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  ED12 - Regional Tobacco Control Policies: Advances & Challenges (ID 281)

  • Event: WCLC 2016
  • Type: Education Session
  • Track: Epidemiology/Tobacco Control and Cessation/Prevention
  • Presentations: 1
  • Moderators:Z. Zain, F. Mihaltan
  • Coordinates: 12/07/2016, 11:00 - 12:30, Hall C7

  • 18098

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    ED12.01 - Tobacco Control Policies in Eastern Europe (ID 6489)

    11:00 - 12:30  |  Author(s): Z. Cselkó
    • Abstract
    • Presentation
    • Slides

    Abstract:
    According to the regional distribution of the World Health Organization (WHO), Europe extends from the Atlantic Ocean to Central Asia, encompassing states of the former Soviet Union. In political terms however, Eastern Europe refers to countries located on the eastern border of the European Union (EU). Consequently, in our presentation we focus on how smoking status has changed in some of the policy-wise emerging countries located here – namely the Czech Republic, Hungary, Poland and Romania – and how these data compare to Austria’s indicators. We present data on smoking prevalence and trends, restricting use, taxation and average cigarette prices, as well as the distribution of tobacco products in specific countries. Reference is made to restricting advertising and tobacco industry sponsorship activities. Smoking cessation support practice is another important aspect, while electronic cigarette (e-cigarette) regulation is a relatively new issue. Table 1 presents smoking prevalence and trends of specific countries.

    	CZE	HUN	POL	ROM	AUT
    1980	26,2	34,8	42,5	26,8	27,8
    1996	26,6	31,1	33,7	30,6	29,6
    2006	26,3	32,9	30,5	26,7	32,5
    2012	24,4	28,5	27,6	27,5	32,3

    Table 1. Smoking prevalence (%) (+15 years old) It is striking that while the proportion of smokers has decreased in Hungary and Poland, an opposite tendency may be observed in Austria. Smoking prevalence stagnated in Romania and the Czech Republic. It is noteworthy that the proportion of women smokers is high in Austria (28.3%), in Hungary (25.8%) and in Poland (24.1%). Smoke-free laws were adopted in the beginning of this Century in North America and Western Europe, and soon resulted in decreasing the proportion of smokers. Although there were smoking and trade control laws earlier in the presented countries, effective legislation has only been promulgated a few years ago and in some countries it hasn’t even been published. Hungary applies total ban on smoking in enclosed public places (with the exception of psychiatric units) since 2011. In Poland, a partial ban is in place, smoking is allowed in certain restaurants. The Czech Republic exercises a slightly more liberal regulation regarding restaurants. A partial ban exists in Romania in restaurants and there may be designated smoking areas in enclosed places where smoking is prohibited. Smoking is allowed in restaurants in Austria. Smoking is otherwise banned in all other enclosed places in these countries as well. It is well known that raising the price of tobacco products is the best tobacco control measure, we therefore compared tax rates and prices of popular cigarette brands. Although EU member states must comply with EU tax regulation requirements, recently joined members are allowed several years to converge, therefore significant differences may be observed in this manner between discussed countries. Countries generally apply combined taxation policy on cigarettes in agreement with Article 6 of the WHO Framework Convention on Tobacco Control Guideline: apart from the value added tax (VAT), the excise duty consists of an ad valorem and a specific element In 2015, the average 20 piece pack price (in Euro) was 4.6 in Austria, 3 in the Czech Republic, 3.2 in Hungary, 3.2 in Poland and 2.8 in Romania. Regulating the distribution and limiting the access to certain tobacco products is an important tool in tobacco control, and even more so in the prevention of youth smoking. The sale of tobacco products to minors is generally prohibited under 18 years (in Austria, under 16 years), however there are noteworthy differences where vending machines are concerned, e.g. in Austria these are allowed to operate. Sale of cigarettes over the internet is legal in the Czech Republic. Directly accessible distribution of tobacco products is allowed in Poland and Romania. Hungary applies the highest degree on distribution restriction: tobacco may only be purchased in supervised tobacco stores, vending machines and internet sale are prohibited. Advertising and tobacco industry sponsorship activities are uniformly forbidden in these countries. Yet another important issue of tobacco control is the accessibility and financial support of smoking cessation programs. Austria focuses its efforts on youth smoking prevention, nevertheless cessation programs are also coordinated nationally. The Czech Republic lays great effort on disseminating brief intervention practice among physicians and nurses. Health insurance covers smoking cessation programs, however pharmacotherapies are excluded. The National Health Fund partially covers smoking cessation programs in Poland. Romania has established specialized quit centers whose activities are partially covered by health insurance. In Hungary, the Methodological Centre coordinates cessation activity in nearly one hundred pulmonary outpatient clinics around the country, offering individual and group cessation counseling. Counseling is covered by health insurance, excluding pharmacotherapy. In addition, telephone counseling and cessation support is also available free of charge. Regarding e-cigarettes, diverse regulatory schemes are detected across Europe. In Hungary, the distribution of nicotine containing e-cigarette cartridges fall under the drugs act, whereas the same regulation applies to the use as to regular cigarettes. The latter is observed also in Poland. Promotion and distribution of e-cigarettes is prohibited in Austria. In the Czech Republic however, both advertising and distribution is analogues to that of regular cigarettes. The Association of European Cancer Leagues (ECL) assesses European countries’ efforts in tobacco control every three years using the Tobacco Control Scale (TCS). The TCS quantifies the implementation of tobacco control policies based on six strategies described by the World Bank: price increases, public information campaigns, bans on advertising and promotion, smoke free work and other public places, health warnings and treatment to help smokers stop. It is informative to observe the 2013 ranking of the discussed countries: the Czech Republic had a continuously deteriorating position and ranked 31[st], while Austria earned the 34[th], Poland the 20[th] and Romania the 19[th] position among the 34 surveyed countries. Hungary has significantly improved its position between 2010 and 2013, and due to fierce government measures in recent years it ranked 11[th] as compared to the previous 27[th] spot. References: 1. World Health Organization Framework Convention on Tobacco Control Implementation Database. 2. Ng, M., et al.: Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012. JAMA. 2014;311(2):183-192. doi:10.1001/jama.2013.284692
    
    

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