Smoking Prevention Policies Research Articles

25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis

ObjectiveTo examine and interpret trends in UK cancer incidence and mortality for all cancers combined and for the most common cancer sites in adults aged 35-69 years.DesignRetrospective secondary data analysis.Data...

Prevalence, Risk Factors, Harm Perception, and Attitudes Toward E-cigarette Use Among University Students in Qatar: A Cross-Sectional Study.

Background: Electronic cigarette (e-cigarette) use is becoming more popular worldwide, especially among youth. Studies report that university students have inadequate knowledge as well as misconceptions about the health risks of e-cigarettes, which may lead to their use even in populations where smoking prevalence is relatively low. At this age, the influence of peers is also significant. Understanding attitudes of university students toward the use of e-cigarettes is important for effective tobacco prevention interventions. In this study, we assess the prevalence of e-cigarette use among students in Qatar's largest national university, as well as their knowledge, attitudes, and perceptions of harm in relation to e-cigarettes.Methodology: We conducted a cross-sectional study among Qatar University students using a self-administered online questionnaire. Descriptive univariate analyses were conducted as well as bivariate analyses to check the association of e-cigarette use with variables of interest. A binary logistic regression analysis was conducted to assess determinants of e-cigarette use among students.Results: One hundred ninety-nine students completed the questionnaire. The prevalence of e-cigarette use among students was 14%, with no significant difference by gender (16.2% in males and 12.8% in females). In bivariate analyses, significantly fewer e-cigarette users believed that e-cigarettes cause disease compared to non-users. 67.9% of e-cigarette users compared to 37.6% of non-users believed that e-cigarettes were less harmful than traditional cigarettes, and 78.6% of users compared to 40.4% of non-users believed that their use could be helpful in preventing smoking traditional cigarettes. Bivariate associations between e-cigarette use and knowledge items were significant (p < 0.05) as well as having a smoker among siblings or friends. In the multivariate analysis, only having a friend who was a smoker remained significant after controlling for other variables (OR = 7.3, p < 0.001).Conclusion: Our study found that university students have knowledge gaps and misconceptions with regard to the harms associated with e-cigarettes use, especially among users. A comprehensive smoking prevention policy, educational interventions, and quit support are needed to enhance awareness among university students about the health effects associated with e-cigarettes use. Such interventions should also take into account the influence of peers on smoking practices.

Prevalence of tobacco use among young adults in Palestine.

Smoking tobacco is a worldwide public health issue. Over the last few decades, smoking patterns have been changing, reflected by increasing rates among young people and females in particular. This study aimed to determine the prevalence and modalities of smoking and to assess the factors, habits and beliefs that might encourage or discourage smoking among young adults in Palestine. A cross-sectional study was conducted in the West Bank in 2014 among Palestinians aged 18-25 years old. Subjects were recruited from six Palestinian universities (n=1997). Participants were asked to complete a questionnaire focusing on sociodemographics, knowledge and beliefs towards tobacco smoking, and the reasons that motivate or hinder smokers to quit. The prevalence of tobacco smoking was found to be 47.7%. Males had higher smoking rates, consumption levels, and initiated smoking at younger ages (74.4% started at ≤18 years old). Smoking cigarettes and waterpipe were the most common forms among both sexes. Smokers were also found to consume higher amounts of caffeinated drinks and fast food, showed lower scores towards anti-smoking beliefs, and reported significantly higher prevalence of smoking-related symptoms and diseases, primarily shortness of breath (20.5%) and cough (16.6%). The majority of smokers reported attempting and willingness to quit smoking. Health and financial costs were the strongest factors encouraging quitting while mood changes and lack of self-control were the most reported discouraging factors. Moreover, smoking among family members and peers increased the odds of smoking. Increasing rates of smoking among young Palestinians and a growing popularity of waterpipe use should alert stakeholders to the necessity for the implementation of smoking prevention and awareness policies and programmes.

Daily tobacco consumption and associated socioeconomic factors in the Portuguese population: National Health Interview Survey data 1987-2014

Introduction and ObjectivesSmoking patterns inform tobacco control policies. This study aimed to assess trends in smoking prevalence and associated socioeconomic factors in Portugal between 1987 and 2014. MethodsWe used data from National Health Interview Surveys (NHIS) conducted in 1987, 1995/96, 1998/99, 2005/06 and 2014/15. For each NHIS, we estimated gender-specific and age-standardized smoking prevalences, stratified by education, occupation, marital status and region. We constructed NHIS- and gender-specific logistic regression models, adjusting for the above-mentioned variables. We describe changes in smoking prevalence and inequalities in associated socioeconomic factors between 1987 and 2014. ResultsIn men, smoking prevalence (32.2% and 26.7%, respectively) and inequalities for all factors except for education decreased between 1987 and 2014. For women, inequalities decreased for region, age and occupation, and these changes occurred through increasing smoking prevalence in all groups. For marital status and education, inequalities were stable but smoking prevalence increased for all groups within these variables. In both sexes, the unemployed (adjusted odds ratio [aOR] 2014: men 2.33, women 2.76) and divorced (aOR 2014: men 2.12, women 3.18) consistently had the highest prevalences and aORs of smoking. For the first three NHIS higher aORs of smoking were observed among less-educated men and highly-educated women, while for the last two the higher odds were for the less-educated in both sexes. ConclusionsSmoking trends among men showed decreasing prevalences and diminishing inequalities. For women, inequalities were stable but there was an overall increase in prevalence. The unemployed and divorced had the highest smoking prevalences in both sexes. Smoking prevention and cessation policies in Portugal should take into consideration inequalities, particularly among men, and increasing consumption among women.

Tobacco Control in Hospitals in Jordan: Policy Analysis

&lt;p&gt;&lt;em&gt;Despite the concerns about very high rates of smoking in Jordanian population and the growing efforts to combat the tobacco epidemic, smoking at hospitals in Jordan and the poor complying with smoking prevention policies are important aspects of the problem. The paper examined the scope &lt;/em&gt;&lt;em&gt;and the progress &lt;/em&gt;&lt;em&gt;of smoking problem in Jordanian hospitals, &lt;/em&gt;&lt;em&gt;recognized public health policies on tobacco control &lt;/em&gt;&lt;em&gt;in hospitals in Jordan, and explored the obstacles in applying tobacco control policies in hospitals. The paper also proposed some recommendations for effective public health policies that regulate tobacco smoking in hospitals and other health care facilities in Jordan.&lt;/em&gt;&lt;/p&gt;

Vertical epistemic communities in multilevel governance

Literature defines epistemic communities as knowledge-based networks whose purpose is to influence policy. While previous studies often focused on the horizontal functioning of epistemic communities, we expand the debate by integrating the vertical dimension as an additional governing structure. We argue that vertical epistemic communities take advantage of multiple-scale systems to generate coherent strategies which enable them to influence policymaking. Through the case of Swiss smoking prevention policy, we study how vertical epistemic communities in federalist systems can lead to policy harmonisation between member states. They do so by shifting the decision-making process away from the political towards expert arenas.

Costs and cost-effectiveness of youth smoking prevention policies across seven European countries

Costs and cost-effectiveness of youth smoking prevention policies across seven European countries

Evidence From Qualitative Studies of Youth About the Impacts of Tobacco Control Policy on Young People in Europe: A Systematic Review.

A range of tobacco control policies endeavor to prevent smoking uptake in young people, yet relatively little is known about how such interventions impact young people's engagement with smoking. We reviewed existing qualitative evidence on young people and smoking in Europe to assess whether, in what ways and why young people comply with, adapt to, resist, or circumvent tobacco control policies in their respective countries. We undertook a systematic review of academic literature presenting qualitative research from Europe on smoking and young people (11-18 years), published from 2000 to 2015. Bibliographic searches (PubMed, PsycInfo, SSCI) produced 1357 records, from which 43 relevant articles were assessed for quality and 39 included in the review. Most studies were from the United Kingdom (27), with a small number (one or two each) from other European countries (Denmark, Sweden, Switzerland, Belgium, Cyprus, Greece, Hungary, Ireland, and Spain). Only 16 articles (11 from United Kingdom) provided any evidence about the impacts of tobacco control policies on young people's smoking. These focused on smoke-free legislation (four), age of sale laws (four), plain packaging (three), and black market tobacco (one). There is very little qualitative evidence exploring the impacts of tobacco control on youth smoking in Europe. To develop more effective smoking prevention policies that take account of local political, social, and cultural contexts, more qualitative research from a wider range of European countries is needed to understand how tobacco control impacts on young people's social worlds and smoking behaviors. Smoking is the leading cause of premature mortality in Europe. However, there is little qualitative evidence exploring the impact of tobacco control policies on young people in Europe. Most comes from the United Kingdom and focuses on a narrow range of policies. Thus, we have a limited understanding of how and in what ways tobacco control policies reach young people, their engagement with these, and how local context affects their impact. More qualitative research is needed, from a wider range of countries and on a broader range of tobacco control policies, to strengthen the evidence-base for reducing youth smoking.

Cost-effectiveness of tobacco control policies and programmes targeting adolescents: a systematic review.

BackgroundConsistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such interventions has not been systematically documented. We performed a systematic review on the cost-effectiveness of policies and programmes preventing tobacco consumption targeting adolescents.MethodsWe systematically reviewed literature on the (i) cost and effectiveness of (ii) prevention policies targeting (iii) smoking by (iv) adolescents. PubMed, Web of Science, Cochrane, CEA-TUFTS, Health Economic Evaluations, Wiley Online Library, Centre for Reviews and Dissemination Database, the National Institute for Health and Care Excellence and Google Scholar databases were used, and Google search engine was used for other grey literature review.ResultsWe obtained 793 full-text papers and 19 grey literature documents, from which 16 studies fulfilled the inclusion criteria. Of these, only one was published in the last 5 years, and 15 were performed in high-income countries. Eight analyzed the cost-effectiveness of school-based programmes, five focused on media campaigns and three on legal bans. Policies and programmes were found to be cost-effective in all studies, and both effective and cost-saving in about half of the studies.ConclusionsEvidence is scarce and relatively obsolete, and rarely focused on the evaluation of legal bans. Moreover, no comparisons have been made between different interventions or across different contexts and implementation levels. However, all studies conclude that smoking prevention policies and programmes amongst adolescents are greatly worth their costs.

Trends in incidence of lung cancer in Croatia from 2001 to 2013: gender and regional differences.

AimTo provide an overview of the lung cancer incidence trends in the City of Zagreb (Zagreb), Split-Dalmatia County (SDC), and Croatia in the period from 2001 to 2013.MethodIncidence data were obtained from the Croatian National Cancer Registry. For calculating incidence rates per 100 000 population, we used population estimates for the period 2001-2013 from the Croatian Bureau of Statistics. Age-standardized rates of lung cancer incidence were calculated by the direct standardization method using the European Standard Population. To describe incidence trends, we used joinpoint regression analysis.ResultsJoinpoint analysis showed a statistically significant decrease in lung cancer incidence in men in all regions, with an annual percentage change (APC) of -2.2% for Croatia, 1.9% for Zagreb, and -2.0% for SDC. In women, joinpoint analysis showed a statistically significant increase in the incidence for Croatia, with APC of 1.4%, a statistically significant increase of 1.0% for Zagreb, and no significant change in trend for SDC. In both genders, joinpoint analysis showed a significant decrease in age-standardized incidence rates of lung cancer, with APC of -1.3% for Croatia, -1.1% for Zagreb, and -1.6% for SDC.ConclusionThere was an increase in female lung cancer incidence rate and a decrease in male lung cancer incidence rate in Croatia in 2001-20013 period, with similar patterns observed in all the investigated regions. These results highlight the importance of smoking prevention and cessation policies, especially among women and young people.

"It's Easy to Get Fags": A Qualitative Study of Disadvantaged Young People's Perspectives on Cigarette Availability and Access.

Reducing young people's access to cigarettes is a key element of smoking prevention policies. This article explores how young people source cigarettes following the increase in the UK minimum age of sale from 16 to 18 years. Semi-structured individual, paired and triadic interviews with 60 disadvantaged young people aged between 12 and 17. Participants were recruited from clubs and voluntary organizations offering advice and support to disadvantaged young people. Most participants said they sourced cigarettes from shops, but understandings of "buying cigarettes from shops" included using intermediaries for proxy purchases. Access from social sources was contingent on reciprocation, and blackmarket sources were avoided. The distinction between potential and actual sources reflected participants concerns about their presentation of self. Those who bought cigarettes directly from shops accrued status and power in negotiating social hierarchies. Participants therefore highlighted their smoking related competencies, that is, ability to secure regular retail access to tobacco, while downplaying the significant difficulties they experienced. The presentational dimension of youth cigarette access highlights a need for caution in associating self-reported changes in young people's cigarette sources straightforwardly with access policies. The conflation of direct retail purchases with proxy purchases, and the interrelationship between commercial and social cigarette sources also raises issues for interpreting data on "usual" cigarette sources from national surveys. Findings suggest that some young people may still be both reliant on making retail cigarette purchases following the increase in the age of sale in the United Kingdom, and experiencing significant difficulties making these. This study highlights the self-presentational dimension of youth cigarette access in a particular community context, and the important distinction between the apparent range of sources available and their social acceptability in young people's social networks. Young smokers tended to conflate direct retail purchases with proxy purchases, raising issues for interpreting survey data on "usual" cigarette source. The presentational dimension of youth cigarette access also highlights a need for caution in associating self-reported changes in young people's cigarette sources with access policies. Despite participants' stated easy access, few were able to buy cigarettes directly, underscoring the effectiveness of youth access policies.

What Are the Major Determinants in the Success of Smoking Cessation: Results from the Health Examinees Study.

Understanding mechanisms underlying smoking-related factors should be prioritized in establishing smoking prevention and cessation policy. The aim of this study was to identify factors significantly associated with smoking initiation and/or smoking cessation as well as the most important determinants of successful smoking cessation in a developed non-Western setting. Based on multiple logistic regression models, the odds ratios (ORs) for smoking initiation and cessation were estimated among males (N = 24,490) who had participated in the Health Examinees (HEXA) study. The Cox proportional hazards regression model was used to assess the association between selected predictors of smoking cessation and the likelihood of reaching this goal. Finally, Kaplan–Meier curves were constructed to illustrate the distribution of time from age at smoking initiation to age at smoking cessation. We found that the ORs for successfully quitting smoking increased with age, married status, educational achievement, having a non-manual job, drinking cessation and disease morbidity. Those exposed to secondhand smoking showed less likelihood of quitting smoking. A continual decrease in the ORs for successfully quitting smoking was observed according to increased smoking duration, smoking dose per day and lifetime tobacco exposure (p trend <0.001). Among the selected predictors, lifetime tobacco exposure, educational attainment, alcohol drinking status and birth cohort were the major determinants in the success of smoking cessation. Our findings suggest that lifetime tobacco exposure, educational attainment, alcohol drinking status and birth cohort can determine success in smoking cessation. Public interventions promoting a smoke-free environment are needed to reinforce discouraging the initiation of, reducing, and quitting cigarette smoking.

Stages of change of the readiness to quit smoking among a random sample of minority Arab male smokers in Israel.

BackgroundDespite advanced smoking prevention and cessation policies in many countries, the prevalence of cigarette smoking among indigenous and some ethnic minorities continues to be high. This study examined the stages of change (SOC) of the readiness to quit smoking among Arab men in Israel shortly after new regulations of free-of-charge smoking cessation workshops and subsidized medications were introduced through primary health care clinics.MethodsWe conducted a countrywide study in Israel between 2012–2013. Participants, 735 current smokers; 18–64 years old; were recruited from a stratified random sample and interviewed face-to-face using a structured questionnaire in Arabic. We used ordered regression to examine the contribution of socio-economic position (SEP), health status, psychosocial attributes, smoking-related factors, and physician advice to the SOC of the readiness to quit smoking (pre-contemplation, contemplation and preparation).ResultsOf the current smokers, 61.8 % were at the pre-contemplation stage, 23.8 % were at the contemplation stage, and only 14.4 % were at the preparation stage. In the multinomial analysis, factors significantly (P < 0.05) contributing to contemplation stage compared to pre-contemplation stage included [odds ratio (OR), 95 % confidence interval (CI)]: chronic morbidity [0.52, (0.31-0.88)], social support [1.35, (1.07-1.70)], duration of smoking for 11–21 years [1.94, (1.07-3.50)], three or more previous attempts to quit [2.27, (1.26-4.01)], knowledge about smoking hazards [1.75, (1.29-2.35)], positive attitudes toward smoking prevention [1.44, (1.14-1.82)], and physician advice to quit smoking [1.88, (1.19-2.97)]. The factors significantly (P < 0.05) contributing to preparation stage compared to pre-contemplation stage were [OR, (95 % CI)]: chronic morbidity [0.36, (0.20-0.67)], anxiety [1.07, (1.01-1.13)], social support [1.34, (1.01-1.78)], duration of smoking 5 years or less [2.93, (1.14-7.52)], three or more previous attempts to quit [3.16, (1.60-6.26)], knowledge about smoking hazards [1.57, (1.10-2.21)], and positive attitudes toward smoking prevention [1.34, (1.00-1.82)].ConclusionsMost Arab men who currently smoke are in the pre-contemplation stage, indicating low readiness to quit smoking. New policies of free-of-charge smoking-cessation group sessions and subsidized medications introduced through primary health care clinics in Israel may be less effective among Arab men. For these policies to promote cessation more successfully, tailored interventions and campaigns may be needed to increase the readiness to quit smoking in this population, especially for those at the pre-contemplation stage.

Losing jobs and lighting up: Employment experiences and smoking in the Great Recession

The Great Recession produced the highest rates of unemployment observed in decades, in part due to particularly high rates of people losing work involuntarily. The impact of these job losses on health is unknown, due to the length of time required for most disease development, concerns about reverse causation, and limited data that covers this time period. We examine associations between job loss, employment status and smoking, the leading preventable cause of death, among 13,571 individuals participating in the 2001–2011 waves of the U.S.-based Panel Study of Income Dynamics. Results indicate that recent involuntary job loss is associated with an average 1.1 percentage point increase in smoking probability. This risk is strongest when people have returned to work, and appears reversed when they leave the labor market altogether. Although some job loss is associated with changes in household income and psychological distress levels, we find no evidence that these changes explain smoking behavior modifications. Smoking prevention programs and policies targeted at displaced workers or the newly employed may alleviate some negative health effects produced by joblessness during the Great Recession.

A path model of smoking behaviour among senior high school students in Taiwan

Objective: The purpose of this study was to explore the ways in which social smoking expectations mediate the relationship between adolescent smoking behaviour and the smoking behaviour of family and peers. Design: Descriptive, cross-sectional survey. Setting: Taiwan, Republic of China. Method: The participants were 921 senior high school students who completed a questionnaire to measure smoking status, family and peer smoking and social smoking expectations. The survey was conducted from November to December in 2009. Structural equation modelling was performed to test a mediation model. Analysis was performed using PRELIS 2 and LISREL 8.7 software. Results: After adjusting for students’ gender, age and school type, it is clear that social expectations mediate the relationship between sibling smoking, peer smoking and adolescent smoking. The path coefficients of sibling and peer smoking on social expectations in the mediator model were moderate, β = .15–.41, p &lt; .05, but the coefficient of social expectations on adolescent smoking was strong, β = .95, p &lt; .001. The total indirect effects between exogenous latent variables and adolescent smoking were .54, indicating a strong association that, in this model, is explained by the mediation of social expectations. Conclusion: Determining the mechanisms that influence adolescent smoking is of scientific interest because knowledge of these mechanisms is a prerequisite for the development of recommendations aimed at prevention. With this knowledge, health professionals can develop smoking-prevention policies and education programmes based on reducing the mediating effect of social smoking expectations on the relationship of family smoking and peer smoking with adolescent smoking.

Strategies for an effective tobacco harm reduction policy in Indonesia.

Tobacco consumption is a major causative agent for various deadly diseases such as coronary artery disease and cancer. It is the largest avoidable health risk in the world, causing more problems than alcohol, drug use, high blood pressure, excess body weight or high cholesterol. As countries like Indonesia prepare to develop national policy guidelines for tobacco harm reduction, the scientific community can help by providing continuous ideas and a forum for sharing and distributing information, drafting guidelines, reviewing best practices, raising funds, and establishing partnerships. We propose several strategies for reducing tobacco consumption, including advertisement interference, cigarette pricing policy, adolescent smoking prevention policy, support for smoking cessation therapy, special informed consent for smokers, smoking prohibition in public spaces, career incentives, economic incentives, and advertisement incentives. We hope that these strategies would assist people to avoid starting smoking or in smoking cessation.

Cigarette smoking among psychiatric patients in Brazil.

The aim of this study was to estimate tobacco smoking prevalence among psychiatric patients attended in care facilities in Brazil and assess associated factors. A cross-sectional multicenter study was conducted of psychiatric patients (N = 2,475) selected from 26 care facilities. Current and ex-smokers were compared to those who had never smoked. Odds ratios were estimated using logistic regression. The current and past smoking prevalence rates were 52.7% and 18.9%, respectively. Being male, aged 40 years or over, drug and alcohol use, unprotected sex and a history of physical violence were factors associated with both current and past smoking, while a low education level (≤ 8 years of schooling), history of homelessness, not practicing a religion, current or previous psychiatric hospitalization, and main psychiatric diagnosis substance use disorders, were factors only associated with current smoking. Tobacco smoking prevalence among this population was high and was higher than the rate in the general population. Appropriate interventions and smoking prevention policies should be incorporated into mental health services.

Design of a school-based randomized trial to reduce smoking among 13 to 15-year olds, the X:IT study.

BackgroundAdolescent smoking is still highly prevalent in Denmark. One in four 13-year olds indicates that they have tried to smoke, and one in four 15-year olds answer that they smoke regularly. Smoking is more prevalent in socioeconomically disadvantaged populations in Denmark as well as in most Western countries. Previous school-based programs to prevent smoking have shown contrasting results internationally. In Denmark, previous programs have shown limited or no effect. This indicates a need for developing a well-designed, comprehensive, and multi-component intervention aimed at Danish schools with careful implementation and thorough evaluation.This paper describes X:IT, a study including 1) the development of a 3-year school-based multi-component intervention and 2) the randomized trial investigating the effect of the intervention. The study aims at reducing the prevalence of smoking among 13 to 15-year olds by 25%.Methods/DesignThe X:IT study is based on the Theory of Triadic Influences. The theory organizes factors influencing adolescent smoking into three streams: cultural environment, social situation, and personal factors. We added a fourth stream, the community aspects. The X:IT program comprises three main components: 1) smoke-free school premises, 2) parental involvement including smoke-free dialogues and smoke-free contracts between students and parents, and 3) a curricular component. The study encompasses process- and effect-evaluations as well as health economic analyses. Ninety-four schools in 17 municipalities were randomly allocated to the intervention (51 schools) or control (43 schools) group. At baseline in September 2010, 4,468 year 7 students were eligible of which 4,167 answered the baseline questionnaire (response rate = 93.3%).DiscussionThe X:IT study is a large, randomized controlled trial evaluating the effect of an intervention, based on components proven to be efficient in other Nordic settings. The X:IT study directs students, their parents, and smoking prevention policies at the schools. These elements have proven to be effective tools in preventing smoking among adolescents. Program implementation is thoroughly evaluated to be able to add to the current knowledge of the importance of implementation. X:IT creates the basis for thorough effect and process evaluation, focusing on various social groups.Trial registrationCurrent Controlled Trials ISRCTN77415416.

Effect of a Smoking Ban and School-Based Prevention and Control Policies on Adolescent Smoking in Spain: A Multilevel Analysis

We evaluated the impact of a smoking ban in schools and of school-based smoking prevention and control policies on adolescent smoking. Annual surveys carried out between 2001 and 2005 that were representative of students in the 4th year of secondary education in the Madrid region, with 203 schools and 9127 students participating. The student questionnaire gathered information about personal and family variables. The contextual factors were: the periods before (years 2001-2002) and after the law; and through a survey of school management boards: compliance with the law, policy reflected in the school regulations, existence of complaints against smoking, and undertaking of educational activities regarding smoking. Multilevel logistic regression models were constructed with two dependent variables: current smoking and the proportion giving up smoking. Smoking declined in 2003, the first year after the law came into force (Odds ratio: 0.80; CI 95%: 0.66-0.96), and this decline was maintained in 2005. By contrast, smoking increased in those schools that did not undertake educational programmes regarding smoking (Odds ratio: 1.34; CI 95%: 1.13-1.59), and in those that received complaints about smoking (Odds ratio: 1.12; CI 95%: 0.96-1.29). This association is partly due to the effect of the increase in giving up smoking. The inclusion of contextual variables into the model with the individual factors reduces the variability of smoking between schools by 32.6%. In summary, the coming into force of a law banning smoking in schools, and the implementing of educational policies for the prevention and control of smoking are related to a lower risk of adolescent smoking.

Trends in lung cancer incidence and mortality in Croatia, 1988 to 2008

AimTo describe and interpret lung cancer incidence and mortality trends in Croatia between 1988 and 2008.MethodsIncidence data on lung cancer for the period 1988-2008 were obtained from the Croatian National Cancer Registry, while mortality data were obtained from the World Health Organization mortality database. Population estimates for Croatia were obtained from the Population Division of the Department of Economic and Social Affairs of the United Nations. We also calculated and analyzed age-standardized incidence and mortality rates. To describe time incidence and mortality trends, we used joinpoint regression analysis.ResultsLung cancer incidence and mortality rates in men decreased significantly in all age groups younger than 70 years. Age-standardized incidence rates in men decreased significantly by -1.3% annually. Joinpoint analysis of mortality in men identified three trends, and average annual percent change (AAPC) decreased significantly by -1.1%. Lung cancer incidence and mortality rates in women increased significantly in all age groups older than 40 years and decreased in younger women (30-39- years). Age-standardized incidence rates increased significantly by 1.7% annually. Joinpoint analysis of age-standardized mortality rates in women identified two trends, and AAPC increased significantly by 1.9%.ConclusionDespite the overall decreasing trend, Croatia is still among the European countries with the highest male lung cancer incidence and mortality. Although the incidence trend in women is increasing, their age standardized incidence rates are still 5-fold lower than in men. These trends follow the observed decrease and increase in the prevalence of male and female smokers, respectively. These findings indicate the need for further introduction of smoking prevention and cessation policies targeting younger population, particularly women.