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

Introduction: Tobacco 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. Objectives: This 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). Methods: We 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. Results: Airborne 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). Conclusions: There 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

Secondhand Smoke Exposure and Other Signs of Tobacco Consumption at Outdoor Entrances of Primary Schools in Eleven European Countries

Introduction: Although smoking restrictions at child-related settings are progressively being adopted, school out-door entrances are neglected in most smoke-free policies across Europe. Objectives:To describe secondhand smoke (SHS) exposure and tobacco-related signs in outdoor entrances of primary schools in Europe according to area-level socioeconomic status (SES), smoke-free policy, national smoking prevalence, and geographical region. Methods:In this cross-sectional study we monitored vapor-phase nicotine concentrations at 220 school outdoor entrances in 11 European countries (March 2017–October 2018). To account for nicotine presence, we used the laboratory\u27s limit of quantification of 0.06μg/m3as point threshold. We also recorded the presence of smell of smoke, people smoking, cigarette butts, and ashtrays. Half of the schools were in deprived areas. We grouped countries according to their Tobacco Control Scale (TCS) score, smoking prevalence (2017–2018), and United Na-tions M49 geographical region. Results:There were detectable levels of nicotine in 45.9% of the outdoor entrances, in 29.1% smell of smoke, in43.2% people smoking, in 75.0% discarded butts, and in 14.6% ashtrays. Median nicotine concentration was below the laboratory\u27s limit of quantificationb0.06μg/m3(Interquartile range:b0.06–0.119). We found higher SHS levels in countries with lower TCS scores, higher national smoking prevalence, and in the Southern and East-ern European regions. People smoking were more common in schools from lower area-level SES and in countries with lower TCS scores (pb0.05). Conclusions: Smoking at school outdoor entrances is a source of SHS exposure in Europe. These findings support the extension of smoking bans with a clear perimeter to the outdoor entrances of schools

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

Objective: Due 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. Methods: Cross-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. Results: Nicotine 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. Conclusions: Our 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

Measurement of airborne nicotine, as a marker of secondhand smoke exposure, in homes with residents who smoke in 9 European countries

Objective Smoke-free policies are effective in preventing secondhand smoke (SHS) exposure, but their adoption at home remains largely voluntary. This study aimed to quantify SHS exposure in homes with residents who smoke in Europe according to households’ characteristics, tobacco consumption habits, and national contextual factors. Methods Cross-sectional study (March 2017–September 2018) based on measurements of air nicotine inside 162 homes with residents who smoke from nine European countries. We installed passive samplers for seven consecutive days to monitor nicotine concentrations. Through self-administered questionnaires, we collected sociodemographic information and the number of individuals who smoke, smoking rules, frequency, location, and quantity of tobacco use in households. Country-level factors included the overall score in the Tobacco Control Scale 2016, the smoking prevalence, and self-reported SHS exposure prevalence. Nicotine concentrations were analyzed as continuous and dichotomous variables, categorized based on the limit of quantification of 0.02 μg/m3. Results Overall, median nicotine concentration was 0.85 μg/m3 (interquartile range (IQR):0.15–4.42), and there was nicotine presence in 93% of homes. Participants reported that smoking was not permitted in approximately 20% of households, 40% had two or more residents who smoked, and in 79% residents had smoked inside during the week of sampling. We found higher nicotine concentrations in homes: with smell of tobacco smoke inside (1.45 μg/m3 IQR: 0.32–6.34), where smoking was allowed (1.60 μg/m3 IQR: 0.68–7.63), with two or more residents who smoked (2.42 μg/m3 IQR: 0.58–11.0), with more than 40 cigarettes smoked (2.92 μg/m3 IQR: 0.97–10.61), and where two or more residents smoked inside (4.02 μg/m3 IQR: 1.58–11.74). Household nicotine concentrations were significantly higher in countries with higher national smoking prevalence and self-reported SHS exposure prevalence (p < 0.05). Conclusions SHS concentrations in homes with individuals who smoke were approximately twenty times higher in homes that allowed smoking compared to those reporting smoke-free household rules. Evidence-based interventions promoting smoke-free homes should be implemented in combination with strengthening other MPOWER measures

Who Smokes in Europe? Data From Twelve European Countries in the TackSHS Survey (2017-2018)

Background: Population data on tobacco use and its determinants require continuous monitoring and careful inter-country comparison. We aimed to provide the most up-to-date estimates on tobacco smoking from a large cross-sectional survey, conducted in selected European countries. Methods: Within the TackSHS Project, a face-to-face survey on smoking was conducted in 2017–2018 in 12 countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain, representing around 80% of the 432 million European Union (EU) adult population. In each country, a representative sample of around 1,000 subjects aged 15 years and older was interviewed, for a total of 11,902 participants. Results: Overall, 25.9% of participants were current smokers (31.0% of men and 21.2% of women, P \u3c 0.001), while 16.5% were former smokers. Smoking prevalence ranged from 18.9% in Italy to 37.0% in Bulgaria. It decreased with increasing age (compared to Conclusions: These smoking prevalence estimates represent the most up-to-date evidence in Europe. From them, it can be derived that there are more than 112 million current smokers in the EU-28. Lower socio-economic status is a major determinant of smoking habit in both sexes

Who smokes in Europe? Data from 12 European countries in the TackSHS survey (2017-2018)

Background: Population data on tobacco use and its determinants require continuous monitoring and careful inter-country comparison. We aimed to provide the most up-to-date estimates on tobacco smoking from a large cross-sectional survey, conducted in selected European countries. Methods: Within the TackSHS Project, a face-to-face survey on smoking was conducted in 2017-2018 in 12 countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain, representing around 80% of the 432 million European Union (EU) adult population. In each country, a representative sample of around 1,000 subjects aged 15 years and older was interviewed, for a total of 11,902 participants. Results: Overall, 25.9% of participants were current smokers (31.0% of men and 21.2% of women, P < 0.001), while 16.5% were former smokers. Smoking prevalence ranged from 18.9% in Italy to 37.0% in Bulgaria. It decreased with increasing age (compared to <45, multivariable odds ratio [OR] for ≥65 year, 0.31; 95% confidence interval [CI], 0.27-0.36), level of education (OR for low vs high, 1.32; 95% CI, 1.17-1.48) and self-rated household economic level (OR for low vs high, 2.05; 95% CI, 1.74-2.42). The same patterns were found in both sexes. Conclusions: These smoking prevalence estimates represent the most up-to-date evidence in Europe. From them, it can be derived that there are more than 112 million current smokers in the EU-28. Lower socio-economic status is a major determinant of smoking habit in both sexes

Raising awareness against TAPS in Bulgaria

A case study from Bulgaria demonstrates lessons learned from building awareness against TAPS from zero in a TI-dominated political and media environment. Unexpectedly quick reaction by supportive lawmakers and energetic voluntary involvement of creative professionals for high level media campaign caught united TI front groups and lobby by surpise. But a united TI lobbyists' counter-offensive blocked legislative proposals for TAPS ban submission. Lessons learned in Bulgaria can be useful and appropriate for many countries where the tobacco advertisements still exist. This review of lessons learned in Bulgaria, employing action-research, analyzes the steps and actions taken over a year by the Smoke-free Life Coalition in Bulgaria to facilitate the submission to Parliament of a legislative proposal for a ban of TAPS. While the proposal was eventually withdrawn, the paper explores lessons learned from: - start-up public awareness raising for a comprehensive TAPS; - employing links to public debate over related tobacco control legislation's enforcement (such as control and enforcement of the comprehensive smoking ban in public places); - familiarizing MPs with legislative changes and structuring supportive documentation and evidence; attracting wide media attention in increasingly hostile media environment, dominated by TI-related ownership; - tactics in public/Parliamentary hearings; engaging with state institutions; and - desihning and implementing a high-visibility campaign in support of a TAPS ban, to gain public and media attention. The paper reports the outcomes from two Impact Assessments - on TAPS ban and enforcement of Total Smoking Ban in public places, conducted during 2016 - 2017. Outcomes show that the state budget relies on "toxic money" while the macro-economy of Bulgaria losses from tobacco consumption double that the budget benefits from excise duties on cigarettes. The Impact Assessment on total smoking ban enforcement showed that the money invested in better control of the total ban are not lost money. The paper builds up on previously reported findings about TI arguments employed against TAPS ban (ENSP 2017). Funding : The reported research and activities were performed as part of a project of the Smoke-free Life Coalition, Bulgaria, supported by The Union against Tuberculoses and Lung Disease

Wolf in sheep's clothing: tobacco industry’s sponsorship and CSR in Bulgaria

The WHO Framework Convention on Tobacco Control (FCTC) highlights the comprehensive ban of tobacco sponsorship as one of the effective measures to drop smoking levels. Countries that have ratified it pledge to put this measure in practice in favor of public health. Even though the Convention was ratified in Bulgaria by law in 2005, sponsorship by tobacco production or tobacco trade industry is still allowed with only two exceptions - sponsorship of radio and TV productions; and sponsorship of events that take place in several EU member states, EEA member states, or have other transborder effect. In summer of 2018 the fourth edition of a program called "Summer for Joy, Autumn for Care" was launched, funded by Philip Morris Bulgaria. It includes educational academy for children, medical check-ups for elderly people, local entrepreneurs academy and teachers academy in tobacco producing regions in Bulgaria. As of December 2018 the program has received six awards for a charity initiative and corporate social responsibility (CSR). One of the award ceremonies was hosted by the Bulgarian President. The program is as well noted as a positive example of CSR in a textbook by a university lecturer. The presentation will focus on notable practices of tobacco sponsorship and CSR in Bulgaria. It will track on tobacco industry approaches of sidestepping existing regulations and benefiting from the lacking ones. It will as well note the forms of recognition of tobacco industry initiatives received by media, academics as well as state institutions