Impact of the 2005 smoke-free policy in Italy on prevalence, cessation and intensity of smoking in the overall population and by educational group

Aims To estimate the immediate as well as the longer‐term impact of the 2005 smoke‐free law on smoking prevalence, cessation and intensity both in the overall population and separately by educational level. Design Interrupted time–series analyses of 11 cross‐sectional nationally representative surveys. Setting Italy, 1999–2010. Participants Adults aged 20–64 years. Measurements For each year we computed the prevalence of current smoking, the quit ratio and the mean number of cigarettes smoked per day. All measures were standardized by age. Segmented linear regression analyses were performed for each smoking variable separately by sex. Findings Among males, smoking prevalence decreased by 2.6% (P = 0.002) and smoking cessation increased by 3.3% (P = 0.006) shortly after the ban, but both measures tended to return to pre‐ban values in the following years. This occurred among both highly and low‐educated males. Among low‐educated females, the ban was followed by a 1.6% decrease (P = 0.120) in smoking prevalence and a 4.5% increase in quit ratios (P < 0.001). However, these favourable trends reversed over the following years. Among highly educated females, trends in smoking prevalence and cessation were not altered by the ban. Among both males and females, long‐term trends in the daily number of cigarettes, which were already declining well before the implementation of the policy, changed to a minor extent. Conclusion The impact of the Italian smoke‐free policy on smoking and inequalities in smoking was short‐term. Smoke‐free policies may not achieve the secondary effect of reducing smoking prevalence in the long term, and they may have limited effects on inequalities in smoking.     

Do smoking attitudes predict behaviour? A longitudinal study on the bi‐directional relations between adolescents’ smoking attitudes and behaviours

Aims Prevention and intervention programmes focus frequently upon retaining or creating negative attitudes towards smoking in an effort to prevent adolescents from smoking. As the focus upon attitudes is central in these programmes it is essential to know whether smoking attitudes actually precede smoking behaviour or, conversely, are affected by it. Therefore, in the present study we examined to what extent bi‐directional relations existed between smoking attitudes and behaviour. Design Data were used from the three annual waves of the ‘Family and Health’ project. Setting Participants were asked to complete questionnaires individually at their homes. Participants Addresses of families consisting of two parents and two adolescents were obtained from the records of 22 municipalities in the Netherlands. At baseline, 428 families participated with a response rate of 94% at the third measurement. Measurements Self‐reports were used to assess adolescents’ smoking attitudes and behaviour. Associations between smoking attitudes and behaviour were tested using structural equation modelling. Findings Findings revealed that smoking attitudes did not predict smoking consistently over time. However, past smoking affected subsequent attitudes moderately, suggesting that adolescents who started to smoke developed less negative attitudes towards smoking. Conclusions The current findings imply that smoking behaviour predominantly shapes smoking‐related attitudes, rather than vice versa. Focusing merely on smoking attitudes is probably not enough to prevent adolescents from smoking.     

German EstSmoke: estimating adult smoking‐related costs and consequences of smoking cessation for Germany

Aims

We compared predicted life‐time health‐care costs for current, never and ex‐smokers in Germany under the current set of tobacco control polices. We compared these economic consequences of the current situation with an alternative in which Germany were to implement more comprehensive tobacco control policies consistent with the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC) guidelines.

Design

German EstSmoke, an adapted version of the UK EstSmoke simulation model, applies the Markov modelling approach. Transition probabilities for (re‐)currence of smoking‐related diseases were calculated from large German disease‐specific registries and the German Health Update (GEDA 2010). Estimations of both health‐care costs and effect sizes of smoking cessation policies were taken from recent German studies and discounted at 3.5%/year.

Setting

Germany.

Participants

German population of prevalent current, never and ex‐smokers in 2009.

Measurement

Life‐time cost and outcomes in current, never and ex‐smokers.

Findings

If tobacco control policies are not strengthened, the German smoking population will incur €41.56 billion life‐time excess costs compared with never smokers. Implementing tobacco control policies consistent with WHO FCTC guidelines would reduce the difference of life‐time costs between current smokers and ex‐smokers by at least €1.7 billion.

Conclusions

Modelling suggests that the life‐time healthcare costs of people in Germany who smoke are substantially greater than those of people who have never smoked. However, more comprehensive tobacco control policies could reduce health‐care expenditures for current smokers by at least 4%.