Sarah O Nogueira1,2,3,4, Esteve Fernández1,2,3,4, Pete Driezen5,6, Marcela Fu1,2,3,4, Olena Tigova1,2,3,4, Yolanda Castellano1,2,4, Ute Mons7,8, Aleksandra Herbeć9,10, Christina N Kyriakos11,12, Tibor Demjén13, Antigona C Trofor14,15, Krzysztof Przewoźniak9,16,17, Paraskevi A Katsaounou18, Constantine I Vardavas12,19,20, Geoffrey T Fong5,6,21. 1. Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain. 2. Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain. 3. School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain. 4. Consortium for Biomedical Research in Respiratory Diseases (CIBERES), Madrid,Spain. 5. Department of Psychology, University of Waterloo, Waterloo,Canada. 6. School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada. 7. Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center, Heidelberg, Germany. 8. Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 9. Health Promotion Foundation, Warsaw, Poland. 10. Centre for Behaviour Change, Clinical, Educational and Health Psychology, University College London, London, UK. 11. Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK. 12. European Network on Smoking and Tobacco Prevention, Brussels, Belgium. 13. Smoking or Health Hungarian Foundation, Budapest, Hungary. 14. University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, Romania. 15. Aer Pur Romania, Bucharest, Romania. 16. Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 17. Collegium Civitas, Warsaw, Poland. 18. First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece. 19. European Respiratory Society, Lausanne, Switzerland. 20. Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece. 21. Ontario Institute for Cancer Research, Toronto, ON, Canada.
Abstract
INTRODUCTION: Exposure to secondhand smoke (SHS) poses serious and extensive health and economic-related consequences to European society and worldwide. Smoking bans are a key measure to reducing SHS exposure but have been implemented with varying levels of success. We assessed changes in the prevalence of self-reported SHS exposure and smoking behavior in public places among smokers in six European countries and the influence of the country's type of smoking ban (partial or total ban) on such exposure and smoking behavior. AIMS AND METHODS: The EUREST-PLUS ITC Europe Surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, and Spain in 2016 (Wave 1, n = 6011) and 2018 (Wave 2, n = 6027). We used generalized estimating equations models to assess changes between Waves 1 and 2 and to test the interaction between the type of smoking ban and (1) self-reported SHS exposure, (2) self-reported smoking in several public places. RESULTS: A significant decrease in self-reported SHS exposure was observed in workplaces, from 19.1% in 2016 to 14.0% in 2018 (-5.1%; 95% CI: -8.0%; -2.2%). Self-reported smoking did not change significantly inside bars (22.7% in Wave 2), restaurants (13.2% in Wave 2) and discos/nightclubs (34.0% in W2). SHS exposure in public places was significantly less likely (adjusted odds ratio = 0.35; 95% CI: 0.26-0.47) in the countries with total bans as compared to those countries with partial bans. CONCLUSION: The inverse association between smoking in public places and smoking bans indicates an opportunity for strengthening smoke-free legislation and protecting bystanders from exposure to SHS in public places. IMPLICATIONS: Prevalence of smokers engaging in and being exposed to smoking in public places varied by type of smoke-free legislation across six European Union countries in our study; those with total smoke bans reported significantly less exposure to SHS than those with partial or no bans. Our results indicate room for improvement, not only to decrease the prevalence of exposure to SHS in Europe but also to diminish the variability between countries through common, more restrictive smoke-free legislation, and importantly, strong and sustained enforcement.
INTRODUCTION: Exposure to secondhand smoke (SHS) poses serious and extensive health and economic-related consequences to European society and worldwide. Smoking bans are a key measure to reducing SHS exposure but have been implemented with varying levels of success. We assessed changes in the prevalence of self-reported SHS exposure and smoking behavior in public places among smokers in six European countries and the influence of the country's type of smoking ban (partial or total ban) on such exposure and smoking behavior. AIMS AND METHODS: The EUREST-PLUS ITC Europe Surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, and Spain in 2016 (Wave 1, n = 6011) and 2018 (Wave 2, n = 6027). We used generalized estimating equations models to assess changes between Waves 1 and 2 and to test the interaction between the type of smoking ban and (1) self-reported SHS exposure, (2) self-reported smoking in several public places. RESULTS: A significant decrease in self-reported SHS exposure was observed in workplaces, from 19.1% in 2016 to 14.0% in 2018 (-5.1%; 95% CI: -8.0%; -2.2%). Self-reported smoking did not change significantly inside bars (22.7% in Wave 2), restaurants (13.2% in Wave 2) and discos/nightclubs (34.0% in W2). SHS exposure in public places was significantly less likely (adjusted odds ratio = 0.35; 95% CI: 0.26-0.47) in the countries with total bans as compared to those countries with partial bans. CONCLUSION: The inverse association between smoking in public places and smoking bans indicates an opportunity for strengthening smoke-free legislation and protecting bystanders from exposure to SHS in public places. IMPLICATIONS: Prevalence of smokers engaging in and being exposed to smoking in public places varied by type of smoke-free legislation across six European Union countries in our study; those with total smoke bans reported significantly less exposure to SHS than those with partial or no bans. Our results indicate room for improvement, not only to decrease the prevalence of exposure to SHS in Europe but also to diminish the variability between countries through common, more restrictive smoke-free legislation, and importantly, strong and sustained enforcement.
Authors: G T Fong; A Hyland; R Borland; D Hammond; G Hastings; A McNeill; S Anderson; K M Cummings; S Allwright; M Mulcahy; F Howell; L Clancy; M E Thompson; G Connolly; P Driezen Journal: Tob Control Date: 2006-06 Impact factor: 7.552
Authors: Filippos T Filippidis; Israel T Agaku; Charis Girvalaki; Carlos Jiménez-Ruiz; Brian Ward; Christina Gratziou; Constantine I Vardavas Journal: Eur J Public Health Date: 2015-10-27 Impact factor: 3.367
Authors: Geoffrey T Fong; Lorraine V Craig; Romain Guignard; Gera E Nagelhout; Megan K Tait; Pete Driezen; Ryan David Kennedy; Christian Boudreau; Jean-Louis Wilquin; Antoine Deutsch; François Beck Journal: PLoS One Date: 2013-06-21 Impact factor: 3.240
Authors: Geoffrey T Fong; Mary E Thompson; Christian Boudreau; Nicolas Bécuwe; Pete Driezen; Thomas K Agar; Anne C K Quah; Witold A Zatoński; Krzysztof Przewoźniak; Ute Mons; Tibor Demjén; Yannis Tountas; Antigona C Trofor; Esteve Fernández; Ann McNeill; Marc Willemsen; Constantine I Vardavas Journal: Tob Induc Dis Date: 2018-12-12 Impact factor: 2.600
Authors: Constantine I Vardavas; Nicolas Bécuwe; Tibor Demjén; Esteve Fernández; Ann McNeill; Ute Mons; Yannis Tountas; Antigona C Trofor; Aristides Tsatsakis; Gernot Rohde; Marc Willemsen; Krzysztof Przewozniak; Witold A Zatonski; Geoffrey T Fong Journal: Tob Induc Dis Date: 2018-08-21 Impact factor: 2.600