Presentation plan
• The impact of the smoking ban in Italy (2005)
• Smoking bans in Spain (2006, 2011)
• Smoking bans in Greece (2009, 2010, 2011)
• Implementation of the WHO-FCTC in Italy
The smoking ban
(article 51- Law 3/2003)
entered into force
on 10th January 2005
Italy
The Italian smoking ban is not classified as a 100% smoke-free law, but it works
as it was. Why?
Smoking room: with a size less than half of the size of the whole premise, closed by automatic sliding doors, with a negative pressure of at least 5 Pascal, provided by very powerful forced ventilation (flow rate of ≥30 litres per second per person, considering a crowding rate of 0.7 persons per square meter)
Actually, <1% of hospitality venues reported to have built smoking rooms, because of the high cost due to the tight standards on air quality.
Gorini G, et al. Ann Oncol, 2007
A long legislative process
Positive key-points in the history of the Italian smoking ban:
the leadership of two consecutive Health Ministers, both physicians, who introduced the bill four times between 2000-2002;
the troian horse strategy: repeated presentations and final approval of the bill as an amendment within a framework bill on public administration. This strategy enabled timely approval of the ban;
the stringent air quality standards in the 2003 regulation that made building smoking rooms impracticable and prohibitively expensive.
[Gorini, Ann Ist Sup Sanità, 2011]
Limiting factors in the legislative
process • the 6-month delay in approving the
regulation on smoking rooms;
• the 1.5-year delay in approving the regulation establishing owners’ responsibility for enforcing the ban in hospitality premises
• the legal action in August 2005 which shifted responsibility for enforcement from owners of hospitality premises to police.
Press review,1998-2008, 50 Italian newspapers Key-words: smoking, cigarette, surname of Ministers of Health in
charge
106
62
147
91 92
188
33
5 827
49
0
20
40
60
80
100
120
140
160
180
200
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
anno
N. art
ico
li p
ub
blicati
[Gorini,2011]
Press articles and debates in this
long period (2000-2004) succeeded in
“training” Italians to this radical change
The long legislative process of the bill and its related regulations (2000-2004), stimulated journalists to publish articles informing people about tobacco control issues, such as health gains of smoke-free bars, or of quitting smoking.
Impact in terms of:
1. Attitudes of Italians towards the smoking ban and its compliance
2. Drop of Second Hand Smoke (SHS) Exposure in hospitality premises
3. Health gains for hospitality workers
4. Cigarette Sales & smoking prevalence
5. Rates of hospital admission for acute myocardial infarction (AMI)
6. Economic Impact of the Smoking Ban in Hospitality Industry
Attitudes of Italians towards
the smoking ban and its compliance at
the very beginning -- 2005 DOXA Survey 90%: perception of
compliance with the smoking ban in bars & restaurants
-- 2005 Survey
amongst owners of 1,641 hospitality premises :
92% all customers complied with the ban
only 11% asked to some customers to stop smoking
% in favour of a
smoking ban
90%83%
75
80
85
90
95
2001 DOXA Survey 2005 DOXA Survey
Compliance with the Italian
smoking ban: an 8-year update
PASSI surveys, 2008-2012
• PASSI (Italian behavioural risk factor surveillance system) is an ongoing surveillance system from 2008 onwards, coordinated by the National Institute of Health and supported by the Ministry of Health.
• In 2008- 2012 187,865 people have been interviewed (about 37,000 persons per year).
• For the current analysis only areas participating in the entire 5-year period were considered (N = 176,236).
[Minardi, Int J Public Health, 2014]
Respondents (%) reporting the smoking ban was
fully/almost fully implemented
in hospitality premises, PASSI survey
75
85
95
2008 2009 2010 2011 2012
%
Italy Northern Center Southern & Islands
[Minardi, Int J Public Health, 2014]
Respondents (%) reporting the smoking ban was
fully/almost fully implemented
in workplaces, PASSI survey
80
85
90
95
2008 2009 2010 2011 2012
%
Italy Northern Center Southern & Islands
[Minardi, Int J Public Health, 2014]
Respondents (%) reporting 100% smoke-free homes,
PASSI survey
65
70
75
80
85
2008 2009 2010 2011 2012
%
Italy Northern Center Southern & Islands
[Minardi, Int J Public Health, 2014]
Smoke-free homes by smoking habits
40
50
60
70
80
90
2008 2009 2010 2011 2012
%
Smoke-free Homes, Smokers Smoke-free homes, Non-smokers
[Minardi, Int J Public Health, 2014]
Self-reported SHS exposure, 2010, Italy
Prevalence of SHS exposure was 10.2% in
public places, 15.6% at home and 17.9%
in cars, according to DOXA 2010 survey.
Among 15–24 years were 21.4% in public
places, 27.1% at home and 32.9% in cars.
By multivariate analysis, males, the young,
subjects from southern Italy and former
smokers were more frequently exposed.
[Martinez-Sanchez, Eur J Public Health, 2012]
Perception of the compliance with the ban
was consistent with inspections and site visits
• In 2005-2012, the Italian Police carried out
25,600 random inspections: 2.4% of the sites
were found people smoking and 4.0% had
inappropriate no-smoking signs.
• In 2010-2012 NHS inspections in 1,298 HPs,
693 workplaces, and 2,404 hospital areas in 9
Italian regions. People smoking cigarettes were
found in <2%.
[Ministry of Health, 2013]
Police inspections, 2002-2012
0
1000
2000
3000
4000
5000
6000
7000
2002 2004 2005 2007 2008 2009 2010 2011 2012
Fines for inappropriate no smoking signs
Fines for currently smoking clients
No fines
[Ministry of Health, 2013]
In 2002 inspections only in postal offices, hospitals, outpatient clinics, libraries,
Museums, airports. In 1975: ban in schools, cinemas, public transportations;
in 1995: ban in public offices
Trend in police fines, 2002-2012
28,5
16,9
1,5
10
31,8 2,8 2,2 3,6 2,9 2,5
5,23,63,9 3,5
5,64,7
3,3
0
5
10
15
20
25
30
2002 2004 2005 2007 2008 2009 2010 2011 2012
%
Fines for currently smoking clients
Fines for inappropriate no smoking signs
[Ministry of Health, 2013]
Fines (%) by type of venue, 2007-2012
0,3%
0,9%
2,9%
2,0%
0,9%
1,5%
3,9%
0,7%
2,7%
4,7%5,8%
5,7%
6,1%
2,3%
4,6%
4,9%
2,4%
1,2%
2,8%
1,1%Postal Offices
Airports
Train Stations
Schools and Universities
Outpatient departments
Indoor markets
Hospitals
Libraries & Museums
Restaurants, Pubs & Discos
Casinos, Bingos
% fines forinappropriate nosmoking signs
% fines for smokers
[Ministry of Health, 2013]
NHS Inspections, 2010-2012
Hospitals
N=2,404
rooms
Workplaces
N=693
(2,822 rooms)
Hospitality
premises
N=1,298
Smokers 2% 2% 1%
Ashtrays 2% 3% 5%
Butts 3% 2% 1%
Smoking smell 7% 5% 5%
[Ministry of Health, 2013]
carried out by food and work inspectors
of Local Health Authorities in 9 Italian Regions
Interviews to hospitality owners: North to South gradient
% owners reported that
customers complied with
the ban Regions
[Ministry of Health, 2013]
Impact in terms of:
1. Attitudes of Italians towards the smoking ban and its compliance
2. Drop of Second Hand Smoke (SHS) Exposure in hospitality premises
3. Health gains for hospitality workers
4. Cigarette consumption & smoking prevalence
5. Rates of hospital admission for acute myocardial infarction (AMI)
6. Economic Impact of the Smoking Ban in Hospitality Industry
Nicotine: Tobacco-specific, sensitive
personal monitor or environmental monitor
flow rate: 2.4 mL/min
gas chromatography (GC/MS) in Barcelona Lab
mean values in the sampling period
detection limit: 0.01 µg/m3
Second-hand smoke exposure markers - 1
Drop of Nicotine concentration
(in µg/m3) in Hospitality Premises
immediately after the ban: 1. Florence: 4 Pubs, 3 Discos
Before the ban
(Nov-Dec 2004)
After the ban
(Feb-Mar 2005) Reduction
Mean 149.1 4.8 97%
Median 138.9 4.5
Range 33.0 - 276.5 1.7 - 8.7
[Gorini, J Occup Environ Med, 2005]
µg/m3
Italy & Austria Before and After Study
• Nicotine concentration before & after 2 years from the introduction of the Italian smoking ban in Italy (Experimental Country) & Austria (Control Country) in:
• 28 hospitality premises (HPs) in Florence,
Belluno and 19 HPs in Vienna with
measurements in 2002-2004 and in 2007 (post-
ban)
• Only post-ban measurements in 27 HPs in
other 3 Italian towns (Torino, Milano, Napoli)
Results: Italy (Florence, Belluno), before & after - 1
Nicotine Nicotine
(N° of premises)
concentration
(median,
µg/m3)
concentration
(median,
µg/m3)
2.03 0.1
35.16 0.01
19.02 0.25
8.86 0.01
Bars (3) 6 7 0.003
Overall (28) 58 59 <0.001
Restaurants (10) 22 21 <0.001
Discos & Pubs (15) 30 31 <0.001
N°
samples
N°
samples
Before After
P-value the Italian smoking the Italian smoking
[Gorini, Indoor Air, 2008]
Results: Austria - 1
Nicotine Nicotine
(N° of premises)
concentration
(median,
in µg/m3)
concentration
(median,
in µg/m3)
2.53 2.57
24.31 28.24
49.6 31.43
11 15.76Overall (19) 46 47 0.681
Bars (4) 9 9 0.145
Discos & Pubs (6) 14 15 0.921
N°
samples
N°
samples
Restaurants (9) 23 23 0.965
Before After
P-value the Italian smoking the Italian smoking
Impact in terms of:
1. Attitudes of Italians towards the smoking ban and its compliance
2. Drop of Second Hand Smoke (SHS) Exposure in hospitality premises
3. Health gains for hospitality workers 4. Cigarette consumption & smoking prevalence
5. Rates of hospital admission for acute myocardial infarction (AMI)
6. Economic Impact of the Smoking Ban in Hospitality Industry
Occupational exposure to SHS in Italy, 2001
[Mirabelli, Kauppinen, J Occup Environ Health 2005]
Lavori
manuali
139.550
(17%)Ristorazione
alberghi
375.000
(47%)Impiegati
292.000
(36%)
In Italy in 2001, 806,550 workers (3.7%) were exposed to SHS for >=75% working time
CAREX Study
Hospitality
workers
(47%)
Manual
workers
(17%)
Clerks
(36%)
[Eurobarometer, 2015]
5%
0 2 4 6 8 10 12
GreeceRomania
PolandMalta
CroatiaAustriaCyprusLatvia
Zcech Rep.Bulgaria
SpainGermanySloveniaLituaniaHungary
FranceEstonia
BelgiumSlovakiaPortugal
DenmarkItaly
UKNetherlandsLuxembourg
IrelandFinlandSweden
%
> 5 hrs/day
(-68%: 256,000 workers)
5%
1%
Urine cotinine in hospitality workers
in Rome before & after 1 year from the
introduction of the law Valente, Tob Control 2007 73% reduction (from 17.8 to 4.9 ng/ml)
[Valente, tob Control, 2007]
Health gains in hospitality
workers: quitting smoking
24%
61%
15%
0 20 40 60 80
smoke the same cig/day
smoke fewer cig/day
quitted smoking
Survey among 1,641 hospitality owners, Italy, 2005
Galeone, Health Minister, 2006
Impact in terms of:
1. Attitudes of Italians towards the smoking ban and its compliance
2. Drop of Second Hand Smoke (SHS) Exposure in hospitality premises
3. Health gains for hospitality workers
4. Cigarette consumption & smoking prevalence
5. Rates of hospital admission for acute myocardial infarction (AMI)
6. Economic Impact of the Smoking Ban in Hospitality Industry
0
20
40
60
80
100
120
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015
Mil
lio
n o
f k
ilo
s /
%
Legal cigarette sales (millions of kilos) prevalence, men (DOXA survey)
prevalence, women (DOXA survey) prevalence, men (ISTAT survey)
prevalence, women (ISTAT survey)
Tobacco consumption & smoking
prevalence in Italy, 1960-2015
2004-2014: from 29.7% to 24.5% in men (-17%)
from 16.8% to 14.8% in women (-12%)
from 22.9% to 19.5% overall (-15%)
2004-2014: Cigarettes -24%
Impact in terms of:
1. Attitudes of Italians towards the smoking ban and its compliance
2. Drop of Second Hand Smoke (SHS) Exposure in hospitality premises
3. Health gains for hospitality workers
4. Cigarette consumption & smoking prevalence
5. Rates of hospital admission for acute myocardial infarction (AMI)
6. Economic Impact of the Smoking Ban in Hospitality Industry
Reduction of hospital admissions
for AMI, Italy, 2005-2006
• 4% reduction in whole Italy
• In particular, in people <70 years and in low
socio-economic areas (-15%)
• SHS is a trigger factor for AMI, as anger
episodes, exposure to traffic pollution,
intensive physical exercise.
[Barone-Adesi, 2006,2011; Galeone, 2007; Cesaroni, 2008; Richiardi, 2008; Gasparrini, 2009]
AMI hospital admissions, Italy
Introduction of statins: -2.7% mortality reduction for AMI, 1980-2000, Italy
Introduction of anti-hypertensive drugs: -1.7%
[Palmieri, Am J Public Health, 2010; Gorini Epidemiol Prev, 2010]
[Barone-Adesi,2011]
-4%
Acute effects of SHS exposure on cardio-
vascolar system
• Platelet activation
• Endothelial dysfunction
• Inflammation and infection
• Atherosclerosis (Low HDL levels, Plaque instability, Increased oxidized LDL)
• Increased oxidative stress
• Decreased energy metabolism
• Increased insulin resistance
• Increased infarct size
• Decreased heart rate variability
• Increased arterial stiffness
• Increased risk of coronary disease events
Prothrombotic states
[Barnoya & Glantz, 2005]
Economic impact on hospitality industry, Italy
No available studies
Survey on 1,600 hospitality owners in 2005:
• 55% reported no loss or a little increase in
income
• 12% reported a significant loss
The Italian Federation of hospitality industry
(FIPE) reported a significant loss in Casinos
and Bingos
Smoking ban extended in outdoor school
areas (playgrounds, parking)
• Entered into force in November 2013
• Low compliance: in 2014 less than half of high schools complied with the outdoor ban; in some schools, students started again to smoke in places where they no more smoked (toilets)
• Italians were not “trained” for this new restriction.
• No media campaign; no discussion in media or social network on this issue
Outdoor areas in pubs, bars, restaurants
Environmental nicotine concentration (3 settings):
8.28 µg/cubic meter
[Gorini, 2008]
PLoS ONE 2012;7(8): e42130. doi:10.1371/journal.pone.0042130
I would like to express my deep
sorrow over the passing away of 2
great EU researchers on SHS
exposure:
Manel Nebot, Barcelona, Spain
Giovanni Invernizzi, Milan, Italy
Nicotine measurements were higher in:
• Outdoor areas in HPs (high SHS
exposure levels)
• Outdoor areas close to the entrance of
“public” buildings (SHS enters buildings,
causing non-negligible exposures)
[Lopez, PlosOne, 2012]
Ecodiesel car vs. SHS: 1:10
[Invernizzi, Tob Control, 2004]
Diesel truck vs. SHS: 1:5
[De Marco, Multidiscip Respir Med, 2016]
The exhaust pipe of one truck powered by a diesel engine of about
13.000/14.000 cc3 was connected with a flexible hose to a hole in the window of
a container of 36 cubic meter. The truck operated idling for 8 min and then, after
adequate office ventilation, a smoker smoked two cigarettes.
Results
• The indoor air pollution generated by 2-3
cigarettes is 4-6 times higher than that
produced by a diesel truck, and 10 times
higher than that produced by an eco diesel
car.
[Invernizzi, Tob Control, 2004; De Marco, Multidiscip Respir Med, 2016]
Smoking ban in cars, Italy, 2016
In the transposition of the NTP Directive
entered into force in Italy on February 2,
2016, two articles not comprised in the
Directive have been added:
smoking ban in cars with children
smoking ban in outdoor areas around pediatric
and gynecologic departments in hospitals
Spain
Smoking bans in Spain
• 2006: banning smoking in all workplaces;
• HPs >100 sq.mt: smoking area
• HPs <100 sq.mt: choose whether to allow
smoking or not
• 2011: banning in all HPs
Failure of the “Spanish model”: nicotine
concentration after 2 years from the ban
implementation
• Levels of nicotine dropped in workplaces
(offices) from 0.21 (before) to 0.05 μg/cubic
mt (-60%)
• In bars/restaurants where smoking was
allowed nicotine concentration increased from
7.07 (before) to 10.12 μg/cubic mt (+40%)
• 400 repeated measurements before and after
6, 12, 24 months
[Lopez, Tob Control, 2011]
Hospitality workers in Spain
• HPs where smoking was totally banned:
salivary cotinine -56% (from 1.6 to 0.5 ng/ml)
-72% self-reported respiratory symptoms
• HPs with designated smoking areas:
salivary cotinine -28%
• HPs where smoking was allowed:
salivary cotinine -11%
[Fernandez, PlosOne, 2009]
Success of the 2011 ban in HPs
• Measurements of PM2.5, and nicotine in
178 HPs
• -90% decrease:
• Nicotine: from 5.73 to 0.57 μg/cubic mt
• PM2.5: from 233.38 to 18.82 μg/cubic mt
[Lopez, NTR, 2012]
Self-reported SHS exposure, Spain: cross-
sectional representative surveys
[Fernandez, NTR, 2016; Sureda, PlosOne, 2014]
0
20
40
60
80
2004-2005 2006 (post 1) 2011 (post 2)
Self
-rep
ort
ed
SH
S e
xp
o (
%)
Overall Work/education venues Leisure time Transportation/stations Home
-37%
-18%
-8%
-43%
-56%
-5%
-10% -69%
Change in smoking prevalence,
Spain, 2006-2011
• From 23.4% in 2006 to 20.7% in 2011
• -11.5% in 5 years
[Perez-Rios, PlosOne, 2015]
Mortality attributable to SHS exposure,
Spain 2002, 2011
• In 2002, 1228-3237 deaths from lung
cancer and ischaemic heart disease.
• In 2011, 1028 deaths (-50% on average)
[Lopez, Tob Control, 2007; Lopez, NTR, 2015]
Greece
Smoking bans in Greece
• 2009: a law based on the “Spanish model”
• September 2010: in HPs <300 sq. Mt
indoors + covered outdoor areas
• June 2011: in HPs >300 sq.mt.
• Skepticism in 2010 by the media because
the 2009 partial ban was ignored by the
public.
SHS exposure in HPs in Greece
• The PM2.5 concentration dropped from
2006 (pre-ban) the coming into force of the
2010 complete ban from 249 to 46
μg/cubic mt
• Thus, the complete ban led to a reduction
in SHS exposure.
• However, exposure was not eliminated
[Vardavas, 2012]
• Immediately
after the 2010
smoking ban,
-50%
• Subsequently,
increased
[Vardavas, PLosOne, 2013]
SHS exposure in HPs in Greece
2011 2010
Enforcement inadequate
• Population support may not be sufficient to
sustain smoke-free legislation if
enforcement is absent.
• Between wave 2 and 3 change in the
political leadership, less supportive of the
law. No enforcement
• Strong political leadership may be critical
in enforcing smoke-free legislation.
[Vardavas, PLosOne, 2013]
SHS exposure in bars in EU-28
[Eurobarometer, 2015]
SHS exposure in restaurants in EU-28
[Eurobarometer, 2015]
Self-reported SHS exp at work (%)
0 10 20 30 40 50 60
GreeceRomania
CyprusPolandAustria
ItalyCroatia
LituaniaZcech Rep.
MaltaBulgaria
LatviaHungary
EU28SlovakiaEstonia
PortugalFrance
SpainBelgium
GermanySlovenia
NetherlandsIreland
LuxembourgUK
DenmarkFinlandSweden
%
Occasionally
< 1 hr/day
1-5 hrs/day
> 5 hrs/day
2833
3721
33
161213
1213
109
6
3125
1724
11
7119
97
64
5
0 10 20 30 40 50 60
Greece
Romania
Poland
Austria
Italy
//
Portugal
France
Spain
Belgium
Germany
Netherlands
Ireland
UK
//
%
Occasionally
<1hr/day - >5 hrs/day
Status of the FCTC
implementation in Italy
Giuseppe Gorini
Legge 18 marzo 2008, n.75 (GU Serie Generale n.91 del 17-4-2008)
Ratifica ed esecuzione della Convenzione Quadro dell’Organizzazione
mondiale della sanità – OMS – per la lotta al tabagismo, fatta a
Ginevra il 21 maggio 2003.
Italy signed WHO-FCTC on June 20, 2003,
and ratified it on July 2, 2008
WHO FCTC CONTENTS • Core demand reduction provisions:
– Price and tax measures to reduce the demand for tobacco
(Art. 6);
– Non-price measures to reduce the demand for tobacco,
namely:
• Protection from exposure to tobacco smoke (Art. 8);
• Regulation of the contents of tobacco products (Art. 9);
• Regulation of tobacco product disclosures (Art. 10);
• Packaging and labelling of tobacco products (Art. 11);
• Education, communication, training and public
awareness (Art. 12);
• Tobacco advertising, promotion and sponsorship
(Art.13);
• Demand reduction measures concerning tobacco
dependence and cessation (Art.14).
WHO FCTC CONTENTS (cont.)
•The core supply reduction provisions:
– Illicit trade in tobacco products (Art. 15);
– Sales to and by minors (Art. 16);
– Provision of support for economically viable
alternative activities (Art. 17 & 18).
Simulation model Italy SimSmoke
• Entering into force in 2010 each new policy
with estimates of the impact in 2011-2030
in terms of:
• Decrease in smoking prevalence according
to a review of the effect of each policy
• Reduction of smoking-attributable deaths
Price (tax) increase: a simulation
25% increase in 2010-2011: from €5.0 to €6.3
20% increase in 2011-2012: from €6.3 to €7.5
15% increase in 2012-2013: from €7.5 to €8.6
10% increase in 2013-2014: from €8.6 to €9.5
5% increase in 2014-2015: from €9.5 to €10.0
In following years price should remain similar to
the 2015
Almost doubling the price
5
10
15
20
25
30
2010 2015 2020 2025 2030
Pre
vale
nza d
i fu
mo
(%
)
uomini, status quo
uomini, aumentoprogressivo delprezzodonne, status quo
donne, aumentoprogressivo delprezzo
Men, 2030: - 12% compared to status quo
Women, 2030: - 11%
Men, status quo
Men, increasing
price
Women, status
quo
Women,
increasing price
3
4
5
6
7
8
2010 2015 2020 2025 2030
nu
mero
di fu
mato
ri (
in m
ilio
ni)
uomini, status quo
Uomini, aumento
progressivo del
prezzo
donne, status quo
Donne, aumento
progressivo del
prezzo
Men, 2030: -723,000 smokers
Women, 2030:
-439,000 smokers
Men, status quo
Men, increasing
price
Women, status
quo
Women,
increasing price
0
10
20
30
40
50
60
70
2010 2015 2020 2025 2030
de
ce
ss
i a
ttri
bu
ibili a
fu
mo
(in
mig
lia
ia)
Uomini, status quo
Uomini, aumento
progressivo del
prezzo
Donne, status quo
Donne, aumento
progressivo del
prezzo
Men, 2011-30: -33,000
deaths
Women, 2011-30 : -4,000
deaths
Men, status quo
Men, increasing
price
Women, status
quo
Women,
increasing price
Evidence-based mass media
campaigns
Campaigns reduce smoking prevalence,
increase quit attempts and successful quitting
Messages with negative emotional contents,
are effective
Anti-tobacco Italian ads are too “politically
correct”
We need a change on contents of anti-tobacco
ads in Italy
[CDC, 2006; Durkin, 2012; Hammond, 2012]
Are you stupid? Smoking hurts, 2015
CDC TIPS from Former Smokers
Campaign, USA, 2012-2013
Hooked
5
10
15
20
25
30
2010 2015 2020 2025 2030
Pre
va
len
za
di
fum
o (
%)
Uomini, status quo
Uomini, campagnemediatiche bendiffuse Donne, status quo
Donne, campagnemediatiche bendiffuse
Men, 2030: - 8%
Women, 2030: - 8%
Men, status quo
Men, evidence-based
media campaigns
Women, status quo
Women, evidence-
based media
campaigns
Smoking cessation policies
Empowering the national quitline which actually
doesn’t follow callers during their quit attempts.
Quitline only passively receives the first call.
That’s all
More health professionals should deliver brief
advice (current: about 40%)
Empowering 350 NHS smoking cessation centers
(each treats only 100 smokers per year)
Reimbursement of therapy to quit
5
10
15
20
25
30
2010 2015 2020 2025 2030
Pre
va
len
za
di
fum
o (
%)
Uomini, status quo
Uomini, politichepromuoventi lacessazioneDonne, status quo
Donne, politichepromuoventi lacessazione
Men, 2030: - 6%
Women, 2030: - 6%
Men, status quo
Men, empowering
smoking cessation
Women, status quo
Women, empowering
smoking cessation
0
10
20
30
40
50
60
70
2010 2015 2020 2025 2030
de
ce
ss
i a
ttri
bu
ibili a
fu
mo
(in
mig
lia
ia)
Uomini, status quo
Uomini, politiche
promuoventi la
cessazione
Donne, status quo
Donne, politiche
promuoventi la
cessazione
Men, status quo
Men, empowering
smoking cessation
Women, status quo
Women, empowering
smoking cessation
Men 2011-30: - 18,000 deaths
compared to status quo
Women 2011-30 :
-7,000 deaths
Internet-based interventions for smoking
cessation (Cochrane)
• They are effective
• RR=1.48 (95%CI:1.11-2.78)
Civljak M, Stead LF, Hartmann-Boyce J, Sheikh A, Car J.
Internet-based interventions for smoking cessation.
Cochrane Database Syst Rev. 2013 Jul 10;7:CD007078.
http://www.exsmokers.eu/lt-lt/index.html
Introduction of pictorial warnings in EU28: a
great occasion to re-launch tobacco control
Transposition of the NTP Directive 40/2014
entered into force in Italy on February 2016
Thanks to:
• Esteve Fernandez, Catalan Institue of
Oncology, Barcelona, Spain
• Maria Josè Lopez, Public Health Agency
of Barcelona, Spain
• Constantine Vardavas, Crete, Greece
Thank you
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