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Objective To measure, exposure to PM2.5 particles in outdoor smoking areas and changes in breathing rates in patients with asthma or chronic obstructive pulmonary disease (COPD). Setting Sixty venues in Czechia, Ireland and Spain, in an open, non-randomised, clinical trial. Participants We studied 60 patients-30 asthma patients (Female 63.3%), with a mean age (+/-standard deviation [SD]) of 47.4 (19.0 SD), and 30 COPD patients (Female 51.6%), mean age 63.5 (10.1 SD), smokers, non-smokers or ex-smokers, recruited through medical clinics. Intervention Patients wore a PM2.5 particle monitor (AirSpeck), and a breath monitor (RESpeck) for 24 hours to determine changes in breathing rates (Br) at rest and during a visit to an outside smoking area. Spirometry and breath CO were measured before and the day after visiting an outdoor smoking area. Results PM2.5 levels in the 60 venues were highly variable, in 1 premises levels of PM2.5 were sustained for at least 15 minutes at ≥ 2,000 µg/m3, in 4 premises, ≥ 500 (range 1,933-539) µg/m3, in 8 premises, ≥ 200(range 480-203) µg/m3, in 9 premises, ≥ 100 (range 170-108) µg/m3, in 8 premises, ≥ 40 (range 80.5- 40.1) µg/m3, in 9 premises, ≥ 25 µg/m3, in 10 premises, ≥ 10 µg/m3, in 8 premises, and ≤10 µg/m3 in only 3 premises, with a single wall. The overall breathing rates/minute (Br)did not change significantly but in 28 patients mean Br increased from 21.47 (1.74 SD) to 22.8 (2.29 SD), change of -1.35 (-1.80-0.91 C.I), p value 0.00 and mean in 29 patients Br decreased from 21.95(2.43 SD) to 20.38(2.79 SD), 1.57(1.03-2.12 C.I), p value 0.00. Conclusion Exposure to high levels of PM2.5, and associated alteration of patients’ breathing rates occurred in outdoor smoking areas despite national comprehensive smokefree laws. These exposure levels support the abolition of such areas. (Words 295) ClinicalTrials.gov ID: NCT03074734 Ethics: Approval Number: Ref: 15-103

Smoking is related to 25% of all cases of malignant diseases globally. In 2020, in EU, 2.7 million people were diagnosed and 1.3 million died from malignant diseases. It is estimated that, in Europe, 1.6 million cases of lung cancer could be prevented with appropriate implementation of evidence-based tobacco control measures. In Serbia, more than 15.000 people die prematurely due to tobacco use every year. In addition, more than 800.000 of current smokers in Serbia will die prematurely if tobacco control measures are not implemented. Thus, tobacco control is of great importance for reducing the burden of malignant diseases. The aim of the article is to gain insight into tobacco control actions in key international and national documents and initiatives aimed at malignant disease prevention. Europe's Beating Cancer Plan includes activities that should decrease the share of the population in EU using tobacco to below 5% by 2040, which would be a significant reduction compared to current 25%. Joint Action "Innovative Partnership for Action Against Cancer", is aimed, among other things, at strengthening cancer prevention and raising awareness of the European Code Against Cancer, which stipulates 12 key recommendations for cancer risk reduction. Among these, two refer to tobacco use and exposure to tobacco smoke. Program for the improvement of cancer control in the Republic of Serbia for 2020-2022 foresees enhanced implementation of the existing tobacco-related legislation and its alignment with the WHO Framework Convention of Tobacco Control (FCTC) and EU acquis, as well as strengthening the network of smoking cessation services. Although many countries are signatories of the WHO FCTC and thus committed to the implementation of evidence-based tobacco control measures, tobacco use prevalence is still high, leading to higher cancer morbidity. Therefore, additional efforts and emphasis on tobacco control are needed within prevention of non-communicable diseases. Current strategic documents in the EU and in Serbia recognize the importance of tobacco control and provide a framework for reduction of tobacco use, but appropriate implementation of these measures is also necessary.

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. 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. 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). 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. This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 681040. The work of SG was partially supported by the Italian League Against Cancer (LILT, Milan). EF is partly supported by Ministry of Universities and Research, Government of Catalonia (2017SGR319) and by the Instituto Carlos III and co-funded by the European Regional Development Fund (FEDER) (INT16/00211 and INT17/00103), Government of Spain.

Lung cancer is the leading cause of cancer-related deaths in Europe. Europe's Beating Cancer Plan calls for a comprehensive approach to the disease in general but not specifically to lung cancer. Such a comprehensive approach, integrating efforts to strengthen anti-tobacco policies, early detection and underlying models of care, is sorely needed for lung cancer -particularly considering disruptions to care during the COVID-1 9 pandemic. In a recently published think piece, a multidisciplinary group of experts proposed four key policy priority areas. First, to reduce stigma and improve awareness of potential symptoms, there is a need to foster a better understanding of lung cancer -among the public and healthcare professionals. Second, opportunities for early detection should be enhanced, and the implementation of targeted screening through low-dose computed tomography should be encouraged as a complement to smoking cessation services. This complementarity should be recognised and built into joint policy proposals, with development and better integration of screening and smok-ing cessation programmes on the ground. Third, the socioeconomic inequalities under-pinning disparities in outcomes in people with lung cancer must be addressed, with targeted approaches to overcome barriers to access Finally, the overall quality of lung cancer care must be improved, making multidisciplinary care available to all and ensuring survivorship is given due attention. 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background The EUREST-PLUS ITC Europe surveys aim to evaluate the impact of the European Union’s Tobacco Products Directive (EU TPD) implementation within the context of the WHO FCTC. This article describes the methodology of the 2016 (Wave 1) and 2018 (Wave 2) International Tobacco Control 6 European (6E) Country Survey in Germany, Greece, Hungary, Poland, Romania and Spain; the England arm of the 2016 (Wave 1) and 2018 (Wave 2) ITC 4 Country Smoking and Vaping (4CV) Survey; and the 2016 (Wave 10) and 2017 (Wave 11) ITC Netherlands (NL) Survey. All three ITC surveys covering a total of eight countries are prospective cohort studies with nationally representative samples of smokers. Methods In the three surveys across the eight countries, the recruited respondents were cigarette smokers who smoked at least monthly, and were aged 18 and older. At each survey wave, eligible cohort members from the previous waves were retained, regardless of smoking status, and dropouts were replaced by a replenishment sample. Results Retention rates between the two waves of the ITC 6E Survey by country were 70.5% for Germany, 41.3% for Greece, 35.7% for Hungary, 45.6% for Poland, 54.4% for Romania and 71.3% for Spain. The retention rate for England between ITC 4CV1 and ITC 4CV2 was 39.1%; the retention rates for the ITC Netherlands Survey were 76.6% at Wave 10 (2016) and 80.9% at Wave 11 (2017). Conclusion The ITC sampling design and data collection methods in these three ITC surveys allow analyses to examine prospectively the impact of policy environment changes on the use of cigarettes and other tobacco products in each country, to make comparisons across the eight countries.

Background Further evidence is needed on the effects that short- and long-term exposure to secondhand smoke (SHS) have on the respiratory health of patients with lung disease. Within the TackSHS project we aimed to assess the acute respiratory effects in lung function that result from short-term SHS exposure among patients with asthma and chronic obstructive pulmonary disease (COPD). Methods The study design was an intervention trial with measurements before/after exposure to SHS in legal outdoor smoking areas. We studied patients with asthma or COPD from Czechia, Ireland, and Spain. Forced spirometry, peak flow and carbon monoxide (CO) measurements were performed pre- and 24 h post- exposure. Results Overall, 60 patients were studied, 30 with asthma, and 30 with COPD; 35 (58.3%) were female. There were no significant differences observed in exhaled CO between pre- and 24 h post-exposure neither in women (p = 0.210), nor in men (p = 0.169). A statistically significant decrease in forced vital capacity (FVC) was seen, overall, in asthma participants (p = 0.02) and in forced expiratory volume in the first second (FEV1), (p = 0.02), FVC (p = 0.04) and peak expiratory flow rate (PEFR) (p = 0.04) in female asthmatic participants. The observed decreases in respiratory measurements in COPD were not significant. There were no reported increases in symptoms, respiratory medication, or use of health services 24 h after the exposure. Conclusion We conclude that acute, short-term SHS exposure had a statistically significant effect on spirometry in female asthma patients but did not significantly modify spirometric indices 24 h later in COPD patients.

Introduction: In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals' knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines. Methods: We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019. Results: Healthcare professionals' self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals' self-efficacy in delivering tobacco treatment interventions (p

Introduction The latest evidence-based Guidelines for Treating Tobacco Dependence highlight the significant role of healthcare professionals in supporting smokers interested to quit. This study aimed to identify the current practices of healthcare professionals in Europe and perceived barriers in delivering tobacco treatment to their patients who smoke. Methods In the context of EPACTT-Plus, collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine) worked for the development of an accredited eLearning course on Tobacco Treatment Delivery available at http://elearning-ensp.eu/. In total, 444 healthcare professionals from the wider European region successfully completed the course from December 2018 to July 2019. Cross-sectional data were collected online on healthcare professionals' current practices and perceived barriers in introducing tobacco-dependence treatment into their daily clinical life. Results At registration, 41.2% of the participants reported having asked their patients if they smoked. Advise to quit smoking was offered by 47.1% of the participants, while 29.5% reported offering assistance to their patients who smoked in order to quit. From the total number of participants, 39.9% regarded the lack of patient compliance as a significant barrier. Other key barriers were lack of: interest from the patients (37.4%), healthcare professionals training (33.1%), community resources to refer patients (31.5%), and adequate time during their everyday clinical life (29.7%). Conclusions The identification of current practices and significant barriers is important to build evidence-based guidelines and training programs (online and/or live) that will improve the performance of healthcare professionals in offering tobacco-dependence treatment for their patients who smoke.

Background The study assessed awareness and use of heated tobacco products (HTPs) and factors that influenced these issues among cigarette smokers from six European countries in 2016 (Wave 1) and 2018 (Wave 2). Methods A survey was conducted among a nationally representative sample of cigarette smokers aged 18 years or older from Germany, Greece, Hungary, Poland, Romania and Spain in 2016 (N = 6011) and 2018 (N = 6027; 53% of smokers from the previous wave were retained, regardless of smoking status and dropouts were replaced by a replenishment sample of smokers). Data were collected through face-to-face interviews. Estimates were produced using weighted data. The study presents the cross-sectional results. Results Awareness of HTPs increased from 8% to 17% between the two waves. At Wave 1, 1.1% of the smokers declared having used HTPs at least once during their lifetime; and at Wave 2, this increased to 1.9% (around 1% or less in four countries, except for Greece and Romania where it was around 4%). Factors associated with HTPs use among those who had ever heard about these products at Wave 1 were country of residence, being a daily cigarette smoker and ever use of electronic cigarettes. At Wave 2, ever use of HTPs was significantly higher among those who had tried to quit smoking combustible cigarettes in the last 12 months, had tried electronic cigarettes during lifetime and perceived HTPs as less dangerous than combustible cigarettes; the country of residence was also associated with HTPs use. Conclusion This study offers insights into the behaviours and perceptions of European adult smokers regarding HTPs, an important emerging issue in the field of tobacco control.

IntroductionExposure to secondhand aerosol from e-cigarette (SHA) may pose harmful effects to bystanders. This study aims to investigate the prevalence, duration and determinants of SHA exposure in various indoor settings in 12 European countries.MethodsIn 2017–2018, we conducted a cross-sectional study, the TackSHS survey, on a representative sample of the population aged ≥15 years in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). We described the prevalence and duration of exposure to SHA in several indoor settings among 11 604 e-cigarette non-users. Individual-level and country-level characteristics associated with SHA exposure were also explored using multilevel logistic regression analyses.ResultsOverall, 16.0% of e-cigarette non-users were exposed to SHA in any indoor setting at least weekly, ranging from 4.3% in Spain to 29.6% in England. The median duration of SHA exposure among those who were exposed was 43 min/day. ‘Other indoor settings’ (eg, bar and restaurant) was reported as the place where most of e-cigarette non-users were exposed (8.3%), followed by workplace/educational venues (6.4%), home (5.8%), public transportation (3.5%) and private transportation (2.7%). SHA exposure was more likely to occur in certain groups of non-users: men, younger age groups, those with higher level of education, e-cigarette past users, current smokers, those perceiving SHA harmless and living in countries with a higher e-cigarette use prevalence.ConclusionsWe found inequalities of SHA exposure across and within European countries. Governments should consider extending their tobacco smoke-free legislation to e-cigarettes to protect bystanders, particularly vulnerable populations such as young people.Trial registration numberNCT02928536.

The session is aimed to take a regional look at tobacco control in Europe in order to better understand cultural, social, economic and political conditions for development of tobacco control policies and programs at this region. In addition, the regional approach for tobacco control helps complete geographical look at tobacco control in European region, raise awareness on best practices in analyzed countries and open the door for stronger collaboration and partnership between them in tobacco control policies and programs. Four countries, representing different parts of Europe and considered as case studies, have been selected for comparative analysis: Belgium, Georgia, Poland and Romania. Three of them reflect the level of tobacco control in Western, Central and Southern part of the European Union, one in non-EU Eastern region of Europe. The session refers to the book under the same title that is now planned to be published by the European Network for Smoking Prevention and is based on the template of the US Surgeon General Report on the Health Consequences of Tobacco Use. The session consists of seven short presentations that present the project’s approach, concept and methodology and summarize results and conclusions of comparative analysis made in particular parts of the book dedicated to exposure to tobacco smoke, its health consequences, public beliefs, opinions and attitudes about smoking, its health effects and tobacco control policies, advances in tobacco control legislation and strategy, smoking prevention, cessation and tobacco control advocacy, and a vision of the future strategy for tobacco control.

Smoke-free legislation reduced second-hand smoke (SHS) exposure in public places, and indirectly promoted private smoke-free settings. Nevertheless, a large proportion of adults is still exposed to SHS at home. The aim of this paper is to quantify the burden of disease due to home SHS exposure among adults in the 28-European Union (EU) countries for year 2017. The burdens by gender from lung cancer, chronic obstructive pulmonary disease (COPD), breast cancer, ischemic heart disease (IHD), stroke, asthma, and diabetes were estimated in an original research analysis using the comparative risk assessment method. Relative risks of death/diseases by gender for adults exposed to SHS at home compared to not exposed ones were estimated updating existing meta-analyses. Prevalence of home SHS exposure by gender was estimated using a multiple imputation procedure based on Eurobarometer surveys. Data on mortality and disability adjusted life years (DALYs) were obtained from the Global Burden of Disease, Injuries and Risk Factors Study. In 2017, 526,000 DALYs (0.36% of total DALYs) and 24,000 deaths (0.46% of total deaths) were attributable to home SHS exposure in the 28-EU countries, mainly from COPD and IHD. South-Eastern EU countries showed the highest burden, with proportion of DALYs/deaths attributable to SHS exposure on total higher than 0.50%/0.70%, whereas northern EU-countries showed the lowest burden, with proportions of DALYs/deaths lower than 0.25%/0.34%. The burden from SHS exposure is still significant in EU countries. More could be done to raise awareness of the health risks associated with SHS exposure at home.

Objective: The study assessed awareness, opinions, practices regarding electronic cigarettes (e-cigarettes) and factors associated with their use among Romanian high school students. Methods: A cross-sectional study was conducted in 2013 in two major Romanian cities, distributing anonymous questionnaires to 342 high school students aged 16–18. Results: 52.3% of the smokers, 29.2% of the ex-smokers and 7% of the never-smokers had tried e-cigarettes at least once in their life; 7.8% of the smokers and 4.6% of the ex-smokers had used e-cigarettes in the last month. Among smokers, e-cigarette use was associated with lower participation in school health education regarding e-cigarettes and with having parents using e-cigarettes.. Among ex-smokers and never-smokers, e-cigarette use was associated with intention to use e-cigarettes in the next year and with having friends who use e-cigarettes. Conclusion: Health education programmes and regulatory interventions addressing e-cigarettes are needed in Romania. More research is necessary on how to develop effective public health messages.

Our aim was to provide a systematic review of studies on the burden of disease due to second-hand smoke (SHS) exposure, reviewing methods, exposure assessment, diseases causally linked to SHS, health outcomes, and estimates available to date. A literature review of studies on the burden of disease from SHS exposure, available in PubMed and SCOPUS, published 2007–2018 in English language, was carried out following the PRISMA recommendations. Overall, 588 studies were first identified, and 94 were eligible. Seventy-two studies were included in the systematic review. Most of them were based on the comparative risk assessment approach, assessing SHS exposure using mainly surveys on exposure at home/workplaces. Diseases more frequently studied were: lung cancer, ischemic heart disease, stroke, chronic obstructive pulmonary disease, asthma and breast cancer in adults; lower respiratory tract infection, otitis media, asthma, sudden infant death syndrome and low birth weight in children. The SHS exposure assessment and the reported population attributable fractions (PAF) were largely heterogeneous. As an example, the PAF from lung cancer varied between 0.6% and 20.5%. Moreover, PAF were estimated applying relative risks and SHS exposures with no consistent definitions or with different age classes. The research gap on the SHS exposure burden is shrinking. However, estimates are not yet available for a number of countries, particularly the Middle Eastern and African countries, and not all diseases with the strongest evidence of causation, such as sudden infant death syndrome, have been explored. Moreover, in some cases the applied methodology revealed relatively low quality of data. info:eu-repo/semantics/acceptedVersion

The current study examined symptoms of irritation reported by non-smokers passively exposed to e-cigarette aerosols and their timing and association with the concentrations of volatile organic compounds (VOCs) produced.40 healthy non-smoking adults were exposed to e-cigarette aerosols for 30 min in a 35 m20 males and 20 females, with a mean age of 24.6 years (SD = 4.3) and exhaled CO 7 ppm participated. PM concentrations in both experimental sessions were higher than the Control (p 0.001). The most commonly reported symptoms were burning, dryness, sore throat, cough, breathlessness and headache. During both experimental sessions, ocular, nasal, throat-respiratory symptoms and general complaints increased significantly (p 0.05). Ocular and nasal symptoms returned to baseline by tA 30-min exposure to SHA provoked symptoms of sensory irritation and general complaints that lasted up to 30 min after the exposure and were positively associated with the concentrations of the VOC mixture emitted.

Aim and objective Smoke free law came into effect in Serbia on December 2010. Law bans smoking in enclosed public places with exemption to hospitality sector. The aim of the study is to present changes in smoking status after the adoption of the smoking ban. Methods We used data of nine surveys which are conducted since the adoption of the law. First survey was conducted at the time of adoption, followed by surveys three and nine months after adoption of the law and afterwards on annual basis. These surveys were conducted on representative samples of the ca 1000 of Serbian adults. Results Three months after adoption of the law 22.9% smokers stated that smoke free law had influence on their smoking status in the way they stoped smoking or reduced number of smoked cigarettes. Percentage of smokers that reduced or stopped smoking reached 29.2% in the fourth year after adoption of the law (2014), followed by the decrease. In 2017, less smokers stopped or reduced number of cigarettes (21.6%) compared to the first year. The changes in smoking status by years were statistically significant (p=0.000). One of the factors contributing to the reversed trend might be lower compliance with the Law. Same surveys showed that also that in the fourth year after adoption of the law, percentage of people estimating compliance with the current smoke free law as not good, started to increase and reached 22,8% in 2017. Conclusions The smoke free law contributed to changes in smoking status and patterns of smoking in Serbia. However, the influence of the smoke free law started to weaken in the forth year after the implementation. Contributing factor might be lower compliance with the law.

Introduction The aim of this pilot study was to assess the short-term effectiveness of the EuroPean Accredited Curriculum on Tobacco Treatment Training intervention in improving health care providers' knowledge, attitudes and self-efficacy related to tobacco dependence treatment. Methods A pre-post pilot study was conducted. The two-day training intervention took place in Brussels in April 2016. Health care professionals from six European countries (Russia, Ukraine, Georgia, Armenia, Romania and Greece) were purposively invited to participate in the study. Evaluation was performed before the intervention, immediately after, and at approximately two months following the intervention. Changes in outcomes of interest were examined before and after exposure to the intervention program. Results In all, 47 health care professionals participated in the training of which 40 completed the evaluation surveys. Significant increases in providers' self-efficacy and perceived behavioral control related to tobacco treatment delivery were documented immediately following the training and at the 2 months follow-up. Significant improvement in provider knowledge and attitudes were observed in some items assessed. Conclusions The results demonstrate that training is able to improve provider self-efficacy related to tobacco treatment delivery in this cross-national European sample of health care professionals. Additional research is required to examine the generalizability of our findings.

Introduction Smoking among young people is an important public health problem. Aim and objectives: This study has two objectives. The first one is to evaluate the status of the research concerning prevalence of tobacco consumption, factors which influence it and associated behaviors among Romanian youth. The second one is to present educational programs and tobacco control measures aimed at smoking prevention and cessation among Romanian young people developed in the last 13 years. Methods The information are based on data from literature such as articles published in peer-reviewed journals, national and international reports, legislation as well as experience in this field of the authors. Results There are several international studies which included also Romania regarding smoking behavior among youth (Global Youth Tobacco Survey, Health behavior in school aged children) as well as cross-sectional and longitudinal studies investigating the factors associated with smoking. There were several projects developed in the last years aimed at smoking prevention and cessation among different age groups of youth and one of them (I do not smoke) was also evaluated through a randomized controlled trial, showing positive results. Several tobacco control measures such as ban of smoking in public places, warning pictorials on cigarette packages, increase of the cigarette price were also noticed in the last years. Conclusions The review presents the context and challenges of smoking prevention and cessation for youth in Romania and makes recommendations for future actions in this field.

Introduction: Tobacco control efforts have been advancing globally, including the adoption and entry into force of the World Health Organization (WHO) Framework Convention of Tobacco Control (FCTC), as well as the adoption of the European Union EU Tobacco Products Directive. With the present review, the European Network for Smoking and Tobacco Prevention (ENSP) and European Respiratory Society (ERS) aim to provide a comprehensive overview on the status of WHO FCTC implementation, policy achievements and priority areas across countries in the WHO Europe Region. Methods: The review was conducted through a triangulation of data extracted from a survey administered to ENSP members, the WHO FCTC Implementation Database, Tobacco Control Laws and the Tobacco Control Scale 2016. Results: Using the WHO MPOWER measures as a framework, we report on the implementation status of nine FCTC articles across 47 countries in the WHO Europe Region. The average number of articles fully implemented was 3.58. FCTC articles least fully implemented were: Article 5.3 on Tobacco Industry Interference (25.5%, n=12), Article 20 on Research (34.0%, n=16), and Article 15 on Illicit trade (40.4%, n=19). The most commonly fully implemented articles were: Article 8 on Smoke-free legislation (63.8%, n=30), Article 16 on Underage sales (57.4%, n=27), and Article 6 on Price and tax measures (51.2%, n=24). Policy achievements and recommended priority areas for future national tobacco control activities varied greatly among countries. Conclusions: Findings highlight the multitude of successes in tobacco control efforts across the region in recent years, but point out the need to address gaps in FCTC implementation.

Background: Lack of knowledge of evidence-based treatments in smoking cessation is a known barrier in delivering smoking cessation interventions. Aims and Objectives: Our program aimed to evaluate the change in knowledge of health care professionals following a one day training intervention dedicated to advancing evidence-based tobacco dependence treatment. Methods: A pre-post study design was used while the CME accredited educational intervention took place in Brussels in April 2016. The training intervention was tested among 44 health care professionals from 5 European Countries (Russia, Ukraine, Georgia, Armenia and Romania). The effectiveness of the seminar was evaluated by a 13-item knowledge survey. Results: Pre intervention data indicated that the health care professionals’ knowledge was limited. However, after the intervention, significant changes in participants’ knowledge was noted in 5 out of 13 domains addressed: pharmacotherapy effectiveness (Pre 2.7% vs. Post 68%, p Conclusions: The results demonstrate that a fast track smoking cessation training program is able to improve the knowledge of health professionals. Further research is needed to assess its long term impact.

Introduction Exposure to secondhand smoke (SHS) is classified as a Group 1 carcinogen by the International Agency for Research on cancer and has been shown to have adverse health effects on adults and children, including heart and respiratory diseases. Electronic cigarettes (e-cigarettes) have irrupted in the market with sales volumes increasing considerably across the EU. The TackSHS Project is aimed to elucidate the impact that SHS and e-cigarette aerosols have on the respiratory health and how health effects vary according to socio-economic parameters with particular emphasis on specific vulnerable groups (patients suffering from chronic lung diseases, heavy smokers, etc.). Material and Methods Through an integrated series of workpackages, the TackSHS Project will investigate the determinants of SHS exposure, both assessed at the individual level and in the environment (survey and SHS assessment in 12 countries), the overall burden of disease caused (lung diseases and cardiovascular diseases), including the specific respiratory health changes in patients and healthy people, the economic impact of both mortality and morbidity caused by these exposures, the methods to characterize these exposures and novel interventions to reduce them. Results This integrated approach will enable significant step-change beyond the state-of-the-art in understanding SHS and e-cigarette aerosols exposure. The Project will put together for the first time the first-line research teams, and the conjunction of the workpackages will result in a step forward to tackle exposure to SHS and e-cigarettes aerosols. Conclusions TackSHS is a four-year project that started in 2015. Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 681040

Introduction Development of smoking prevention programs for disadvantaged groups, including adolescents with sensorial deficiencies, represents an important challenge. The goal of this paper is to present the development of the first smoking prevention program for adolescents with hearing deficiencies aged 13-15 from Romania. Material and Methods A peer-led smoking prevention programme on video, with proved effects on smoking prevention among Romanian adolescents without sensoral deficiencies, was adapted for children with hearing disabilities, using specific language for people with hearing deficiencies. The program is under current implementation among Romanian pupils with hearing deficiencies from two big cities from North-West Romania. Results The programme uses the social influence approach and concentrates on enhancing self-efficacy and the acquisition of cigarette refusal skills. It consists of five lessons with the following structure a. introduction of the theme in a class on DVD, b. activities in small groups, peer-led, c. return to one group and continuation of the lesson on DVD, d. activities in small groups, peer-led, e. (sometimes) home activities.Regarding attitudes, the programme focuses on reasons why people do or do not smoke, effects of smoking, passive smoking, addiction and alternatives to smoking. Regarding social influences, it discusses direct pressure to smoke from peers, indirect pressure from adults and dvertisements. Self-efficacy is incorporated by demonstrating resistance skills and by their practice in various challenging situations. Conclusions The program developed easy to use educational materials, which might be used for smoking prevention among Romanian adolescents with hearing deficiencies from different areas of Romania. Funding This work was supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNCS - UEFISCDI, project number PN-II-RU-TE-2014-4-2631.

Introduction The purpose of the study was to evaluate the effectiveness of a one-day training program in changing the perceptual role of participants and their self-efficacy to introduce tobacco treatment delivery into their daily clinical practice in the near future. Material and Methods The training program took place in Brussels in April 2016. A pre-post study design was used to evaluate the effectiveness and data from 44 health care professionals from Eastern European Region were analyzed. A 15-item survey was used for the data collection. Results The training program managed to establish new social and clinical norms related to tobacco dependence treatment in primary care practice settings, increase providers perceptions about the ease of delivering tobacco treatment and self-efficacy to deliver smoking cessation treatment. All six items of perceived behavioral control were significantly improved, 3 out of 4 items of subjective norms, 3 out of 5 items of attitudes significantly changed and 5 out of 6 items of self-efficacy. Immediately after the intervention health care professionals were more confident to advice their patient to quit smoking, mean (SD)= 8.77(1.6) vs. 8.28(2.3), p=0.019; provide brief smoking cessation counseling, 8.72(1.6) vs. 8.03(2.7), p

Introduction The aim of the EPACTT2 project is to: 1) translate and disseminate the European Network for Smoking Prevention (ENSP) Network’s Guidelines for treating tobacco dependence in 15 languages. 2) train and accredit professionals in Europe in smoking cessation and cutting edge issues in tobacco control. Material and Methods A multi-country team has been assembled to support local adaptation and dissemination of the training program and guidelines. The updated 2017 ENSP guidelines will be translated into local language and disseminated in an e-format to health care professionals (>1000) in all ENSP associated network via project partners and linkages to professional associations in all 28 EU Member States and the wider European region. An interactive online curriculum will be developed in the 15 languages based on the ENSP guidelines and housed in a dedicated e-learning platform on the ENSP website. The online training will be fully accredited by the official European Accreditation Council for Continuing Medical Education (EACCME). Within all the participating countries we will train and accredit approx. 45 health care professionals per country. A pre-post evaluation will be used to assess the program’s impact increases provider knowledge, attitudes, beliefs, perceived behavioral control, intentions and rates of provider’s tobacco treatment delivery. Conclusions Our project’s future direction is to continue the development and expansion of an accredited curriculum for tobacco cessation in Europe, enhance the formulation of a network of healthcare professionals, dedicated to advancing evidence-based tobacco dependence treatment, facilitate and broaden network’s outreach in Eastern and Southern Europe. Funding This work is supported by Global Bridges: Healthcare Alliance for Tobacco Dependence Treatment through a Pfizer Independent Grants for Learning and Change (GB- 25944945).

This study had two objectives. The first was to assess the frequency and content of school-based anti-smoking education received by Romanian adolescents aged 14-15. Secondly, the study aimed to evaluate to what extent the implementation of a specific 5 lessons smoking prevention program influences the quality of anti-smoking school education among Romanian adolescents. The investigation was performed in twenty schools from Cluj- Napoca, Romania, which were randomly assigned to the control and experimental conditions, resulting in 55 participating classes from the seventh grade (28 in the control group and 27 in the experimental group). The experimental group participated in a school-based smoking prevention program consisting of 5 lessons. The control group beneficiated only in the standard anti-smoking education offered by their schools. Six months after the program implementation, students from both experimental and control groups filled in a questionnaire, assessing several issues regarding their exposure to anti-smoking school education in the last year. The results showed a low exposure to anti-smoking school education among the Romanian adolescents. The implementation of the specific school-based smoking prevention program increased the exposure of Romanian adolescents to a higher number of lessons of smoking prevention and influenced positively the quality of these lessons. The study identified several gaps with respect to anti-smoking education in Romanian schools. It underlines the benefits of the implementation of a school based smoking prevention program with a clear structure, which contains appropriate educational messages and it is easy to implement.

In our presentation we are evaluating the progress of the tobacco control in Romania looking form the point of view on NGO in the last 26 years. We are signalling the progressive steps towards policy and an advocacy from our perspective and the consequences of our success. The final result is reflected in the new law starting in force on March 17th, 2016, a real advance in our fight. We are identifying in the same time the new challenging problems after launching the new law. Probably the biggest gain of our fight is the extensive partnership with all the factors, our efforts to bring together in a big family as the coalition “Romania Respira” politicians, advocates, judges, economists, young’s and also the new way found to encourage all: mass media, politicians, journalists, public to support us.

Romanian expertise in tobacco control and cessation is relatively young, as it has effectively started in the early ‘90’s. Ever since, smoking prevalence in the general population has decreased from 36.1% (48% B/25%F) in 2000 to 26.7% (37.4% B/16.7% F) in 2012, but it is still high and needs further efforts from the Romanian tobacco control community. Romania has ratified FCTC in May 2003 and has signed it in June 2004. A recent achievement we are all proud of consists of the new law to ban smoking in public places, applied from March 2016, a much stronger law than the past one. However, the future challenges will be to implement and ensure respect of this new law, to avoid its future amendments which already arise at the horizon, but also to introduce new regulation about taxation, illegal cigarettes traffic and e-cigarettes brands. A good point is the national Stop Smoking program that is still running since 2007 in over 50 Romanian smoking cessation centers to almost fully reimburse costs of pharmacotherapy and counselling. The constant preoccupation for education and expertise development inside the Romanian Society of Pulmonologists, in particular through its Tobaccology section established in 2007 is another plus of the Romanian tobacco control society, as well as its numerous alliances with other national and international professionals. This was fructified in various networks that have contributed to producing national smoking cessation guidelines, to creating many partnerships in tobacco control projects and in the newly successful anti-tobacco legislation.