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  • 1
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    Tobacco Control 17 (3), 215-216 
    Keywords: Germany ; HEALTH ; RE ; ENGLAND
    Type of Publication: Journal article published
    PubMed ID: 18522972
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  • 2
    Keywords: IMPLEMENTATION ; SECONDHAND SMOKE ; 4 COUNTRY SURVEY ; IRELAND ; RESTRICTIONS ; CROSS-SECTIONAL SURVEY ; CHILD EXPOSURE ; SCOTLAND ; LAW ; HOUSEHOLDS
    Abstract: ObjectivesTo measure changes in prevalence and predictors of home smoking bans (HSBs) among smokers in four European countries after the implementation of national smoke-free legislation.DesignTwo waves of the International Tobacco Control Policy Evaluation Project Europe Surveys, which is a prospective panel study. Pre- and post-legislation data were used from Ireland, France, Germany and the Netherlands. Two pre-legislation waves from the UK were used as control.Participants4634 respondents from the intervention countries and 1080 from the control country completed both baseline and follow-up and were included in the present analyses.MethodsMultiple logistic regression models to identify predictors of having or of adopting a total HSB, and Generalised Estimating Equation models to compare patterns of change after implementation of smoke-free legislation to a control country without such legislation.ResultsMost smokers had at least partial smoking restrictions in their home, but the proportions varied significantly between countries. After implementation of national smoke-free legislation, the proportion of smokers with a total HSB increased significantly in all four countries. Among continuing smokers, the number of cigarettes smoked per day either remained stable or decreased significantly. Multiple logistic regression models indicated that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation HSB. Prospective predictors of imposing a HSB between survey waves were planning to quit smoking, supporting a total smoking ban in bars and the birth of a child. Generalised Estimating Equation models indicated that the change in total HSB in the intervention countries was greater than that in the control country.ConclusionsThe findings suggest that smoke-free legislation does not lead to more smoking in smokers homes. On the contrary, our findings demonstrate that smoke-free legislation may stimulate smokers to establish total smoking bans in their homes.
    Type of Publication: Journal article published
    PubMed ID: 22331456
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  • 3
    Keywords: COHORT ; IMPACT ; RISK-FACTORS ; HEALTH ; TOBACCO ; ALL-CAUSE MORTALITY ; CHRONIC DISEASES
    Abstract: Background and aims Standard epidemiological measures of the risk of premature death from smoking might be unsuitable for risk communication in actual counselling situations. The rate advancement period (RAP) is an epidemiologic metric that could be useful for conveying information on the benefits of quitting. More effective risk communication could motivate older smokers to make an attempt at quitting. We provide empirical evidence on the impact of smoking, and the benefits of quitting on all-cause mortality and RAPs for people aged 60 years and older in a large cohort of older adults. Methods Smoking information was obtained from 6545 participants aged 60-74 years of ESTHER, a population-based German cohort. Cox proportional hazards regression was applied to estimate associations of smoking status, amount of smoking and time since smoking cessation with all-cause mortality. Premature mortality was quantified by RAPs. Results Current smokers had a 2.5-fold increased risk for all-cause mortality (adjusted HR: 2.53, 95% CI 2.10 to 3.03) and an RAP of 10.7 years when compared with never smokers. Strong dose-response relationships were seen with both current and life-time amount of smoking. Compared with current smokers, significant mortality reductions by 30%, 39% and 59%, and rate advancement reductions of 4.0, 5.6 and 10.0 years within 〈10 years, 10-19 years and 〉= 20 years after cessation were found for former smokers, respectively. Conclusions Smoking remains a strong risk factor for premature mortality, and smoking cessation remains highly beneficial also at older ages.
    Type of Publication: Journal article published
    PubMed ID: 23002181
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  • 4
  • 5
    Keywords: CANCER ; RISK ; IMPACT ; CIGARETTE-SMOKING ; MEN ; SMOKERS ; PRODUCTS ; SMOKING-CESSATION ; 4 COUNTRY SURVEY
    Abstract: OBJECTIVES: To examine if exclusive Roll-Your-Own (RYO) tobacco use relative to factory-made (FM) cigarette use has been rising over time, to determine the extent to which economic motives and perceptions that RYO cigarettes are less harmful act as primary motivations for use, and to examine the association of income and education with the level of RYO tobacco use among smokers in four European countries. METHODS: Data were obtained from the International Tobacco Control (ITC) Europe Surveys, and a cohort sample of 7070 smokers from the Netherlands, Germany, France and UK were interviewed between June 2006 and December 2012. Generalised estimating equations (GEE) were used to assess trends in RYO use, and whether RYO consumption varied by socioeconomic variables. RESULTS: Exclusive RYO use over the study period has increased significantly in the UK from 26.4% in 2007 to 32.7% in 2010 (p〈0.001); France from 12.2% in 2006 to 19.1% in 2012 (p〈0.001); and Germany from 12.7% in 2007 to 18.6% in 2011 (p=0.031), with increased borderline significantly in the Netherlands (31.7% to 34.3%, p=0.052), from 2008 to 2010. Over three-quarters of users in each of the study countries indicated that lower price was a reason why they smoked RYO. Just over a fourth of smokers in the UK, less than a fifth in France, and around a tenth in Germany and the Netherlands believed that RYO is healthier. Compared with exclusive FM users, exclusive RYO users were more likely to have lower incomes and lower education. CONCLUSIONS: Effective tobacco tax regulation is needed in the European Union and elsewhere to eliminate or reduce the price advantage of RYO tobacco. Additional health messages are also required to correct the misperception that RYO tobacco is healthier than FM cigarettes.
    Type of Publication: Journal article published
    PubMed ID: 26101043
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  • 6
    Abstract: OBJECTIVE: We sought to quantify the evolution of smoking-attributable mortality (SAM) in Germany and explore the impact of demographic ageing. METHODS: Smoking and mortality statistics from 1992 to 2013 were obtained from the German Statistical Office, from which SAM was calculated separately for each cause of death. The impact of demographic ageing was explored by comparing actual (crude) and age-standardised SAM. In order to estimate the impact of demographic ageing on future SAM, a forward projection until 2035 was modelled (assuming continuation of recent trends in smoking rates and constant cause-specific mortality rates). RESULTS: Total SAM only slightly declined from 139 000 cases in 1992 to 125 000 cases in 2013 (-10%), despite a decrease in age-adjusted SAM by 33%. Differences between actual and age-standardised SAM were particularly striking in men. While the age-standardised SAM in men decreased nearly by half, SAM remained more or less stable in women. The forward projection of SAM suggests that demographic ageing will lead to a further steady increase in SAM within the next two decades, for both, men and women. CONCLUSIONS: Especially in men, actual SAM hardly declined despite a sharp drop in age-standardised SAM, indicating that decreases were largely compensated by demographic ageing. The increasing number of deaths resulting from the ageing population will lead to a steady increase in SAM in the near future if no efforts are taken to curb smoking.
    Type of Publication: Journal article published
    PubMed ID: 27377343
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  • 7
    Keywords: HEALTH ; smoking ; CESSATION ; PRICE
    Abstract: Background Legal tobacco tax avoidance strategies such as cross-border cigarette purchasing may attenuate the impact of tax increases on tobacco consumption. Little is known about socioeconomic and country variations in cross-border purchasing. Objective To describe socioeconomic and country variations in cross-border cigarette purchasing in six European countries. Methods Cross-sectional data from adult smokers (n=7873) from the International Tobacco Control (ITC) Surveys in France (2006/2007), Germany (2007), Ireland (2006), The Netherlands (2008), Scotland (2006) and the rest of the UK (2007/2008) were used. Respondents were asked whether they had bought cigarettes outside their country in the last 6 months and how often. Findings In French and German provinces/states bordering countries with lower cigarette prices, 24% and 13% of smokers, respectively, reported purchasing cigarettes frequently outside their country. In non-border regions of France and Germany, and in Ireland, Scotland, the rest of the UK and The Netherlands, frequent purchasing of cigarettes outside the country was reported by 2-7% of smokers. Smokers with higher levels of education or income, younger smokers, daily smokers, heavier smokers and smokers not planning to quit smoking were more likely to purchase cigarettes outside their country. Conclusions Cross-border cigarette purchasing is more common in European regions bordering countries with lower cigarette prices and is more often reported by smokers with higher education and income. Increasing taxes in countries with lower cigarette prices, and reducing the number of cigarettes that can be legally imported across borders could help to avoid cross-border purchasing.
    Type of Publication: Journal article published
    PubMed ID: 23644287
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  • 8
    Abstract: BACKGROUND: Despite advertising bans in most European Union (EU) member states, outlets for promotion of tobacco products and especially e-cigarettes still exist. This study aimed to assess the correlates of self-reported exposure to tobacco products and e-cigarettee advertising in the EU. METHODS: We analysed data from wave 82.4 of the Eurobarometer survey (November-December 2014), collected through interviews in 28 EU member states (n=27 801 aged 〉/=15 years) and data on bans of tobacco advertising extracted from the Tobacco Control Scale (TCS, 2013). We used multilevel logistic regression to assess sociodemographic correlates of self-reported exposure to any tobacco and e-cigarette advertisements. RESULTS: 40% and 41.5% of the respondents reported having seen any e-cigarette and tobacco product advertisement respectively within the past year. Current smokers, males, younger respondents, those with financial difficulties, people who had tried e-cigarettes and daily internet users were more likely to report having seen an e-cigarette and a tobacco product advertisement. Respondents in countries with more comprehensive advertising bans were less likely to self-report exposure to any tobacco advertisements (OR 0.87; 95% CI 0.79 to 0.96 for one-unit increase in TCS advertising score), but not e-cigarette advertisements (OR 1.08; 95% CI 0.95 to 1.22). CONCLUSION: Ten years after ratification of the Framework Convention for Tobacco Control, self-reported exposure to tobacco and e-cigarette advertising in the EU is higher in e-cigarette and tobacco users, as well as those with internet access. The implementation of the Tobacco Products Directive may result in significant changes in e-cigarette advertising, therefore improved monitoring of advertising exposure is required in the coming years.
    Type of Publication: Journal article published
    PubMed ID: 28607098
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  • 9
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    Tobacco Control 12 (3), 246-247 
    Keywords: Germany
    Type of Publication: Journal article published
    PubMed ID: 12958373
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  • 10
    Keywords: Germany ; MODEL ; THERAPY ; DRUG ; PATIENT ; treatment ; TRIAL ; DESIGN ; smoking ; RECRUITMENT ; CLUSTER ; SERUM ; REGRESSION ; RE ; INTERVAL ; analysis ; methods ; PROMOTION ; DRUGS ; EVALUATE ; odds ratio ; ANTISMOKING ADVICE ; GENERAL-PRACTITIONERS ; NICOTINE DEPENDENCE ; PERCEIVED BARRIERS
    Abstract: Objective: To evaluate new strategies to enhance the promotion of smoking cessation in general practice. Design: Cluster randomised trial, 262 factorial design. Setting: 82 medical practices in Germany, including 94 general practitioners. Participants: 577 patients who smoked at least 10 cigarettes per day ( irrespective of their intention to stop smoking) and were aged 36 - 75 years. Interventions: Provision of a 2- h physician group training in smoking cessation methods and direct physician payments for every participant not smoking 12 months after recruitment ( TI, training+ incentive); provision of the same training and direct participant reimbursements for pharmacy costs associated with nicotine replacement therapy or bupropion treatment ( TM, training+ medication). Main outcome measure: Self- reported smoking abstinence obtained at 12 months follow- up and validated by serum cotinine. Results: In intention- to- treat analysis, smoking abstinence at 12 months follow- up was 3% ( 2/ 74), 3% ( 5/ 144), 12% ( 17/ 140) and 15% ( 32/ 219) in the usual care, and interventions TI, TM and TI+ TM, respectively. Applying a mixed logistic regression model, no effect was identified for intervention TI ( odds ratio ( OR) 1.26, 95% confidence interval ( CI) 0.65 to 2.43), but intervention TM strongly increased the odds of cessation ( OR 4.77, 95% CI 2.03 to 11.22). Conclusion: Providing cost- free effective drugs to patients along with improved training opportunities for general practitioners could be an effective measure to achieve successful promotion of smoking cessation in general practice
    Type of Publication: Journal article published
    PubMed ID: 17297068
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