Katerina Nikitara1, Charis Girvalaki1,2, Christina N Kyriakos1,2, Pete Driezen3, Filippos T Filippidis4,5, Sarah Kahnert6,7, Sara C Hitchman8, Ute Mons6, Esteve Fernández9,10,11,12, Antigona C Trofor13,14, Krzysztof Przewoźniak15,16,17, Tibor Demjén18, Paraskevi A Katsaounou5,19, Witold Zatoński15,20, Geoffrey T Fong3,21, Constantine I Vardavas1,2. 1. European Network for Smoking and Tobacco Prevention, Brussels, Belgium. 2. School of Medicine, University of Crete, Heraklion, Greece. 3. Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada. 4. Department of Primary Care and Public Health, Imperial College London, London, UK. 5. Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 6. German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany. 7. Medical Faculty, Heidelberg University, Heidelberg, Germany. 8. Department of Addictions, King's College London, London, UK. 9. Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain. 10. Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain. 11. School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain. 12. Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain. 13. University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania. 14. AerPur Romania, Bucharest, Romania. 15. Health Promotion Foundation, Warsaw, Poland. 16. Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 17. Collegium Civitas, Warsaw, Poland. 18. Smoking or Health Hungarian Foundation, Budapest, Hungary. 19. First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece. 20. European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland. 21. Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
Abstract
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.
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.
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