking and Vaping (4CV) survey. The study comprised 832 current e-cigarette users who had been vaping for at least 4 months. MeasurementsPerceived addiction to e-cigarettes and relative addictiveness of e-cigarettes were examined. Socio-demographic factors were age, gender and education; markers of addiction included urge to vape, time to first vape after waking and nicotine strength used; vaping and smoking characteristics included frequency and duration of e-cigarette use, intention to quit, adjustable power or temperature, enjoyment, satisfaction relative to tobacco cigarettes and tobacco cigarette smoking status. FindingsA total of 17% of participants reported feeling very addicted to e-cigarettes, while 40% considered e-cigarettes equally/more addictive than tobacco cigarettes. Those who felt very addicted had higher odds of regarding e-cigarettes as more addictive than tobacco cigarettes (odds ratio 3.4, 95% confidence interval 2.3-5.1). All markers of addiction, daily use and enjoyment were associated with higher perceived addiction, whereas time to first vape after waking, daily vaping and perceiving vaping as less satisfying than smoking were associated with relative addictiveness. ConclusionsMarkers of addiction to e-cigarettes appear to correspond with perceived addiction to e-cigarettes, suggesting that self-reported perceived addiction might serve as an indicator of addiction. Prevalence both of markers of addiction and perceived addiction were comparatively low overall, suggesting a limited but relevant addictive potential of e-cigarettes. Additionally, positive and negative reinforcement, reflected here by enjoyment and relative satisfaction, might play a role in e-cigarette addiction.

Background: Efforts to regulate tobacco products and reduce consumption in the European Union (EU) include the European Tobacco Products Directive (TPD), which went into force in May 2016. Despite the initial discussion to include a ban on sale of slim cigarettes, it was excluded in the final TPD. The main goal of this study was to examine support for a ban on slim cigarettes among smokers in six European Countries. Methods: Data from the 2018 (Wave 2) International Tobacco Control Policy Evaluation Project 6 European Country (ITC 6E) EUREST-PLUS project survey, a cross sectional study of adult smokers (n=5592) from Germany, Greece, Hungary, Poland, Romania, and Spain, was analysed. Descriptive statistics were used to estimate support for a ban on slim cigarettes by sociodemographic characteristics and smoking behaviors. Logistic regression analysis was used to examine factors associated with support for a ban on slim cigarettes and perceptions of harm. Results: Support for a ban on slims varied across countries, with highest support in Romania (33.8%), and lowest in Greece (18.0%). Female smokers (OR=0.77; 95%CI=0.66-0.90, daily smokers (OR=0.59; 95%CI=0.42-0.83), menthol smokers (OR=0.56; 95%CI=0.36-0.87), and smokers who did not have plans to quit within next six months (OR=0.45; 95%CI=0.36-0.57) had significantly lower odds of supporting a ban on slim cigarettes. Overall, 20% of smokers perceived slim cigarettes as less harmful than regular cigarettes. Conclusions: Support for a ban of slim cigarettes was relatively low among smokers, while misperceptions that slim cigarettes are less harmful is high, particularly among countries where slim cigarette use is more prevalent. Findings support a ban on slim cigarettes to reduce misperceptions around slim cigarettes being less harmful.

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.

The European Tobacco Products Directive (TPD) introduced a ban on characterizing flavours in cigarettes (2016), including menthol (2020). The longitudinal data analysis of the EUREST-PLUS International Tobacco Control (ITC) Project Europe Surveys (n = 16 534; Wave 1 in 2016 and Wave 2 in 2018) found significant but small declines in the weighted prevalence of menthol (by 0.94%; P = 0.041) and other flavoured cigarette use (by 1.32%; P

BackgroundThe 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.MethodsProspective cohort surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, Spain and England in 2016 (n = 9547; just after TPD) and 2018 (n = 10 287; 2 years after TPD). Multivariable logistic regression models employing generalized estimating equations assessed changes in support for four EC policies, and tested for country differences and strength of key predictors of support.ResultsBanning 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.ConclusionsSmokers 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.

This population epidemiology study describes trends in overall and age- and sex-specific alcohol-related deaths in Poland between 2002 and 2017, following the weakening in 2001 of policy measures designed to reduce alchohol consumption.

BackgroundWe examined quit attempts, use of cessation assistance, quitting beliefs and intentions among smokers who participated in the 2018 International Tobacco Control (ITC) Europe Surveys in eight European Union Member States (England, Germany, Greece, Hungary, the Netherlands, Poland, Romania and Spain).MethodsCross-sectional data from 11 543 smokers were collected from Wave 2 of the ITC Six European Country (6E) Survey (Germany, Greece, Hungary, Poland, Romania and Spain—2018), the ITC Netherlands Survey (the Netherlands—late 2017) and the Four Countries Smoking and Vaping (4CV1) Survey (England—2018). Logistic regression was used to examine associations between smokers’ characteristics and recent quit attempts.ResultsQuit attempts in the past 12 months were more frequently reported by respondents in the Netherlands (33.0%) and England (29.3%) and least frequently in Hungary (11.5%), Greece (14.7%), Poland (16.7%) and Germany (16.7%). With the exception of England (35.9%), the majority (56–84%) of recent quit attempts was unaided. Making a quit attempt was associated with younger age, higher education and income, having a smoking-related illness and living in England. In all countries, the majority of continuing smokers did not intend to quit in the next 6 months, had moderate to high levels of nicotine dependence and perceived quitting to be difficult.ConclusionsApart from England and the Netherlands, smokers made few quit attempts in the past year and had low intentions to quit in the near future. The use of cessation assistance was sub-optimal. There is a need to examine approaches to supporting quitting among the significant proportion of tobacco users in Europe and increase the use of cessation support as part of quit attempts

BackgroundTobacco 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.MethodsKey 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.ResultsIn the pooled sample, the warning labels’ effectiveness increased significantly over time in terms of salience (adjusted OR = 1.18; 95% CI: 1.03–1.35), while cognitive and behavioural reactions did not show clear increases. Generally, among women, more highly educated smokers and less addicted smokers, the effectiveness of warning labels tended to be higher.ConclusionWe 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.

BackgroundThe emergence of new types of tobacco and tobacco-related products on the European Union (EU) market has precipitated the possibility for both poly-tobacco use and transitions between products. In the EU, the regulatory environment has shifted with the implementation of the European Tobacco Products Directive (TPD) in May 2016, which may influence consumer transitions between products.MethodsThe aim of this paper was to examine trends and transitions in tobacco products from 2016 to 2018 -before and after implementation of the TPD in the EU. Data come from Wave 1 (pre-TPD) and Wave 2 (post-TPD) of the EUREST-PLUS ITC Six European Country Survey, a cohort study of adults who at the time of recruitment were smokers from six EU countries- Germany, Greece, Hungary, Poland, Romania, and Spain. D (N = 3195). Bivariate and logistic regression analyses of weighted data was conducted using SAS-callable SUDAANResultsOverall, among those who smoked factory-made cigarettes (FM) only at Wave 1, 4.3% switched to roll-your-own tobacco (RYO) only. Among RYO only users at Wave 1, 17.0% switched to FM only, however compared to all other countries, respondents from Hungary had the highest percentage of FM only users at Wave 1 switch to RYO only at Wave 2 (18.0%).ConclusionsThe most prominent transition overall was from smoking RYO exclusively at Wave 1 to smoking FM tobacco exclusively at Wave 2, however this varied across countries. As the tobacco control regulatory environment of the EU develops, it is important to continue to monitor transitions between types of products, as well as trends in cessation.

BackgroundArticle 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.MethodsData 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.ResultsIn 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 Conclusionse-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.

Background The EUREST-PLUS ITC Europe surveys aim to evaluate the impact of the European Union’s Tobacco Products Directive (EU TPD) implementation within the context of the WHO FCTC. This article describes the methodology of the 2016 (Wave 1) and 2018 (Wave 2) International Tobacco Control 6 European (6E) Country Survey in Germany, Greece, Hungary, Poland, Romania and Spain; the England arm of the 2016 (Wave 1) and 2018 (Wave 2) ITC 4 Country Smoking and Vaping (4CV) Survey; and the 2016 (Wave 10) and 2017 (Wave 11) ITC Netherlands (NL) Survey. All three ITC surveys covering a total of eight countries are prospective cohort studies with nationally representative samples of smokers. Methods In the three surveys across the eight countries, the recruited respondents were cigarette smokers who smoked at least monthly, and were aged 18 and older. At each survey wave, eligible cohort members from the previous waves were retained, regardless of smoking status, and dropouts were replaced by a replenishment sample. Results Retention rates between the two waves of the ITC 6E Survey by country were 70.5% for Germany, 41.3% for Greece, 35.7% for Hungary, 45.6% for Poland, 54.4% for Romania and 71.3% for Spain. The retention rate for England between ITC 4CV1 and ITC 4CV2 was 39.1%; the retention rates for the ITC Netherlands Survey were 76.6% at Wave 10 (2016) and 80.9% at Wave 11 (2017). Conclusion The ITC sampling design and data collection methods in these three ITC surveys allow analyses to examine prospectively the impact of policy environment changes on the use of cigarettes and other tobacco products in each country, to make comparisons across the eight countries.

Background This study presents perceptions of the harmfulness of electronic cigarettes (e-cigarettes) relative to combustible cigarettes among smokers from six European Union (EU) countries, prior to the implementation of the EU Tobacco Products Directive (TPD), and 2 years post-TPD. Methods Data were drawn from the EUREST-PLUS ITC Europe Surveys, a cohort study of adult smokers (≥18 years) from Germany, Greece, Hungary, Poland, Romania and Spain. Data were collected in 2016 (pre-TPD: N = 6011) and 2018 (post-TPD: N = 6027). Weighted generalized estimating equations were used to estimate perceptions of the harmfulness of e-cigarettes compared to combustible cigarettes (less harmful, equally harmful, more harmful or ‘don’t know’). Results In 2016, among respondents who were aware of e-cigarettes (72.2%), 28.6% reported that they perceived e-cigarettes to be less harmful than cigarettes (range 22.0% in Spain to 34.1% in Hungary). In 2018, 72.2% of respondents were aware of e-cigarettes, of whom 28.4% reported perceiving that e-cigarettes are less harmful. The majority of respondents perceived e-cigarettes to be equally or more harmful than cigarettes in both 2016 (58.5%) and 2018 (61.8%, P > 0.05). Overall, there were no significant changes in the perceptions that e-cigarettes are less, equally or more harmful than cigarettes, but ‘don’t know’ responses significantly decreased from 12.9% to 9.8% (P = 0.036). The only significant change within countries was a decrease in ‘don’t know’ responses in Spain (19.3–9.4%, P = .001). Conclusions The majority of respondents in these six EU countries perceived e-cigarettes to be equally or more harmful than combustible cigarettes.

BACKGROUND: The association among gallbladder disease, cholecystectomy, and pancreatic cancer is unclear. Moreover, time interval between gallbladder disease or cholecystectomy and pancreatic cancer diagnosis is not considered in most previous studies. AIM: To quantify the association among gallbladder disease, cholecystectomy, and pancreatic cancer, considering time since first diagnosis of gallbladder disease or cholecystectomy. METHODS: We used data from nine case-control studies within the Pancreatic Cancer Case-Control Consortium, including 5760 cases of adenocarcinoma of the exocrine pancreas and 8437 controls. We estimated pooled odds ratios and the corresponding 95% confidence intervals by estimating study-specific odds ratios through multivariable unconditional logistic regression models, and then pooling the obtained estimates using fixed-effects models. RESULTS: Compared with patients with no history of gallbladder disease, the pooled odds ratio of pancreatic cancer was 1.69 (95% confidence interval, 1.51-1.88) for patients reporting a history of gallbladder disease. The odds ratio was 4.90 (95% confidence interval, 3.45-6.97) for gallbladder disease diagnosed

There is a high prevalence of premature mortality and unhealthy lifestyle behaviours in Lower Silesia in Poland (regional capital is the city of Wroclaw). One plausible reason is low health literacy among this population. Health literacy is one of the most important elements of public health and health promotion endeavours. It can be conceptualised as abroad range of cognitive and social skills as well as knowledge needed by an individual to maintain good health, prevent or manage diseases, and effectively engage with healthcare professionals and resources. The Health Promotion Foundation (HPF), in collaboration with regional institutions and organisations, initiated in 2017 a broad initiative to improve health in this region. The overarching aim of the wider programme is to improve the quality of care among primary care patients. The project stream led by HPF aims to improve knowledge and health-related competences in the population of primary care patients in Lower Silesia. It involves (1) needs assessment based on the analysis of data on health status and neds from 50 participating primary care clinics, followed by (2) development of tailored face-to-face workshops that will be delivered by trained public health students, (3) who will be mentored using train-the-trainer approach. It is anticipated that the project will impact on three main areas in the long term. First, it will lead to creation of a package of workshops that could be delivered to other primary care patients. Second, it will create opportunities for students majoring in public health in the region to become directly involved in activities focused on health education and promotion. Three, it is anticipated that the project will lead to improvements in health and wellbeing among the participating patient groups. The present report describes the scope and method of the project.

Background Tobacco use is the leading cause of preventable disease and death in Europe and worldwide. Nurses, if properly educated, can contribute to decreasing the burden of tobacco use in the region by helping smokers quit smoking. Aims To assess: (a) the feasibility of an online program to educate nurses in Czech Republic and Poland on evidence-based smoking cessation interventions for patients and (b) self-reported changes in practices related to consistently (usually or always) providing smoking cessation interventions to smokers, before and 3 months after participation in the program. Methods A prospective single-group pre-post design. Results A total of 280 nurses from Czech Republic and 156 from Poland completed baseline and follow-up surveys. At 3 months, nurses were significantly more likely to provide smoking cessation interventions to patients who smoke and refer patients for cessation services (p < .01). Nurses significantly improved their views about the importance of nursing involvement in tobacco control. Implications for Practice Education about tobacco control can make a difference in clinical practice, but ongoing support is needed to maintain these changes. Health system changes can also facilitate the expectation that delivering evidence-based smoking cessation interventions should be routine nursing care. Linking Evidence to Action Educating nurses on cessation interventions and tobacco control is pivotal to decrease tobacco-related disparities, disease, and death. Online methods provide an accessible way to reach a large number of nurses.

Background The prevalence of roll-your-own tobacco (RYO) in Europe has been increasing. The aim of this study was to investigate transitions between factory-made (FM) cigarettes and RYO in a longitudinal sample of European smokers, and their perceptions of relative harmfulness and knowledge of health effects. Methods We used data collected from the EUREST-PLUS ITC 6 European Country (6E) Surveys in 2016 (n = 6011 smokers) and in 2018 (n = 6027) in Germany, Greece, Hungary, Poland, Romania and Spain. A total of 3195 cohort respondents were interviewed in both years. Use of RYO and FM, knowledge of health effects of smoking as well as perceptions about RYO were assessed. We used logistic regression models to explore sociodemographic correlates of transitions from one product to the other, of perceptions and knowledge related to smoking health effects. Results Approximately 7.4% of exclusive FM smokers transitioned to RYO and 29.5% of exclusive RYO smokers transitioned to FM cigarettes from 2016 to 2018. RYO use in 2018 was more frequent among smokers of low education and income, but none of these factors were associated with transitions. Most RYO smokers perceived RYO as cheaper than FM and 21.7% of them considered RYO to be less harmful than FM. Knowledge of the health effects of smoking was not associated with type of product smoked. Conclusions RYO is popular among European smokers; its lower cost seems to be a major factor for RYO users; reasons for transitions to and from RYO are less clear and need to be further investigated.

Introduction The European Union (EU) Tobacco Product Directive (TPD), which went into effect in 2016, regulates tobacco product content and packaging design, aimed at decreasing misperceptions around reduced harmfulness and addiction potential. The aim of the current study was to examine the extent to which smokers noticed TPD-related changes to tobacco product design and correlates associated with noticing these changes. Methods Data came from Wave 2 of the ITC 6 European Country Survey as part of the EUREST-PLUS project, among a nationally representative sample of adult smokers from six EU countries in 2018 (n=6037). Bivariate and logistic regression analyses of weighted data were conducted using SAS-callable SUDAAN. Results 56.3% of smokers noticed any TPD-related design change to cigarettes or roll-your-own tobacco. Over one-quarter of smokers noticed changes to health warnings (30.0%), standardized opening (27.7%), minimum unit size (27.9%), and the removal of tar, nicotine, and carbon monoxide (TNCO) information (26.7%) on packaging. Fewer smokers noticed packages no longer resembling food/cosmetic products (18.7%) and the removal of characterising flavours (12.8%). Noticing any change was significantly associated with older age (compared to ages 18-24), higher education, higher income, being a daily smoker, and usually smoking a menthol or other flavoured tobacco product. Awareness of changes varied significantly across countries for all measures. Compared to Spanish smokers, Greek smokers had 14.8 greater odds of noticing the removal of TNCO information (28.8% vs 4.9%, OR=14.8, p

This paper presents baseline results of the Prospective Urban Rural Epidemiology (PURE) Poland substudy of differences in prevalence of diabetes and impaired fasting glucose (IFG) between urban and rural areas. It covers group of 1643 people, aged 35 to 70 years old, inhabitants of Lower Silesia. The PURE study reached 22 countries with different statuses of economic development. All participants were tested in accordance to PURE project protocol. Data was collected at family (household) level and individual level. Diabetes was found in 12.0 % of our study population, IFG in 28.1 %, and normal glucose level in 59.9 %. Diabetes and IFG were more common in rural than in urban population, and higher percentage of people with diabetes was found in men comparing to women. In the PWBEC study conducted in years 1998–2000, diabetes prevalence was 5.3 %, in the NATPOL study conducted in years 1997–2002, 5.6 %; and in the latest PONS study from Świetokrzyskie voivodeship, 8.4 %. The percentage of people with diabetes in PURE Poland substudy was as high as 12 % and was higher than projections of diabetes prevalence in Poland for year 2030 (11.6 %). Significant differences of diabetes and IFG prevalence in respect to education and place of residence may arise from different attitudes of groups of patients to many other factors connected with prevention, treatment, and rehabilitation. Our study will continue to disclose other relevant risk factors in chosen areas.

Wstep . Artykul ten ma celu przedstawienie obrazu umieralności wśrod kobiet w krajach Unii Europejskiej z powodu nowotworow zlośliwych pluca na tle umieralności z powodu raka piersi. Badanie ma takze na celu zwrocenie uwagi na czynnik ryzyka nowotworow pluca, jakim jest palenie tytoniu — wciąz rozwijający sie problem zdrowia publicznego. Material i metody . Material bedący podstawą tego opracowania stanowią dane o zgonach z powodu nowotworow zlośliwych pluca i piersi u kobiet w Polsce i w innych krajach Unii Europejskiej za wszystkie dostepne lata w okresie 1960–2010. Analize trendow czasowych umieralności z powodu nowotworow zlośliwych pluca i piersi przeprowadzono przy uzyciu programu Joinpoint Regression Program. Analizą objeto kobiety w wieku 45–74 lat. Wyniki . Umieralnośc z powodu raka pluca wśrod kobiet rośnie od wielu lat i w wiekszości krajow ta przyczyna zgonow juz jest lub w najblizszej dekadzie bedzie najczestszą przyczyną zgonow nowotworowych Europejek. Podsumowanie . Nowotwory zlośliwe pluca stają sie pierwszą przyczyną zgonow nowotworowych wśrod kobiet w Europie. W wiekszości krajow trendy czasowe umieralności wykazują tendencje wzrostową. Glownym tego powodem jest rozwoj epidemii palenia tytoniu wśrod kobiet. Leczenie zespolu uzaleznienia od tytoniu wydaje sie byc najskuteczniejszym sposobem na zmiane tych niekorzystnych tendencji. Edukowanie kobiet i wskazywanie efektywnych sposobow zerwania z paleniem papierosow powinno pozostawac priorytetem w zakresie dzialan prewencji pierwotnej nowotworow i promocji zdrowia.

Introduction In the last decade daily cigarette smoking among children has been rapidly declining in several countries around the world. Studies conducted in this period in Poland include the Health Behaviour in in School-aged Children (HBSC) study (2010 and 2014) and the Global Youth Tobacco Survey (GYTS, 2016). This paper explores whether this positive trend also applied in Poland. Material and Methods GYTS, a nationally representative school-based survey of students, was conducted in Poland in 2016. This paper compares the smoking prevalence in Poland among 15-year-olds in GYTS with earlier studies. Results GYTS included responses from 5154 pupils, among whom 1699 were aged 15. The overall response rate was 81.7%. Among participants aged 15 daily smoking prevalence has decreased for the first time to under 5% (to 4.8% among boys and 3.6% among girls). This constitutes a significant decrease since 1998, the year with the highest daily smoking among 15-year-olds in Poland, when the prevalence was 24% among boys and 14.4% among girls 1 . Conclusions A similar decline has been noted in other European countries. In Norway in 1998 among 15-year-olds smoking prevalence stood at 18.2% among boys and 20.9% among girls. By 2014 the daily smoking prevalence declined among 15-year-old boys to 2.1%, and among girls to 0.6% 2 . In several other countries, including USA, daily smoking prevalence among children is at similar levels of under 5% 3 . 1. Zatoński WA, Aaro LE, Samdal O, Mazur J. Smoking- or nicotine-free generation, or both? What should be the public health priority? J Health Inequal 2016; 2 (2): 105–108. 2. Aarø LE, Mazur J, Zatoński WA, Samdal O. Trends in smoking among Polish and Norwegian youth 1986-2014. J Health Inequal 2016; 2 (1): 44–51. 3. Zatoński WA and al. Rapid decline cigarette smoking by children. J Health Inequal 2017 (2). In print.

Background Smoking among cancer patients is related to poor treatment outcomes and lower quality of life. Intensive treatment of cancer patients in secondary care offers opportunities to deliver more intensive cessation support. As a first step in creating appropriate stop smoking interventions it is important to characterise smoking patterns among cancer patients. Methods We conduct an ongoing cross-sectional survey among adult cancer patients treated at the Dolnośląskie Centrum Onkologii (DCO; Lower Silesian Oncology Center) in the city of Wroclaw, Poland. Data are being collected on smoking status, dependence, quitting history and motivation, and cessation support received. Results Among 62 cancer patients surveyed through a pilot questionnaire to date, 47 were ever smokers, of whom 50% were current daily smokers (52% women), smoking on average 17 cigarettes per day (range 6-40). A majority of current smokers (70%) wanted to quit, 56.5% tried to quit smoking at least once a year in the past 10 years, 100% tried to quit at least once and 30% tried to quit more than 3 times or more in the past 12 months. Only 30% has ever received any advice on quitting from a healthcare professional, 35% ever used any cessation medications, and only 17% believed that smoking cessation support available to them was of sufficient quality. Among current daily smokers, 52% lived with other smokers, 52% did not know when to find support with sustaining abstinence, and 40% were not sure how to manage crises moments in abstinence on their own. Data collection continues and updated results will be presented at the conference. Conclusions Secondary care cancer patients in Poland who are smoking tend to be moderately dependent and are motivated to quit. However, most are not aware of the available cessation support, and only about a third has ever received support with quitting or used cessation pharmacotherapy.

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.

Alcohol consumption is a major cause of disease and death. In a previous study, we reported that in 2002, 3.6% of all cases of cancer and a similar proportion of cancer deaths were attributable to the consumption of alcohol. We aimed to update these figures to 2012 using global estimates of cancer cases and cancer deaths, data on the prevalence of drinkers from the World Health Organization (WHO) global survey on alcohol and health, and relative risks for alcohol-related neoplasms from a recent meta-analysis. Over the 10-year period considered, the total number of alcohol-attributable cancer cases increased to approximately 770,000 worldwide (5.5% of the total number of cancer cases)-540,000 men (7.2%) and 230,000 women (3.5%). Corresponding figures for cancer deaths attributable to alcohol consumption increased to approximately 480,000 (5.8% of the total number of cancer deaths) in both sexes combined-360,000 (7.8%) men and 120,000 (3.3%) women. These proportions were particularly high in the WHO Western Pacific region, the WHO European region and the WHO South-East Asia region. A high burden of cancer mortality and morbidity is attributable to alcohol, and public health measures should be adopted in order to limit excessive alcohol consumption.

W pracy przedstawiono obraz epidemiologiczny nowotworow zlośliwych w Polsce, jego zmiany w czasie oraz porownanie z krajami Unii Europejskiej. Przebieg trendow czasowych umieralności w glownych lokalizacjach nowotworow zlośliwych w Polsce jest podobny do obrazu nowotworowego krajow UE. Transformacja epidemiologiczna umieralności z powodu nowotworow w Polsce odbywa sie w stosunku do krajow Europy Zachodniej z pewnym opoźnieniem czasowym. Ogolem trendy epidemiologiczne wszystkich lokalizacji nowotworowych są uśrednieniem rozbieznych trendow w zachorowaniach na poszczegolne nowotwory, czesto zdominowanym przez zmiany trendow najwiekszych lokalizacji nowotworowych. Tak dzieje sie np. u mezczyzn w Polsce w przypadku umieralności na nowotwory zlośliwe pluca. W drugiej cześci pracy poddano analizie zjawisko zachorowalności, ktore takze wskazuje na wyraźne zroznicowanie trendow czasowych poszczegolnych lokalizacji. Trendy czestości zachorowan mierzone bezwzgledną liczbą nowo diagnozowanych chorob zalezą od wielu czynnikow — środowiskowych czynnikow ryzyka (np. czestości palenia), ktore są modyfikowalne, ale takze kluczowe znaczenie mają zmiany struktury wieku populacji. Krzywa zachorowan rośnie wykladniczo wraz ze wzrostem dlugości zycia (czynnik niemodyfikowalny). Znaczna wiekszośc (60%) zachorowan na nowotwory zlośliwe jest diagnozowana wśrod osob po 65 r.z., a w Polsce obserwuje sie staly przyrost ludności w tym wieku. Trzy zjawiska są najbardziej charakterystyczne dla obrazu trendow czasowych zachorowalności z powodu nowotworow zlośliwych w Polsce: 1) gwaltowny spadek zachorowan z powodu nowotworow zlośliwych pluca u mezczyzn (po okresie trwającego kilka dekad wzrostu zachorowan); 2) bardzo szybki wzrost zachorowan z powodu nowotworow zlośliwych prostaty, szczegolnie po 1990 roku; 3) dramatyczny wzrost nowo diagnozowanych nowotworow zlośliwych piersi u kobiet, ktory zdominowal zachorowalnośc na nowotwory zlośliwe w Polsce u kobiet (obecnie co czwarty nowo diagnozowany nowotwor u kobiet to nowotwor zlośliwy piersi). Dodatkowo szczegolowej analizie epidemiologicznej poddano kilka glownych lokalizacji nowotworow zlośliwych (nowotwory pluca, piersi, gruczolu krokowego, jelita grubego, szyjki macicy i zolądka) oraz przedstawiono ich po­rownanie z innymi krajami. Najwiekszy sukces w kontrolowaniu nowotworow zlośliwych osiągnieto w tych schorzeniach, w ktorych mozliwa jest prewencja (przede wszystkim nowotwory zlośliwe pluca u mezczyzn), ale takze w tych nowotworach, gdzie mozliwy jest skuteczny populacyjny skrining (nowotwory zlośliwe szyjki macicy, nowotwory zlośliwe piersi).

The International Head and Neck Cancer Epidemiology (INHANCE) consortium is a collaboration of research groups leading large epidemiology studies to improve the understanding of the causes and mechanisms of head and neck cancer. The consortium includes investigators of 35 studies who have pooled their data on 25 500 patients with head and neck cancer (i.e., cancers of the oral cavity, oropharynx, hypopharynx, and larynx) and 37 100 controls. The INHANCE analyses have confirmed that tobacco use and alcohol intake are key risk factors of these diseases and have provided precise estimates of risk and dose response, the benefit of quitting, and the hazard of smoking even a few cigarettes per day. Other risk factors include short height, lean body mass, low education and income, and a family history of head and neck cancer. Risk factors are generally similar for oral cavity, pharynx, and larynx, although the magnitude of risk may vary. Some major strengths of pooling data across studies include more precise estimates of risk and the ability to control for potentially confounding factors and to examine factors that may interact with each other. The INHANCE consortium provides evidence of the scientific productivity and discoveries that can be obtained from data pooling projects. © 2015 John Wiley & Sons A/S.

In the early 1990s the premature mortality of young and middle-aged adults in many countries of Central and Eastern Europe (CEE) reached some of the highest levels in the world. It was not only twice higher than in the countries of Western Europe, but also above the rates of many developing countries, including China and India. The main cause underlying this health catastrophe in CEE were tobacco-caused diseases. In November 1990, almost precisely a year after the collapse of the Berlin Wall, a summit of tobacco control leaders took place in the town of Kazimierz in Poland. The aim of the meeting was to devise a strategy and plan of action that would allow to counteract the tobacco epidemic ravaging the post-communist states. The Kazimierz conference gathered leading tobacco control experts from across Europe and North America. Almost thirty years on from the Kazimierz Declaration, most of its health goals have been fully accomplished. The gap in smoking between young adults in CEE and Western Europe is almost closed, as evidenced by converging lung cancer morbidity and mortality rates. However, tobacco control in Europe is far from being finished business. There is an urgent need to formulate a new plan, akin to the Kazimierz Declaration in the early 1990s, that would allow tobacco control in Europe to take another leap forward. We need a Declaration of Athens that outlines the vision of civil society movement for tobacco end game, and the ENSP is best placed to launch such an initiative.

During the first summit of world tobacco control leaders in Central and Eastern Europe, held in 1990 in Kazimierz in Poland, the inadequate engagement of medical professionals in helping people to quit smoking was identified as one of the main problems of the region. The Health Promotion Foundation was established in 1992 to co-ordinate the anti-tobacco movement in Poland and to implement the resolutions of Kazimierz. The Foundation initiated actions to introduce anti-tobacco legislation in Poland passed by the Polish Parliament in 1995. It was one of the first legislative acts in the world to recommend tobacco dependence treatment. The Foundation also took active part in the preparation of the Framework Convention on Tobacco Control, and was one of the contributing authors of Article 14. The Foundation has also engaged in competence building among healthcare providers. It has trained thousands of Polish doctors and nurses using a core, nation-wide tool: the Consensus on Diagnosis and Treatment of Tobacco Dependence. Finally, the Foundation engaged in activities to increase cessation drug availability, e.g. by conducting research, disseminating knowledge on, and promoting cytisine. Since the 1990s millions of Poles quit smoking, also thanks to the Foundation’s comprehensive activities. Further work is now focused on developing effective ways to engage greater numbers of medical doctors in the treatment of tobacco dependence and building innovative technologies supporting them and people who want to quit smoking.