Implementation Of Tobacco Control Policies Research Articles

Up in smoke? Global tobacco control advocacy and local mobilization in Africa

Abstract Even though most African states have signed and ratified the Framework Convention on Tobacco Control (FCTC), a global treaty to limit tobacco use, African states have been slow to pass and implement tobacco control policies like regulations on sales, smoke-free environments and taxes. This article examines how the ineffectiveness of local tobacco-control advocacy contributes to this suboptimal outcome. It asserts that the disconnect between the global tobacco-control advocacy network and local advocates shapes this ineffectiveness. With funding and direction predominately from the Bloomberg Initiative, local advocates emulate the funders' goal of achieving quick, measurable policy results. Their reliance on the network drives African advocates to strive to pass legislation, even in difficult political climates, and to remake their agendas when funders change their priorities. They also emulate the network's focus on evidence-based arguments that stress epidemiological data and biomedical interventions, even when this issue frame does not resonate with policy-makers. Financial dependence can draw local advocates into expectations about patronage politics, undermine their ability to make principled arguments, and lead them to downplay the ways that their home country's socioeconomic and cultural contexts affect tobacco use and control. Based on key informant interviews with African advocates, media analysis and the case-studies of Ghana and Tanzania, the article broadens the study of philanthropy in global health, it adds an African perspective to the literature on global health advocacy, and it deepens knowledge on power dynamics between external funders and local actors in the realms of health and development.

Trends in Attempts to Quit Smoking in England Since 2007: A Time Series Analysis of a Range of Population-Level Influences.

To quantify population-level associations between quit attempts and factors that have varied across 2007-2017 in England. Data from 51 867 past-year smokers participating in the Smoking Toolkit Study (a monthly cross-sectional survey of individuals aged 16+) were aggregated over an 11-year period. Time series analysis was undertaken using ARIMAX modeling. The input series were: (1) prevalence of smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy; (2) prevalence of roll-your-own tobacco use; (3) prevalence of (a) smoking and (b) non-daily smoking; (4) mass media expenditure; (5) average expenditure on smoking; (6) characteristics in the form of (a) prevalence of high motivation to quit, (b) average age, (c) proportion from lower social grades, and (d) average number of cigarettes smoked; and (7) implementation of tobacco control policies. There was a decline in the prevalence of quit attempts from 44.6% to 33.8% over the study period. The partial point-of-sale ban was associated with a temporary increase in quit attempt prevalence (Badjusted = 0.224%; 95% confidence interval [CI] 0.061 to 0.388). Quit attempts were positively associated with the prevalence of high motivation to quit (Badjusted = 0.165%;95% CI 0.048 to 0.282) and negatively associated with the mean age of smokers (Badjusted = -1.351%; 95% CI -2.168 to -0.534). All other associations were nonsignificant. Increases in the prevalence of high motivation to quit was associated with higher prevalence of attempts to quit smoking, while an increase in the mean age of smokers was associated with lower prevalence. The introduction of the partial point-of-sale ban appeared to have a temporary positive impact. This study provides insight into how monthly changes in a wide range of population-level factors are associated with changes in quit attempts over an extended time period in a country with a strong tobacco control climate. The findings suggest a need for intervention or policy to stimulate quit attempts in older smokers. Otherwise, increases in the mean age of a smokers appears likely to undermine wider efforts to promote quit attempts in a population.

Estado actual y desafíos emergentes en la prevención y el control del tabaco

To review the implementation of the WHO Framework Convention onTobacco Control in theAmericas, describe two national case studies and analyze the evidence on electronic cigarettes from a public health perspective. Revision of the tobacco control legislation and the scientific evidence regarding electronic cigarettes. Implementation of tobacco control policies is not homogeneous, with important advances in smoke-free environments, pictorial health warnings, and epidemiological surveillance, but challenges that remain for the implementation of a total ban of tobacco advertising, increases in tobacco taxes, and tobacco cessation programs. Tobacco industry interference is one of the main obstacles for advancing and novel products create uncertainty about their regulation. There is a need for political will for a comprehensive implementation of the Convention, with evidence-based decisions to confront challenges and to defend the achievements from tobacco industry interference.

Relation between tobacco control policies and population at high risk of lung cancer in the European Union

IntroductionLung cancer accounts for nearly 2 million deaths per year worldwide, the majority of cases due to smoking as the main risk factor associated. The aim of this study was to assess the relation between the level of implementation of tobacco control policies and the population at high risk of lung cancer in the European Union (EU). MethodsThe Special Eurobarometer 458 “Attitudes of Europeans towards tobacco and electronic cigarettes”, conducted in 2017, and the Tobacco Control Scale (TCS) 2010, 2013, and 2016 were the sources of our data. High risk of lung cancer was defined by the inclusion criteria in the National Lung Screening Trial (NLST) and the Dutch-Belgian Lung Cancer Screening Trial (NELSON), the largest lung cancer screening trials carried out in the US and the EU. We calculated Spearman's rank correlation coefficients (rsp) and fitted multilevel generalized linear mixed models using the quasi-Poisson family to assess the correlation at the national level and analyze the association at the individual level, respectively, between the scores in the TCS (higher scores means better implementation of tobacco control policies) and the proportion of individuals at high risk of lung cancer in member states of the EU. ResultsThe scores in the TCS 2010 were statistically negatively correlated with the current proportion of ever and former smokers at high risk according to NELSON criteria (−0.41; 95%CI −0.68, −0.04 and −0.49; 95%CI −0.73, −0.13, respectively). We observed statistically significant inverse associations between the scores in the TCS 2010 for the highest quartiles and the proportion of individuals at high risk of lung cancer according to both criteria. Non-statistically significant negative correlations and inverse associations were observed with other TCS. ConclusionThere is a lag between the implementation of tobacco control policies and the reduction of the rates of high risk of lung cancer. Member states should reinforce comprehensive tobacco control policies to reduce the population at high risk of lung cancer in the EU.

Tobacco control in Europe: A review of campaign strategies for teenagers and adults.

In Europe the prevalence of tobacco use in adults and adolescents is among the highest within the WHO regions. Many resources have been allocated toward the prevention and support for smoking cessation. However, the implemented strategies in Europe have not been systematically evaluated. A systematic literature review was carried out to identify studies that analyzed the efficacy of the main smoking-prevention campaigns conducted in Europe. PRISMA guidelines were used to systematically review and extract data. A total of 24 studies meeting inclusion criteria were identified. Each article was thoroughly reviewed and evaluated for quality, design, and methodology, with reference to the main areas of intervention: school (8); mass media (4) and technological tools (4); smoke-free environments (3); packaging (2) and taxes (3). The school programmes focusing on building skills to recognize and resist negative influences, the intensive use of media and technological equipments, health warnings and excise taxes have showed to be effective tools in reducing the tobacco use. Intervention programmes to implement tobacco control policies and smoking cessation are active in many European countries. However, these programmes need to be constantly sustained to achieve a long term efficacy.

Adherence to tobacco control policy implementation: a cross sectional study in a selected area in Ragama town, Sri Lanka

Adherence to tobacco control policy implementation: a cross sectional study in a selected area in Ragama town, Sri Lanka

Implementing tobacco control policies in Balkan countries. What has been done and what we need to do

Implementing tobacco control policies in Balkan countries. What has been done and what we need to do

Tobacco control policies and smoking among older adults: a longitudinal analysis of 10 European countries

Background and AimsThe impact of tobacco control on European older adults has not been studied, despite evidence that smoking cessation at old age can bring significant life expectancy gains. Our aim was to evaluate the impact of tobacco control policies on smoking among older adults in Europe from 2004 to 2013.DesignWe used longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE, aged 50+ years) from four waves from 2004 to 2013. We used logistic regression models with clustered standard errors to determine whether the implementation of tobacco control policies was associated with changes in smoking status. Furthermore, we studied whether these associations varied by socio‐demographic characteristics. Regression coefficients were converted to changes the probability of smoking [marginal effects (ME)].MeasurementsSmoking status was the dependent variable, and the Tobacco Control Scale (TCS) was the explanatory variable, overall and by its main policy components (pricing and smoke‐free policies). Covariates included age, sex, education and country and wave fixed‐effects.FindingsA 10‐point increase in TCS was associated with a lower probability of smoking by 1.6 percentage points [95% confidence interval (CI) = −3.208, −0.056] for those aged 50–65, but not for older Europeans. Among those with primary school or no education, the associated drop was of 1.5 percentage points (95% CI = –2.751, −0.253). By contrast, no significant relation between TCS and smoking was observed among those with high education. Higher TCS scores for pricing (ME = –0.636, 95% CI = –0.998, −0.275) and smoke‐free policies (ME = –0.243, 95% CI = –0.445, −0.041) were associated with a significantly lower probability of smoking (P = 0.001 and P = 0.018, respectively).ConclusionIncreases in tobacco taxes and smoke‐free policies are significantly related with a reduction in smoking among European older adults, suggesting potential health gains for this rising share of the population. These policies may be more effective among the lowest educated.

Knowledge and risk perceptions of Israelis towards combustible cigarettes: the need for immediate remedial action

BackgroundDevastation from the tobacco epidemic continues, with strong government tobacco control policy absent in most countries. Knowledge of the full scope of tobacco harm in populations may form the basis for healthier behavior, de-normalization of smoking, and a consensus about necessary public policy. However, many populations may be poorly-informed about the risks, and this ignorance may undermine both effective policy-making and implementation of tobacco control policies. We present knowledge and risk perceptions about smoking tobacco smoke exposure in Israel.MethodsA nationally-representative phone survey was conducted in Israel (n = 505; response rate = 61%). We assessed knowledge about active and passive smoking using four questions, three of which addressed knowledge about harm, and one of which addressed knowledge of tobacco-related harm relative to knowledge of harm due to traffic accidents. The three questions which addressed knowledge of harm were combined into a composite score. We also asked four risk perception questions concerning tobacco smoke exposure, which were measured on a 7-point Likert scale and then combined. Multivariable logistic regression and linear models were used to identify whether smoking status or socio-demographic variables were associated with knowledge of harm, comparative knowledge of harm, and risk perceptions.ResultsJust two in five respondents, and one in five respondents who were current smokers, accurately answered three simple questions about harms of smoking. Fewer than three in ten respondents, and fewer than one in five smokers, knew that smoking causes more damage than traffic accidents. Many (30.3%) were unaware that tobacco smoke exposure causes both lung cancer and heart disease, 27.7% did not know that smoking both shortens life and injures quality of life, and 31.1% did not know that smoking-attributable health problems will afflict all or most heavy smokers. Overall, risk perceptions regarding tobacco smoke exposure were high (mean = 24.5, SD:4.5, on a scale of 7–28, with 28 the indicating highest level). Smoking status was consistently associated with lower levels of knowledge, comparative knowledge, and risk perceptions, with current smokers having the lowest levels of knowledge and the lowest risk perceptions.ConclusionsLike many others, Israelis, and particularly Israeli smokers, do not fully grasp tobacco’s true dangers. Effective communication of the full range of tobacco risks to the public, with a focus on communication with smokers, is an essential component of comprehensive tobacco control policy.

Trends in smoking prevalence and implication for chronic diseases in China: serial national cross-sectional surveys from 2003 to 2013

China is the world's largest consumer of tobacco and has a large smoking-related chronic disease burden. In this nationwide study, we aimed to evaluate smoking prevalence and its implication on chronic diseases in the Chinese population. We collected data from serial cross-sectional National Health Service Surveys done in China in 2003, 2008, and 2013. These surveys cover all 31 provinces, autonomous regions, and municipalities in mainland China, and use multistage stratified cluster sampling. We divided mainland China into east, central, and west regions and then sampled counties from each region stratified by urban and rural areas. All respondents aged 15 years or older in the selected households were eligible. We analysed the variation in smoking prevalence from 2003 to 2013, further identified risk factors for smoking, and assessed the association between smoking and chronic diseases by using multiple logistic regression. The number of individuals interviewed and involved in the study was 153 450 in 2003, 145 223 in 2008, and 229 676 in 2013. The standardised smoking prevalence in China was consistently high, with a proportion of current smokers of 26·0% (95% CI 25·8-26·2) in 2003, 24·9% (24·8-25·1) in 2008, and 25·2% (25·1-25·4) in 2013 (p value for trend 0·5062). For men, prevalence was 48·4% (48·1-48·7) in 2003, 47·0% (46·6-47·4) in 2008, and 47·2% (46·9-47·5) in 2013. For women, prevalence was 3·1% (3·0-3·2) in 2003, 2·3% (2·2-2·5) in 2008, and 2·7% (2·6-2·8) in 2013. Smoking prevalence varied in different regions, and we identified four major patterns. While a consistently high proportion of Chinese men smoked, the standardised smoking prevalence in women younger than 40 years increased from 1·0% in 2003 to 1·6% in 2013. Moreover, the smoking prevalence among adolescent smokers aged 15-24 years increased from 8·3% in 2003 to 12·5% in 2013. Alcohol consumption was closely linked to smoking in adolescents (odds ratio 7·5, 95% CI 6·9-8·1). Risk factors for adolescent smoking were having older family members who smoke (1·9, 1·8-1·9) and low level education (1·3, 1·2-1·4). Increased risks of chronic diseases were related to smoking (1·1, 1·0-1·1), with higher risks related to early smoking initiation (1·1, 1·0-1·1) and long-term smoking (1·2, 1·2-1·3). The implementation of tobacco control policies in China since the signing of the WHO Framework Convention on Tobacco Control in 2003 has not been effective in reducing smoking prevalence. Smoking prevalence among adolescents of both genders has increased substantially and there has been a steady increase among young women. More practical and effective policies targeting adolescents and women are urgently needed. Action is needed to prevent the large and growing smoking-related chronic disease burden further increasing as China's population ages. National Health Commission of the People's Republic of China.

Country-specific costs of implementing the WHO FCTC tobacco control policies and potential financing sources.

BackgroundOne of the major obstacles to the full implementation of the World Health Organization (WHO) Framework Convention of Tobacco Control (FCTC) tobacco control measures is the lack of sustainable financing resources.GoalTo update and simulate country-specific indicators that are highly relevant to the costs and financial resources of the treaty policy implementation. We also developed an Excel tool for simulation and assessed the aggregated-level indicators by the 2016 World Bank income groups.ApproachesUsing mostly 2016 data or 2014–15 data if 2016 one are not available, we updated five indicators relevant to the treaty implementation, which are the gap between current and desirable policy implementation, cigarette affordability, the costs of implementing best- buy tobacco control policies, the number of smoking-attributable deaths, and the simulated tax revenue resulting from a $1 tax increase. We also aggregated indicators and simulation results by the World Bank income groups, encompassing the five indicators and the reduction in smoking and in attributable deaths due to a hypothetical 1I$ tax increase. Finally, the policy implementation cost was compared with tax revenue and revenue increases.FindingsAs of 2016, smoking remains one of the leading causes of premature deaths worldwide while the implementation of best-buy tobacco control policies was below the recommended levels. Meanwhile, there was room to further increase cigarette taxes and prices, as cigarettes remained affordable in many countries. The total costs of implementing best-buy policies in the next 15 years merely account for 8.3% of the 2016 excise tax revenue, indicating that a small proportion of annual tax revenue could fund the implementation of tobacco control policies recommended by the WHO FCTC.ConclusionsIncreasing taxes could have a multiplier impact on curbing tobacco use through aiding the implementation of the WHO FCTC.

Governing the Commercial Determinants of Noncommunicable Diseases: Maintaining the Regulatory Power of Governments

Background and context: “Through the manufacture, sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of noncommunicable diseases (NCDs)” (Moodie et al., 2013). Furthermore, the impact of trade and investment liberalization has been correlated with the rapidly increasing prevalence of some cancers, diabetes and cardiovascular diseases in developing countries. Reaching the SDG targets is a challenging task for governments of low- and middle-income countries who face constraints in regulating the commercial determinants of NCDs due to the increasing influence of unhealthy commodity industries in policy making. Although the literature recommends various approaches to maintain or strengthen the regulatory power of governments, the impact of these strategies on the governance of commercial determinants of NCDs remains unclear. Aim: Identifying the strategies which have been successfully applied in strengthening the governance of commercial determinants of NCDs in regard to tobacco. Strategy/Tactics: The strategies for strengthening the governance of unhealthy commodities recommended by the literature mostly target the issues of fragmentation of governments and the constraints on regulatory capacity. This research examines the way the governments of Fiji and Vanuatu applied these strategies for the sake of implementing tobacco control policies. The methods involve literature review, document analysis and in-depth interviews with key informants across government departments, NGOs and development agencies in these countries. The document analysis and in-depth interviews are currently ongoing in Fiji and Vanuatu. The results and conclusions will be available by early September.

Did Slowdown on Taxes and Program Impact California's Smoking Decline?

Author(s): Pierce, John P; Shi, Yuyan; Hendrickson, Erik; White, Martha; Noble, Madison; Kealey, Sheila; Strong, David | Abstract: Objective: In this paper, we examine whether a slowdown in implementing tobacco control policies in California after 2000 influenced trends in smoking behavior. Methods: We assessed the strength of state tobacco control policies using excise tax data (1990-2014), tobacco control expenditures per capita, and workplace and home smoking restrictions (from the Tobacco Use Supplement of the Current Population Survey, 1992-2015). Smoking prevalence was assessed with the National Health Interview Survey, 1985-2015. We compared trends between California and the rest of the US using split regression models with a knot at 2000. Results: Throughout the 1990s, compared to the rest of the US, California had higher cigarette excise taxes, higher expenditures on tobacco control, more smoke-free workplaces, and more smokers with smoke-free homes. Except for smoke-free homes, these differences disappeared after 2000. During the 1990s, smoking prevalence declined much faster in California than in the rest of the US, but the decline slowed significantly after 2000. Conclusions: Smoking prevalence is sensitive to continued implementation of tobacco control policies.

Facilitators and barriers in the formulation and implementation of tobacco control policies in Kenya: a qualitative study

BackgroundTobacco use has serious public health implications for both smokers and non-smokers and significant economic implications on health care spending for governments. Tobacco-related deaths are preventable through well-formulated and implemented tobacco control policies. Using tobacco policy as a case study, we aim to describe the tobacco control policy formulation and implementation and the associated facilitators and barriers in Kenya.MethodWe used a case-study methodology to integrate two sources of data: a document review of relevant policy documents, published articles and reports between 2004 and 2015 (N = 24 documents) and in-depth interviews (N = 39). Participants were from sectors relevant to tobacco control: research and academia, government, private industry, civil society and non-governmental organizations. Thematic analysis was used to analyze all data.ResultsKenya developed a comprehensive tobacco policy in 2007. The main facilitators to the policy formulation and implementation process were (1) political commitment and strong leadership, (2) the presence of a coordination mechanism, (3) stakeholder passion and commitment, (4) resources and (5) constitutional requirement for inclusion of stakeholders. The main barriers to policy formulation and implementation were (1) industry interference, (2) resources, (3) poor enforcement and (4) lack of clear roles.ConclusionAlthough the process for formulating a tobacco control policy in Kenya was protracted, the current policy aligns well with current global efforts. The implementation is still weak and this can be enhanced by provision of necessary resources and continued engagement of all relevant stakeholders. There is a need for continued engagement with political leadership and continuous international information exchange on how policy-makers can address and counter industry interference in tobacco control efforts.

Mapping the mix: Linking instruments, settings and target groups in the study of policy mixes

This article proposes the extension of a conceptual framework aimed at analysing policy mixes and their outcomes and demonstrates its value added for the study of sustainability transitions. The argument is that policy mixes research should not focus only on the form of policy instruments, but also on their implementation context. Policy mix form designates the specific policy instruments that are involved according to a policy strategy. Policy mix context includes the specific setting where each policy measure is implemented, such as enterprise or family. It also includes the specific target group of each measure, such as youth or smokers. We apply this conceptual framework to the policy concept and implementation of tobacco control policies in Switzerland, which are an exemplary case for analysing transitions as they are geared towards behavioural change. In a mixed method approach, we triangulate different sets of quantitative and qualitative indicators in order to assess the implementation of eleven subnational policy mixes. Our findings show that taking into account the moderating role of settings between policy instruments and target groups allows for a more in depth analysis of policy processes. Observing the interactions between the four elements policy instruments, policy strategy, the implementation settings and the target groups allows capturing the complexity of policy mixes, at the crossroads of policy design, policy implementation and policy outcomes. Taking implementation settings and target groups into account in the analysis of policy mixes allows for a refined understanding of policy compliance and thus, from a broader perspective, of sustainability transitions.

Assessment of the multi-sectoral approach to tobacco control policies in South Africa and Togo

BackgroundTobacco use is the world’s leading preventable cause of illness and death and the most important risk factor for non-communicable diseases (NCDs), particularly cardiovascular and chronic respiratory diseases (heart attack, stroke, congestive obstructive pulmonary disease, and lung cancer). Tobacco control is one of the World Health Organization’s “best-buys” interventions to prevent NCDs. This study assessed the use of a multi-sectoral approach (MSA) in developing and implementing tobacco control policies in South Africa and Togo.MethodsThis two-country case study consisted of a document review of tobacco control policies and of key informant interviews (N = 56) about the content, context, stakeholders, and strategies employed throughout policy formulation and implementation in South Africa and Togo. To guide our analysis, we used the Comprehensive Framework for Multi-Sectoral Approach to Health Policy, which is built around four major constructs of context, content, stakeholders and strategies.ResultsThe findings show that the formulation of tobacco control policies in both countries was driven locally by the political, historical, social and economic contexts, and globally by the adoption WHO Framework Convention on Tobacco Control (FCTC). In both countries, the health department led policy formulation and implementation. The stakeholders involved in South Africa were more diverse, proactive and dynamic than those in Togo, whereas the strategies employed were more straightforward in Togo than in South Africa. The extent of understanding and use of MSA in both countries consisted of an inter-sectoral action for health, whereby the health department strove to collaborate with other sectors within and outside the government. Consequently, information sharing was identified as the main outcome of the interactions between institutions and interest groups within and across three critical sectors of the state, namely the public (government), the private and the civil society.ConclusionTobacco control policies in South Africa and Togo were formulated and implemented from an inter-sectoral approach perspective, which relied heavily on information transfer between stakeholders and less on collaborative problem-solving approach. Incorporation of multiple stakeholders allowed both countries to formulate policies to meet FCTC goals for tobacco control and NCD reduction.

Influence of the WHO framework convention on tobacco control on tobacco legislation and policies in sub-Saharan Africa

BackgroundThe World Health Organization’s Framework Convention on Tobacco Control, enforced in 2005, was a watershed international treaty that stipulated requirements for signatories to govern the production, sale, distribution, advertisement, and taxation of tobacco to reduce its impact on health. This paper describes the timelines, context, key actors, and strategies in the development and implementation of the treaty and describes how six sub-Saharan countries responded to its call for action on tobacco control.MethodsA multi-country policy review using case study design was conducted in Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo. All documents related to the WHO Framework Convention on Tobacco Control and individual country implementation of tobacco policies were reviewed, and key informant interviews related to the countries’ development and implementation of tobacco policies were conducted.ResultsMultiple stakeholders, including academics and activists, led a concerted effort for more than 10 years to push the WHO treaty forward despite counter-marketing from the tobacco industry. Once the treaty was enacted, Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo responded in unique ways to implement tobacco policies, with differences associated with the country’s socio-economic context, priorities of country leaders, industry presence, and choice of strategies. All the study countries except Malawi have acceded to and ratified the WHO tobacco treaty and implemented tobacco control policy.ConclusionsThe WHO Framework Convention on Tobacco Control provided an unprecedented opportunity for global action against the public health effects of tobacco including non-communicable diseases. Reviewing how six sub-Saharan countries responded to the treaty to mobilize resources and implement tobacco control policies has provided insight for how to utilise international regulations and commitments to accelerate policy impact on the prevention of non-communicable diseases.

The impact of tobacco control policies on smoking among older adults: A longitudinal analysis of 10 European countries

Background Comprehensive tobacco control policies have been introduced in many European countries during the last decades. Earlier studies suggested an important impact of these policies on smoking behaviors on adults and teenagers. However little attention has been put to old adults, even though smoking cessation at old ages can still bring significant life expectancy gains. Our aim is to evaluate the impact of tobacco control policies on smoking among older adults in Europe from 2004 to 2013. Methods We used longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from 4 waves from 2004 to 2013. We measured the implementation of Tobacco Control Policies with the Tobacco Control Scale (TCS). We used linear probability models with country and wave fixed effects and panel data models with individual fixed effects [AK1] to relate the implementation of tobacco control policies with changes in smoking status. Furthermore, we studied whether these associations vary by education, sex and age. Results A 10-points increase in TCS was associated with a drop in the probability of smoking by 1.1 pp, at a close to significance level (P-value = 0.091). Pricing was found to be most strongly associated with smoking (P-value Conclusion Our results suggest that tobacco control policies have significantly reduced smoking prevalence among the European older adults from the year 2004. Rises in prices seem to be the most effective policies as compared to others, especially among the lowest educated.

Smoking and school absenteeism among 15–16-years-old adolescents: A cross-section analysis on 36 countries

Introduction Prevention of youth smoking is a cornerstone of tobacco control policies, where schools have a crucial role to play. However, the well-known long-term consequences of adolescent smoking may be insufficient to convince education stakeholders to implement tobacco control policies at school level. Although they may be individually aware of public health issues, they may hardly devote much time to efforts for which they will not be rewarded. In this paper, we investigate the link between smoking behaviors and school attendance. Methods We performed logistic regressions on the risk of more than three missed school days, by cause, as function of daily smoking, adjusting for age, sex, socioeconomic status, academic performance, parental involvement, and other risk behaviours. Then, generalized linear models were estimated on the number of missed days, by cause, as function of regular smoking, adjusting for the same covariates. The consistency of results was assessed by replicating the analyses for each sex and age group. Results Daily smoking was significantly linked to school absenteeism, with a 43% excess risk of more than three missed school days per month due to illness (OR = 1.43, 95% CI: 1.37–1.49), and a 86% excess risk due to skipping (OR = 1.86; 95% CI: 1.78–1.95). Daily smoking was also linked to a 26% excess number of monthly missed days due to illness (beta = 0.26; 95% CI: 0.24–0.29), and to a 66% excess number of monthly missed days due to skipping (beta = 0.66; 95% CI: 0.64–0.69). These findings were consistent across age and sex groups. Discussion By showing the link between daily smoking and absenteeism, we argue that smoking may also be upholding school performance, and thus bringing short-term damaging effects to the adolescents.

Smoking and school absenteeism among 15-16 years-old adolescents: a cross-section analysis on 36 countries

Introduction Prevention of youth smoking is a cornerstone of tobacco control policies, where schools have a crucial role to play. However, the well-known long-term consequences of adolescent smoking may be insufficient to convince education stakeholders to implement tobacco control policies at school level. Although they may be individually aware of public health issues, they may hardly devote much time to efforts for which they will not be rewarded. In this paper, we investigate the link between smoking behaviors and school attendance. Methods We performed logistic regressions on the risk of more than three missed school days, by cause, as function of daily smoking, adjusting for age, sex, socioeconomic status, academic performance, parental involvement, and other risk behaviours. Then, generalized linear models were estimated on the number of missed days, by cause, as function of regular smoking, adjusting for the same covariates. The consistency of results was assessed by replicating the analyses for each sex and age group. Results Daily smoking was significantly linked to school absenteeism, with a 43% excess risk of more than three missed school days per month due to illness (OR = 1.43, 95% CI: 1.37–1.49), and a 86% excess risk due to skipping (OR = 1.86; 95% CI: 1.78–1.95). Daily smoking was also linked to a 26% excess number of monthly missed days due to illness (beta = 0.26; 95% CI: 0.24–0.29), and to a 66% excess number of monthly missed days due to skipping (beta = 0.66; 95% CI: 0.64–0.69). These findings were consistent across age and sex groups. Discussion By showing the link between daily smoking and absenteeism, we argue that smoking may also be upholding school performance, and thus bringing short-term damaging effects to the adolescents.