60 results on '"Kuipers MAG"'
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2. Impact of smoke-free policies in hospitality venues and the home environment on smoking behaviour and exposure to second-hand smoke: results of two systematic reviews
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da Costa Senior, YY, primary, Rozema, AD, additional, Kunst, AE, additional, and Kuipers, MAG, additional
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- 2022
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3. Tobacco outlet availability in Dutch rural and urban areas
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van Deelen, T, primary, Belmonte, S, additional, van denPutte, B, additional, Kunst, AE, additional, and Kuipers, MAG, additional
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- 2022
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4. Policies to reduce availability of tobacco products in the retail environment
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Kunst, AE, primary, van den Putte, B, additional, Veldhuizen, EM, additional, and Kuipers, MAG, additional
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- 2022
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5. Nicotine dependence among adolescents in the European Union: How many and who are affected?
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Social Determinants of Health, Coban, F.R.; Kunst, A.E.; Van Stralen, M.M.; Richter, M.; Rathmann, K.; Perelman, J.; Alves, J.; Federico, B.; Rimpelä, A.; Lorant, V.; Kuipers, MAG., Social Determinants of Health, and Coban, F.R.; Kunst, A.E.; Van Stralen, M.M.; Richter, M.; Rathmann, K.; Perelman, J.; Alves, J.; Federico, B.; Rimpelä, A.; Lorant, V.; Kuipers, MAG. more...
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- 2017
6. Trends in smoking behavior in adolescents and young adults in the Netherlands
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Nuyts, PAW, primary, Kuipers, MAG, additional, Willemsen, MC, additional, and Kunst, AE, additional
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- 2016
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7. Tobacco control policies and socioeconomic inequalities in adolescent smoking: comparisons between 13 European countries in 2003, 2007 and 2011
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Kuipers, MAG, primary, Monshouwer, K, additional, Stronks, K, additional, and Kunst, AE, additional
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- 2014
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8. Effects of tobacco control policies on educational inequalities in adolescent smoking: Trend analysis of Dutch national data
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Kuipers, MAG, primary, Nagelhout, GE, additional, Willemsen, M, additional, and Kunst, AE, additional
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- 2013
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9. Smoking at football clubs with and without smoke-free policies in the Netherlands: an observational study.
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Keijzer J, Smit RA, Rozema AD, Kuipers MAG, and Kunst AE
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- Humans, Netherlands epidemiology, Cross-Sectional Studies, Smoking epidemiology, Soccer statistics & numerical data, Tobacco Smoke Pollution prevention & control, Tobacco Smoke Pollution statistics & numerical data, Sports and Recreational Facilities statistics & numerical data, Smoke-Free Policy legislation & jurisprudence
- Abstract
Objectives: Research shows that smoking persists in sports clubs with smoke-free policies (SFPs). It is unknown to what extent smoking occurs at such clubs and how much that may differ from clubs without SFPs. This study aimed to determine whether and to what extent smoking differs at Dutch football clubs with and without SFPs., Study Design: This cross-sectional study used a purposive sampling method to compare smoking indicators at 117 Dutch football clubs, with 49 clubs (41.8%) having an SFP., Methods: Using a standardised checklist, three smoking indicators were observed (number of people smoking, smoking facilities, and cigarette butts) and combined in a total smoking score (scale 0-9). Multi-level linear regression analysis was used to analyse the association between club SFP, local tobacco control policies (TCPs), and smoking indicators., Results: Significantly fewer smoking facilities were present at clubs with an SFP (-2.35, 95% confidence interval [CI]: -3.61; -1.09), but no significant associations were found between SFP and the number of people smoking and cigarette butts. The total smoking score was 1.74 points lower for clubs with an SFP (95% CI: -2.53; -0.96) and 1.85 points lower for clubs in municipalities with strong local TCPs (95% CI: -2.98; -0.72). Strong local TCPs were associated with significantly fewer people smoking at clubs (-1.79, 95% CI: -3.41; -0.17)., Conclusions: SFPs at sports clubs succeed in limiting the number of smoking facilities but do not show differences in terms of smoking rates or smoking-related litter when compared to clubs without SFPs. Our results highlight the need for enhancing implementation of comprehensive SFPs, including clear guidelines for compliance and enforcement., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.) more...
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- 2024
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10. Tobacco Outlet Availability, Density, and Proximity in Rural Areas in the Netherlands: An Ex ante Evaluation of the Impact of Tobacco Sales Bans.
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van Deelen TRD, Belmonte S, Veldhuizen EM, van den Putte B, Kunst AE, and Kuipers MAG
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Introduction: The Netherlands will ban tobacco sales from supermarkets in 2024 and from petrol stations and small outlets after 2030 (tobacco specialist shops exempted). Previous studies showed that this will reduce outlet availability, density, and proximity in Dutch urban areas., Aims and Methods: This study assessed the distribution of tobacco outlets in Dutch rural areas, and potential outlet reductions after implementation of these bans. A cross-sectional quantitative audit of tobacco outlets was conducted in seven rural municipalities in the Netherlands. Tobacco outlet availability (N), density (per 10 000 capita and km2), and proximity (average distance of a street or city block to the closest tobacco outlet [meters]) were calculated, as well as predicted changes after implementation of upcoming sales bans., Results: 97 tobacco retailers were identified. There were 5.00 outlets per 10 000 capita and 0.09 per km2. The tobacco sales ban in supermarkets is expected to reduce availability by 57 outlets, and density by 2.94/10 000 per capita and 0.05/km2, while increasing average distance by 824 m. A tobacco sales ban in petrol stations is expected to further reduce availability (-26), density/10 000 capita (-1.34), and density/km2 (-0.02), while increasing distance (+1595 m). For small outlets, these numbers are -12, -0.62, and -0.01, respectively, while the closest tobacco outlet will be mostly outside municipality borders., Conclusions: Assuming no new tobacco outlets will emerge in response to future tobacco sales bans, the bans could nearly eliminate tobacco outlets in rural areas. To meet the demand for tobacco, there is a risk that new tobacco specialist shops will be established., Implications: This study shows the potential impact of tobacco sales bans in, sequentially, supermarkets, petrol stations, and small outlets on tobacco outlet density and proximity in rural municipalities in the Netherlands. A ban on tobacco sales in supermarkets, petrol stations, and small outlets could reduce the number of tobacco outlets in rural areas of the Netherlands to nearly zero. As a result, supermarkets may be inspired to open tobacco specialist shops, which are exempt from the bans. To prevent the proliferation of such shops, retail licensing schemes may need to be established., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) more...
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- 2024
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11. Suitability of smoking cessation support from social and community service organizations: perspectives of Dutch clients.
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Visser JEM, Burger J, Rozema AD, Kunst AE, and Kuipers MAG
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- Humans, Male, Female, Adult, Middle Aged, Netherlands, Social Support, Interviews as Topic, Qualitative Research, Smoking psychology, Smoking Cessation methods
- Abstract
Social and community service organizations (SCSOs) may be a promising new environment to more successfully reach people with a lower socioeconomic position (SEP) for smoking cessation support. However, studies that investigate clients' perspectives of the suitability of SCSOs as a setting to discuss smoking are scarce. This study aimed to (i) investigate the suitability of smoking cessation support provided by SCSOs, according to people with a low SEP, and (ii) explore their reasons for considering it suitable or unsuitable. Semi-structured interviews were conducted with 19 individuals with a low SEP who smoked regularly (N = 14) or had smoked regularly (N = 5). They have been in contact with SCSOs in a specific neighborhood in Amsterdam. Data were analyzed using a thematic approach. Participants generally considered SCSOs as suitable for providing smoking cessation support, as professionals are involved, build a relationship of trust, and offer personalized and holistic support. SCSOs are located nearby and familiar, they provide support in both group and individual settings and might offer additional supportive (group)activities. A number of participants expressed doubts about the waiting time for support, the fact that the needed support might exceed professionals' expertise, and the lack of aftercare. SCSOs can be an additional opportunity for providing smoking cessation support that aligns with the circumstances of lower SEP people. To harness the potential, smoking cessation could be integrated into education programs and training among professionals could be promoted. Policy changes within and outside SCSOs would be needed., (© The Author(s) 2024. Published by Oxford University Press.) more...
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- 2024
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12. Smoking Cessation Support in Social and Community Service Organizations: Potential Activities, Barriers, and Facilitators.
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Visser JEM, Rozema AD, Kunst AE, and Kuipers MAG
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- Humans, Female, Male, Counseling methods, Adult, Middle Aged, Netherlands, Community Health Services, Social Work, Smoking Cessation methods, Smoking Cessation psychology
- Abstract
Introduction: Social and Community Service Organizations (SCSOs) are a potential setting to reach and support people with a low socioeconomic position who smoke, yet smoking cessation is not widely supported by SCSO professionals., Aims and Methods: This study aims to identify SCSO professionals' (1) potential activities to support smoking cessation and (2) barriers and facilitators in undertaking these activities. Between July and November 2022, semi-structured interviews were conducted with 21 professionals recruited through SCSOs in Amsterdam North, including participation workers, welfare workers, parent and child counselors, budget coach, debt counselor, welfare work, community sports, and community center coordinators. Data were analyzed using a thematic approach., Results: Eight activities were identified that could support the client either directly (ie, recognizing smoking clients, discussing smoking and smoking cessation, referring clients, providing smoking cessation counseling, offering help around services) or indirectly (ie, collaboration with relevant network partners, implementing smoke-free environments, enhancing professional skills). Various barriers and facilitators were identified related to the (1) client and their environment (ie, clients' readiness and social environment), (2) interaction between professional and client (ie, topic sensitivity), (3) professional (ie, professional is non-smoker, knowledge, and self-efficacy), (4) professionals' work environment (ie, necessity, responsibility, priority, and time), and (5) smoking cessation services (ie, availability of appropriate services and referral process)., Conclusions: There is potential for SCSO professionals to support smoking cessation, but several barriers hinder their efforts. To address these barriers, it is essential to take into account the factors that SCSO professionals believe facilitate the provision of smoking cessation support., Implications: This study provides insight into how the potential of SCSOs in Amsterdam North to support smoking cessation efforts among people with a low socioeconomic position can be harnessed. Barriers were found at multiple levels (client, professional, client-professional interaction, and organizational) and these findings imply that stakeholders across these levels will need to prioritize smoking cessation to facilitate and stimulate SCSO professionals in supporting smoking cessation. A concrete action would be to offer SCSO professionals additional training in conversational skills to discuss smoking. As a prerequisite, easily accessible and suitable smoking cessation services should be available in the neighborhood., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.) more...
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- 2024
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13. Socioeconomic Inequalities in Type 2 Diabetes: Mediation Through Status Anxiety?
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Crielaard L, Motazedi E, Galenkamp H, van de Werfhorst HG, Hulvej Rod N, Kuipers MAG, Nicolaou M, and Stronks K
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- Humans, Cross-Sectional Studies, Health Status Disparities, Social Class, Anxiety epidemiology, Socioeconomic Factors, Diabetes Mellitus, Type 2 epidemiology
- Abstract
Objectives: While status anxiety has received attention as a potential mechanism generating health inequalities, empirical evidence is still limited. Studies have been ecological and have largely focused on mental and not physical health outcomes. Methods: We conducted individual-level analyses to assess status anxiety (feelings of inferiority resulting from social comparisons) and resources (financial difficulties) as mediators of the relationship between socioeconomic status (SES) (education/occupation/employment status) and type 2 diabetes (T2D). We used cross-sectional data of 21,150 participants (aged 18-70 years) from the Amsterdam-based HELIUS study. We estimated associations using logistic regression models and estimated mediated proportions using natural effect modelling. Results: Odds of status anxiety were higher among participants with a low SES [e.g., OR = 2.66 (95% CI: 2.06-3.45) for elementary versus academic occupation]. Odds of T2D were 1.49 (95% CI: 1.12-1.97) times higher among participants experiencing status anxiety. Proportion of the SES-T2D relationship mediated was 3.2% (95% CI: 1.5%-7.0%) through status anxiety and 10.9% (95% CI: 6.6%-18.0%) through financial difficulties. Conclusion: Status anxiety and financial difficulties played small but consistent mediating roles. These individual-level analyses underline status anxiety's importance and imply that status anxiety requires attention in efforts to reduce health inequalities., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2023 Crielaard, Motazedi, Galenkamp, van de Werfhorst, Hulvej Rod, Kuipers, Nicolaou and Stronks.) more...
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- 2023
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14. The association of adolescents' smoking with the physical activity levels of their friends.
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Smit RA, Kuipers MAG, Federico B, Clancy L, Perelman J, Rozema AD, and Kunst AE
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Background: Smoking is inversely related to people's Physical Activity Level (PAL). As the behavior of friends may affect the choices and behavior of adolescents, having friends with a high PAL may potentially protect against adolescent smoking. This study aims to assess whether adolescents' smoking is associated with the PAL of their friends., Methods: SILNE-R survey data of 11.918 adolescents from 55 different schools in 7 European cities was used to determine weekly smoking, individual PAL, PAL of friends, school PAL, and smoking of friends. Multilevel, multivariable logistic regression analysis were used to assess the association between the PAL of friends and weekly smoking. Several socio-demographic variables were included as covariates in the analysis., Results: Our results indicated that 10.8% of the respondents was smoking weekly. Weekly smoking was most common among adolescents whose friends had a PAL of 0-42.0 min per day (14.5%). Respondents were significantly more likely to be smoking weekly if their friends were on average 0-42 min vs. 80-180 min physically active (OR 1.27 [95% CI 1.04-1.55]). This association existed independently of the individual PAL of respondents. Stratification for smoking of friends yielded equal results, although the association appeared to be somewhat stronger for those with smoking friends (OR 1.38 [95% CI 1.06-1.82])., Conclusion: Adolescents are less likely to smoke weekly if they associate with friends who spend >80 min per day on physical activity. Initiatives aimed at the prevention of smoking among adolescents may benefit from organizing group-based physical activity programs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.) more...
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- 2023
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15. Ex ante evaluation of the impact of tobacco control policy measures aimed at the point of sale in the Netherlands.
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van Deelen TRD, Kunst AE, van den Putte B, Veldhuizen EM, and Kuipers MAG
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- Humans, Smoking, Tobacco Control, Netherlands, Commerce, Policy, Tobacco Products
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Introduction: The Netherlands aims to implement stricter tobacco control policies targeting the retail environment. This paper is an ex ante policy evaluation of the potential impact of the current tobacco display and advertising ban as well as future tobacco sales bans on tobacco outlet visibility and availability., Methods: Between September 2019 and June 2020, all potential tobacco retailers in four Dutch cities (Amsterdam, Eindhoven, Haarlem and Zwolle) were visited and mapped using Global Positioning System. For each retailer selling tobacco, we completed a checklist on the visibility of tobacco products and advertising. Expected reductions in tobacco outlet visibility and availability were calculated per policy measure in absolute numbers (percentage or percentage point decrease) as well as density and proximity., Results: Out of 870 tobacco outlets, 690 were identified with visible tobacco products/advertising. The display ban in supermarkets and small outlets (respectively) is expected to decrease the number (-15; -42 percentage points), outlet density per 10 000 capita (-0.9; -2.6) and proximity in metres (+27 m; +400 m) of outlets with visible products/advertising. The upcoming bans on vending machines and sales in supermarkets are expected to decrease the number (-12%; -31%), density (-0.7; -1.9) and proximity (+12 m; +68 m) of tobacco outlets. Further changes in the number, density and proximity (respectively) of tobacco outlets may be achieved with future sales bans in petrol stations (-7%; -0.4; +60 m) and particularly with a ban on sales in small outlets (-43%; -2.7; +970 m)., Conclusion: A display ban and a sales ban in small outlets will contribute most to reducing tobacco outlet visibility and availability, assuming that no market shift towards other tobacco outlets will take place., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2023
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16. Socioeconomic differences in tobacco outlet presence, density, and proximity in four cities in the Netherlands.
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van Deelen TRD, Veldhuizen EM, van den Putte B, Kunst AE, and Kuipers MAG
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- Humans, Socioeconomic Factors, Cities, Netherlands epidemiology, Commerce, Residence Characteristics, Tobacco Products
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Background: Previous studies found that tobacco outlets were unevenly distributed by area socioeconomic status (SES). However, evidence from continental Europe is limited. This study aims to assess differences in tobacco outlet presence, density and proximity by area SES in the Netherlands., Methods: All tobacco outlets in four Dutch cities (Amsterdam, and medium-sized cities Eindhoven, Haarlem, and Zwolle) were mapped between September 2019 and June 2020. We estimated associations between average property value of neighbourhoods (as an indicator of SES, grouped into quintiles) and (1) tobacco outlet presence in the neighbourhood (yes/no), (2) density (per km
2 ), and (3) proximity to the closest outlet (in meters), using logistic and linear regression models., Results: 46% of neighbourhoods contained at least one tobacco outlet. Tobacco outlets were mostly situated in city centres, but the distribution of tobacco outlets varied per city due to differences in urban structures and functions. In the medium-sized cities, each quintile higher neighbourhood-SES was associated with lower tobacco outlet presence (OR:0.71, 95%CI:0.59;0.85), lower density (B:-1.20 outlets/km2 , 95%CI:-2.20;-0.20) and less proximity (B:40.2 m, 95%CI 36.58;43.83). Associations were the other way around for Amsterdam (OR:1.22, 95%CI:1.05;1.40, B:3.50, 95%CI:0.81;6.20, and B:-18.45, 95%CI:-20.41;-16.49, respectively). Results were similar for most types of tobacco outlets., Conclusion: In medium-sized cities in the Netherlands, tobacco outlets were more often located in low-SES neighbourhoods than high-SES. Amsterdam presented a reverse pattern, possibly due to its unique urban structure. We discuss how licensing might contribute to reducing tobacco outlets in low-SES neighbourhoods., (© 2023. BioMed Central Ltd., part of Springer Nature.) more...- Published
- 2023
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17. Bans on tobacco display, advertising and vending machines in the Netherlands: impact on visibility of tobacco and compliance of retailers.
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Borowiecki M, van Deelen TRD, van den Putte B, Kunst AE, and Kuipers MAG
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Introduction: Visibility of tobacco products at retail tobacco outlets is associated with smoking initiation. To address this, across 2020-2022 the Netherlands banned tobacco product displays, advertisements and vending machines in the retail environment. Tobacco/vape specialist shops were exempted. This study assessed the impact of these policies on tobacco visibility in the retail environment and retailer compliance., Methods: We conducted observational audits of all tobacco outlets in four Dutch cities (Amsterdam, Haarlem, Eindhoven and Zwolle) between 2019 and 2022 (before and after policy implementation), assessing visibility of tobacco products and advertisements, compliance and remaining sources of tobacco visibility (after implementation). We described results by location and outlet type., Results: The number of tobacco outlets with any tobacco advertising or product visibility declined from 530 to 267 (-50%). Among outlets not exempt from the ban, the number with visibility declined from 449 to 172 (-62%), with lower postban visibility in petrol stations (12%) and supermarkets (6%) than small shops (47%). Visibility among tobacco/vape shops increased by 17%. Tobacco product displays remained the main source of visibility. 93% of tobacco vending machines were removed. Maps showed that non-compliance is concentrated in Amsterdam's city centre and more evenly distributed in other cities., Conclusion: The bans on tobacco display and tobacco advertising halved the visibility of tobacco in the retail environment, and the vending machine ban practically eradicated vending machines. To further reduce tobacco visibility, violations in small shops should be addressed and tobacco visibility should be regulated in currently exempt tobacco specialist shops., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2023
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18. A Novel Methodological Approach to Measure Linear Trends in Health Inequalities: Proof of Concept With Adolescent Smoking in Europe.
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Kuipers MAG, Kang K, Dragomir AD, Monshouwer K, Benedetti E, Lombardi G, Luta G, and Kunst AE
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- Female, Male, Humans, Adolescent, Socioeconomic Factors, Europe epidemiology, Tobacco Smoking epidemiology, Smoking epidemiology, Social Class
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We describe a new method for presenting and interpreting linear trends in health inequalities, and present a proof-of-concept analysis of inequalities in smoking among adolescents in Europe. We estimated the regression line of the assumed linear relationship between smoking prevalence in low- and high-socioeconomic status (SES) youth over time. Using simulation, we constructed a 95% confidence interval (CI) for the smoking prevalence in low-SES youth for when this would be 0% in high-SES youth, and we calculated the likelihood of eradicating smoking inequality (<5% for both low and high SES). This method was applied to data on adolescents aged 15-16 years (n = 250,326) from 23 European countries, derived from the 2003-2015 European Survey Project on Alcohol and Other Drugs. Smoking prevalence decreased more slowly among low- than among high-SES adolescents. The estimated smoking prevalence was 9.4% (95% CI: 6.1, 12.7) for boys and 5.4% (95% CI: 1.4, 9.2) for girls with low SES when 0% with high SES. The likelihood of eradicating smoking inequality was <1% for boys and 37% for girls. We conclude that this novel methodological approach to trends in health inequalities is feasible in practice. Applying it to trends in smoking inequalities among adolescents in Europe, we found that Europe is currently not on track to eradicate youth smoking across SES groups., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journalpermissions@oup.com.) more...
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- 2023
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19. Tobacco retail licencing systems in Europe.
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Kuipers MAG, Nuyts PAW, Willemsen MC, and Kunst AE
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- Humans, Child, Marketing, Commerce, Tobacco Products, Tobacco Industry
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Tobacco retailer licencing has been recommended as an effective tobacco control strategy. In most European countries, however, retailers do not need a licence to sell tobacco products. We aimed to stimulate a discussion on the potential for tobacco retail licencing in Europe by describing (1) potential public health benefits, (2) licencing methods and (3) barriers and success factors in adoption of licencing systems. There is limited scientific evidence, but tobacco retail licencing may reduce smoking in three ways: (1) improved enforcement of and compliance to existing point-of-sale tobacco control policies (eg, minimum age of sale), (2) a reduction in the number and/or density of tobacco retail outlets and (3) denormalisation of tobacco. Licencing systems may take diverse forms. Systems may make licences expensive, and set criteria for purchasing a licence and retaining the licence after first purchase. In Europe, licencing systems have been implemented in Finland, Hungary, France, Italy and Spain. Licencing in Finland and Hungary was adopted for public health reasons; in Finland, with strong public support. In France, Italy and Spain, tobacco sales were state-monopolised, driven by economic motives. The cases of Norway and Scotland show that adoption of retail licencing may fail when political support is insufficient and tobacco retailers organise opposition with support from the tobacco industry. In conclusion, tobacco retailer licencing is a promising method to contribute to tobacco control efforts. Placing tobacco retailer licencing in a child protection framework may help generate the strong political and public support needed to effectively adopt licencing systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2022
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20. Intervention Activities Associated with the Implementation of a Comprehensive School Tobacco Policy at Danish Vocational Schools: A Repeated Cross-Sectional Study.
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Hjort AV, Kuipers MAG, Stage M, Pisinger C, and Klinker CD
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- Cross-Sectional Studies, Denmark, Humans, Public Policy, Schools
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School tobacco policies are often poorly implemented, which may explain their limited effectiveness. Further, constructs to measure implementation outcomes of school tobacco policies are missing. The Smoke-Free Vocational Schools intervention was designed to stimulate the implementation of a comprehensive school tobacco policy into routine practice. This study (1) developed implementation fidelity outcomes measures for the school tobacco policy and (2) examined associations between intervention activities and implementation fidelity at two time points. We applied a repeated cross-sectional survey study design across seven schools: the first time point was >5 months after the policy was established and the second time point > 14 months after policy establishment. The dependent/outcome variables were four binary fidelity domains as well as a total score across domains. A total of six intervention activities were measured among either students (e.g., new school-break facilities) or staff/managers (e.g., a joint workshop before policy implementation). Associations were analyzed separately for students and staff/managers using generalized linear mixed models, adjusted for confounders. A total of n = 2674 students and n = 871 staff/managers participated. The total implementation fidelity scores increased over time among both students and staff/managers. Three intervention activities were consistently associated with the total implementation fidelity score, including: new school-break facilities (B
T1 = 0.08, 95% CI = 0.03; 0.12; BT2 = 0.07, 95% CI = 0.04-0.50), the joint workshop before policy implementation (BT1 = 0.13, 95% CI = 0.02; 0.25; BT2 = 0.13, 95% CI = 0.004; 0.24), and internalization of fixed procedures for enforcement (BT1 = 0.19, 95% CI = 0.13-0.26; BT2 = 0.16, 95% CI = 0.13-0.26). These findings can be applied by schools and other actors in practice. The developed implementation fidelity outcomes measures can be applied in future research on school tobacco policies. more...- Published
- 2022
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21. Educational inequalities in exposure to tobacco promotion at the point of sale among adolescents in four Dutch cities.
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Zijp A, van Deelen TRD, van den Putte B, Kunst AE, and Kuipers MAG
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- Adolescent, Cities, Educational Status, Humans, Tobacco Use, Tobacco Products
- Abstract
This study aimed to assess educational differences in adolescents' exposure to tobacco outlets. Data were collected among 312 13-17-year-old non-smoking secondary school students in four Dutch cities. In a smartphone app, exposure (≤10 m from outlet) was measured using GPS and participants reported their educational track (pre-vocational vs. pre-university). Associations were estimated in negative binomial regression models. Mean exposure to tobacco outlet was 16.6 times in 14 days. Pre-vocational education was associated with higher exposure compared to pre-university education (IRR:1.46, 95%CI:1.08-1.98), especially around school (IRR:2.61,95%CI:1.50-4.55). These differences may contribute to socioeconomic inequalities in smoking., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.) more...
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- 2022
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22. Tobacco Retailers' Support for Point-of-Sale Tobacco Control Policies in England: Association Study of Retailers' Perceived Importance of Tobacco Sales, Contact with the Tobacco Industry, and the Perceived Impact of the Policy.
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van Deelen TRD, Arnott D, Hitchman S, van den Putte B, Kunst AE, and Kuipers MAG
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- Commerce, Cross-Sectional Studies, England, Humans, Public Policy, Tobacco Industry, Tobacco Products
- Abstract
Introduction: Political acceptability and successful implementation of tobacco control policies at the point of sale may depend on, among other factors, tobacco retailers' level of support for these policies. This study quantified the level of support among small tobacco retailers for four point-of-sale tobacco control policies and its association with three predictors., Methods: We used cross-sectional telephone survey data (August 2019) of 508 small tobacco retailers in England. Weighted logistic regression analyses examined associations between support for the product display ban, price display ban, minimum pack size, and standardized packaging, and self-reported importance of tobacco sales for a business, contact with the tobacco industry, and the perceived impact of the policy on their overall business., Results: A majority of retailers support minimum pack size (66%), product display ban (65%), price display ban (54%), and standardized packaging (55%). The importance of tobacco sales was not associated with support for the policies. More frequent contact with the tobacco industry was associated with higher odds of support for minimum pack size (OR: 2.01, 95%CI:1.25-3.21), but not with the other three policies. The negative perceived impact of the policies, compared with neutral, was associated with 1.5 to three times lower odds of support for all four policies., Conclusion: In England, small retailers' support for the four point-of-sale tobacco control policies varied between 54% and 66%. Support seems unrelated to the perceived importance of tobacco sales, and contact with the tobacco industry, but seems strongly related to the perceived impact of tobacco control policies on their business., Implications: This study shows that small independent retailers' support for point-of-sale (PoS) tobacco control policies is fairly high and that the lack of support voiced by retail trade organizations is not representative of the views of retailers in England. Support rates may be further improved by addressing retailers' perceptions of the impact of policies on their business. Support was not related to retailers' perceived importance of tobacco sales for their business and their contact with the tobacco industry. The industry rhetoric is not supported by our findings, as the majority of small independent retailers in England support tobacco control regulations., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) more...
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- 2022
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23. Association Between Smoke-Free Legislation in Hospitality Venues and Smoking Behavior of Young People: A Systematic Review.
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Garritsen HH, da Costa Senior YY, Rozema AD, Kunst AE, and Kuipers MAG
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- Adolescent, Adult, Humans, Restaurants, Smoking, Smoking Prevention, Air Pollution, Indoor analysis, Tobacco Smoke Pollution analysis
- Abstract
Introduction: While evaluations of indoor smoke-free legislation have demonstrated major public health benefits among adults, their impact on the smoking behavior of young people remains unclear. Therefore, we performed a systematic review of the association between smoke-free legislation in hospitality venues and smoking behavior of young people., Aims and Methods: A systematic search was conducted in PubMed, Scopus, and Embase in June 2020. We searched for studies that assessed the association of any form of smoke-free legislation in any hospitality venue (eg, bar and restaurant) with a smoking behavior outcome (eg, initiation and current smoking) among young people (aged 10-24 years). ., Results: Our search yielded 572 articles of which 31 were screened based on full-text and 9 were included in the analysis. All studies were published between 2005 and 2016. The majority of studies used a quasi-experimental design. Four studies evaluated smoke-free legislation in hospitality venues specifically. Two studies reported that comprehensive, but not weaker, smoke-free legislation decreases progression to established smoking. Two other studies provided mixed results on which level of comprehensiveness of legislation would be effective, and which smoking outcomes would be affected. Five studies evaluated legislation that also included other workplaces. Out of these five studies, three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity, whereas two other studies did not., Conclusions: Most of the studies found that smoke-free legislation in hospitality venues is associated with a decrease in smoking behavior among young people. Their results indicate the need for comprehensive smoke-free legislation without exemptions., Implications: This is the first systematic review to provide insight into the relationship between smoke-free legislation in hospitality venues and smoking behavior of young people. Our findings show that there is a need for comprehensive smoke-free legislation without exemptions (such as designated smoking areas)., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) more...
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- 2022
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24. The role of health literacy in the association between academic performance and substance use.
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Kinnunen JM, Paakkari L, Rimpelä AH, Kulmala M, Richter M, Kuipers MAG, Kunst AE, and Lindfors PL
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- Adolescent, Adult, Child, Humans, Socioeconomic Factors, Students, Surveys and Questionnaires, Young Adult, Academic Performance, Health Literacy, Substance-Related Disorders epidemiology
- Abstract
Background: To address social inequalities in adolescent substance use and consequent disparities in health, it is important to identify the mechanisms of the association between substance use and academic performance. We study the role of health literacy (HL) in the association between academic performance and weekly smoking, monthly alcohol use and cannabis ever-use among adolescents in Europe., Methods: SILNE-R school survey data, which was collected in 2016-17 with paper-and-pencil-method from Hanover (GE), Amersfoort (NL) and Tampere (FI), were used (N = 5088, age 13-19). Health Literacy for School-aged Children instrument was used to assess students' HL. Logistic regression analyzed the association of substance use with academic performance and HL, separately and in the same model. Linear and multinomial logistic regression analyzed the association between academic performance and HL., Results: Poor academic performance compared with high was associated with smoking [odds ratio (OR) 3.94, 95% confidence interval (CI) 2.83-5.49], alcohol use (OR: 2.94, 95% CI: 2.34-3.68) and cannabis use (OR: 2.56, 95% CI: 1.89-3.48). Poor HL was also associated with each substance use (with ORs of 2.32, 1.85 and 1.29). HL was positively associated with academic performance (β = 1.04, 95% CI: 0.89-1.20). The associations between academic performance and substance use were only slightly attenuated after controlling for HL., Conclusions: Academic performance and HL were both determinants of substance use, confirming their role in tackling the disparities in substance use. However, HL did not demonstrably mediate the association between academic performance and substance use. A wider set of factors needs to be tackled to address emerging social inequalities in adolescent substance use., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.) more...
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- 2022
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25. Systems perspective for equitable tobacco control in the future.
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Kuipers MAG
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- Humans, Tobacco Use, Tobacco Industry, Tobacco Products
- Abstract
Competing Interests: Competing interests: None to declare.
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- 2022
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26. Self-reported exposure of Indonesian adolescents to online and offline tobacco advertising, promotion and sponsorship (TAPS).
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Septiono W, Kuipers MAG, Ng N, and Kunst AE
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- Adolescent, Cross-Sectional Studies, Female, Humans, Indonesia, Male, Self Report, Tobacco Products, Advertising
- Abstract
Objectives: To quantify tobacco advertising, promotion and sponsorship (TAPS), self-reported exposure from online and offline platforms among adolescents in Indonesia., Methods: A cross-sectional school-based survey was conducted in 2017. In total, 2820 students aged 13-18 years were recruited from 22 schools in seven cities. Respondents reported TAPS exposure on online (online news, YouTube, Facebook, Twitter and Instagram ), and offline platforms (broadcast media, tobacco industry sponsored events and outdoor advertising). For outdoor advertisements, respondents reported the locations where they were exposed. We used multilevel analysis to assess TAPS exposure by age, gender, smoking status and city., Results: Online TAPS exposure was high on Instagram (29.6%), and relatively low on Twitter (7.3%). Offline TAPS exposure was high via television (74.0%), billboards (54.4%) and live music events (46.2%), but low on radio (6.9%). In all cities, outdoor advertising was seen particularly on the streets and in minimarkets. Overall, TAPS exposure was higher among older than younger adolescents, boys than girls, and smokers than non-smokers., Conclusions: Overall TAPS exposure was high on both online and offline platforms. Banning online tobacco advertising, in addition to complete bans on outdoor and television advertising, is essential to adequately protect Indonesian adolescents from tobacco advertising., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2022
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27. The Mediating Role of Parental Factors in the Social Patterning of Smoking among Adolescents in Urban Indonesia.
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Septiono W, Kuipers MAG, Ng N, and Kunst AE
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- Adolescent, Cross-Sectional Studies, Educational Status, Female, Humans, Indonesia epidemiology, Male, Permissiveness, Prevalence, Regression Analysis, Religion, Sex Distribution, Sex Factors, Smoking epidemiology, Social Facilitation, Socioeconomic Factors, Students psychology, Students statistics & numerical data, Urban Population, Adolescent Behavior psychology, Family Characteristics, Parents education, Parents psychology, Role, Smoking psychology
- Abstract
Introduction: Parental factors may explain part of the social patterning of smoking among adolescents. This study aims at assessing the association between adolescent smoking and family characteristics (parental education, family wealth, and religion) and the mediating role of parental factors (smoking, control, and permissiveness towards smoking)., Methods: In 2017, a cross-sectional survey was conducted in eight Indonesian cities among 2,393 students aged 13-18 years. Multilevel logistic regression analysis estimated the associations between family characteristics and adolescent smoking. Generalized Structural Equation Models (GSEM) quantified mediation of these associations by parental factors. Analyses were stratified by gender., Results: Smoking prevalence was 35.8% among boys and 2.6% among girls. Odds of smoking were higher among those with lower parental education among boys (low vs. high: OR:1.57, 95%CI:1.01-2.43), but not girls (OR:0.91, 95%CI:0.24-3.43). The association among boys was partially mediated by father's smoking status, parental control, and parental permissiveness towards smoking. High family wealth was associated with higher odds of smoking among girls (poorer vs. wealthier: OR:0.39, 95%CI:0.15-0.99), but not boys (OR:0.76, 95%CI:0.52-1.10). This association among girls was not clearly mediated by parental factors. Religion was not associated with smoking among boys or girls., Conclusions: In Indonesia's urban settings, inequalities in boys' smoking by educational background may be addressed by measures aimed at supporting lower educated parents to improve parental control and to reduce permissiveness towards smoking. more...
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- 2021
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28. Smoking cessation among adolescents in Europe: The role of school policy and programmes.
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Mertens AEJ, Kunst AE, Lorant V, Alves J, Rimpelä A, Clancy L, and Kuipers MAG
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- Adolescent, Cross-Sectional Studies, Europe epidemiology, Humans, Schools, Smoke-Free Policy, Smoking Cessation
- Abstract
Introduction: European estimates of adolescent smoking cessation are lacking and studies on the role of schools in quit behaviour are scarce. We aimed to describe smoking cessation attempts and success among adolescents in Europe and explored the association with school policy and programmes., Methods: We used cross-sectional data from the 2013 and 2016-2017 surveys of the European SILNE and SILNE-R projects. We included 4,509 12-19-year-old current or ex-smokers in 67 secondary schools in seven countries (Belgium, Germany, Finland, Ireland, Italy, the Netherlands, and Portugal). School staff reported strength of smoke-free school policies (SFSPs), proportion of grades in which anti-tobacco education was offered, and whether the school offered any form of cessation support programme. Multilevel logistic regression analysis determined school-level variation and the association of school-level and individual-level variables with self-reported and self-defined quit attempts and quit success., Results: Over three quarters (77.3%) of students reported a quit attempt and half of them (50.1%) reported quit success. Prevalence rates of quit success and quit attempts, showed relatively small variations between schools within countries. Associations of smoke-free school policy, tobacco educational programmes and cessation programmes with quit attempts and quit success could not be demonstrated with statistical significance. Quit attempts and quit success were inversely associated with alcohol use, parental smoking, and friend smoking., Conclusion: This study demonstrates that adolescence is an important time to encourage quitting and to support quit attempts. We did not find evidence for a contribution of school policies and programmes to quit behaviour of adolescent smokers., (Copyright © 2021 Elsevier B.V. All rights reserved.) more...
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- 2021
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29. Dutch youth's smoking behaviour during a partial Covid-19 lockdown.
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Van Deelen TRD, Van den Putte B, Kunst AE, and Kuipers MAG
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Previous research found that adult smokers increased their smoking in response to the Covid-19 lockdown in spring 2020. This study explored changes in youth's smoking during, compared to before, the partial lockdown in the Netherlands in a cross-sectional sample of 287 adolescents. Smoking prevalence increased from 4.5% to 5.2%. Cigarette consumption remained the same on school days and increased with +1.9 cigarettes per weekend day. The largest increase in cigarette consumption on weekend days was observed for adolescents who 1) did not consider smoking a risk factor for contracting Covid-19 (+4.5), 2) had smoking siblings (+4.1), and 3) had smoking friends (+2.4). Youth without smoking friends (-0.8) and who considered smoking a risk factor for Covid-19 (-0.2) decreased their cigarette consumption. more...
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- 2021
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30. The Association Between Tobacco Outlet Density and Smoking Among Young People: A Systematic Methodological Review.
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Nuyts PAW, Davies LEM, Kunst AE, and Kuipers MAG
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- Adolescent, Humans, Social Environment, Commerce statistics & numerical data, Smoking epidemiology, Tobacco Products adverse effects, Tobacco Products supply & distribution
- Abstract
Aim: Evidence on the association between tobacco outlet density and proximity and smoking behavior among youth is inconsistent, which may be due to methodological problems in some studies. We assessed the association of outlet density or proximity with smoking behavior among young people while taking into account the methodological quality of studies., Methods: MEDLINE, EMBASE, and Google Scholar were systematically searched for studies on the relationship between outlet density or proximity and smoking behavior among 12- to 25-year-olds, published between 1997 and 2017. Methodological quality of the included studies was evaluated independently by two reviewers., Results: Twenty studies were included in the review. The quality assessment identified five primary sources of potential bias: overadjustment for mediators (problems identified in 14 studies), underadjustment for confounders (six studies), poor statistical model fit (four studies), selection bias (three studies), and misclassification of exposure measurements (eight studies). Four studies were of high methodological quality. In studies with relatively high quality, 10 associations were reported, of which seven were nonsignificant, two positive, and one negative. Similarly, the complete body of evidence demonstrated mostly nonsignificant associations, but a larger proportion of positive associations than negative., Conclusion: Although there is some support for a positive direction, current literature does not provide consistent evidence for a positive association between outlet density and smoking among youth. This is not necessarily due to bias in specific studies, but more to fundamental challenges in study design and exposure measurements. These issues need to be addressed in future studies using more rigorous methods., Implications: Our findings suggest that, although there is some evidence for a positive association, current scientific literature does not provide consistent support to claim an effect of tobacco outlet density or proximity on youth smoking. This underlines the need for more research with improved methodology. There is a need for quasiexperimental studies, in which the outlet density changes substantially, studies measuring the actual exposure of youth to tobacco outlets, and qualitative research on the mechanisms underlying any association., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.) more...
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- 2021
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31. The impact of local smoke-free policies on smoking behaviour among adults in Indonesia: a quasi-experimental national study.
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Septiono W, Kuipers MAG, Ng N, and Kunst AE
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- Adult, Female, Health Knowledge, Attitudes, Practice, Health Surveys, Humans, Indonesia epidemiology, Male, Middle Aged, Smoke-Free Policy, Smoking epidemiology
- Abstract
Aims: To investigate to what extent the adoption of local smoke-free policies (SFPs) in Indonesia in 2007-13 was associated with changes in adult smoking behaviour., Design: A quasi-experimental study., Setting: Indonesia, 2007 and 2013., Participants: A total of 1 052 611 > 25-year-old adults. Data were derived from the 2007 and 2013 Indonesian national health survey., Measurements: For both years, provincial and district SFPs were identified from government documents in 497 districts in 33 provinces. Multi-level logistic regression analysis assessed the association of adoption of provincial and district SFPs between 2007 and 2013 with smoking continuation (among ever-smokers), current smoking and high smoking intensity (among current smokers). We controlled for survey year, SFP in 2007, socio-demographics and district characteristics., Findings: Provincial SFP exposure was associated with lower odds of smoking continuation [strong SFP versus no SFP: odds ratio (OR) = 0.71, 95% confidence interval (CI) = 0.66-0.76] and smoking intensity (strong SFP: OR= 0.91, 95% CI = 0.86-0.97), but also with higher odds of current smoking (strong SFP versus no SFP: OR = 1.08; 95% CI = 1.04-1.12). District SFP exposure was associated with higher odds of smoking continuation (strong SFP versus no SFP: OR = 1.07, 95% CI = 1.01-1.14) and current smoking (strong SFP versus no SFP: OR = 1.09, 95% CI = 1.05-1.14), but with lower odds of smoking intensity (moderately strong SFP versus no SFP: OR = 0.95, 95% CI = 0.91-0.99)., Conclusions: There may be an association between the adoption of local smoke-free policies in Indonesia and decreased adult smoking intensity. However, the evidence is inconsistent, which may reflect problems with policy implementation and enforcement., (© 2020 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.) more...
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- 2020
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32. The Association Between Smoke-Free School Policies and Adolescents' Perceived Antismoking Norms: Moderation by School Connectedness.
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Schreuders M, van den Putte B, Mlinarić M, Mélard N, Perelman J, Richter M, Rimpela A, Kuipers MAG, Lorant V, and Kunst AE
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- Adolescent, Adolescent Behavior, Europe epidemiology, Female, Humans, Male, Peer Group, Prevalence, Schools, Smoking epidemiology, Smoking psychology, Surveys and Questionnaires, Friends psychology, Health Knowledge, Attitudes, Practice, Smoke-Free Policy legislation & jurisprudence, Smoking legislation & jurisprudence, Students psychology
- Abstract
Introduction: Many European schools implement smoke-free school policies (SFSPs). SFSPs may decrease adolescent smoking by causing adolescents to perceive stronger antismoking norms, yet there exists no quantitative evidence that indicates for which norms and for whom such effects may occur. This study therefore assessed to what extent adolescents' perceived antismoking norms among best friends, teachers, and society at large were associated with SFSPs, and whether these associations were moderated by adolescents' level of school connectedness., Aims and Methods: Survey data were collected in 2016/2017 on 10,653 adolescents aged 14-16 years old and 315 staff members in 55 schools from seven European cities. Associations of adolescent-perceived SFSPs and staff-reported SFSPs with best friend, teacher, and societal antismoking norms were estimated in multilevel logistic regression models, adjusted for demographics and school-level smoking prevalence. We tested for interaction between school connectedness and SFSPs., Results: Adolescent-perceived SFSPs were positively associated with antismoking norms by teachers (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 1.15-1.85), were negatively associated with antismoking norms by best friends (OR: 0.81, 95% CI: 0.67-0.99), but were not significantly associated with antismoking norms by society at large (OR: 0.87, 95% CI: 0.74-1.02). All interaction tests between adolescent-perceived SFSPs and school connectedness were nonsignificant. Staff-reported SFSPs were not associated with any norm and showed no significant interaction with school connectedness., Conclusions: We found that SFSPs are associated with adolescents' perception of more antismoking norms by teachers, but less antismoking norms by best friends, irrespective of adolescents' level of school connectedness., Implications: Smoke-free school policies, just as many other tobacco control policies, are assumed to foster adolescents' perception of antismoking norms. Still, current evidence does not demonstrate which antismoking norms may be influenced by SFSPs and whether this influence is equal for adolescents with different levels of school connectedness. This study suggests that SFSPs foster adolescents' perception of antismoking norms by teachers, but may concurrently lead to the perception of less antismoking norms by best friends, irrespective of adolescents' school connectedness. SFSPs may therefore need to be complemented with interventions that target antismoking norms in adolescent peer groups., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.) more...
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- 2020
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33. Youth Access to Cigarettes Across Seven European Countries: A Mixed-Methods Study.
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Nuyts PAW, Hewer RMF, Kuipers MAG, Lorant V, Grard A, Hill S, and Amos A
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- Adolescent, Adolescent Behavior, Attitude to Health, Commerce legislation & jurisprudence, Europe epidemiology, Female, Focus Groups, Humans, Male, Surveys and Questionnaires, Tobacco Products legislation & jurisprudence, Tobacco Smoking epidemiology, Tobacco Smoking psychology, Tobacco Use Disorder psychology, Students psychology, Tobacco Products statistics & numerical data, Tobacco Smoking legislation & jurisprudence, Tobacco Use Disorder epidemiology, Tobacco Use Disorder prevention & control
- Abstract
Background: Despite widespread age-of-sale restrictions on tobacco, adolescents continue to obtain cigarettes and experiment with smoking. This mixed-methods study aimed to understand how European adolescents access cigarettes and how the policy context may influence this process, using a realist evaluation approach. This is the first study to assess access to cigarettes across various European contexts., Methods: A survey of 4104 students was combined with qualitative data from focus groups among 319 adolescents aged 14-19 across seven European countries. Data were synthesized to explore mechanisms via which young people obtain cigarettes despite age-of-sale restrictions., Results: While purchasing cigarettes from supermarkets was widely regarded as difficult, many participants purchased cigarettes from noncompliant retailers (often in smaller shops or cafes). Other contra-mechanisms included circumventing age checks, proxy purchases, and/or social sources. Dominant forms of access differed across the seven contexts, with direct purchases more common where perceived enforcement was low (eg, Belgium) and proxy purchases more important where perceived enforcement of age-of-sale laws was high (eg, Finland). The effectiveness of age-of-sale restrictions in reducing youth access appears to be influenced by a range of contextual factors including retailer compliance, the availability of vending machines, and the specific minimum age-of-sale., Conclusions: Our findings illustrate the relevance of programme theory in understanding the contra-mechanisms that undermine the effectiveness of age-of-sale laws in discouraging youth smoking. Young people's access to cigarettes could be further limited by addressing these contra-mechanisms, including an increase in the legal sales age (particularly in Belgium), banning vending machines, and strengthening enforcement., Implications: Despite widespread implementation of age-of-sale laws, a substantial proportion of minors continue to access cigarettes. Young people use a number of contra-mechanisms to circumvent age-of-sale restrictions. These include accessing cigarettes via social sources, proxy sales or by circumventing age checks. Our findings show that in contexts where perceived enforcement of age-of-sale restrictions is high, young people are more reliant on irregular forms of access such as proxy sales. Young people's access to cigarettes may be further reduced by policy interventions that address these contra-mechanisms-for example, banning vending machines, strengthening enforcement of age-of-sale laws, and increasing the minimum age-of-sale., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.) more...
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- 2020
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34. School tobacco policies and adolescent smoking in six European cities in 2013 and 2016: A school-level longitudinal study.
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Mélard N, Grard A, Robert PO, Kuipers MAG, Schreuders M, Rimpelä AH, Leão T, Hoffmann L, Richter M, Kunst AE, and Lorant V
- Subjects
- Adolescent, Cities, Humans, Longitudinal Studies, Public Policy, Schools, Smoking epidemiology, Smoking Prevention, Tobacco Products, Adolescent Behavior
- Abstract
Assessment of the effectiveness of school tobacco policies (STPs) in reducing adolescent smoking remains inconclusive. Previous studies took insufficient account of different dimensions of STPs, the different views of students and staff, and policy changes over time. This study assessed how a multidimensional STP, as perceived by students and staff, was associated with adolescent smoking over time in six European cities. The SILNE and SILNE-R surveys were conducted among students (n = 18,502) and staff (n = 438) in 38 schools in 2013 and 2016. Three dimensions (comprehensiveness, enforcement, and communication) were assessed and we calculated total STP scores. Multilevel logistic regressions estimated associations of STPs with adolescent smoking on and just outside school premises and with weekly smoking. Further analyses estimated associations between 2013 and 2016 STP changes and smoking outcomes in 2016, controlling for STP and smoking prevalence in 2013. On average, there were few increases in STP scores over time. Greater STP enforcement, as perceived by students, was associated with lower odds of weekly smoking (OR:0.93, 95%CI:0.89-0.97) and of smoking on school premises (OR:0.80, 95%CI:0.72-0.90). Higher total STP scores were associated with lower odds of smoking on school premises (OR:0.76, 95%CI:0.67-0.86), but not of smoking just outside premises or smoking weekly. Greater increases in STP scores over time were associated with lower odds of smoking on school premises in 2016 (OR:0.65, 95%CI:0.47-0.89). Well-enforced STPs may help reduce adolescent smoking at school. Schools should be supported in adopting comprehensive policies that also extend to the surroundings of their premises., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.) more...
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- 2020
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35. Impact of the "Stoptober" Smoking Cessation Campaign in England From 2012 to 2017: A Quasiexperimental Repeat Cross-Sectional Study.
- Author
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Kuipers MAG, West R, Beard EV, and Brown J
- Subjects
- Adolescent, Adult, Bayes Theorem, Cross-Sectional Studies, England epidemiology, Female, Humans, Male, Non-Randomized Controlled Trials as Topic, Prevalence, Smoking Cessation methods, Smoking Cessation psychology, Surveys and Questionnaires, Tobacco Use Disorder epidemiology, Young Adult, Smokers psychology, Smoking Cessation statistics & numerical data, Tobacco Use Cessation Devices statistics & numerical data, Tobacco Use Disorder psychology, Tobacco Use Disorder therapy
- Abstract
Introduction: Since 2012, England has an annual "Stoptober" campaign for collective smoking cessation. Our aim was to assess (1) overall impact of the Stoptober campaign on quit attempts over its first 6 years, (2) consistency of impact over the campaign years, and (3) the role of the campaign budget., Methods: We used data of 51 399 adult smokers and ex-smokers in 132 repeat cross-sectional monthly surveys in England, 2007-2017. In a quasiexperimental design, adjusted logistic regression analyses compared past-month quit attempt rate between (1) October and other months in the year, between 2007-2011 and 2012-2017; (2) October and other months, across years 2012-2017; and (3) October and other months, between high-budget (2012-2015) and low-budget Stoptober campaigns (2016-2017). Bayes factors (BF) differentiated insensitive data and absence of an effect., Results: (1) In 2012-2017, quit attempts were more prevalent in October versus other months (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.00 to 1.53), whereas similar in 2007-2011 (OR: 0.95, 95% CI: 0.76 to 1.18; BF = 0.2); data were somewhat insensitive but supported this difference (OR: 1.30, 95% CI: 0.97 to 1.75; BF = 2.1). (2) In 2012-2017, quit attempt prevalence ranged from 3.1% to 8.5% in October and 5.0% to 7.3% in other months. The difference between October and other months was large in 2012 (absolute unadjusted difference of 3.3%; OR: 1.92, 95% CI: 1.23 to 2.98) and 2015 (3.1%; OR: 1.84, 95% CI: 1.14 to 2.95), but small in 2013-2014 and 2016-2017 (0.36 < BF < 1.02). (3) Data were somewhat insensitive but supported interaction with campaign budget (OR: 1.50, 95% CI: 0.92 to 2.44; BF = 2.2)., Discussion: In 2012-2017, there appears to have been an increase in past-month quit attempts during October in England. The increase was inconsistent across Stoptober campaigns and appears to have been greater when the campaign budget was higher., Implications: Over the first 6 years of Stoptober campaigns, there appears to have been an overall increase in past-month quit attempts during October in England, and the data imply that a sufficiently high budget contributes to greater impact of the Stoptober campaign. These findings encourage the further spread of the Stoptober campaign to other countries. Future research should clarify how increased quit attempts as a consequence of Stoptober translate into quit success and which of Stoptober's ingredients were most important in increasing quit attempts, especially among vulnerable groups., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.) more...
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- 2020
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36. Trends in Attempts to Quit Smoking in England Since 2007: A Time Series Analysis of a Range of Population-Level Influences.
- Author
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Beard E, Jackson SE, West R, Kuipers MAG, and Brown J
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- Adolescent, Adult, Behavior Therapy, Cross-Sectional Studies, England epidemiology, Female, Humans, Male, Mass Media, Motivation, Prevalence, Smoking Cessation psychology, Time Factors, Tobacco Use Cessation Devices statistics & numerical data, Tobacco Use Disorder epidemiology, Young Adult, Smokers psychology, Smoking Cessation statistics & numerical data, Tobacco Use Cessation Devices trends, Tobacco Use Disorder psychology, Tobacco Use Disorder therapy
- Abstract
Aim: To quantify population-level associations between quit attempts and factors that have varied across 2007-2017 in England., Methods: Data from 51 867 past-year smokers participating in the Smoking Toolkit Study (a monthly cross-sectional survey of individuals aged 16+) were aggregated over an 11-year period. Time series analysis was undertaken using ARIMAX modeling. The input series were: (1) prevalence of smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy; (2) prevalence of roll-your-own tobacco use; (3) prevalence of (a) smoking and (b) non-daily smoking; (4) mass media expenditure; (5) average expenditure on smoking; (6) characteristics in the form of (a) prevalence of high motivation to quit, (b) average age, (c) proportion from lower social grades, and (d) average number of cigarettes smoked; and (7) implementation of tobacco control policies., Results: There was a decline in the prevalence of quit attempts from 44.6% to 33.8% over the study period. The partial point-of-sale ban was associated with a temporary increase in quit attempt prevalence (Badjusted = 0.224%; 95% confidence interval [CI] 0.061 to 0.388). Quit attempts were positively associated with the prevalence of high motivation to quit (Badjusted = 0.165%;95% CI 0.048 to 0.282) and negatively associated with the mean age of smokers (Badjusted = -1.351%; 95% CI -2.168 to -0.534). All other associations were nonsignificant., Conclusion: Increases in the prevalence of high motivation to quit was associated with higher prevalence of attempts to quit smoking, while an increase in the mean age of smokers was associated with lower prevalence. The introduction of the partial point-of-sale ban appeared to have a temporary positive impact., Implications: This study provides insight into how monthly changes in a wide range of population-level factors are associated with changes in quit attempts over an extended time period in a country with a strong tobacco control climate. The findings suggest a need for intervention or policy to stimulate quit attempts in older smokers. Otherwise, increases in the mean age of a smokers appears likely to undermine wider efforts to promote quit attempts in a population., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.) more...
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- 2020
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37. An Increase in the Tobacco Age-of-Sale to 21: For Debate in Europe.
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Nuyts PAW, Kuipers MAG, Willemsen MC, and Kunst AE
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- Adolescent, Adult, Age Factors, Europe epidemiology, Government Regulation, Humans, Young Adult, Commerce legislation & jurisprudence, Minors legislation & jurisprudence, Tobacco Products legislation & jurisprudence, Tobacco Smoking epidemiology
- Abstract
A debate on the adoption of a tobacco age-of-sale of 21 in Europe has not occurred, with the recent exception of the United Kingdom. The current legally set age of 18 years is proving to be inadequate as adolescents continue to access cigarettes. Tobacco 21 laws have the potential to further limit access to cigarettes by minors. We believe that soon the time will be ripe for this discussion to spread throughout Europe, specifically among countries that have adopted a smoke-free generation movement., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.) more...
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- 2020
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38. Never-smoking adolescents' perceived accessibility of cigarettes following an increase in the tobacco age-of-sale from 16 to 18: A quasi-experimental study of two cities in the Netherlands and Belgium.
- Author
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Nuyts PAW, Kuipers MAG, Willemsen MC, Lorant V, and Kunst AE
- Subjects
- Adolescent, Belgium, Cross-Sectional Studies, Female, Humans, Male, Netherlands, Prevalence, Commerce legislation & jurisprudence, Minors psychology, Tobacco Products economics
- Abstract
Background: The Netherlands increased the tobacco age-of-sale from 16 to 18 in 2014, paired with mass-media campaigns. We evaluated changes in perceived accessibility of cigarettes between 2013 and 2016 among adolescent never-smokers in the Netherlands compared with Belgium, where the age-of-sale remained 16 and no campaigns were conducted., Methods: Repeated cross-sectional surveys were conducted in 2013 and 2016 among 4112 13-17-year-olds at a total of 22 schools in Amersfoort (the Netherlands) and Namur (Belgium). Multilevel Poisson regression quantified changes over time in prevalence of easy perceived accessibility to cigarettes (i.e., thinking it would be fairly/very easy to get cigarettes). Interaction terms were used to test whether changes differed between the Netherlands and Belgium. Analyses were stratified by age (13-15 and 16-17 years), sex (male and female), family smoking (0 and ≥1 smoking family members), and friend smoking (no and at least some smoking friends)., Results: Perceived accessibility to cigarettes decreased in the Netherlands (Prevalence Ratio (PR): 0.82; 95% CI: 0.72-0.93) and Belgium (PR: 0.78; 95% CI: 0.70-0.87), to a similar extent (PR interaction: 1.04; 95% CI: 0.90-1.21). Results by sex, age, and family/friend smoking were similar to those for the total population; there were no significant differences in the decrease in perceived access over time between the Netherlands and Belgium within each of these subgroups., Conclusion: This study found approximately the same rate of decline between 2013 and 2016 in adolescent never-smokers' perceived access to cigarettes in the Netherlands as in Belgium. This implies that we did not find clear evidence for an effect of the 2014 increase in legal age of tobacco sales from 16 to 18 years in the Netherlands., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.) more...
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- 2020
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39. Impact of a ban on the open display of tobacco products in retail outlets on never smoking youth in the UK: findings from a repeat cross-sectional survey before, during and after implementation.
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Ford A, MacKintosh AM, Moodie C, Kuipers MAG, Hastings GB, and Bauld L
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- Adolescent, Child, Female, Health Behavior, Health Policy, Health Promotion, Health Status, Humans, Legislation, Drug, Male, Odds Ratio, Tobacco Industry economics, Tobacco Products economics, United Kingdom, Adolescent Behavior, Child Behavior, Cigarette Smoking, Commerce legislation & jurisprudence, Marketing legislation & jurisprudence, Tobacco Industry legislation & jurisprudence, Tobacco Products legislation & jurisprudence
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Background: In the UK, a ban on the open display of tobacco products at the point of sale (POS) was phased in between 2012 and 2015. We explored any impact of the ban on youth before, during and after implementation., Methods: A repeat cross-sectional in-home survey with young people aged 11-16 years old in the UK was conducted preban (2011, n=1373), mid-ban (2014, n=1205) and postban (2016, n=1213). The analysis focuses on the never-smokers in the sample (n=2953 in total). Preban, we quantified the associations of noticing cigarettes displayed at POS and cigarette brand awareness with smoking susceptibility. We measured any change in noticing cigarettes displayed at POS, cigarette brand awareness and smoking susceptibility between preban, mid-ban and postban. Postban, we assessed support for a display ban, perceived appeal of cigarettes and perceived acceptability of smoking as a result of closed displays., Results: Preban, noticing cigarettes displayed at POS (adjusted OR [AOR]=1.97, 95% CI 1.30 to 2.98) and higher brand awareness (AOR=1.15, 95% CI 1.03 to 1.29) were positively associated with smoking susceptibility. The mean number of brands recalled declined from 0.97 preban to 0.69 postban (p<0.001). Smoking susceptibility decreased from 28% preban to 23% mid-ban and 18% postban (p for trend <0.001). Postban, 90% of never-smokers supported the display ban and indicated that it made cigarettes seem unappealing (77%) and made smoking seem unacceptable (87%)., Conclusions: Both partial and full implementation of a display ban were followed by a reduction in smoking susceptibility among adolescents, which may be driven by decreases in brand awareness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.) more...
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- 2020
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40. Changes in adolescent smoking with implementation of local smoke-free policies in Indonesia: Quasi-experimental repeat cross-sectional analysis of national surveys of 2007 and 2013.
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Septiono W, Kuipers MAG, Ng N, and Kunst AE
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- Adolescent, Child, Cross-Sectional Studies, Female, Health Surveys methods, Humans, Indonesia epidemiology, Male, Smoking Prevention methods, Adolescent Behavior psychology, Health Surveys trends, Smoke-Free Policy trends, Smoking epidemiology, Smoking psychology, Smoking Prevention trends
- Abstract
Background: Banning smoking from public places may prevent adolescent smoking, but there is little evidence on impact of smoke-free policies (SFPs) from low and middle-income countries. This study assessed to what extent the adoption of local SPFs in Indonesia between 2007 and 2013 associated with adolescent smoking., Methods: Data on 239,170 adolescents (12-17 years old) were derived from the 2007 and 2013 national health surveys in 497 districts and 33 provinces. This study compared 2013 survey respondents living in districts/provinces that adopted SFPs between 2007 and 2013, with 2007 respondents and 2013 respondents in districts/provinces that did not adopt policies. Multilevel logistic regression analysis assessed whether SFP was associated with daily and non-daily smoking. We controlled for survey year, SFP in 2007, socio-demographics, and district characteristics., Results: Strong district SFPs was significantly associated with lower odds of daily smoking (OR:0.81, 95 %CI:0.69-0.97), but non-significantly with non-daily smoking (OR:0.89, 95 %CI:0.76-1.05). Strong provincial SFPs was not associated with daily smoking (OR:1.02, 95 %CI:0.84-1.25), but was associated with higher odds of non-daily smoking (OR:1.22, 95 %CI:0.99-1.51). Moderately strong SFPs did not consistently show associations in the same direction. For example, moderately strong provincial SFP was associated with higher odds of daily smoking (OR:1.27, 95 %CI:1.11-1.46) and lower odds of non-daily smoking (OR:0.82, 95 %CI:0.72-0.93)., Conclusion: We did not detect a consistent short-term effect of district and province-level smoke-free policies on adolescent smoking in Indonesia. Weak implementation and poor compliance may compromise effectiveness, which would call for improvement of SFP implementation in Indonesia., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.) more...
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- 2020
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41. Population-level predictors of changes in success rates of smoking quit attempts in England: a time series analysis.
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Beard E, Jackson SE, West R, Kuipers MAG, and Brown J
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- Adult, Behavior Therapy statistics & numerical data, Cross-Sectional Studies, Electronic Nicotine Delivery Systems statistics & numerical data, England epidemiology, Female, Humans, Interrupted Time Series Analysis, Male, Mass Media economics, Models, Statistical, Prevalence, Tobacco Use Cessation Devices statistics & numerical data, Guidelines as Topic, Smoking Cessation methods, Smoking Cessation statistics & numerical data, Smoking Prevention methods, Smoking Prevention trends
- Abstract
Aims: To quantify associations between the success of smoking quit attempts and factors that have varied throughout 2007-2018 at a population level., Design: time series analysis using Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling., Setting and Participants: Data were aggregated from 54 847 past-year smokers taking part in the Smoking Toolkit Study which involves monthly repeated cross-sectional household surveys of individuals aged 16+ in England., Measurements: The input series were: (1) attempts at smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy (NRT); (2) use during a quit attempt of (a) e-cigarettes, (b) NRT over-the-counter, (c) medication on prescription and (d) face-to-face behavioural support; (3) use of roll-your-own tobacco; (4) prevalence of (a) smoking and (b) non-daily smoking; (5) tobacco control mass media expenditure; (6) expenditure on smoking; (7) smoker characteristics in the form of (a) high motivation to quit, (b) average age, (c) socio-economic status and (d) cigarette consumption; (8) implementation of tobacco control policies; and (9) quit attempt rate., Findings: The licensing of NRT for harm reduction was associated with a 0.641% [95% confidence interval (CI) = 0.073-1.209, P = 0.027] increase in the mean point prevalence of the success rate of quit attempts. For every 1% increase in the mean point prevalence of e-cigarette use and use of prescription medication during a quit attempt, the mean point prevalence of successful quit attempts increased by 0.106% (95% CI = 0.011-0.201, P = 0.029) and 0.143% (95% CI = 0.009-0.279, P = 0.038), respectively. For every 1% increase in the mean expenditure on tobacco control mass media, the mean point prevalence of successful quit attempts increased by 0.046% (95% CI = 0.001-0.092, P = 0.046). Other associations were not statistically significant., Conclusion: In England between 2007 and 2018, licensing of nicotine replacement therapy for use in harm reduction, greater use of e-cigarettes and prescription medications during a quit attempt and higher expenditure on tobacco control mass media were all associated with higher success rates of quit attempts., (© 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.) more...
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- 2020
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42. The Use of the Alcohol Use Disorders Identification Test - Consumption as an Indicator of Hazardous Alcohol Use among University Students.
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Verhoog S, Dopmeijer JM, de Jonge JM, van der Heijde CM, Vonk P, Bovens RHLM, de Boer MR, Hoekstra T, Kunst AE, Wiers RW, and Kuipers MAG
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- Adolescent, Adult, Cross-Sectional Studies, Educational Status, Female, Humans, Male, Netherlands, Predictive Value of Tests, Sensitivity and Specificity, Sex Factors, Young Adult, Alcohol Drinking in College psychology, Alcohol-Related Disorders diagnosis, Diagnostic Techniques and Procedures instrumentation, Health Surveys statistics & numerical data
- Abstract
Background: Hazardous drinking among students in higher education is a growing concern. The alcohol use disorders identification test (AUDIT) is the gold standard screening instrument for hazardous drinking in the adult population, for which an abbreviated version has been developed: the -AUDIT-Consumption (AUDIT-C). Currently, there's no gold standard for identifying hazardous drinking among students in higher education and little evidence regarding the concurrent validity of the AUDIT-C as a screening instrument for this group. This study investigated the concurrent validity of the AUDIT-C in a sample of university students and suggests the most appropriate cutoff points., Methods: Cross-sectional data of health surveys from 5,401 university and university of applied sciences in the Netherlands were used. Receiver operating characteristic (ROC) curves, sensitivity, specificity, and positive and negative predictive values for different cutoff scores of AUDIT-C were calculated for the total sample and for subgroups stratified by age, gender, and educational level. AUDIT-score ≥11 was used as the criterion of hazardous and harmful drinking., Results: Twenty percent of students were hazardous and harmful drinkers. The area under the ROC curve was 0.922 (95% CI 0.914-0.930). At an AUDIT-C cutoff score of ≥7, sensitivity and specificity were both >80%, while other cutoffs showed less balanced results. A cutoff of ≥8 performed better among males, but for other subgroups ≥7 was most suitable., Conclusion: AUDIT-C seems valid in identifying hazardous and harmful drinking students, with suggested optimal cutoffs 7 (females) or 8 (males). However, considerations regarding avoiding false-positives versus false-negatives, in relation to the type of intervention following screening, could lead to selecting different cutoffs., (© 2019 The Author(s) Published by S. Karger AG, Basel.) more...
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- 2020
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43. The visibility of smoking in Europe and its relationship with youth's positive beliefs about smoking.
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Lagerweij NA, Kuipers MAG, Schreuders M, Grard A, Mlinarić M, Richter M, Leão T, Kinnunen JM, and Kunst AE
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- Adolescent, Cities statistics & numerical data, Cross-Sectional Studies, Europe, Female, Humans, Male, Adolescent Behavior psychology, Attitude to Health, Students psychology, Tobacco Smoking psychology
- Abstract
Objectives: To determine adolescent-reported visibility of smoking in different public and private spaces in Europe and associations between smoking visibility and beliefs about the benefits of smoking., Methods: We used SILNE-R cross-sectional survey data (2016/2017) of 10,798 14-16-year-old students from 55 secondary schools in seven European cities. Respondents reported for private and public spaces whether they had seen others smoke there in the last 6 months. Beliefs about the benefits of smoking were measured on a 7-item scale; higher scores indicated more positive beliefs. Multilevel linear regression analyses determined associations while controlling for potential confounders and stratifying by smoking status., Results: Most students reported observing others smoke in public spaces, especially at train/bus stations (84%). Positive beliefs about smoking of never smokers were positively associated with seeing others smoke in train/bus stations and leisure/sports facilities, but not at home, a friend's home, restaurants or bars, when fully adjusted. Associations were of similar magnitude for ever smokers., Conclusions: Smoking in several public places is highly visible to adolescents. Reducing this visibility might weaken positive beliefs that adolescents have about smoking. more...
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- 2019
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44. Where do teens smoke? Smoking locations of adolescents in Europe in relation to smoking bans in bars, schools and homes.
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Lagerweij NA, Kunst AE, Mélard N, Rimpelä A, Alves J, Hoffmann L, Richter M, and Kuipers MAG
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- Adolescent, Europe epidemiology, Female, Humans, Logistic Models, Male, Prevalence, Smoking psychology, Surveys and Questionnaires, Young Adult, Smoke-Free Policy, Smoking epidemiology
- Abstract
This study aimed to assess where European adolescents smoke. Data of 2,140 13-19-year-olds from 55 secondary schools in seven European cities was analysed using multilevel logistic regression analyses. Adolescents most often reported regularly smoking in 'other public locations (e.g., streets and parks)' (69%) and friends' homes (50%). Adolescents were less likely to smoke in bars, at school or at home when exposed to strong smoking bans at these locations. Bans on smoking in bars or at home were associated with regular smoking in other public locations, suggesting that smoking may have displaced towards these locations., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.) more...
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- 2019
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45. Inequalities in adolescent self-rated health and smoking in Europe: comparing different indicators of socioeconomic status.
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Moor I, Kuipers MAG, Lorant V, Pförtner TK, Kinnunen JM, Rathmann K, Perelman J, Alves J, Robert PO, Rimpelä A, Kunst AE, and Richter M
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- Adolescent, Europe epidemiology, Female, Humans, Male, Self Report, Adolescent Health statistics & numerical data, Health Status Disparities, Smoking epidemiology, Social Class
- Abstract
Background: Although there is evidence for socioeconomic inequalities in health and health behaviour in adolescents, different indicators of socioeconomic status (SES) have rarely been compared within one data sample. We examined associations of five SES indicators with self-rated health (SRH) and smoking (ie, a leading cause of health inequalities) in Europe., Methods: Data of adolescents aged 14-17 years old were obtained from the 2013 SILNE survey (smoking inequalities: learning from natural experiments), carried out in 50 schools in 6 European cities (N=10 900). Capturing subjective perceptions of relative SES and objective measures of education and wealth, we measured adolescents' own SES (academic performance, pocket money), parental SES (parental educational level) and family SES (Family Affluence Scale, subjective social status (SSS)). Logistic regression models with SRH and smoking as dependent variables included all SES indicators, age and gender., Results: Correlations between SES indicators were weak to moderate. Low academic performance (OR=1.96, 95% CI 1.53 to 2.51) and low SSS (OR=2.75, 95% CI 2.12 to 3.55) were the strongest indicators of poor SRH after adjusting for other SES-indicators. Results for SSS were consistent across countries, while associations with academic performance varied. Low academic performance (OR=5.71, 95% CI 4.63 to 7.06) and more pocket money (OR=0.21, 95% CI 0.18 to 0.26) were most strongly associated with smoking in all countries., Conclusions: Socioeconomic inequalities in adolescent health were largest according to SES indicators more closely related to the adolescent's education as well as the adolescent's perception of relative family SES, rather than objective indicators of parental education and material family affluence. For future studies on adolescent health inequalities, consideration of adolescent-related SES indicators was recommended., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2019
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46. Nicotine dependence among adolescents in the European Union: How many and who are affected?
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Coban FR, Kunst AE, Van Stralen MM, Richter M, Rathmann K, Perelman J, Alves J, Federico B, Rimpelä A, Lorant V, and Kuipers MAG
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- Adolescent, Adolescent Behavior, Europe epidemiology, European Union statistics & numerical data, Female, Humans, Ireland epidemiology, Logistic Models, Male, Risk Factors, Sex Distribution, Surveys and Questionnaires, Smoking epidemiology, Tobacco Use Disorder epidemiology
- Abstract
Background: Nicotine dependence during adolescence increases the risk of continuing smoking into adulthood. The magnitude of nicotine dependence among adolescents in the European Union (EU) has not been established. We aimed to estimate the number of nicotine dependent 15-year-old adolescents in the EU, and identify high-risk groups., Methods: The number of nicotine dependent 15-year-olds in the EU was derived combining: (i) total number of 15-year-olds in the EU (2013 Eurostat), (ii) smoking prevalence among 15-year-olds (2013/2014 HBSC survey) and (iii) proportion of nicotine dependent 15-year-olds in six EU countries (2013 SILNE survey). Logistic regression analyses identified high-risk groups in the SILNE dataset., Results: We estimated 172 636 15-year-olds were moderately to highly nicotine dependent (3.2% of all 15 years old; 35.3% of daily smokers). In the total population, risk of nicotine dependence was higher in males, adolescents with poor academic achievement, and those with smoking parents or friends. Among daily smokers, only lower academic achievement and younger age of smoking onset were associated with nicotine dependence., Conclusion: According to our conservative estimates, more than 172 000 15-year-old EU adolescents were nicotine dependent in 2013. Prevention of smoking initiation, especially among adolescents with poor academic performance, is necessary to prevent a similar number of adolescents getting addicted to nicotine each consecutive year., (© The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) more...
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- 2019
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47. Progress of smoke-free policy adoption at district level in Indonesia: A policy diffusion study.
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Septiono W, Kuipers MAG, Ng N, and Kunst AE
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- Humans, Indonesia, Government Regulation, Smoke-Free Policy trends, Tobacco Industry legislation & jurisprudence
- Abstract
Background: Even though Indonesia has not ratified the Framework Convention on Tobacco Control (FCTC), district and provincial stakeholders are increasingly adopting smoke-free policies (SFPs). This study aimed to 1) assess whether local SFP adoption in Indonesia followed a horizontal or vertical diffusion pattern and 2) identify district characteristics that are associated with the SFP adoption., Methods: Policy documents enacted during 2004-2015 were compiled from 33 provinces and 510 districts in Indonesia. First, we described the geographical distributions of the policy adoption. Second, we ran logistic regression to assess the associations of district SFP adoption with having adjacent districts that had adopted SFPs (i.e. horizontal diffusion) and being situated in a province that had adopted SFPs (i.e. vertical diffusion). Third, the associations between district characteristics (population density, GDP, tobacco production) and SFP adoption were assessed using logistic regression., Results: By 2015, a total of 17 provinces and 143 districts had adopted SFPs. Districts with SFPs were more concentrated in the western part of Indonesia. Adoption was more likely in districts of which adjacent districts had already adopted SFPs (OR: 2.02; 95%CI: 1.26-3.23), and less likely when the province had already adopted SFPs (OR: 0.19; 95%CI: 0.11 - 0.34). Adoption was more likely in districts with higher GDP (OR high vs low GDP: 3.28; 95%CI: 1.80-5.98) and higher population density (OR high vs low density: 6.57; 95%CI: 3.63-11.9). High tobacco production showed a strong inverse association with SPF adoption (OR high vs. no production: 0.36; 95%CI: 0.17-0.74)., Conclusions: Smoke-free policy adoption in Indonesian districts followed a horizontal diffusion pattern, with poorer and rural districts lagging behind in their policy adoption. Our results indicate that local-level policy development is important for smoke-free policy adoption in countries with decentralised governments, but that effective advocacy is needed to counteract tobacco industry interference., (Copyright © 2019 Elsevier B.V. All rights reserved.) more...
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- 2019
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48. Impact of removing point-of-sale tobacco displays on smoking behaviour among adolescents in Europe: a quasi-experimental study.
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Van Hurck MM, Nuyts PAW, Monshouwer K, Kunst AE, and Kuipers MAG
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- Adolescent, Advertising, Cross-Sectional Studies, Europe epidemiology, Female, Humans, Male, Program Evaluation, Public Policy, Adolescent Behavior, Commerce ethics, Commerce legislation & jurisprudence, Commerce methods, Marketing legislation & jurisprudence, Marketing methods, Smoking, Smoking Prevention methods, Tobacco Industry ethics, Tobacco Industry methods, Tobacco Products legislation & jurisprudence
- Abstract
Background: An increasing number of European countries implemented a point-of-sale (PoS) display ban on tobacco products. This study assessed the association between PoS display bans in Europe and adolescent smoking and perceived accessibility of tobacco, 2-6 years after PoS display ban implementation., Methods: In a quasi-experimental design, we compared individuals in countries that did and countries that did not implement a PoS display ban, before and after implementation. We used repeated cross-sectional data of 174 878 15-year-old and 16-year-old adolescents from 25 countries from the 2007, 2011 and 2015 European Survey Project on Alcohol and Other Drugs surveys. Multilevel logistic regression models examined smoking behaviour (regular smoking vs other) and perceived access (easy vs difficult) as a function of display ban implementation and controlled for survey year, gender, parental education and implementation of other tobacco control policies. Interaction with gender was tested., Results: The implementation of a PoS display ban was associated with a 15% larger drop in the odds of regular smoking (OR 0.85, 95% CI 0.79 to 0.91), but was not significantly associated with perceived accessibility of tobacco (OR 0.97, 95% CI 0.892 to 1.03). Associations were similar in males and females (cross-level interactions of gender with display ban were not statistically significant for either outcome)., Conclusion: The implementation of PoS display bans in Europe was associated with a stronger decrease in regular smoking among adolescents. This decrease does not appear to be driven by a decreasing accessibility of tobacco, but might be caused by further de-normalisation of tobacco as a result of PoS display bans., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2019
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49. Adolescents notice fewer tobacco displays after implementation of the point-of-sale tobacco display ban in Finland.
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Kinnunen JM, Ollila H, Linnansaari A, Timberlake DS, Kuipers MAG, and Rimpelä AH
- Abstract
Introduction: Finland implemented a point-of-sale (POS) display ban for tobacco products and their trademarks in 2012, and for electronic cigarettes in 2016. In this study we examine whether noticing tobacco products changed among adolescents after the implementation of the display ban and describe the noticing of e-cigarette displays post-implementation., Methods: Repeated cross-sectional national survey data of 12-to 16-year-olds from years 2011, 2013, 2015 and 2017 were used. Measures included adolescent self-report on noticing displays of tobacco and e-cigarettes in shops, kiosks and service stations. Adjusting for age, gender, smoking and academic achievement, logistic regression analyses were conducted by retailer type to test the association between survey year and noticing POS tobacco displays., Results: The proportions of adolescents noticing tobacco displayed in shops, kiosks and service stations decreased from 2011 to 2013 (from over 80% to about 30%). Between 2013 and 2017, exposure to tobacco displays decreased for kiosks but slightly increased for shops and service stations. However, in all retailer types, rates in 2017 were still well below the pre-ban levels of 2011. In 2017, noticing e-cigarette displays by 12- to16-year-old adolescents was reported by 5.6% in shops, 20.5% in kiosks and 5.1% in service stations., Conclusions: The pronounced decline in adolescents' exposure to tobacco products at POS observed in the current study implies adherence to the ban, as intended by the law. We encourage more countries to enact POS tobacco advertising and display bans, and to enforce the POS regulations to all tobacco products and novel nicotine delivery systems., Competing Interests: The authors declare that they have no competing interests, financial or otherwise, related to the current work. JM Kinnunen and AH Rimpelä report grants from Ministry of Social Affairs and Health, during the conduct of the study. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest., (© 2019 Kinnunen JM.) more...
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- 2019
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50. Smoking in bars in eight European countries in 2010 and 2016: an observational comparative study.
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van Beek KNJ, Kuipers MAG, Lignac O, and Kunst AE
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- Adult, Aged, Austria, Belgium, Czech Republic, Denmark, England, Female, Forecasting, France, Germany, Humans, Male, Middle Aged, Netherlands, Restaurants statistics & numerical data, Restaurants trends, Restaurants legislation & jurisprudence, Tobacco Smoke Pollution legislation & jurisprudence, Tobacco Smoke Pollution prevention & control, Tobacco Smoking legislation & jurisprudence, Tobacco Smoking trends
- Abstract
Background: Most European countries established laws against smoking in public places. We aimed to describe the prevalence of smoking in bars in 2010 and 2016 in eight European countries and to characterise those bars in which smoking still occurred in 2016., Methods: Smoking in bars was studied in 16 cities in 8 European countries (Austria, Belgium, Czech Republic, Denmark, England, France, Germany and the Netherlands). In 2010, 96 bars were visited. In 2016, 51 bars were revisited and 45 new bars were visited. Smoking indoors and characteristics of bars, terrace and customers were observed using a standard observation template. Associations between bar characteristics and smoking were analyzed using logistic regression., Results: Overall prevalence of in-bar smoking was 39.6% in 2010 and 34.4% in 2016. Prevalence in bars covered by smoke-free legislation decreased from 24.2 to 13.0% between 2010 and 2016 whereas prevalence in bars where smoking was legally allowed increased from 73.3 to 88.9%. In-bar smoking almost exclusively occurred in countries with partial smoke-free legislation compared with more comprehensive legislation. Smoking was more prevalent in bars for locals, with a counter for drinks, slot-machines, no outside seating and no food service. Size of the bar, comfort of the terrace and the presence of cigarette vending machines were not associated with in-bar smoking., Conclusions: Whereas comprehensive smoke-free legislation resulted in high compliance, smoking increased in bars in countries with partial or no smoke-free legislation. This study confirms that comprehensive smoke-free legislation is needed to protect customers and personnel against second-hand-smoke exposure in all bars. more...
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- 2019
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