Sarah Kahnert1,2, Pete Driezen3,4, James Balmford5, Christina N Kyriakos6,7, Tibor Demjén8, Esteve Fernández9,10,11,12, Paraskevi A Katsaounou13,14, Antigona C Trofor15,16, Krzysztof Przewoźniak17,18,19, Witold A Zatoński17,20, Geoffrey T Fong3,4,21, Constantine I Vardavas6,7,14, Ute Mons1. 1. Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany. 2. Medical Faculty, Heidelberg University, Heidelberg, Germany. 3. Department of Psychology, University of Waterloo, Waterloo, ON, Canada. 4. School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada. 5. Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany. 6. European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium. 7. School of Medicine, University of Crete, Heraklion, Greece. 8. Smoking or Health Hungarian Foundation, Budapest, Hungary. 9. Department of Cancer Epidemiology and Prevention, Catalan Institute of Oncology (ICO), Barcelona, Spain. 10. Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. 11. School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain. 12. Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain. 13. First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece. 14. European Respiratory Society, Lausanne, Switzerland. 15. University of Medicine and Pharmacy 'Grigore T. Popa', Iasi, Romania. 16. Aer Pur Romania, Bucharest, Romania. 17. Health Promotion Foundation, Warsaw, Poland. 18. Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 19. Collegium Civitas, Warsaw, Poland. 20. European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland. 21. Ontario Institute for Cancer Research, Toronto, ON, Canada.
Abstract
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.
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.
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