Publications
221 results found
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, Tobacco Control, Vol: 31, ISSN: 0964-4563
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.
Hedman L, Ashley D, Filippidis F, et al., 2021, Tobacco is still the most important preventable cause of respiratory diseases, ERS Monograph, Vol: 2021, Pages: 1-17, ISSN: 2312-508X
Tobacco use and exposure to ETS remain the main causes of respiratory diseases, both in adults and children. It places significant burden on both individual and public health, particularly in vulnerable groups such as children and people of lower socioeconomic status. Tobacco smoking is still the most preventable cause of premature death and respiratory diseases and it interferes with most of the sustainable development goals. Moreover, tobacco smoking is a chronic dependence disorder that needs a systematic diagnostic approach and treatment. Most smokers want to quit, but although safe, evidence-based nicotine-dependence treatments exist, they remain poorly implemented in medical education and practice. The content and emissions of cigarettes and their impact on health are well known. By stronger enforcement of existing tobacco control measures, the tobacco epidemic can be curbed.
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, Pages: 1-7, ISSN: 0091-7435
Despite their implications for tobacco control, data on concurrent dual (using two tobacco products) and poly-tobacco use (using more than two products) are relatively scarce globally. This study aimed to estimate the prevalence of dual and poly-tobacco use among men in 19 low-and middle-income countries (LMICs) and assess potential associations with individual and country level factors. Data from 19 LMICs were obtained from the most recent wave of the Demographic and Health Survey (DHS), collected between 2015 and 2016 comprising 235,975 men aged 15–49 years. The prevalence of current single, dual and poly-tobacco use were estimated using available sample weights. Mixed-effect multilevel models were used to estimate associations of individual and country level factors with tobacco use. Results showed that the prevalence of dual or poly-tobacco use among men was highest in Timor Leste (27.1%), Nepal (18.3%), Lesotho (13.2%) and India (9.3%). Factors associated with dual and poly-tobacco use were older age, low academic achievement, low income status, being divorced, living in urban areas and high frequency of media use. Among country-level characteristics, national wealth was not associated with dual and poly-tobacco use. Implementation of MPOWER measures was inversely associated with single tobacco use; this was not the case for dual and poly-tobacco use. Findings suggest that dual and poly-tobacco use are common among men especially in South-East Asian countries. This study highlights the need for MPOWER measures to be expanded and strengthened to address all tobacco products and explicitly consider dual and poly use.
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.
Kyriakos CN, Driezen P, Girvalaki C, et al., 2020, Awareness and correlates of noticing changes to cigarette packaging design after implementation of the European Tobacco Products Directive: findings from the EUREST-PLUS ITC Europe Surveys., European Journal of Public Health, Vol: 30, Pages: iii98-iii107, ISSN: 1101-1262
BACKGROUND: The European Tobacco Products Directive (TPD), which went into effect in May 2016, regulates packaging design and labelling of cigarettes and roll-your-own (RYO) tobacco. The aim of the current study was to examine whether smokers and recent quitters in six European Union (EU) countries (Germany, Greece, Hungary, Poland, Romania and Spain) reported noticing TPD-related changes to packaging, and correlates of noticing these changes. METHODS: Cross-sectional data from the Wave 2 of the ITC 6 European Country Survey in 2018 after implementation of the TPD. Bivariate analyses included adult smokers (n = 5597) and recent quitters (n = 412). Adjusted logistic regression analyses were restricted to the subset of current smokers (n = 5597) and conducted using SAS-callable SUDAAN. RESULTS: Over half of smokers (58.2%) and 30% of quitters noticed at least one of five types of TPD-related pack changes. Over one-quarter of all respondents noticed changes to health warnings (30.0%), standardized openings (27.7%), minimum pack unit size (27.9%), and the removal of tar, nicotine and carbon monoxide information (26.7%) on packaging. Cross-country differences were observed across all measures, with noticing all pack changes markedly lower in Spain than the other countries. Correlates of noticing specific pack changes included sociodemographic characteristics, smoking behaviours and related to packaging. CONCLUSIONS: This is one of the first cross-country studies to examine the extent to which TPD changes to cigarette and RYO tobacco packaging are being noticed by smokers and recent quitters. Findings indicate that the majority of smokers noticed at least one type of pack change, but this varied across countries and sub-populations.
Lotrean LM, Trofor A, Radu-Loghin C, et al., 2020, Awareness and use of heated tobacco products among adult smokers in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys, European Journal of Public Health, Vol: 30, Pages: iii78-iii83, ISSN: 1101-1262
BackgroundThe study assessed awareness and use of heated tobacco products (HTPs) and factors that influenced these issues among cigarette smokers from six European countries in 2016 (wave 1) and 2018 (wave 2).MethodsA survey was conducted among a nationally representative sample of cigarette smokers aged 18 years or older from Germany, Greece, Hungary, Poland Romania and Spain in 2016 (N= 6,011) and 2018 (N=6,027; 53% of smokers from the previous wave were retained, regardless of smoking status, and dropouts were replaced by a replenishment sample of smokers). Data were collected through face-to-face interviews. Estimates were produced using weighted data. The study presents the cross-sectional results.ResultsAwareness of HTPs increased from 8% to 17% between the two waves. At Wave 1, 1.1% of the smokers declared having used HTPs at least once during their lifetime, and at Wave 2 this increased to 1.9% (around 1% or less in four countries, except for Greece and Romania where it was around 4%). Factors associated with HTPs use among those who had ever heard about these products at Wave 1 were: country of residence, being a daily cigarette smoker, and ever use of electronic cigarettes. At wave 2 ever use of HTPs was significantly higher among those who had tried to quit smoking combustible cigarettes in the last 12 months, had tried electronic cigarettes during lifetime and perceived HTPs as less dangerous than combustible cigarette; the country of residence was also associated with HTPs use.ConclusionThis study offers insights into the behaviours and perceptions of European adult smokers regarding HTPs, an important emerging issue in the field of tobacco control.
Pappa S, Patrinos S, Sakkas N, et al., 2020, COPD patients continue to smoke after being diagnosed for COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Girvalaki C, Filippidis FT, Kyriakos CN, et al., 2020, Perceptions, predictors of and motivation for quitting among smokers from six European countries from 2016 to 2018: findings from EUREST-PLUS ITC Europe surveys, International Journal of Environmental Research and Public Health, Vol: 17, Pages: 1-16, ISSN: 1660-4601
The European Tobacco Products Directive (TPD) was introduced in 2016 in an effort to decrease prevalence of smoking and increase cessation in the European Union (EU). This study aimed to explore quitting behaviours, motivation, reasons and perceptions about quitting, as well as predictors (reported before the TPD implementation) associated with post-TPD quit status. A cohort study was conducted involving adult smokers from six EU countries (n = 3195). Data collection occurred pre-(Wave 1; 2016) and post-(Wave 2; 2018) TPD implementation. Bivariate and logistic regression analyses of weighted data were conducted. Within this cohort sample, 415 (13.0%) respondents reported quitting at Wave 2. Predictors of quitting were moderate or high education, fewer cigarettes smoked per day at baseline, a past quit attempt, lower level of perceived addiction, plans for quitting and the presence of a smoking-related comorbidity. Health concerns, price of cigarettes and being a good example for children were among the most important reasons that predicted being a quitter at Wave 2. Our findings show that the factors influencing decisions about quitting may be shared among European countries. European policy and the revised version of TPD could emphasise these factors through health warnings and/or campaigns and other policies.
Millett C, Filippidis FT, 2020, Socioeconomic inequalities, migration and poly tobacco use among male adults in developing countries., Publisher: OXFORD UNIV PRESS, Pages: V416-V416, ISSN: 1101-1262
Chen THC, Millett CM, Filippidis FTP, 2020, THE IMPACT OF HEALTH SYSTEM SUPPORT AND MIGRATION RELATED RISK FACTORS ON DUAL AND POLY-TOBACCO USE AMONG MALE ADULTS IN 15 LOW AND MIDDLE-INCOME COUNTRIES - IMPLICATIONS FOR GLOBAL TOBACCO CONTROL, Publisher: BMJ PUBLISHING GROUP, Pages: A7-A7, ISSN: 0143-005X
van Schalkwyk M, McKee M, Been J, et al., 2020, Size matters: an analysis of cigarette pack sizes across 23 European Union countries using Euromonitor data, 2006 to 2017, PLoS One, Vol: 15, ISSN: 1932-6203
IntroductionThe tobacco industry (TI) has used small cigarette pack sizes to encourage brand-switching and consumption, and to mitigate the impacts of tobacco tax increases. Since 2016, the European Union (EU) Tobacco Products Directive (TPD) specifies a minimum pack size of 20 cigarettes. We examined cigarette pack sizes in the EU and whether pack size composition differed between cheap and expensive price segments, as well as the impact of the revised TPD.MethodsWe conducted a longitudinal analysis of pricing data from 23 EU countries between 2006–2017. We examined pack sizes over time to assess the impact of the TPD, differences in pack size composition between cheap and expensive price segments, and compared gaps in median prices between products using actual and ‘expected’ prices (price if all packs contained 20 sticks).ResultsCigarette pack sizes changed over time, across the EU. The distribution of pack sizes varied between price segments, with small pack sizes especially frequent in the cheap segment of the cigarette market, but this varied over time and across countries. Packs of <20 cigarettes almost disappeared from the data samples after implementation of the TPD.ConclusionImplementation of the TPD appears to have virtually eliminated packs with <20 cigarettes, restricting their use by the TI. Our analysis suggests pack sizes have been used differentially across the EU. Country-level analyses on the industry’s use of pack sizes, consumer responses, and evaluations of restricting certain pack sizes are needed to confirm our findings and strengthen policy.
Crookes C, Palladino R, Seferidi P, et al., 2020, The impact of the economic crisis on household health expenditure in Greece: an interrupted time series analysis, BMJ Open, Vol: 10, Pages: 1-11, ISSN: 2044-6055
Objectives and setting The 2008 financial crisis had a particularly severe impact onGreece. To contain spending, the government capped public health expenditure andintroduced increased cost-sharing. The Greek case is important for studying theimpact of recessions on health systems. This study analysed changes in householdhealth expenditure in Greece over the economic crisis and explored whether theimpact differed across socioeconomic groups.Participants We used data from the Greek Household Budget Survey for the years2004 and 2008-2017. The dataset comprised 51,654 households, with a total of128,111 members.Design We compared pre- and post-crisis trends in Greek household out-of-pocketpayments for healthcare from 2004-2017 using an interrupted time series analysis.This study explored spending in Euros and as a share of total household purchases.Results Our results indicated that the population level trend in household healthspending was reversed after the crisis began (pre-crisis trend:€0.040 decrease perquarter (95% CI: -0.785 to -0.022), post-crisis trend:€0.315 increase per quarter(95% CI: -0.004 to 0.635)). We also found that spending on inpatient services andpharmaceuticals has been increasing since the start of the crisis, whereas outpatientservices expenditure has been decreasing. Across all households, out-of-pocketpayments incurred a greater financial burden after the crisis relative to pre-existingtrends, but the poorest households incurred a disproportionately higher burden.Conclusions This was the first study to use an interrupted time series analysis toassess the impact of the economic crisis on household health expenditure in Greece.Our findings suggest that there was an erosion of financial protection for Greekhouseholds as a consequence of the economic crisis. This effect was particularlypronounced amongst poorer households, which is indicative of a regressivefinancing system.
Nogueira SO, Tigova O, Driezen P, et al., 2020, Do smokers want to protect non-smokers from the harms of second-hand smoke in cars? Findings from the EUREST-PLUS ITC Europe Surveys, European Journal of Public Health, Vol: 30, Pages: iii108-iii112, ISSN: 1101-1262
BACKGROUND: There is currently no comprehensive legislation protecting non-smokers and children from second-hand smoke (SHS) exposure in private cars at the European Union (EU) level. This study aims to assess smokers' support for smoke-free cars legislation in six EU countries. METHODS: Data come from the EUREST-PLUS ITC Europe Surveys: Wave 1 (2016, n = 6011) and Wave 2 (2018, n = 6027) conducted in Germany, Greece, Hungary, Poland, Romania and Spain. Support for smoke-free cars carrying pre-school children and non-smokers and voluntary implementation of smoke-free cars were assessed among adult smokers. Generalized estimating equations models were used to assess changes in support between waves. RESULTS: In 2018, 96.3% [95% confidence interval (CI) 95.4-97.0%] of the overall sample supported smoke-free legislation for cars carrying pre-school children, representing an increase of 2.4 percentage points in comparison to 2016. Smoke-free legislation for cars transporting non-smokers was supported by 85.2% (95% CI 83.1-87.1%) of smokers' in 2016 and 90.2% (95% CI 88.6-91.7%) in 2018. Among smokers who owned cars, there was a significant 7.2 percentage points increase in voluntary implementation of smoke-free cars carrying children from 2016 (60.7%, 95% CI 57.2-64.0%) to 2018 (67.9%, 95% CI 65.1-70.5%). All sociodemographic groups of smokers reported support higher than 80% in 2018. CONCLUSION: The vast majority of smokers in all six EU countries support smoke-free legislation for cars carrying pre-school children and non-smokers. This almost universal support across countries and sociodemographic groups is a clear indicator of a window of opportunity for the introduction of comprehensive legislation to protect non-smokers and children from SHS exposure in cars.
Thompson ME, Driezen P, Boudreau C, et al., 2020, Methods of the international tobacco control (ITC) EUREST-PLUS ITC Europe surveys., European Journal of Public Health, Vol: 30, Pages: iii4-iii9, ISSN: 1101-1262
BACKGROUND: The EUREST-PLUS ITC Europe surveys aim to evaluate the impact of the European Union's Tobacco Products Directive (EU TPD) implementation within the context of the WHO FCTC. This article describes the methodology of the 2016 (Wave 1) and 2018 (Wave 2) International Tobacco Control 6 European (6E) Country Survey in Germany, Greece, Hungary, Poland, Romania and Spain; the England arm of the 2016 (Wave 1) and 2018 (Wave 2) ITC 4 Country Smoking and Vaping (4CV) Survey; and the 2016 (Wave 10) and 2017 (Wave 11) ITC Netherlands (NL) Survey. All three ITC surveys covering a total of eight countries are prospective cohort studies with nationally representative samples of smokers. METHODS: In the three surveys across the eight countries, the recruited respondents were cigarette smokers who smoked at least monthly, and were aged 18 and older. At each survey wave, eligible cohort members from the previous waves were retained, regardless of smoking status, and dropouts were replaced by a replenishment sample. RESULTS: Retention rates between the two waves of the ITC 6E Survey by country were 70.5% for Germany, 41.3% for Greece, 35.7% for Hungary, 45.6% for Poland, 54.4% for Romania and 71.3% for Spain. The retention rate for England between ITC 4CV1 and ITC 4CV2 was 39.1%; the retention rates for the ITC Netherlands Survey were 76.6% at Wave 10 (2016) and 80.9% at Wave 11 (2017). CONCLUSION: The ITC sampling design and data collection methods in these three ITC surveys allow analyses to examine prospectively the impact of policy environment changes on the use of cigarettes and other tobacco products in each country, to make comparisons across the eight countries.
Kahnert S, Driezen P, Balmford J, et al., 2020, Impact of the tobacco products directive on self-reported exposure to e-cigarette advertising, promotion and sponsorship in smokers-findings from the EUREST-PLUS ITC Europe Surveys, European Journal of Public Health, Vol: 30, Pages: iii55-iii61, ISSN: 1101-1262
BACKGROUND: Advertising, promotion and sponsorship of electronic cigarettes (ECAPS) have increased in recent years. Since May 2016, the Tobacco Products Directive 2014/40/EU (TPD2) prohibits ECAPS in various advertising channels, including media that have cross-border effects. The objective of this study was to investigate changes in exposure to ECAPS in a cohort of smokers from six European Union member states after implementation of TPD2. METHODS: Self-reported exposure to ECAPS overall and in various media and localities was examined over two International Tobacco Control Policy Evaluation survey waves (2016 and 2018) in a cohort of 6011 adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (EUREST-PLUS Project) using longitudinal generalized estimating equations models. RESULTS: Self-reported ECAPS exposure at both timepoints varied between countries and across examined advertising channels. Overall, there was a significant increase in ECAPS exposure [adjusted odds ratio (aOR): 1.25, 95% CI: 1.09-1.44]. Between waves, no consistent patterns of change in ECAPS exposure across countries and different media were observed. Generally, ECAPS exposure tended to decline in some channels regulated by TPD2, particularly on television and radio, while exposure tended to increase in some unregulated channels, such as at points of sale. CONCLUSIONS: The findings suggest that the TPD2 was generally effective in reducing ECAPS in regulated channels. Nonetheless, further research is warranted to evaluate its role in reducing ECAPS exposure, possibly by triangulation with additional sources of data.
Kahnert S, Driezen P, Balmford J, et al., 2020, Effectiveness of tobacco warning labels before and after implementation of the European Tobacco Products Directive-findings from the longitudinal EUREST-PLUS ITC Europe surveys, European Journal of Public Health, Vol: 30, Pages: iii84-iii90, ISSN: 1101-1262
BACKGROUND: Tobacco product packaging is a key part of marketing efforts to make tobacco use appealing. In contrast, large, prominent health warnings are intended to inform individuals about the risks of smoking. In the European Union, since May 2016, the Tobacco Products Directive 2014/40/EU (TPD2) requires tobacco product packages to carry combined health warnings consisting of a picture, a text warning and information on stop smoking services, covering 65% of the front and back of the packages. METHODS: Key measures of warning label effectiveness (salience, cognitive reactions and behavioural reaction) before and after implementation of the TPD2, determinants of warning labels' effectiveness and country differences were examined in a longitudinal sample of 6011 adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (EUREST-PLUS Project) using longitudinal Generalized Estimating Equations (GEE) models. RESULTS: In the pooled sample, the warning labels' effectiveness increased significantly over time in terms of salience (adjusted OR = 1.18; 95% CI: 1.03-1.35), while cognitive and behavioural reactions did not show clear increases. Generally, among women, more highly educated smokers and less addicted smokers, the effectiveness of warning labels tended to be higher. CONCLUSION: We found an increase in salience, but no clear increases for cognitive and behavioural reactions to the new warning labels as required by the TPD2. While it is likely that our study underestimated the impact of the new pictorial warning labels, it provides evidence that health messages on tobacco packaging are more salient when supported by large pictures.
Chung-Hall J, Fong GT, Meng G, et al., 2020, Support for e-cigarette policies among smokers in seven European countries: longitudinal findings from the 2016-18 EUREST-PLUS ITC Europe surveys, European Journal of Public Health, Vol: 30, Pages: iii68-iii77, ISSN: 1101-1262
BACKGROUND: The 2016 European Tobacco Products Directive (TPD) required Member States (MS) to implement new regulations for electronic cigarettes (ECs). We conducted a longitudinal study to assess changes over 2 years in smokers' support for EC policies and identify predictors of support in seven European countries after TPD implementation. METHODS: Prospective cohort surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, Spain and England in 2016 (n = 9547; just after TPD) and 2018 (n = 10 287; 2 years after TPD). Multivariable logistic regression models employing generalized estimating equations assessed changes in support for four EC policies, and tested for country differences and strength of key predictors of support. RESULTS: Banning EC use in smoke-free places was supported by 53.1% in 2016 and 54.6% in 2018 with a significant increase in Greece (51.7-66.0%) and a decrease in Spain (60.1-48.6%). Restricting EC/e-liquid nicotine content was supported by 52.2 and 47.4% in 2016 and 2018, respectively, with a significant decrease in England (54.2-46.5%) and Romania (52.5-41.0%). An EC promotion ban was supported by 41.1 and 40.2%. A flavour ban was supported by 33.3% and 32.3% with a significant increase in Hungary (34.3-43.3%). Support was generally higher in Poland, Hungary and Greece vs. England. Support was lower among dual and EC-only users, and low-income smokers. CONCLUSIONS: Smokers in all countries strongly supported banning EC use in smoke-free places and restricting nicotine content after TPD implementation, with no clear trends for changes in policy support.
Filippidis F, Pete D, Christina K, et al., 2020, Transitions from and to roll-your-own tobacco, perceptions and health beliefs among smokers: Findings from the EUREST-PLUS ITC Europe Surveys, European Journal of Public Health, Vol: 30, Pages: iii18-iii25, ISSN: 1101-1262
Background:The prevalence of roll-your-own tobacco (RYO) in Europe has been increasing. The aim of this study was to investigate transitions between factory-made cigarettes (FM) and RYO in a longitudinal sample of European smokers, and their perceptions of relative harmfulness and knowledge of health effects.Methods:We used data collected from the EUREST-PLUS ITC 6 European Country (6E) Surveys in 2016 (n=6011 smokers) and in 2018 (n=6027) in Germany, Greece, Hungary, Poland, Romania, and Spain. A total of 3195 cohort respondents were interviewed in both years. Use of RYO and FM, knowledge of health effects of smoking as well as perceptions about RYO were assessed. We used logistic regression models to explore sociodemographic correlates of transitions from one product to the other, of perceptions and knowledge related to smoking health effects.Results:Approximately 7.4% of exclusive FM smokers transitioned to RYO and 29.5% of exclusive RYO smokers transitioned to FM cigarettes from 2016 to 2018. RYO use in 2018 was more frequent among smokers of low education and income, but none of these factors were associated with transitions. Most RYO smokers perceived RYO as cheaper than FM and 21.7% of them considered RYO to be less harmful than FM. Knowledge of the health effects of smoking was not associated with type of product smoked.Conclusions:RYO is popular among European smokers; its lower cost seems to be a major factor for RYO users; reasons for transitions to and from RYO are less clear and need to be further investigated.
Zatoński M, Herbeć A, Zatoński W, et al., 2020, Cessation behaviours among smokers of menthol and flavoured cigarettes following the implementation of the EU Tobacco Products Directive: findings from the EUREST-PLUS ITC Europe Surveys, European Journal of Public Health, Vol: 30, Pages: iii34-iii37, ISSN: 1101-1262
The European Tobacco Products Directive (TPD) introduced a ban on characterizing flavours in cigarettes (2016), including menthol (2020). The longitudinal data analysis of the EUREST-PLUS International Tobacco Control (ITC) Project Europe Surveys (n = 16 534; Wave 1 in 2016 and Wave 2 in 2018) found significant but small declines in the weighted prevalence of menthol (by 0.94%; P = 0.041) and other flavoured cigarette use (by 1.32%; P < 0.001) following the 2016 TPD. The declines tended to be driven primarily by the menthol and flavoured cigarette (MFC) smokers switching to unflavoured tobacco. Cigarette consumption declined between waves, but there were no statistically significant difference in decline between MFC and unflavoured tobacco smokers on smoking and cessation behaviours between the waves.
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