Publications
216 results found
Vrinten C, Parnham J, Filippidis F, et al., 2023, Patterns of cigarette and e-cigarette use among UK adolescents: a latent class analysis of the Millennium Cohort Study, European Journal of Public Health, ISSN: 1101-1262
Background Patterning of cigarette and e-cigarette use among young people remains poorlycharacterised. We aimed to describe these patterns in the UK Millennium Cohort Study atage 14 and 17 years.Methods Data on cigarette and e-cigarette use come from 9,731 adolescents. Latent class analysisassigned participants to membership of classes of product use and multinomial logisticregression analyses assessed differences in the likelihood of belonging to classes bysociodemographic (age, gender, ethnicity, household income, maternal education, countryof residence) and smoking-related social factors (caregiver tobacco use, caregiver ecigarette use, and peer smoking).ResultsWe identified four classes of use: 45.8% of adolescents continued to abstain from cigarettesor e-cigarettes; 21.3% experimented (used once or in the past but not currently) withcigarettes and/or e-cigarettes by age 17 but were not current users; 19.0% were lateadopters, characterised by low levels of use at age 14 but high levels of experimentation andcurrent use at age 17; and 13.9% were early adopters, characterised by high levels ofexperimentation and current use at ages 14 and 17. At age 17, 70.4% of early adopterssmoked cigarettes regularly plus an additional 27.3% experimented with cigarettes.Corresponding percentages for e-cigarettes were 37.9% and 58.9%. Tobacco and ecigarette use by caregivers, and cigarette use by peers, were associated with being both lateadopters and early adopters. ConclusionApproximately one in seven adolescents in the UK are early adopters of nicotine products.This highlights the need to develop and implement effective policies to prevent nicotine useuptake.
Kyriakos C, Driezen P, Fong GT, et al., 2023, Illicit purchasing and use of flavour accessories after the European Union menthol cigarette ban: Findings from the 2020-2021 ITC Netherlands Surveys, European Journal of Public Health, Vol: 33, Pages: 619-626, ISSN: 1101-1262
BackgroundThe 2020 European Union (EU) menthol cigarette ban increased quitting among pre-ban menthol smokers in the Netherlands, but some reported continuing to smoke menthol cigarettes. This study examined three possible explanations for post-ban menthol use—(i) illicit purchasing, (ii) use of flavour accessories and (iii) use of non-menthol replacement brands marketed for menthol smokers.MethodsData were from the ITC Netherlands Cohort Surveys among adult smokers before the menthol ban (Wave 1: February–March 2020, N = 2067) and after the ban (Wave 2: September–November 2020, N = 1752; Wave 3: June–July 2021, N = 1721). Bivariate, logistic regression and generalized estimating equation model analyses were conducted on weighted data.ResultsIllicit purchasing remained low from pre-ban (2.4%, 95% CI: 1.8–3.2, Wave 1) to post-ban (1.7%, 1.2–2.5%, Wave 3), with no difference between menthol and non-menthol smokers from Wave 1 to Wave 3. About 4.4% of post-ban menthol smokers last purchased their usual brand outside of the EU and 3.6% from the internet; 42.5% of post-ban menthol smokers and 4.4% of smokers overall reported using flavour accessories, with greater odds among those aged 25–39 years vs. 55+ (aOR = 3.16, P = 0.002). Approximately 70% of post-ban smokers who reported using a menthol brand were actually using a non-menthol replacement brand.ConclusionsThere was no increase in illicit purchasing or of smuggling outside the EU among menthol and non-menthol smokers in the Netherlands 1 year after the EU menthol cigarette ban. Use of flavour accessories and non-menthol replacement brands best explain post-ban menthol use, suggesting the need to ban accessories and ensure industry compliance.
Weth N, Qi D, Chang K, et al., 2023, Price differences between capsule, menthol non-capsule and unflavoured cigarettes in 65 countries in 2018, Preventive Medicine Reports, Vol: 34, Pages: 1-5, ISSN: 2211-3355
The global consumption of flavoured cigarettes, particularly capsule and menthol non-capsule cigarettes, has been rising rapidly. Their attractiveness has been fuelled by perceptions of improved palatability, along with industry marketing tactics such as lower price points in some regions. This study aimed to compare prices of unflavoured, capsule, and menthol non-capsule cigarettes across 65 countries by analysing 2018 cigarette price data from Euromonitor Passport. Median prices of capsule and menthol non-capsule cigarettes were each compared to unflavoured cigarettes at the country-level. Countries were included in the analysis if they contained price data for capsule or menthol non-capsule and unflavoured cigarettes (n = 65). The median price of capsule cigarettes was the same as unflavoured cigarettes in 12 out of 50 countries and not statistically different in another 31 countries (p > 0.05). Capsule cigarettes were more expensive than unflavoured cigarettes in five countries and cheaper in two (p < 0.05). The median price of menthol non-capsule cigarettes was the same as unflavoured cigarettes in 6 out of 51 countries and not statistically different in another 39 countries (p > 0.05). Menthol non-capsule cigarettes were more expensive than unflavoured cigarettes in five countries and cheaper in one country (p < 0.05). There was no pattern found in the pricing of capsule or menthol non-capsule cigarettes, suggesting variability in the tobacco industry’s pricing strategies across countries. Tailoring tobacco control policies to match national market conditions, particularly in countries with significant market shares of capsule and menthol non-capsule cigarettes could help address the public health threat posed by the tobacco epidemic.
Parnham JC, Vrinten C, Cheeseman H, et al., 2023, Changing awareness and sources of tobacco and e-cigarettes among children and adolescents in Great Britain., Tob Control
INTRODUCTION: It is illegal in the UK to sell tobacco or nicotine e-cigarettes to people under the age of 18 years, as is displaying tobacco cigarettes at the point of sale. This paper examined changes in exposure to display of these products in shops and sources of these products among children and adolescent users over time METHODS: Data from representative repeated online cross-sectional surveys of youth in Great Britain (11-18 years) were used (2018-2022; n=12 445). Outcome measures included noticing product displays and sources of e-cigarettes and tobacco cigarettes. Logistic regressions examined the associations of these outcome variables over time and with sociodemographic variables. RESULTS: Of 12 040 participants with complete data, 10.1% used some form of nicotine product (4.2% cigarettes, 2.9% e-cigarettes, 3.0% both) at least occasionally. The likelihood of noticing tobacco cigarettes on display fell over time for both supermarkets (2018: 67.1% to 2022: 58.5%) and small shops (2018: 81.3% to 2022: 66.3%), but the likelihood of noticing e-cigarettes in supermarkets rose (2018: 57.4% to 2022: 66.5%). Sources of tobacco cigarettes did not differ over time, but e-cigarette users were more likely to get their e-cigarettes from small shops in 2022 (51.2%) vs 2019 (34.2%) (OR 2.02, 95% CI 1.24, 3.29). CONCLUSION: This study provides evidence that current policies to limit awareness of and access to both tobacco and e-cigarettes among adolescents in the UK may not be effective. UK policies on the advertising, promotion and sale of both tobacco and e-cigarettes need to be reinforced to deter use among children and adolescents.
Chen DT-H, Nargis N, Fong GT, et al., 2023, A longitudinal study of transitions between smoking and smokeless tobacco use from the ITC Bangladesh Surveys: implications for tobacco control in the Southeast Asia region, The Lancet Regional Health - Southeast Asia, Vol: 14, Pages: 1-12, ISSN: 2772-3682
BackgroundIn Southeast Asia, tobacco use is a major public health threat. Tobacco users in this region may switch between or concurrently use smoked tobacco and smokeless tobacco (SLT), which makes effective tobacco control challenging. This study tracks transitions of use among different product users (cigarettes, bidis, and SLT) in Bangladesh, one of the largest consumers of tobacco in the region, and examines factors related to transitions and cessation.MethodsFour waves (2009–2015) of the International Tobacco Control (ITC) Bangladesh Survey with a cohort sample of 3245 tobacco users were analysed. Generalized Estimating Equations (GEE) models were used to explore the socioeconomic correlates of transitions from the exclusive use of cigarettes, bidis, or SLT to the use of other tobacco products or quitting over time.FindingsAmong exclusive cigarette users, most remained as exclusive cigarette users (68.1%). However, rural smokers were more likely than urban smokers to transition to bidi use (odds ratio [OR] = 3.02, 95% confidence interval [CI] = 1.45–6.29); to SLT use (OR = 2.68, 95% CI = 1.79–4.02) and to quit tobacco (OR = 1.57, 95% CI = 1.06–2.33). Among exclusive bidi users, transitional patterns were more volatile. Fewer than half (43.3%) of the exclusive bidi users maintained their status throughout the waves. Those with higher socio-economic status (SES) were more likely to quit (OR = 4.16, 95% CI = 1.08–13.12) compared to low SES smokers. Exclusive SLT users either continued using SLT or quit with minimal transitions to other products (≤2%). Nevertheless, males were more likely to switch to other tobacco products; younger (OR = 2.94, 95% CI = 1.23–6.90 vs. older), more educated (OR = 1.55, 95% CI = 1.77–3.12 vs. less educated), and urban SLT users (OR = 0.52, 95% CI = 0.30–0.86 for rural vs. urban users) were more likely to quit.InterpretationComplex transitional patterns were found among different types
Kyriakos C, Filippidis F, East KA, et al., 2023, Use of menthol cigarettes and accessories among youth who smoked after the menthol cigarette ban in England and Canada, 2021: Implications for health equity, Nicotine and Tobacco Research, ISSN: 1462-2203
Gallus S, Lugo A, Stival C, et al., 2023, Electronic cigarette use in 12 European countries. Results from the TackSHS survey, Journal of Epidemiology, Vol: 33, Pages: 276-284, ISSN: 0917-5040
BACKGROUND: Limited data on electronic cigarette prevalence, patterns and settings of use are available from several European countries. METHODS: Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). Overall, 11,876 participants, representative of the population aged ≥15 years in each country, provided information on electronic cigarette. RESULTS: 2.4% (95% confidence interval, CI: 2.2-2.7) of the subjects (2.5% among men and 2.4% among women; 0.4% among never, 4.4% among current- and 6.5% among ex-smokers) reported current use of electronic cigarette, ranging from 0.6% in Spain to 7.2% in England. Of the 272 electronic cigarette users, 52.6% were dual users (i.e., users of both electronic and conventional cigarettes) and 58.8% used liquids with nicotine. In all, 65.1% reported using electronic cigarette in at least one indoor setting where smoking is forbidden, in particular in workplaces (34.9%), and bars and restaurants (41.5%). Multivariable logistic regression analysis showed that electronic cigarette use was lower among older individuals (p for trend <0.001) and higher among individuals with high level of education (p for trend 0.040). Participants from countries with higher tobacco cigarette prices more frequently reported electronic cigarette use (odds ratio 3.62; 95% CI: 1.80-7.30). CONCLUSIONS: Considering the whole adult population of these 12 European countries, more than 8.3 million people use electronic cigarettes. The majority of users also smoked conventional cigarettes, used electronic cigarettes with nicotine and consumed electronic cigarettes in smoke-free indoor areas.
Filippidis FT, 2023, Reducing the prevalence of smokeless tobacco in an evolving tobacco landscape., Lancet Glob Health, Vol: 11, Pages: e817-e818
Laverty AA, Li CR, Chang KC-M, et al., 2023, Cigarette taxation and price differentials in 195 countries during 2014-2018, Tobacco Control, Vol: 32, Pages: 359-365, ISSN: 0964-4563
INTRODUCTION: Raising tobacco prices via increased taxation may be undermined by tobacco industry tactics to keep budget cigarettes on the market. Price differentials between budget and premium cigarettes allow smokers to trade down in the face of average price rises thus attenuating health benefits. This study examines global trends of price differentials and associations with taxation. METHODS: Ecological analysis of country-level panel data of 195 countries' price differentials was performed and compared against total, specific excise, ad valorem and other taxation. Price differentials were expressed as the difference between budget cigarette and premium pack prices (as % of premium pack prices). Two-level linear regression models with repeated measurements (2014, 2016 and 2018) nested within each country assessed the association between country-level taxation structures and price differentials, adjusted for year, geographical region and income group. RESULTS: Worldwide, median price differential between budget and premium 20-cigarette packs was 49.4% (IQR 25.9%-70.0%) in 2014 and 44.4% (IQR 22.5%-69.4%) in 2018 with significant regional variation. The largest price differentials in 2018 were in Africa, with the lowest in Europe. Total taxation was negatively associated with price differentials (-1.5%, 95% CI -2.5% to -0.4% per +10% total taxation) as was specific excise taxation (-2.5%, 95% CI -3.7% to -1.2% per +10% specific excise tax). We found no statistically significant association between ad valorem taxation and price differentials. CONCLUSION: Total levels of taxation and specific excise taxes were associated with smaller price differentials. Implementing high specific excise taxes may reduce price differentials and improve health outcomes.
Radu-Loghin C, Mocanu K, Al Gouhmani H, et al., 2023, EUREST-RISE: an innovative networking and training project on European Tobacco Control, Tobacco Prevention and Cessation, Vol: 9, ISSN: 2459-3087
Kyriakos CN, Zatonski MZ, Filippidis FT, 2023, Flavour capsule cigarette use and perceptions: a systematic review, Tobacco Control, Vol: 32, Pages: e83-e94, ISSN: 0964-4563
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.
Parnham JC, Vrinten C, Rado MK, et al., 2023, Multistate transition modelling of e-cigarette use and cigarette smoking among youth in the UK, TOBACCO CONTROL, ISSN: 0964-4563
Cox DW, Rodriguez L, Grigg J, et al., 2023, Statement on Tobacco 21 from the European Respiratory Society Tobacco Control Committee., Eur Respir J, Vol: 61
Chen T-H, Nargis N, Fong G, et al., 2023, Perceptions and reasons for quitting and transitioning between smoking and smokeless tobacco products: findings from four waves of the ITC Bangladesh Survey, Tobacco Induced Diseases, Vol: 21, Pages: 1-11, ISSN: 1617-9625
Introduction:Transitions between different tobacco products are frequent among tobacco users in Bangladesh; however, the reasons leading to such transitions and why they quit are not well researched. The aim of the study is to examine perceptions and reasons reported by tobacco users in Bangladesh to transition to other products or quit.Methods:Data from four waves (2009–2015) of the International Tobacco Control (ITC) Bangladesh Survey were used. Repeated data on perceptions and reasons for exclusive cigarette (n=520), bidi (n=130), and SLT users (n=308) to either start using other products or quit were analyzed with sampling weights. The percentages of responses across waves were used to calculate the pooled proportion data using a meta-analysis approach.Results:Common reasonsig for respondents switching to other tobacco products were influence of friends/family (73.8–86.0%), and curiosity (44.4–71.3%). The perceived calming effect of smoking cigarettes and bidis (43.2–56.9%), and the impression that bidis were less harmful (52.3%) and taste better (71.2%) were major reasons for exclusive SLT users to switch products. Health concerns (16.5– 62.7%) and disapproval from friends/family (29.8–56.4%) were generally the main reasons for quitting. For smoked tobacco users, doctor’s advice (41.6%), package warning labels (32.3%), and price (32.4%) seemed to be the major driving factors to quit.Conclusions:Results highlight that the reasons for switching between tobacco products and quitting include social factors (e.g. friends/family) and (mis) perceptions regarding the products. Tobacco control policy could emphasize cessation support, increased price and education campaigns as key policies to reduce overall tobacco use in Bangladesh. Data from four waves (2009–2015) of the International Tobacco Control (ITC) Bangladesh Survey were used. Repeated data on perceptions and reasons for exclusive cigarette (n=520), bidi (n=130)
Weth N, Bustamante L, Weth D, et al., 2023, Engagement with gamification elements in a smoking cessation app and short-term smoking abstinence: a quantitative assessment, JMIR Serious Games, Vol: 11, Pages: 1-7, ISSN: 2291-9279
Background:Gamification in smoking cessation apps has been found to improve cognitive outcomes associated with higher odds of quitting. Although some research has shown that gamification can also positively impact behavioral outcomes such as smoking cessation, studies have largely focused on physical activity and mental health. Only a few studies have explored the effects of gamification on smoking cessation outcomes, of which the majority have adopted qualitative methodologies and/or assessed engagement with apps using self-report.Objective:This study aimed to explore levels of user engagement with gamification features in a smoking cessation app via in-app metrics. Specifically, the objective of this paper was to investigate whether higher engagement with gamification features is associated with the likelihood of quitting in the short term.Methods:Data from a larger online study that recruited smokers seeking to quit were analyzed to address the objectives presented in this paper. The study took place between June 2019 and July 2020, and participants were primarily recruited via social media posts. Participants who met the eligibility criteria used 1 of 2 mobile apps for smoking cessation. In-app metrics shared by the developer of one of the smoking cessation apps, called Kwit, were used to assess engagement with gamification features. Out of 58 participants who used the Kwit app, 14 were excluded due to missing data or low engagement with the app (ie, not opening the app once a week). For the remaining 44 participants, mean (SD) values were calculated for engagement with the app using in-app metrics. A logistic regression model was used to investigate the association between engagement with gamification and 7-day smoking abstinence.Results:In total, data from 44 participants who used the Kwit app were analyzed. The majority of participants were male, married, and employed. Almost 30% (n=13) of participants self-reported successful 7-day abstinence at the end of t
Rajani N, Hoelscher J, Laverty A, et al., 2023, A multi-country analysis of transnational tobacco companies’ market share, Tobacco Induced Diseases, Vol: 21, ISSN: 1617-9625
Introduction:The international tobacco market is dominated by five transnational tobacco companies (TTCs) which continue to interfere with measures to reduce tobacco consumption. The aim of this study is to better understand the current international tobacco industry market structure by providing an overview of the market share of these five companies globally.Methods:A longitudinal multi-country study design was used to understand market share trends across 90 different countries from 2011 to 2020. Descriptive analyses were conducted based on market share and market size data obtained from Euromonitor Passport. Market share (%), maximal market share (%) and cumulative market share (%) were calculated. Maps and boxplots are used to present the descriptive analyses. Median cumulative TTC market share and interquartile ranges for each year were calculated and stratified by country income level.Results:The average maximal market share of one company in a country was 50% (IQR: 40.0–63.5) in 2020 compared to 51.5% in 2011 (IQR: 41.3–69.0). One of the five TTCs had the highest market share in 77 out of the 90 countries. Philip Morris International was the main market player in 38 countries, followed by British American Tobacco (24), Japan Tobacco International (8), Imperial Brands (6), and lastly China National Tobacco Corporation was only dominant in China. The percentage of cigarettes manufactured by one of the five TTCs remained relatively stable between 2011 (86.4%) and 2020 (85.2%). Average cumulative TTC market shares increased between 2011 and 2020 in both low- and middle-, and high-income countries.Conclusions:The international tobacco market is concentrated with a small number of large players, and this has not changed substantially between 2011 and 2020. The impact of this on the ability of the tobacco industry to resist policy changes is unknown but presents a cause for concern.
Filippidis FT, Laverty AA, 2023, Tobacco, novel tobacco and nicotine products, and respiratory health, ERS Monograph, Vol: 2023, Pages: 80-88, ISSN: 2312-508X
Tobacco smoking and exposure to second-hand smoke have been shown to negatively impact human health, including, but not limited to, increased risk of lung cancer, COPD, asthma and lower respiratory tract infections. Novel tobacco and nicotine products, such as e-cigarettes and heated tobacco products, are promoted as less harmful, but whether they actually pose significantly lower health risks is contested. Use of all tobacco and nicotine products is higher among disadvantaged groups and contributes to health inequalities among people in different socioeconomic levels. Tobacco control policies have been shown to substantially lower the prevalence of tobacco use and reduce inequalities within and among countries, while different policies may be needed to address concerns regarding novel products.
Vrinten C, Parnham JC, Filippidis FT, et al., 2022, Risk factors for adolescent smoking uptake: an analysis of prospective data from the Millennium Cohort Study, Publisher: ELSEVIER SCIENCE INC
Vrinten C, Parnham JC, Filippidis FT, et al., 2022, Risk factors for adolescent smoking uptake: an analysis of prospective data from the Millennium Cohort Study., The Lancet, Vol: 400, Pages: S57-S57, ISSN: 0140-6736
BACKGROUND: Preventing smoking uptake among adolescents is essential to achieve a smoke-free generation. The aim of this study was to assess risk factors for smoking in late adolescence and smoking uptake between early and late adolescence, using data from the Millennium Cohort Study. We also present estimates of numbers of smokers and smoking uptake. METHODS: Adolescents aged 14-17 years were included in the analysis. In separate logistic regression models, we assessed associations between age, sex, ethnicity, household income, country of residence, current smoking of a caregiver, current smoking of peers and use of social media, and regular smoking (defined as smoking at least one cigarette per week) at the age of 17 years and smoking uptake between the ages of 14 and 17 years (defined as being a never-smoker at the age of 14 years and a regular smoker at the age of 17 years). We also estimated numbers of regular smoking and smoking uptake using the Office for National Statistics 2018-19 population estimates. FINDINGS: Data from 8944 adolescents aged 14-17 years with smoking data available were included, 948 (10·6%) of which were regular tobacco smokers at the age of 17 years. 488 (51·5%) of these 948 started smoking between the ages of 14 years and 17 years. Smoking uptake was more common among adolescents reporting caregiver smoking (162 [13·6%] of 1188 vs 324 [5·0%] of 6538 with non-smoking caregivers; p<0·0001); peers smoking (223 [12·6%] of 1764 vs 229 [4·3%] of 5350 without smoking peers; p<0·0001), and those reporting higher (at least 5 h/weekday) social media use (115 [9·8%] of 1176 vs 120 [4·1%] of 2947 with lower [less than 1 h/weekday] social media use; p=0·0059), among 7786 adolescents who did not smoke at age 14. We estimated that 164 313 (95% CI 146 815-181 811) adolescents were regular smokers by the age of 17 years, of whom 101 715 (85 994-117 435) took up the habit
Kyriakos CN, Qi D, Chang K, et al., 2022, Global market trends of flavour capsule and menthol cigarettes in 78 countries, 2010-2020, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Laverty AA, Millett C, Been JV, et al., 2022, A healthy future for children and adolescents, LANCET, Vol: 400, Pages: 1100-1100, ISSN: 0140-6736
Kyriakos C, Qi D, Chang CM, et al., 2022, Global market trends of flavour capsule and menthol cigarettes: An ecological analysis using commercial data across 78 countries, 2010-2020, Tobacco Induced Diseases, Vol: 20, Pages: 1-14, ISSN: 1617-9625
Introduction: This study describes market trends of flavour capsule cigarettes (FCCs) and menthol (non-capsule) cigarettes across 78 countries from 2010 to 2020 and examines country-level factors associated with market shares of these products.Methods: Market share and retail volume data came from the Euromonitor Passport database and country-level data came from the World Health Organization (WHO), World Bank, and International Monetary Fund. Multivariable linear fixed effects panel regression analyses were conducted to evaluate the relationship between predictor variables and market share of menthol and FCC, respectively.Results: The overall market share (i.e., the percentage retail volume out of total retail volume of all cigarette types) increased from 0.23% in 2010 to 4.5% in 2020 for FCCs and decreased from 5.0% to 3.8% for menthol cigarettes. Market shares of FCCs grew most rapidly in the Americas region and among upper-middle-income countries. Market shares of menthol cigarettes remained stable across most regions and were highest in the Western Pacific and Africa regions. The overall market share of FCCs was positively associated with unemployment rate (β=0.28, 95%CI: 0.12 to 0.44, p=0.001), and inversely associated with % of the population aged 15-29 (β=-0.57, 95%CI: -0.98 to -0.15, p=0.008), % of urban population (β=-0.88, 95%CI: -1.28 to -0.48, p<0.001), GDP PPP per capita (β=-0.13, 95%CI: -0.24 to -0.03, p=0.015), and age-standardised prevalence of cigarette smoking (β=-0.93, -1.38 to -0.49, p<0.001). In contrast, the overall market share of menthol was positively associated with urbanicity (β=0.24, 95%CI: 0.08 to 0.40, p=0.003), and negatively associated with unemployment rate (β=-0.09, 95%CI: -0.17 to -0.02, p=0.014).Conclusions: Global sales of FCCs grew substantially in the last decade, surpassing menthol (non-capsule) cigarettes, which also continued to be high in many regions. There is a need for increased
Vrinten C, Parnham J, Hopkinson N, et al., 2022, Risk factors for adolescent smoking uptake – analysis of prospective data from the UK Millennium Cohort Study, Tobacco Induced Diseases, Vol: 20, Pages: 1-6, ISSN: 1617-9625
Introduction:Most people who smoke initiate smoking in adolescence. Risk factors for smoking are changing over time as demographics shift, and technologies such as social media create new avenues for the tobacco industry to recruit smokers. We assessed risk factors associated with smoking uptake and regular smoking among a representative cohort of UK adolescents.Methods:Data come from 8944 children followed prospectively as part of the UK Millennium Cohort Study. Smoking uptake was assessed as adolescents who had never smoked tobacco at the age of 14 years, but reported smoking ≥1 cigarette per week by the age of 17 years (regular smoking). We used logistic regression to assess associations between smoking uptake and selected sociodemographic factors including household income, caregiver smoking, peer smoking, and social media use. Weighted percentages and Office for National Statistics Data were used to estimate numbers of regular smokers and new smokers in the UK.Results:Among the whole sample, 10.6% of adolescents were regular smokers at the age of 17 years. Of these, 52% initiated smoking between the ages of 14 and 17 years. Uptake was more common if caregivers smoked (13.6% vs 5.0%, p<0.001) or friends smoked (12.6% vs 4.3%, p<0.001), and among those reporting >5 hours/ day of social media use (9.8% vs 4.1%, p=0.006). Applying these percentages to population data, an estimated 160000 adolescents in the UK were regular smokers by the age of 17 years, of whom more than 100000 initiated smoking between the ages of 14 and 17 years.Conclusions:This analysis of smoking uptake and regular smoking highlight that smoking behavior remains highly transmissible within families and peer groups, reinforcing inequalities. Social media are highlighted as a potential vector.
Kyriakos C, Driezen P, Fong GT, et al., 2022, The impact of the European Union’s menthol cigarette ban on smoking cessation outcomes: Longitudinal findings from the 2020-2021 ITC Netherlands Surveys, Tobacco Control, ISSN: 0964-4563
Introduction: To reduce the appeal of tobacco, the European Union (EU) banned menthol as a characterising flavour in cigarettes in May 2020. This pre-post study evaluated the impact of the menthol ban on smoking cessation outcomes among a representative cohort of Dutch smokers. Methods: Adult (18+ years) smokers were recruited at Wave 1 (pre-ban) of the International Tobacco Control (ITC) Netherlands Surveys (February-March 2020) and followed post-ban at Wave 2 (September-November 2020) and Wave 3 (June-July 2021) (N=1,326, participated in all three waves). Weighted bivariate, logistic regression, and generalised estimating equation model analyses were conducted.Results: Usual menthol use decreased from pre-ban (7.8%) to post-ban (4.0% at Wave 2 and 4.4% at Wave 3) (p<0.001). Pre-ban menthol smokers had greater odds of making a post-ban quit attempt than non-menthol smokers (66.9% vs 49.6%, aOR=1.89, 95%CI: 1.13-3.16). Compared to pre-ban non-menthol smokers, a higher proportion of menthol smokers quit by Wave 2 (17.8% vs 10.2%, p=0.025) and by Wave 3 (26.1% vs 14.1%, p=0.002), although this was not significant after adjusting for other factors. Female pre-ban menthol smokers had greater odds of quitting by Wave 3 than female non-menthol smokers (aOR=2.23, 95%CI: 1.10-4.51). Most pre-ban menthol smokers (n=99) switched to non-menthol cigarettes (40.0%) or reported that they continued to smoke menthol cigarettes (33.0%) at Wave 3. Conclusions: The EU menthol ban was effective in reducing menthol use and in increasing quit attempts and quitting among pre-ban menthol smokers. Impact could be maximised by closing gaps that allow post-ban menthol cigarette use.
Dallera G, Palladino R, Filippidis FT, 2022, Corruption in health care systems: trends in informal payments across twenty eight EU countries, 2013-2019, Health Affairs, Vol: 41, Pages: 1342-1352, ISSN: 0278-2715
Corruption is a major challenge in health care systems across the European Union (EU), where it manifests most visibly as informal payments from patients to providers. A higher prevalence of informal payments has been associated with lower public health care expenditure. EU member states have experienced significant changes in public health care expenditure throughout the 2000s. Given the lack of research on the topic, we explored trends in informal payments using representative data from twenty-eight EU member states during the period 2013-19 and in relation to changes in public health care expenditure. Overall, we found that informal payments increased in 2019 compared with 2013, whereas the perception of corruption decreased. Although higher public health care expenditure was associated with less corruption, we found a smaller effect size between informal payments and this expenditure throughout the study period. Our results suggest that informal payments may be driven by other factors, although the directionality of this relationship requires further investigation. Moreover, additional public health care investments may be insufficient to confront corruption unless coupled with measures to limit wasteful spending and increase transparency. Policy makers should understand that factors external to health systems, including media coverage and cultural and political factors, should be explored to explain country-level differences in corruption.
Radó MK, van Lenthe FJ, Laverty AA, et al., 2022, Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries: a synthetic control study, The Lancet Public Health, Vol: 7, Pages: 1-10, ISSN: 2468-2667
BackgroundThere are few quantitative studies into the effect of comprehensive smoke-free legislation on neonatal and infant mortality in middle-income countries. We aimed to estimate the effects of implementing comprehensive smoke-free legislation on neonatal mortality and infant mortality across all middle-income countries.MethodsWe applied the synthetic control method using 1990–2018 country-level panel data for 106 middle-income countries from the WHO, World Bank, and Penn World datasets. Outcome variables were neonatal (age 0–28 days) mortality and infant (age 0–12 months) mortality rates per 1000 livebirths per year. For each middle-income country with comprehensive smoke-free legislation, a synthetic control country was constructed from middle-income countries without comprehensive smoke-free legislation, but with similar prelegislation trends in the outcome and predictor variables. Overall legislation effect was the mean average of country-specific effects weighted by the number of livebirths. We compared the distribution of the legislation effects with that of the placebo effects to assess the likelihood that the observed effect was related to the implementation of smoke-free legislation and not merely influenced by other processes.Findings31 (29%) of 106 middle-income countries introduced comprehensive smoke-free legislation and had outcome data for at least 3 years after the intervention. We were able to construct a synthetic control country for 18 countries for neonatal mortality and for 15 countries for infant mortality. Comprehensive smoke-free legislation was followed by a mean yearly decrease of 1·63% in neonatal mortality and a mean yearly decrease of 1·33% in infant mortality. An estimated 12 392 neonatal deaths in 18 countries and 8932 infant deaths in 15 countries were avoided over 3 years following the implementation of comprehensive smoke-free legislation. We estimated that an additional 104 063 infant deaths (inc
Rajani NB, Bustamante L, Weth D, et al., 2022, Engagement With Gamification Elements in a Smoking Cessation App and Short-term Smoking Abstinence: Quantitative Assessment (Preprint)
<sec> <title>BACKGROUND</title> <p>Gamification in smoking cessation apps has been found to improve cognitive outcomes associated with higher odds of quitting. Although some research has shown that gamification can also positively impact behavioral outcomes such as smoking cessation, studies have largely focused on physical activity and mental health. Only a few studies have explored the effects of gamification on smoking cessation outcomes, of which the majority have adopted qualitative methodologies and/or assessed engagement with apps using self-report.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study aimed to explore levels of user engagement with gamification features in a smoking cessation app via in-app metrics. Specifically, the objective of this paper was to investigate whether higher engagement with gamification features is associated with the likelihood of quitting in the short term.</p> </sec> <sec> <title>METHODS</title> <p>Data from a larger online study that recruited smokers seeking to quit were analyzed to address the objectives presented in this paper. The study took place between June 2019 and July 2020, and participants were primarily recruited via social media posts. Participants who met the eligibility criteria used 1 of 2 mobile apps for smoking cessation. In-app metrics shared by the developer of one of the smoking cessation apps, called Kwit, were used to assess engagement with gamification features. Out of 58 participants who used the Kwit app, 14 were excluded due to missing data or low engagement with the app (ie, not opening the app once a week). For the remaining 44 participants, mean (SD) values were calculated for engag
Foster PJI, Laverty AA, Filippidis FT, 2022, Perceptions of the safety of vaccines and vaccine associated knowledge levels in Europe: A 2019 cross-sectional study in 28 countries, Preventive Medicine, Vol: 159, ISSN: 0091-7435
Vaccination has saved millions of lives. Vaccine hesitancy was recently declared a major threat to health by the World Health Organisation. Sociodemographic variables and knowledge level about vaccines have been suggested previously to affect vaccine uptake. This study aimed to investigate how levels of vaccination knowledge and concerns around safety of vaccines varied across sociodemographic factors in the European Union and United Kingdom. Levels and sources of knowledge and vaccine attitude patterns were examined across different areas of Europe. Data from the March 2019 Eurobarometer survey was used in this study which had 27,524 participants across the European Union and the United Kingdom. Two-level logistic and linear regressions were used to look for associations between sociodemographic variables, vaccine attitudes and knowledge level. Those who trusted information from healthcare workers and healthcare authorities were most likely to have positive vaccine attitudes; those trusting internet sources the most were the least likely. Those with greater vaccine related knowledge were more likely to report positive vaccination attitudes. Healthcare workers are key to dissemination of vaccination advice however many are becoming hesitant themselves. An increasing number of people are seeking online sources for vaccination information, and this has implications with information accuracy and vaccine hesitancy. A considerable proportion of the adult population in the European Union and the United Kingdom was concerned about the safety or side effects of vaccines. Continued efforts to increase trust in vaccines both in whole populations and specific groups are needed.
El Asmar M, Laverty A, Vardavas C, et al., 2022, How do Europeans quit using tobacco, e-cigarettes and heated tobacco products? A cross-sectional analysis in 28 European countries, BMJ Open, Vol: 12, ISSN: 2044-6055
Objectives: While smoking tobacco remains a substantial cause of harm in Europe, novel products such as electronic cigarettes or e-cigarettes (ECs) and heated tobacco products (HTPs) have entered the market recently. While debate still persists over the role of these novel products, they are now in widespread use. This study aimed to explore the prevalence and methods of attempts to quit EC and HTP.Setting: We analysed the 2020 Eurobarometer survey, which collected data in 28 European countries.Participants: A representative sample of individuals residing in these countries aged ≥15 years.Primary and secondary: outcome measures Multilevel regression analyses were performed to assess differences in quit attempts and cessation methods among tobacco smokers and exclusive EC/HTP users separately.Results: 51.1% of current tobacco smokers and 27.1% of exclusive EC or HTP users reported having ever made a quit attempt. The majority of former and current smokers (75.8%) who made a quit attempt did so unassisted, with 28.8% reporting at least one attempt using a cessation aid. The most popular cessation aids were nicotine replacement therapy or other medication (13.4%) and ECs (11.3%). 58.8% of exclusive EC or HTP users who had made a quit attempt did so unassisted, with 39.5% reporting the use of a cessation aid.Conclusion: Most EC and HTP users in Europe try to quit unassisted, although more of them report the use of a cessation aid compared with tobacco smokers. Cessation support services should take into consideration the increasing numbers of users of EC and HTP who may be trying to quit.
Teshima A, Filippidis F, Laverty A, 2022, Burden of current and past smoking across 28 European countries in 2017: A cross-sectional analysis, Tobacco Induced Diseases, Vol: 20, Pages: 1-11, ISSN: 1617-9625
IntroductionMost studies use the prevalence of current smoking as an indicator to quantify the burden of smoking.However, length and intensity of smoking, as well as time since cessation for former smokers are alsoknown to impact smoking-related health risks. The aim of this study was to quantify and compare theburden of smoking across the European Union (EU) using a range of smoking burden indicators.MethodsWe conducted a cross-sectional analysis using data from the March 2017 Eurobarometer 87.1(n=27,901 aged ≥15 years in 28 Member States [MS]) and the Tobacco Control Scale. We defined fiveindicators of smoking burden including the prevalence of current and ever smoking, length of smoking,pack-years, and discounted pack-years and ranked EU MS by each indicator. Two-level linear andlogistic regressions were performed to assess the association between these indicators and sociodemographic and tobacco policy factors.ResultsWide variations across the EU countries were observed in all smoking burden indicators. While someMS ranked consistently high (e.g. Greece, France) or consistently low (e.g. Ireland, United Kingdom)in all indicators, we found substantial discrepancies in ranking depending on the indicator used for MSsuch as Malta, Denmark, Finland and the Netherlands. All indicators of smoking burden were loweramong women and respondents without financial difficulties; however, the magnitude of thoseinequalities varied two-fold among the different indicators.ConclusionsUsing a range of smoking burden indicators can be more informative than relying on prevalence alone.Our analysis highlights the limitations of relying solely on prevalence of current smoking to estimatethe burden of smoking and the potential value of more nuanced indicators. We recommend thatmultiple and more nuanced indicators that consider former smokers, intensity and duration of smokingshould be utilised to monitor tobacco use and evaluate tobacco control policies.
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