Tobacco Control Scale Scores Research Articles

Correlation between tobacco control policies and tobacco prevention in Mexico: a sub-national analysis.

This study aims to determinate the correlation between tobacco control policies (TCP) and the prevalence of tobacco use in the 32 Mexican states during the 2016-2017 period. This is an ecological study that measured TCP by the Tobacco Control Scale (TCS) which assigns a score (0-100) based on the level of these component's implementation: price, prohibition in public spaces, expenditures of public information campaigns, publicity prohibitions, health warnings, and treatments. We analyzed the associations between the TCS scores and prevalence of tobacco use extracted from the National Survey of Drug, Alcohol and Tobacco Consumption using Spearman correlations. Prevalence of daily smokers is negatively correlated with global TCS scores for adolescents (p = 0.026). Price showed similar negative correlations with daily prevalence in adolescents (p = 0.003), adults (p = 0.040), men (p < 0.006), and women (p = 0.040). Many Mexican states need to improve on tobacco control policies, especially targeting a key population: adolescents.

Secondhand smoke exposure assessment in outdoor hospitality venues across 11 European countries

ObjectiveDue to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants. MethodsCross-sectional study. We measured airborne nicotine and evidence of tobacco use in terraces of bars, cafeterias, and pubs from 11 European countries in 2017–2018. Sites were selected considering area-level socioeconomic indicators and half were visited during nighttime. We noted the smell of smoke, presence of smokers, cigarette butts, ashtrays, and number of physical covers. Contextual determinants included national smoke-free policies for the hospitality sector, the Tobacco Control Scale score (2016), and the national smoking prevalence (2017–2018). We computed medians and interquartile ranges (IQR) of nicotine concentrations and used multivariate analyses to characterize the exposure determinants. ResultsNicotine was present in 93.6% of the 220 sites explored. Overall concentrations were 0.85 (IQR:0.30–3.74) μg/m3 and increased during nighttime (1.45 IQR:0.65–4.79 μg/m3), in enclosed venues (2.97 IQR:0.80–5.80 μg/m3), in venues with more than two smokers (2.79 IQR:1.03–6.30 μg/m3), in venues in countries with total indoor smoking bans (1.20 IQR:0.47–4.85 μg/m3), and in venues in countries with higher smoking prevalence (1.32 IQR:0.49–5.34 μg/m3). In multivariate analyses, nicotine concentrations were also positively associated with the observed number of cigarette butts. In venues with more than two smokers, SHS levels did not significantly vary with the venues’ degree of enclosure. ConclusionsOur results suggest that current restrictions in outdoor hospitality venues across Europe have a limited protective effect and justify the adoption of total smoking bans in outdoor areas of hospitality venues.

Correlation between tobacco control policies and mortality of haematological cancers across Europe: An ecological study.

INTRODUCTIONTo determine the correlation between tobacco control policies and mortality of haematological malignancies: leukemia, lymphoma and multiple myeloma (MM).METHODSEcological study with the countries as the unit of analysis. Tobacco Control Scale (TCS) scores from 2010, 2013 and 2016 were used as measures for the level of tobacco control policy implementation in 27 European countries. Mortality rates for leukemia, lymphoma, and MM, were obtained from the WHO Mortality Database and the European Cancer Information System for each country for 2010, 2013, 2015 and 2018. Correlation between yearly TCS scores and mortality rates from the same and prospective years were calculated using Spearman’s rank correlation coefficients (rsp) and 95% confidence intervals (95% CI) (2010 TCS scores vs 2010, 2013, 2015, 2018 mortality rates; 2013 TCS scores vs 2013, 2015, 2018 mortality rates; and 2016 TCS scores vs 2018 mortality rates).RESULTSThe 2010 TCS scores were significantly negatively associated with leukemia mortality rates in 2013 (rsp=-0.58; 95% CI: -0.79, -0.24; p=0.002), 2015 (rsp=-0.65; 95% CI: -0.85, -0.30; p=0.001) and 2018 (rsp=-0.44; 95% CI: -0.71, -0.06; p=0.021). TCS scores from 2013 and 2016 had significant negative associations with leukemia mortality in all prospective years. TCS scores did not demonstrate consistent correlations with lymphoma and MM mortality.CONCLUSIONSThe level of tobacco control policies in European countries correlates negatively with leukemia mortality at ecological level, with no correlation seen for lymphoma and MM. This study advocates that increased tobacco control implementation may improve leukemia mortality.

The association between tobacco control policy implementation and country-level socioeconomic factors in 31 European countries

European countries have made significant progress in implementing tobacco control policies to reduce tobacco use; however, whether socioeconomic status (SES) of a country may influence the implementation of such policies is unknown. The aim of this study is to assess the association between country-level SES and the implementation level of tobacco control policies in 31 European countries. An ecological study using data from Eurostat, Human Development Reports on several SES indicators and the Tobacco Control Scale (TCS) of 2016 was conducted to measure country-level tobacco control policies. We analysed the relationship between SES indicators and the TCS by means of scatter-plots and Spearman’s rank correlation coefficients (rsp) and multivariable linear regression analysis. In Europe, no statistically significant association was found between SES factors and the level of implementation of tobacco control policies. Only public spending on tobacco control was associated with all SES factors, except for Gini Index (an income inequality index). The strongest associations of TCS scores for this policy domain were found with the Human Development Index (rsp = 0.586; p < 0.001) and the Gross Domestic Product per capita (in Euros) (rsp = 0.562; p = 0.001). The adjusted linear regression model showed an association of tobacco control policy implementation with countries’ geographical location (Western Europe, β = − 15.7; p = 0.009, compared to Northern Europe). In conclusion, no association was found between SES factors and the level of implementation of tobacco control policies in 31 European countries; policymakers should be aware that tobacco control policies could be successfully implemented despite socioeconomic constraints, especially when these policies are of low cost and cost-effective (i.e., smoke-free bans and taxation).

Secondhand smoke exposure in outdoor children’s playgrounds in 11 European countries

IntroductionTobacco presence in outdoor children’s playgrounds is concerning not only because it leads to secondhand smoke (SHS) exposure, but also cigarette butt pollution and tobacco normalization. ObjectivesThis study aimed to assess SHS exposure in children’s playgrounds, according to area-level socioeconomic status (SES), smoke-free regulations, national smoking prevalence, and SHS exposure prevalence in playgrounds (2017–2018). MethodsWe monitored vapor-phase nicotine concentration and tobacco-related variables in 20 different playgrounds in 11 European countries (n = 220 measurements) from March 2017 to April 2018. Playgrounds were selected according to area-level SES. Data on the number of people smoking, and cigarette butts inside the playground and on playground surroundings (<1 m away) were recorded. Playground smoking bans, the Tobacco Control Scale (TCS) score, national smoking prevalence and SHS exposure prevalence in playgrounds were used to group countries. To determine nicotine presence, we dichotomized concentrations using the limit of quantification as a cut-off point (0.06 μg/m3). Nicotine median concentrations were compared using non-parametric tests, and nicotine presence and tobacco-related observational variables using the Chi-squared test. ResultsAirborne nicotine presence was found in 40.6% of the playgrounds. Median nicotine concentration was <0.06 μg/m3 (Interquartile range: <0.06–0.125) and higher median concentrations were found in more deprived neighborhoods, non-regulated playgrounds, in countries with lower overall TCS scores, higher national smoking prevalence and higher SHS exposure prevalence in playgrounds. Overall, people were smoking in 19.6% of the playgrounds. More than half of playgrounds had cigarette butts visible inside (56.6%) and in the immediate vicinity (74.4%). Presence of butts inside playgrounds was higher in sites from a low area-level SES, in countries with low TCS scores, and greater smoking prevalence and SHS exposure prevalence (p<0.05). ConclusionsThere is evidence of SHS exposure in children’s playgrounds across Europe. These findings confirm the need for smoking bans in playgrounds and better enforcement in those countries with smoking bans in playgrounds.

The Tobacco Control Scale as a research tool to measure country-level tobacco control policy implementation.

INTRODUCTIONThe Tobacco Control Scale (TCS) was designed for advocacy purposes but has also been used as a research tool. In the present study, we characterized TCS use, its limitations and strengths, and critically assessed its use as a research instrument.METHODSWe conducted an extensive search of the biomedical databases PubMed and Web of Science for the keyword ‘tobacco control scale’ in all fields. The search was limited to studies published in the period March 2006 to December 2019. Out of 69 hits, 32 studies met the inclusion criteria. Two reviewers independently extracted information from each publication regarding their general characteristics, publication and research aspects, and the characteristics of the use of the TCS.RESULTSWe found that researchers have used the TCS as a tool to monitor tobacco control policies mainly in cross-sectional observational studies with ecological and multilevel designs directed to advocacy and the promotion of further research. Different outcomes, such as smoking prevalence and quit ratios, have been associated with tobacco control policy scores. The main reported limitations of the TCS were a low variance across countries and a failure to express enforcement and to incorporate the most recent legislation.CONCLUSIONSThe TCS has been commonly used to assess differences in outcomes according to tobacco control policies. However, there are still areas for improvement in its use in research regarding the lack of comparability of TCS scores across time. The lessons that have been learned should be used to adapt and expand the TCS overseas.

Association between tobacco control policies and current smoking across different occupational groups in the EU between 2009 and 2017

BackgroundThis study investigated the cross-national and longitudinal associations between national tobacco control policies and current smoking in 28 European Union (EU) member states between 2009 and 2017. It also examined...

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.

Commercial Determinants of Tobacco Control Policy and Smoking Prevalence in High and Low and Middle Income Countries- Is Corporate Power the Smoking Gun?

Background: The tobacco industry has a record of weakening tobacco control policies. We investigate whether the association between corporate power and tobacco consumption is mediated by tobacco control policy. We test whether this relationship is stronger in Low and Middle Income Countries (L&MICS) than in High Income Countries (HIC) and within L&MICS than within HICs. Methods: We used variations in the Corporate Permeation Index (CPI)- a proxy for corporate power - between 2010 and 2015 to explain variations in: the prevalence of smoking, scores on the Tobacco Control Scale (TCS) in Europe and in compliance with smoke free regulations in HICS and L&MICS. Using path analysis, we tested if tobacco control policy mediates the relationship between corporate permeation and smoking rates. We used random and fixed effects models to test whether these associations are stronger across LMIC than across HICs and within L&MICS and HICS, respectively. Findings: In the HICs of Europe, corporate power was associated with higher smoking prevalence and weaker tobacco regulation. Higher TCS scores were associated with lower smoking prevalence and mediate the positive association between corporate power and smoking. Globally, there was a negative effect of corporate power on compliance with smoke free regulation, within and across countries which is stronger in L&MICs than HICS. Interpretation: The ability of corporate power to boost smoking prevalence seems to work via the weakening of tobacco control policy in Europe. The tobacco industry deploys its structural and agency power to weaken enforcement of tobacco control regulations in L&MICS. Funding Statement: Joana Madureira Lima was a recipient of a Doctoral Scholarship from the Portuguese Foundation for Science and Technology at the time of writing. Declaration of Interests: Dr. Madureira Lima has nothing to disclose. Sandro Galea has nothing to disclose. Ethics Approval Statement: This type of paper does not require an ethical approval for as all the data is secondary and collected from publicly accessible sources.

Attitudes towards tobacco product regulations and their relationship with the tobacco control policies

The objective of this work is to describe the acceptability of some tobacco products regulations and to explore their relation with tobacco control legislation levels in Europe.We used data on tobacco control activities in Europe in 2007, 2010 and 2013 measured by the Tobacco Control Scale (TCS) and data regarding attitudes about tobacco control regulations (i.e. adding picture health warnings on all packages of tobacco products or increasing taxes on tobacco products) from the Special Eurobarometer of 2009, 2012 and 2014 (n = 80,831). We calculated the prevalence ratio of favorable attitudes towards tobacco products restrictions in the reference year 2009 vs. the most current year (i.e. 2009 vs 2014), and the effect of previous TCS scores on the attitudes towards tobacco products regulations adjusted for sociodemographic variables.Strong support for the studied tobacco products regulations, which modestly increased over time, was observed. A positive relation was generally observed between TCS scores and support for the studied tobacco products regulations at both the ecological and individual level. A positive correlation was found between TCS scores and support for increasing taxes on tobacco products (rsp:0.29; 95%CI: 0.10, 0.48) at the ecological level, while at the individual level, the positive association was more remarkable in the case of support for adding large health warning labels to packaging.In conclusion, support for the studied tobacco products regulations were positively related with European tobacco control levels of implementation both at the ecological and individual level.

Correlation between tobacco control policies and preterm births and low birth weight in Europe

ObjectiveTo assess the correlation between tobacco control policies— particularly smoking bans in work and public places—and the prevalence of preterm births and low birth weight in the European countries. MethodsThis is an ecological study and the unit of analysis set at the country level. Tobacco control data in Europe were obtained for the years 2010 and 2013 as measured by the Tobacco Control Scale (TCS), which reflects the level of implementation of tobacco control policies. Prevalence data for preterm births and low birth weight were obtained from two sources: the European Perinatal Health Report (EPHR), which provides data for 2010, and the Eurostat data, which includes the years 2013 and 2014. We analyzed the correlation between the TCS score and the prevalence of preterm birth and low birth weight in the European countries by means of Spearman (rsp) rank-correlation coefficients and their 95% confidence intervals (95%CI). ResultsThe 2010 TCS was negatively correlated with the prevalence of preterm births before week 37 (rsp = −0.51; 95% CI: −0.77, −0.15; p = 0.006) and week 32 (rsp = −0.42; 95%CI: −0.73, −0.01; p = 0.030) and with the prevalence of the low birth weight (< 2500g, (rsp = −0.42; 95% CI: −0.66, −0.09; p = 0.028) in European countries in 2010. We found a statistically significant inverse correlation between the level of restrictions on smoking in public places and the prevalence of low birth weight (< 2500g rsp: −0.54; 95%CI: −0.72, −0.10; p = 0.017). ConclusionThe level of smoke-free legislation in European countries correlates with lower preterm birth prevalence rates at the ecological level. Given the important negative effects of premature births for the public health system, these data support greater implementation of smoke-free policies and tend to support the implementation of tobacco control policies, but more research is needed.

The effect of tobacco control policy on smoking cessation in relation to gender, age and education in Lithuania, 1994-2010.

BackgroundThis study aimed to evaluate the association between tobacco control policies and trends in smoking cessation according to gender, age and educational level in Lithuania in 1994–2010.MethodsThe data were obtained from nine cross-sectional postal surveys conducted biennially within the framework of Finbalt Health Monitor project during 1994–2010. Each survey was based on a nationally representative random sample drawn from the National population register. The sample consisted of 3000 citizens aged 20–64 in 1994–2008 surveys and 4000 in the 2010 survey. In total, 17161 individuals participated in all surveys. The development of tobacco control policy in Lithuania was assessed using the Tobacco Control Scale (TCS). The association of the TCS scores with short-term and long-term quitting according to gender, age and education was examined using logistic regression analysis with control for secular trends.ResultsOver the last two decades, a large improvement in the development of tobacco control policy has been achieved in Lithuania. At the same time, this progress was associated with the increase in smoking cessation. A significant increase in both short-term and long-term quit ratios was found among people aged 20–44. An increase by 10 points on the TCS was associated with 17% increase in the odds of short-term quitting and with 15% increase in the odds of long-term quitting. The association between tobacco control policies and long-term quitting was stronger among younger than older people. No differential effect of tobacco control policies on smoking cessation was found in relation to gender and educational level.ConclusionsThe improvement in Lithuanian tobacco control policies was associated with an increase in smoking cessation in long-term perspective. These policies have not only benefitted highly educated groups, but lower educated groups as well. Nonetheless, further development of comprehensive tobacco control policies is needed in order to decrease social inequalities in smoking cessation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1525-8) contains supplementary material, which is available to authorized users.

Tobacco control policy development in the European Union: do political factors matter?

There has been much variation between European countries in the development of tobacco control policy. Not much is known about the factors that shape this variation. This study aimed to assess the role of political factors in tobacco control policy development. We used data from 11 European countries from 1996 to 2010. Multilevel regression modelling was used to investigate associations between the Tobacco Control Scale (TCS) and indicators of left-wing government and government effectiveness (policy formulation, implementation and enforcement), with control for confounders. An association was found between left-wing government and TCS over the period 1996-2003, but not over the whole period. The association between government effectiveness and TCS was significant and negative over the whole period, but positive between 2001 and 2005. Residual analysis showed that TCS scores from 2002 onwards were higher than expected based on the political factors. Associations varied among the five subscales of the TCS. The results suggest that, on the whole, national political factors have had only a minor influence on the large variations in tobacco control policy development in Europe over the last 15 years. However, there are indications that left-wing governments were important for early adoption of tobacco control policy, and high government effectiveness was important in the phase of adopting innovative policies. However, since 2002, with the advent of international treaties, the influence of national politics has diminished.

Relation between national-level tobacco control policies and individual-level voluntary home smoking bans in Europe

BackgroundLittle is known about the relationship between national tobacco control policies and implementation of private home smoking bans.ObjectiveTo determine the relationship between the Tobacco Control Scale (TCS), a score measuring...

Do smoke-free policies in work and public places increase smoking in private venues?

ObjectiveTo evaluate the correlation between the implementation of tobacco control policies, particularly smoke-free bans at work and in public places, and smoking prevalence in private venues in the 27 countries...

Concern about passive smoking and tobacco control policies in European countries: An ecological study

BackgroundBecause of the magnitude of the global tobacco epidemic, the World Health Organisation developed the Framework Convention on Tobacco Control (FCTC), an international legally binding treaty to control tobacco use. Adoption and implementation of specific tobacco control measures within FCTC is an outcome of a political process, where social norms and public opinion play important roles. The objective of our study was to examine how a country’s level of tobacco control is associated with smoking prevalence, two markers of denormalisation of smoking (social disapproval of smoking and concern about passive smoking), and societal support for tobacco control.MethodsAn ecological study was conducted, using data from two sources. The first source was the Tobacco Control Scale (TCS) from 2011, which quantifies the implementation of tobacco control policies in European Union (EU) countries. Data on smoking prevalence, societal disapproval of smoking, concern about passive smoking, and societal support for policy measures were taken from the Eurobarometer survey of 2009. Data from Eurobarometer surveys were aggregated to country level. Data from the 27 European Union member states were used.ResultsSmoking prevalence rates in 2009 were negatively associated with a country’s TCS 2011 score, although not statistically significant (r = −.25; p = .21). Experience of societal disapproval was positively associated with higher TCS scores, though not significantly (r = .14; p = .48). The same was true for societal support for tobacco control (r = .27; p = .18). The TCS score in 2011 was significantly correlated with concern about passive smoking (r = .42; p =.03). Support for tobacco control measures was also strongly correlated with concern about passive smoking (r = .52, p = .006).ConclusionsSmokers in countries with a higher TCS score were more concerned about whether their smoke harms others. Further, support for tobacco control measures is higher in countries that have more of these concerned smokers. Concerns about passive smoking seem central in the implementation of tobacco control measures, stressing the importance of continuing to educate the public about the harm from passive smoking.

Comparison of tobacco control policies in the Eastern Mediterranean countries based on tobacco control scale scores

This cross-sectional survey aimed to provide an overview of tobacco control strategies in the countries of the Eastern Mediterranean Region (EMR). A questionnaire to collate data on implementation of 6 major policies was developed based on the previously published Tobacco Control Scale and using MPOWER measures of the WHO Tobacco Free Initiative and the Tobacco Atlas. Only 3 of the 21 countries scored higher than 50 out of 100: Islamic Republic of Iran (61), Jordan (55) and Egypt (51) More than half of countries scored less than 26. Highest scores were achieved by Afghanistan in cigarette pricing, Oman in smoking bans in public places, Islamic Republic of Iran in budgeting, prohibition of advertisements and health warnings against smoking and Syrian Arab Republic, Tunisia and Kuwait in tobacco cessation programmes. The low mean total score in EMR countries (29.7) compared with European countries (47.2) highlights the need for better future planning and policy-making for tobacco control in the Region.

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

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.

Depression awareness, education and screening through socio-economic burden of depression( SEBoD) project in Korea

The objective of this work is to describe the acceptability of some tobacco products regulations and to explore their relation with tobacco control legislation levels in Europe.We used data on tobacco control activities in Europe in 2007, 2010 and 2013 measured by the Tobacco Control Scale (TCS) and data regarding attitudes about tobacco control regulations (i.e. adding picture health warnings on all packages of tobacco products or increasing taxes on tobacco products) from the Special Eurobarometer of 2009, 2012 and 2014 (n = 80,831). We calculated the prevalence ratio of favorable attitudes towards tobacco products restrictions in the reference year 2009 vs. the most current year (i.e. 2009 vs 2014), and the effect of previous TCS scores on the attitudes towards tobacco products regulations adjusted for sociodemographic variables.Strong support for the studied tobacco products regulations, which modestly increased over time, was observed. A positive relation was generally observed between TCS scores and support for the studied tobacco products regulations at both the ecological and individual level. A positive correlation was found between TCS scores and support for increasing taxes on tobacco products (rsp:0.29; 95%CI: 0.10, 0.48) at the ecological level, while at the individual level, the positive association was more remarkable in the case of support for adding large health warning labels to packaging.In conclusion, support for the studied tobacco products regulations were positively related with European tobacco control levels of implementation both at the ecological and individual level.

Implications and priorities of tobacco control in Belgium and Europe: FIGURE 1.

The present article aims to define what tobacco control is both in Europe and around the world. The situation of tobacco control in Belgium will be compared to other European countries using the tobacco control scale (TCS). If countries demonstrating a high TCS score have lower tobacco smoking prevalence than countries with a low TCS, it is not known whether the decrease in smoking prevalence over several years is well correlated with the increase in TCS score in each country during the same period.Moreover the article will raise the question of how far research will continue control into controlling the use of tobacco.The remaining 20% of smokers in the best tobacco control scale countries who are still smoking are not similar to the 20% that are now ex-smokers. Indeed we are now facing the “hard core smokers”, who show great resistance to policy measures and be considered as ill individuals requiring specialised care rather than individuals with bad habits. The future tobacco control scale should place more importance on the quality of care and the implication of European countries providing improved access to this form of care and validated forms of treatment of this chronic, difficult to treat disease.