Janet Chung-Hall1, Geoffrey T Fong1,2,3, Gang Meng1, Lorraine V Craig1, Ann McNeill4, Sara C Hitchman4, Esteve Fernández5,6,7,8, Ute Mons9, Antigona C Trofor10,11, Krzysztof Przewoźniak12,13,14, Witold A Zatoński12,15, Tibor Demjén16, Paraskevi A Katsaounou17,18, Christina N Kyriakos19,20, Constantine I Vardavas19,20. 1. Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada. 2. School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada. 3. Ontario Institute for Cancer Research, Toronto, Ontario, Canada. 4. Department of Addictions, King's College London, London, UK. 5. Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. 6. Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. 7. School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. 8. Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain. 9. Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany. 10. University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Lasi, Romania. 11. Aer Pur Romania, Bucharest, Romania. 12. Health Promotion Foundation, Warsaw, Poland. 13. Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 14. Collegium Civitas, Warsaw, Poland. 15. European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland. 16. Smoking or Health Hungarian Foundation, Budapest, Hungary. 17. First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece. 18. Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 19. European Network for Smoking and Tobacco Prevention, Brussels, Belgium. 20. School of Medicine, University of Crete, Heraklion, Greece.
Abstract
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.
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.
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Authors: Filippos T Filippidis; Anthony A Laverty; Vasiliki Gerovasili; Constantine I Vardavas Journal: Tob Control Date: 2016-05-24 Impact factor: 7.552