Constantine I Vardavas1,2,3, Christina N Kyriakos1,2, Pete Driezen4, Charis Girvalaki1,2, Katerina Nikitara2, Filippos T Filippidis3,5,6, Esteve Fernández7,8,9,10, Ute Mons11, Krzysztof Przewoźniak12,13,14, Antigona C Trofor15,16, Tibor Demjén17, Paraskevi A Katsaounou3,6,18, Witold Zatoński12,19, Marc Willemsen20, Geoffrey T Fong4,21. 1. Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece. 2. European Network for Smoking and Tobacco Prevention, Brussels, Belgium. 3. European Respiratory Society, Lausanne, Switzerland. 4. Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. 5. Department of Primary Care and Public Health, Imperial College, London, UK. 6. Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 7. Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain. 8. Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain. 9. School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain. 10. Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain. 11. German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany. 12. Health Promotion Foundation, Warsaw, Poland. 13. Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland. 14. Collegium Civitas, Warsaw, Poland. 15. University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania. 16. Aer Pur Romania, Bucharest, Romania. 17. Smoking or Health Hungarian Foundation, Budapest, Hungary. 18. First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece. 19. European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland. 20. Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands. 21. Ontario Institute for Cancer Research, Toronto, Canada.
Abstract
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.
BACKGROUND: The emergence of new types of tobacco and tobacco-related products on the European Union (EU) market has precipitated the possibility for both poly-tobacco use and transitions between products. In the EU, the regulatory environment has shifted with the implementation of the European Tobacco Products Directive (TPD) in May 2016, which may influence consumer transitions between products. METHODS: The aim of this paper was to examine trends and transitions in tobacco products from 2016 to 2018 -before and after implementation of the TPD in the EU. Data come from Wave 1 (pre-TPD) and Wave 2 (post-TPD) of the EUREST-PLUS ITC Six European Country Survey, a cohort study of adults who at the time of recruitment were smokers from six EU countries- Germany, Greece, Hungary, Poland, Romania, and Spain. D (N = 3195). Bivariate and logistic regression analyses of weighted data was conducted using SAS-callable SUDAAN. RESULTS: Overall, among those who smoked factory-made cigarettes (FM) only at Wave 1, 4.3% switched to roll-your-own tobacco (RYO) only. Among RYO only users at Wave 1, 17.0% switched to FM only, however compared to all other countries, respondents from Hungary had the highest percentage of FM only users at Wave 1 switch to RYO only at Wave 2 (18.0%). CONCLUSIONS: The most prominent transition overall was from smoking RYO exclusively at Wave 1 to smoking FM tobacco exclusively at Wave 2, however this varied across countries. As the tobacco control regulatory environment of the EU develops, it is important to continue to monitor transitions between types of products, as well as trends in cessation.
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