176 results found
Chang C-M, Mayne E, Laverty A, et al., 2021, Cigarette prices in eight sub-Saharan African countries in 2018: a cross-sectional analysis, BMJ Open, ISSN: 2044-6055
Kyriakos CN, Zatoński MZ, Filippidis FT, 2021, Flavour capsule cigarette use and perceptions: a systematic review., Tob Control
OBJECTIVE: This systematic review on flavour capsule cigarettes aims to examine prevalence, correlates of use, behaviours and perceptions of these products globally. DATA SOURCES: A search of original, peer-reviewed research without restrictions in publication year, population, study design or language, using a combination of cigarette and capsule terms was conducted across four databases (Medline, Embase, Web of Science and Scopus), indexed until 30 April 2021. STUDY SELECTION: Studies were included if they presented original, human subjects research on flavour capsule cigarettes. DATA EXTRACTION: Two authors independently extracted data on main outcome results and assessed risk of bias using a validated quality assessment tool (QATSDD). DATA SYNTHESIS: Of 842 unduplicated database records and four studies from citation searching screened, 20 studies were included in the review. Studies reported data from 2009 to 2019 across eight countries, the majority of which used cross-sectional or focus group study designs. Current capsule use among smokers was highest in Chile and Mexico (40%) and was associated with younger age, and in some countries, with being female. Capsule cigarettes are perceived as tasting better, being smoother on the throat, more fun to smoke, and more attractive compared with non-capsule cigarettes, particularly among susceptible non-smokers and non-daily smokers. CONCLUSION: Findings call for the adoption of comprehensive tobacco control policies that account for flavour capsules and similar iterations, which can increase appeal through flavours and innovative features. Continued monitoring and research of these products is critical, with particular attention to low-income and middle-income countries, which make up a disproportionately larger share of the capsule market.
Laverty AA, Filippidis FT, Been JV, et al., 2021, Smoke-free vehicles – impact of legislation on child smoke exposure across three countries, European Respiratory Journal, Pages: 2004600-2004600, ISSN: 0903-1936
Kyriakos C, Ahmad A, Chang K, et al., 2021, Price differentials of tobacco products: A cross-sectional analysis of 79 countries, Tobacco Induced Diseases, ISSN: 1617-9625
Laverty AA, Vardavas CI, Filippidis FT, 2021, Prevalence and reasons for use of Heated Tobacco Products (HTP) in Europe: an analysis of Eurobarometer data in 28 countries, The Lancet Regional Health - Europe, Vol: 8, Pages: 1-7, ISSN: 2666-7762
BackgroundHeated Tobacco Products (HTP) are a relatively new class of tobacco products, with limited data on usage patterns. We assessed the prevalence and reasons for use among persons aged ≥15 years in 27 European Union member states and the United Kingdom·MethodsThe 2020 Eurobarometer (93·2) survey was analysed (n=28,300, aged ≥15). Multi-level regression analyses assessed socio-demographic differences in use while separate analyses investigated reasons for starting to use HTP. Results are presented as adjusted Odds Ratios (aOR) and weighted percentages with 95% Confidence Intervals (95%CI).FindingsOverall, 6·5% (95% CI 6·1;7·0) of participants had ever used a HTP. 1·3% (1·1%;1·5%) of participants were current users of HTP, and 0·7% (0·6% to 0·9%) daily users. Current and former tobacco smokers were more likely than never tobacco smokers to use HTP (aOR 36·3 (22·9;57·5), and 7·3 (4·3;12·3) respectively. Youth aged 15-24 years of age were substantially more likely to report use, e.g. aOR for ever use=7·77 (6·56;9·21) compared to those aged ≥55 years. 51·3% of ever HTP users reported at least weekly concurrent use of combustible tobacco. Among those who reported ever use of HTP, but not e-cigarettes, the most popular reason for use was the perception that HTP are less harmful than smoking tobacco (39·5%), followed by use by friends (28·4%) and stopping or reducing smoking (28·2%).InterpretationConsiderable numbers of people in the EU have ever used HTP, although current and daily use remains low. Current use is more common among younger people, and current and former smokers.FundingNone
Chen DT-H, Millett C, Filippidis FT, 2021, The association of migration with multiple tobacco product use among male adults in 15 low- and middle-income countries., Eur J Public Health, Vol: 31, Pages: 500-502
Little is known about the impact of migration on tobacco use patterns among men in low- and middle-income countries (LMICs). This study aims to explore the association between migration and tobacco use among men in LMICs. We used multilevel regression models to analyze data of 154 425 men from 15 countries from the latest wave of the Demographic and Health Survey. Results showed higher risk of single tobacco product use [relative risk ratio (RRR) = 1.22; 95% confidence interval (CI): 1.19-1.26], but importantly of dual (RR = 1.41, 95% CI: 1.36-1.49) and poly-tobacco use (RR = 1.71, 95% CI: 1.57-1.86) among migrant men compared with non-migrants.
Kendrick PJ, Reitsma MB, Abbasi-Kangevari M, et al., 2021, Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019, The Lancet Public Health, Vol: 6, Pages: e482-e499, ISSN: 2468-2667
BackgroundChewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control.MethodsWe estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period.FindingsIn 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15–19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: –1·21% [–1·26 to –1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant
Reitsma MB, Kendrick PJ, Ababneh E, et al., 2021, Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019, The Lancet, Vol: 397, Pages: 2337-2360, ISSN: 0140-6736
BackgroundEnding the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally.MethodsWe estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available.FindingsGlobally in 2019, 1·14 billion (95% uncertainty interval 1·13–1·16) individuals were current smokers, who consumed 7·41 trillion (7·11–7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5–28·5] reduction) and females (37·7% [35·4–39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98–1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16–8·20) deaths and 200 million (185–214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3–21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers.Int
D'Anna L, Filippidis FT, Harvey K, et al., 2021, Extent of white matter lesion is associated with early hemorrhagic transformation in acute ischemic stroke related to atrial fibrillation, Brain and Behavior, ISSN: 2162-3279
BackgroundHemorrhagic transformation (HT) after stroke, related to atrial fibrillation (AF), is a frequent complication, and it can be associated with a delay in the (re-)initiation of oral anticoagulation therapy. We investigated the effect of the presence and severity of white matter disease (WMD) on early HT after stroke related to AF.MethodsA consecutive series of patients with recent (<4 weeks) ischemic stroke and AF, treated at the Hyper Acute Stroke Unit of the Imperial College London between 2010 and 2017, were enrolled. Patients with brain MRI performed 24–72 h from stroke onset and not yet started on anticoagulant treatment were included. WMD was graded using the Fazekas score.ResultsAmong the 441 patients eligible for the analysis, 91 (20.6%) had any HT. Patients with and without HT showed similar clinical characteristics. Patients with HT had a larger diffusion-weighted imaging (DWI) infarct volume compared to patients without HT (p < .001) and significant difference in the distribution of the Fazekas score (p = .001). On multivariable analysis, HT was independently associated with increasing DWI infarct volume (odd ratio (OR), 1.03; 95% confidence interval (CI), 1.01–1.05; p < .001), higher Fazekas scores (OR, 1.94; 95% CI, 1.47–2.57; p < .001) and history of previous intracranial hemorrhage (OR, 4.80; 95% CI, 1.11–20.80; p = .036).ConclusionsPresence and severity of WMD is associated with increased risk of development of early HT in patients with stroke and AF. Further evidence is needed to provide reliable radiological predictors of the risk of HT in cardioembolic stroke.
Been J, Laverty AA, Tsampi A, et al., 2021, European progress in working towards a tobacco-free generation, European Journal of Pediatrics, ISSN: 0340-6199
Children have the right to grow up free from the hazards associated with tobacco smoking. Tobacco smoke exposure can have detrimental effects on children’s health and development, from before birth and beyond. As a result of effective tobacco control policies, European smoking rates are steadily decreasing among adults, as is the proportion of adolescents taking up smoking. Substantial variation however exists between countries, both in terms of smoking rates and regarding implementation, comprehensiveness and enforcement of policies to address smoking and second-hand smoke exposure. This is important because comprehensive tobacco control policies such as smoke-free legislation and tobacco taxation have extensively been shown to carry clear health benefits for both adults and children. Additional policies such as increasing the legal age to buy tobacco, reducing the number of outlets selling tobacco, banning tobacco display and advertising at the point-of-sale, and introducing plain packaging for tobacco products can help reduce smoking initiation by youth. At societal level, health professionals can play an important role in advocating for stronger policy measures, whereas they also clearly have a duty to address smoking and tobacco smoke exposure at the patient level. This includes providing cessation advise and referring to effective cessation services.Conclusion: Framing of tobacco exposure as a child right’s issue and of comprehensive tobacco control as a tool to work towards the ultimate goal of reaching a tobacco-free generation can help accelerate European progress to curb the tobacco epidemic.
Donnat C, Bunbury F, Liu D, et al., 2021, Predicting COVID-19 transmission to inform the management of mass events: a model-based approach, JMIR Public Health and Surveillance, ISSN: 2369-2960
Background:Modelling COVID-19 transmission at live events and public gatherings is essential to control the probability of subsequent outbreaks and communicate to participants their personalised risk. Yet, despite the fast-growing body of literature on COVID transmission dynamics, current risk models either neglect contextual information on vaccination rates or disease prevalence or do not attempt to quantitatively model transmission.Objective:This paper attempts to bridge this gap by providing informative risk metrics for live public events, along with a measure of their uncertainty.Methods:Building upon existing models, our approach ties together three main components: (a) reliable modelling of the number of infectious cases at the time of the event, (b) evaluation of the efficiency of pre-event screening, and (c) modelling of the event’s transmission dynamics and their uncertainty along using Monte Carlo simulations.Results:We illustrate the application of our pipeline for a concert at the Royal Albert Hall and highlight the risk’s dependency on factors such as prevalence, mask wearing, or event duration. We demonstrate how this event held on three different dates (August 20th 2020, January 20th 2021, and March 20th 2021) would likely lead to transmission events that are similar to community transmission rates (0.06 vs 0.07, 2.38 vs 2.39, and 0.67 vs 0.60, respectively). However, differences between event and background transmissions substantially widen in the upper tails of the distribution of number of infections (as denoted by their respective 99th quantiles: 1 vs 1, 19 vs 8, and 6 vs 3 for our three dates), further demonstrating that sole reliance on vaccination and antigen testing to gain entry would likely significantly underestimate the tail risk of the event.Conclusions:Despite the unknowns surrounding COVID-19 transmission, our estimation pipeline opens the discussion on contextualized risk assessment by combining the best tools at hand to as
Chen DT-H, Girvalaki C, Mechili EA, et al., 2021, Global Patterns and Prevalence of Dual and Poly-Tobacco Use: A Systematic Review., Nicotine Tob Res
INTRODUCTION: Improving understanding of the epidemiology of dual and poly-tobacco product use is essential for tobacco control policy and practice. The present study aimed to systematically review existing epidemiologic evidence on current dual and poly-tobacco use among adults globally. METHODS: We systematically searched online databases for studies published up to 30 June 2020. We included quantitative studies with measures of nationally representative prevalence of current dual or poly-tobacco use among adults. Prevalence estimates for each country were extracted manually and stratified by WHO regions and World Bank income classifications. RESULTS: Twenty studies with nationally representative prevalence data on current dual or poly-tobacco use in the adult population across 48 countries were included. Definitions of dual and poly-tobacco use varied widely. Prevalence of dual and poly-tobacco use was higher in low- and lower-middle-income countries compared to other higher-income countries. Current dual use of smoked and smokeless tobacco products among males ranged from 0.2% in Ukraine (2010) and Mexico (2009) to 17.9% in Nepal (2011). Poly-tobacco use among males ranged from 0.8% in Mexico (2009) and 0.9% in Argentina (2010) to 11.4% in the UK and 11.9% in Denmark in 2012. Dual tobacco use was generally higher in South-East Asia; poly-tobacco use was prevalent in Europe as well as in South-East Asia. CONCLUSIONS: This is the first systematic review of the prevalence estimates of dual and poly-tobacco use among adults globally. The results of the current study could significantly help health policy makers to implement effective tobacco control policies.
Rajani N, Mastellos N, Filippidis F, 2021, Self-efficacy and motivation to quit of smokers seeking to quit: quantitative assessment of smoking cessation mobile apps, JMIR mHealth and uHealth, Vol: 9, ISSN: 2291-5222
Background: Decreasing trends in the number of individuals accessing face-to-face support are leaving a significant gap in the treatment options for smokers seeking to quit. Face-to-face behavioral support and other interventions attempt to target psychological factors such as the self-efficacy and motivation to quit of smokers, as these factors are associated with an increased likelihood of making quit attempts and successfully quitting. Although digital interventions, such as smoking cessation mobile apps, could provide a promising avenue to bridge the growing treatment gap, little is known about their impact on psychological factors that are vital for smoking cessation.Objective: This study aims to better understand the possible impact of smoking cessation mobile apps on important factors for successful cessation, such as self-efficacy and motivation to quit. Our aim is to assess the self-efficacy and motivation to quit levels of smokers before and after the use of smoking cessation mobile apps.Methods: Smokers seeking to quit were recruited to participate in a 4-week app-based study. After screening, eligible participants were asked to use a mobile app (Kwit or Quit Genius). The smoking self-efficacy questionnaire and the motivation to stop smoking scale were used to measure the self-efficacy and motivation to quit, respectively. Both were assessed at baseline (before app use), midstudy (2 weeks after app use), and end-study (4 weeks after app use). Paired sample two-tailed t tests were used to investigate whether differences in self-efficacy and motivation between study time points were statistically significant. Linear regression models investigated associations between change in self-efficacy and change in motivation to quit before and after app use with age, gender, and nicotine dependence.Results: A total of 116 participants completed the study, with the majority being male (71/116, 61.2%), employed (76/116, 65.6%), single (77/116, 66.4%), and highly educat
Rajani N, Mastellos N, Filippidis F, 2021, Impact of gamification on the self-efficacy and motivation to quit of smokers: an observational study of two gamified smoking cessation mobile apps, JMIR Serious Games, Vol: 9, ISSN: 2291-9279
Background: The proportion of smokers making quit attempts and the proportion of smokers successfully quitting have been decreasing over the past few years. Previous studies have shown that smokers with high self-efficacy and motivation to quit have an increased likelihood of quitting and staying quit. Consequently, further research on strategies that can improve the self-efficacy and motivation of smokers seeking to quit could lead to substantially higher cessation rates. Some studies have found that gamification can positively impact the cognitive components of behavioral change, including self-efficacy and motivation. However, the impact of gamification in the context of smoking cessation and mobile health has been sparsely investigated.Objective: This study aims to examine the association between perceived usefulness, perceived ease of use, and frequency of use of gamification features embedded in smoking cessation apps on self-efficacy and motivation to quit smoking.Methods: Participants were assigned to use 1 of the 2 mobile apps for a duration of 4 weeks. App-based questionnaires were provided to participants before app use and 2 weeks and 4 weeks after they started using the app. Gamification was quantitatively operationalized based on the Cugelman gamification framework and concepts from the technology acceptance model. The mean values of perceived frequency, ease of use, and usefulness of gamification features were calculated at midstudy and end-study. Two linear regression models were used to investigate the impact of gamification on self-efficacy and motivation to quit.Results: A total of 116 participants completed the study. The mean self-efficacy increased from 37.38 (SD 13.3) to 42.47 (SD 11.5) points and motivation to quit increased from 5.94 (SD 1.4) to 6.32 (SD 1.7) points after app use. Goal setting was perceived to be the most useful gamification feature, whereas sharing was perceived to be the least useful. Participants self-reported that they u
Feliu A, Filippidis FT, Joossens L, et al., 2021, The association between tobacco control policy implementation and country-level socioeconomic factors in 31 European countries, Scientific Reports, Vol: 11, ISSN: 2045-2322
European countries have made significant progress in implementing tobacco control policies to reduce tobacco use; however, whether socioeconomic status (SES) of a country may influence the implementation of such policies is unknown. The aim of this study is to assess the association between country-level SES and the implementation level of tobacco control policies in 31 European countries. An ecological study using data from Eurostat, Human Development Reports on several SES indicators and the Tobacco Control Scale (TCS) of 2016 was conducted to measure country-level tobacco control policies. We analysed the relationship between SES indicators and the TCS by means of scatter-plots and Spearman’s rank correlation coefficients (rsp) and multivariable linear regression analysis. In Europe, no statistically significant association was found between SES factors and the level of implementation of tobacco control policies. Only public spending on tobacco control was associated with all SES factors, except for Gini Index (an income inequality index). The strongest associations of TCS scores for this policy domain were found with the Human Development Index (rsp = 0.586; p < 0.001) and the Gross Domestic Product per capita (in Euros) (rsp = 0.562; p = 0.001). The adjusted linear regression model showed an association of tobacco control policy implementation with countries’ geographical location (Western Europe, β = − 15.7; p = 0.009, compared to Northern Europe). In conclusion, no association was found between SES factors and the level of implementation of tobacco control policies in 31 European countries; policymakers should be aware that tobacco control policies could be successfully implemented despite socioeconomic constraints, especially when these policies are of low cost and cost-effective (i.e., smoke-free bans and taxation).
Cheung C-MM, Vardavas C, Filippidis FT, 2021, Factors associated with abstinence after a recent smoking cessation attempt across 28 European Union member states, Tobacco Prevention and Cessation, Vol: 7, ISSN: 2459-3087
Introduction:There is a lack of information regarding factors associated with successful smoking cessation on a population and European Union (EU)-wide level. Our study seeks to explore individual and country-level factors associated with abstinence after a recent smoking cessation attempt across the EU.Methods:We obtained data from the March 2017 Special Eurobarometer 87.1 (n=27901). Regression analysis was performed on a subset of 1472 individuals who made quit attempts in the past 12 months. Sociodemographic, policy and country-level factors were assessed using logistic regression among smokers and ex-smokers who attempted to quit approximately 12 months before the survey date. We defined and examined the Cessation Ratio (ratio of number of recent quitters to those who did not succeed) across 28 EU Member States.Results:In all, 14.9% (n=1018) of current smokers and 8.80% (n=454) of exsmokers attempted to quit in approximately the last 12 months (n=1472). Cessation Ratios ranged from 0.182 (95% CI: 0.045–0.319) in Estonia to 1.060 (95% CI: 0.262–1.860) in Sweden. There is a quadratic, U-shaped relationship between odds of quitting and smoking prevalence. The lowest odds of cessation were observed at a prevalence of 26.3%, with higher odds of cessation observed above and below this point. Respondents who reported financial difficulties were less likely to quit (AOR=0.66; 95% CI: 0.52–0.83). There was no association of likelihood of success with other sociodemographic factors or the Tobacco Control Scale treatment score.Conclusions:These findings highlight a need for exploring reasons behind the variation in likelihood of abstinence following a recent quit attempt, in order to design policies targeted at population groups or countries that need greater support.
Saller FS, Agaku IT, Filippidis FT, 2021, Association between e-cigarette use initiated after cigarette smoking and smoking abstinence: a cross-sectional study among adolescent established smokers in the USA., Tob Control
BACKGROUND: Recent years have seen a rapid increase in the popularity of electronic cigarettes (e-cigarettes) among adolescents in the USA. Evidence on their role in the continuation of or abstinence from cigarette smoking among young smokers remains scarce. OBJECTIVE: To examine the relationship between e-cigarette use initiated after cigarette smoking and abstinence from cigarette smoking among US adolescent established smokers. METHODS: The data were drawn from the 2015-2018 National Youth Tobacco Survey-a nationally representative survey of US middle and high school students. Multivariable logistic regression was used to assess the association between ever e-cigarette use and past 30-day abstinence from cigarette smoking. The analytical sample comprised ever established cigarette smokers with or without a history of e-cigarette use after smoking initiation. RESULTS: Neither experimental (adjusted OR 0.67, 95% CI 0.39-1.14) nor prior established (adjusted OR 1.56, 95% CI 0.96-2.56) nor current established (adjusted OR 0.65, 95% CI 0.41-1.03) e-cigarette use was statistically significantly associated with subsequent abstinence from cigarette smoking among adolescent ever established smokers. These findings were largely consistent across sensitivity analyses using alternative key definitions, although experimental and current established e-cigarette use was significantly negatively associated with past 6-month abstinence. CONCLUSIONS: We found no evidence that e-cigarette use among US adolescents already smoking cigarettes is associated with subsequent abstinence from cigarette smoking; there was some evidence of an inverse association among experimental and current established e-cigarette users. These findings could inform future regulatory and public health efforts regarding youth e-cigarette use and the reduction of youth cigarette smoking in the USA.
Chen DT-H, Millett C, Filippidis FT, 2021, Prevalence and determinants of dual and poly-tobacco use among males in 19 low-and middle-income countries: Implications for a comprehensive tobacco control regulation, PREVENTIVE MEDICINE, Vol: 142, ISSN: 0091-7435
Gallus S, Lugo A, Liu X, et al., 2021, Who smokes in Europe? data from 12 European countries in the TackSHS survey (2017-2018)., Journal of Epidemiology, Vol: 31, Pages: 145-151, ISSN: 0917-5040
BACKGROUND: Population data on tobacco use and its determinants require continuous monitoring and careful inter-country comparison. We aimed to provide the most up-to-date estimates on tobacco smoking from a large cross-sectional survey, conducted in selected European countries. METHODS: Within the TackSHS Project, a face-to-face survey on smoking was conducted in 2017-2018 in 12 countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain, representing around 80% of the 432 million European Union (EU) adult population. In each country, a representative sample of around 1,000 subjects aged 15 years and older was interviewed, for a total of 11,902 participants. RESULTS: Overall 25.9% of participants were current smokers (31.0% among men and 21.2% among women, p<0.001), while 16.5% were former smokers. Smoking prevalence ranged from 18.9% in Italy to 37.0% in Bulgaria. It decreased with increasing age (compared to <45, multivariable odds ratio, OR, for ≥65 years was 0.31; 95% confidence interval, CI: 0.27-0.36), level of education (OR for low vs. high was 1.32; 95% CI: 1.17-1.48) and self-rated household economic level (OR for low vs. high was 2.05; 95% CI: 1.74-2.42). The same patterns were found in both sexes. CONCLUSIONS: These smoking prevalence estimates represent the most up-to-date evidence in Europe. From them it can be derived that there are more than 112 million current smokers in the EU-28. Lower socio-economic status is a major determinant of smoking habit in both sexes.
Laverty A, Millett C, Hopkinson N, et al., 2020, Introduction of standardised packaging and availability of illicit cigarettes: a difference-in-difference analysis of European Union survey data 2015-2018., Thorax, Vol: 76, Pages: 89-91, ISSN: 0040-6376
Standardised packaging of tobacco products is intended to reduce the appeal of smoking, but the tobacco industry claims this increases illicit trade. We examined the percentage of people reporting being offered illicit cigarettes before and after full implementation of standardised packaging in the UK, Ireland and France and compared this to other European Union countries. Reported ever illicit cigarette exposure fell from 19.8% to 18.1% between 2015 and 2018 in the three countries fully implementing the policy, and from 19.6% to 17.0% in control countries (p for difference=0.320). Standardised packaging does not appear to increase the availability of illicit cigarettes.
Laverty A, Millett C, Filippidis FT, 2020, Associations between cigarette prices and consumption in Europe 2004 - 2014, Tobacco Control, Vol: 30, Pages: 111-113, ISSN: 0964-4563
IntroductionWhile tobacco price increases are known to reduce smoking prevalence, these relationships may be blunted by the availability of budget cigarettes, promoted by the tobacco industry to maintain profits. There has been limited previous research on the impact of budget cigarettes on cigarette consumption and used data from Europe 2004-2014 to investigate this.MethodsAnnual population-weighted cigarette consumption per adult data come from the International Cigarette Consumption Database. Annual tobacco price data come from Euromonitor International for 23 European countries. We examined median prices as well as price differentials, operationalised as percentages obtained by dividing the difference between median and minimum prices by median price. We used a linear random-effects model to assess associations between these and cigarette consumption within-year and with a one-year time lag.ResultsCigarette consumption per capita has declined over the study period (-29.5 cigarettes per capita per year, 95% Confidence Intervals -46.8 to -12.1). Our analysis suggests that increases in cigarette price differentials, a marker of opportunities for smokers to switch to less expensive cigarettes, are associated with greater consumption in the same year (+6.4 for a 10% increase in differential, -40.0 to 52.6) and are associated with greater consumption the following year (+67.6, 25.8 to 109.5). ConclusionThese analyses suggest that even in Europe where tobacco taxes are relatively high compared with other regions, differential cigarette pricing strategies may undermine tobacco control. Further research is needed on links between tobacco price structures and consumption and policy design to maximise the effectiveness of tobacco tax.
Filippidis F, Chang C-M, Blackmore I, et al., 2020, Prices and illicit trade of cigarettes in the European Union, a cross-sectional analysis, Nicotine and Tobacco Research, Vol: 22, Pages: 2271-2275, ISSN: 1462-2203
IntroductionWithin the context of the World Health Organization Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products and the impending revision of the EU directive on tobacco excise rules we assessed whether cigarettes price is linked to being offered illicit cigarettes.MethodsWe combined data being offered illicit cigarettes from the 2015 Special Eurobarometer Survey on Illicit Tobacco (N=27,672) with area-level data on Gross Domestic Product, unemployment, perceived corruption and sharing a border with a non-European Economic Area (non-EEA) state. We used the 2015 Weighted Average Price of cigarettes (WAP), which reflects the average price of a cigarette pack in each member state. We assessed associations between prices and illicit trade using 3-level ordered regression models.Results19.6% of respondents reported ever being offered illicit cigarettes, 6.4% repeatedly. In fully adjusted models WAP was not associated with being more likely to have been offered illicit market cigarettes more often (adjusted Odds Ratio=1.02, 95% Confidence Interval 0.91; 1.15). Sharing a border with a non-EEA member state was associated with increased likelihood of reporting being offered illicit cigarettes more often (1.73, 1.26;2.39).ConclusionThis study found no significant association between cigarette prices and reporting being offered illicit cigarettes; sharing a border with a non-EEA member state was linked to illicit trade. This study adds to evidence that increasing prices of cigarettes are not associated with illicit trade and that the focus should remain on securing supply chains, including through features such independent traceability systems.ImplicationsAfter adjusting for individual and regional factors, we did not identify an association between prices of cigarettes and likelihood of reporting being offered illicit cigarettes in the EU. Sharing a border with a non-EEA state however, was associated with increased likelihood of
D'Anna L, Filippidis F, Nthony S, et al., 2020, EARLY INITIATION OF DIRECT ANTICOAGULATION AFTER STROKE IN PATIENTS WITH ATRIAL FIBRILLATION: THE EIDASAF STUDY., Publisher: SAGE PUBLICATIONS LTD, Pages: 547-547, ISSN: 1747-4930
D'Anna L, Filippidis FT, Antony S, et al., 2020, Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation., European Journal of Neuroscience, Vol: 27, Pages: 2168-2175, ISSN: 0953-816X
BACKGROUND: The safety of early initiation of anticoagulant therapy in patients with ischaemic stroke related to atrial fibrillation (AF) is unknown. We investigated the safety of early initiation of direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs) or no anticoagulation. METHODS: This observational, retrospective, single-centre study included consecutive patients with recent (< 4 weeks) ischaemic stroke and AF. The primary outcome was the rate of major (intra- and extracranial) bleeding in patients on different treatment schemes: DOACs, VKAs and not anticoagulated. We also investigated the rate of ischaemic cerebrovascular events and mortality. RESULTS: We included 959 consecutive patients with AF and ischaemic stroke followed up for an average time of 16.1 days after the index event. 559 patients of 959 (58.3%) were anticoagulated with either VKAs (259) or DOACs (300). Anticoagulation was started after a mean time of 7± 9.4 in the DOACs group and 11.9± 19.7 in the VKAs group. Early initiation of any anticoagulant was not associated with an increased risk of any major bleeding (OR 0.49; CI, 0.21-1.16) and in particular of intracranial bleeding (OR 0.47; CI, 0.17-1.29; p = 0.143) compared with no anticoagulation. In contrast to VKAs (OR 0.78; CI, 0.28-2.13), treatment with DOACs (OR 0.32; CI, 0.10-0.96) reduced the rate of major bleeding compared to no-anticoagulation. Early recurrences of ischaemic stroke did not differ significantly among the three groups. CONCLUSIONS: Starting DOACs within a mean time of 7 days after stroke appears safe. Randomised controlled studies are needed to establish the added efficacy of starting anticoagulation early after stroke.
Williams L, Marongiu A, Reilly G, et al., 2020, Improving methods for patient-reported outcome (PRO) analyses in observational HIV studies, Publisher: JOHN WILEY & SONS LTD, Pages: 61-62
Gravely S, Driezen P, Kyriakos CN, et al., 2020, European adult smokers' perceptions of the harmfulness of e-cigarettes relative to combustible cigarettes: cohort findings from the 2016 and 2018 EUREST-PLUS ITC Europe Surveys., European Journal of Public Health, Vol: 30, Pages: iii38-iii45, ISSN: 1101-1262
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.
Papadakis S, Katsaounou P, Kyriakos CN, et al., 2020, Quitting behaviours and cessation methods used in eight European Countries in 2018: findings from the EUREST-PLUS ITC Europe Surveys., European Journal of Public Health, Vol: 30, Pages: iii26-iii33, ISSN: 1101-1262
BACKGROUND: We 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). METHODS: Cross-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. RESULTS: Quit 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. CONCLUSIONS: Apart 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.
Nikitara K, Girvalaki C, Kyriakos CN, et al., 2020, 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., European Journal of Public Health, Vol: 30, Pages: iii62-iii67, ISSN: 1101-1262
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.
Aleyan S, Driezen P, McNeill A, et al., 2020, 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., European Journal of Public Health, Vol: 30, Pages: iii91-iii97, ISSN: 1101-1262
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; N=9547) and 2 (2018; N=9724) 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.
Vardavas CI, Kyriakos CN, Driezen P, et al., 2020, Transitions in product use during the implementation of the European Tobacco Products Directive: cohort study findings from the EUREST-PLUS ITC Europe Surveys., European Journal of Public Health, Vol: 30, Pages: iii10-iii17, ISSN: 1101-1262
BACKGROUND: The 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. METHODS: The 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 SUDAAN. RESULTS: Overall, 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%). CONCLUSIONS: The 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.
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