Smoking Behaviour, Involuntary Smoking, Attitudes towards Smoke-Free Legislations, and Tobacco Control Activities in the European Union

Carlo La Vecchia,Luke Clancy,Xisca Sureda,Silvano Gallus,Jose M. Martínez-Sánchez,Esteve Fernández,Marcela Fu,Cristina Martínez

doi:10.1371/journal.pone.0013881

Abstract

BackgroundThe six most important cost-effective policies on tobacco control can be measured by the Tobacco Control Scale (TCS). The objective of our study was to describe the correlation between the TCS and smoking prevalence, self-reported exposure to secondhand smoke (SHS) and attitudes towards smoking restrictions in the 27 countries of the European Union (EU27).Methods/Principal FindingsEcologic study in the EU27. We used data from the TCS in 2007 and from the Eurobarometer on Tobacco Survey in 2008. We analysed the relations between the TCS and prevalence of smoking, self-reported exposure to SHS (home and work), and attitudes towards smoking bans by means of scatter plots and Spearman rank-correlation coefficients (rsp). Among the EU27, smoking prevalence varied from 22.6% in Slovenia to 42.1% in Greece. Austria was the country with the lowest TCS score (35) and the UK had the highest one (93). The correlation between smoking prevalence and TCS score was negative (rsp = −0.42, p = 0.03) and the correlation between TCS score and support to smoking bans in all workplaces was positive (rsp = 0.47, p = 0.01 in restaurants; rsp = 0.5, p = 0.008 in bars, pubs, and clubs; and rsp = 0.31, p = 0.12 in other indoor workplaces). The correlation between TCS score and self-reported exposure to SHS was negative, but statistically non-significant.Conclusions/SignificanceCountries with a higher score in the TCS have higher support towards smoking bans in all workplaces (including restaurants, bars, pubs and clubs, and other indoor workplaces). TCS scores were strongly, but not statistically, associated with a lower prevalence of smokers and a lower self-reported exposure to SHS.

Highlights

The effects of tobacco on health of smokers [1] and nonsmokers [2] are well-known and tobacco continues to be the leading preventable cause of death worldwide [3]
The objective of this study is to evaluate the correlation between the implementation of tobacco control policies as measured by Tobacco Control Scale (TCS) and smoking prevalence, self-reported exposure to secondhand smoke (SHS), and attitudes towards smoking bans in the 27 countries of the European Union (EU27)
A study in 18 European countries found a positive association between the quit rate and the TCS score; this relation was similar in high and low educational levels [23]

Summary

Introduction

The effects of tobacco on health of smokers [1] and nonsmokers [2] are well-known and tobacco continues to be the leading preventable cause of death worldwide [3]. All European Union (EU) countries with the exception of the Czech Republic have ratified the WHO Framework Convention on Tobacco Control [6], and most have implemented tobacco control policies consistent with it [7]. The scope of smoking bans which are enacted can be influenced by the public opinion and the pressure of specific groups with commercial interests (such as the tobacco industry or the hospitality sector) [8,9]. In this sense, it is important to provide results about both the effectiveness and the public support of smoke-free policies. The objective of our study was to describe the correlation between the TCS and smoking prevalence, selfreported exposure to secondhand smoke (SHS) and attitudes towards smoking restrictions in the 27 countries of the European Union (EU27)

Objectives

Methods

Results

Conclusion