Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
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SESSION ED12: REGIONAL TOBACCO CONTROL POLICIES:
ADVANCES & CHALLENGES
WEDNESDAY, DECEMBER 7, 2016 - 11:00-12:30
ED12.01 TOBACCO CONTROL POLICIES IN EASTERN EUROPE
Gábor Kovács, Zsuzsa Cselkó
National Korányi Institute for TB and Pulmonology, Budapest/Hungary
According to the regional distribution of the World Health Organization
(WHO), Europe extends from the Atlantic Ocean to Central Asia,
encompassing states of the former Soviet Union. In political terms however,
Eastern Europe refers to countries located on the eastern border of the
European Union (EU). Consequently, in our presentation we focus on how
smoking status has changed in some of the policy-wise emerging countries
located here – namely the Czech Republic, Hungary, Poland and Romania – and
how these data compare to Austria’s indicators. We present data on smoking
prevalence and trends, restricting use, taxation and average cigarette prices,
as well as the distribution of tobacco products in specific countries. Reference
is made to restricting advertising and tobacco industry sponsorship activities.
Smoking cessation support practice is another important aspect, while
electronic cigarette (e-cigarette) regulation is a relatively new issue. Table 1
presents smoking prevalence and trends of specific countries.
CZE HUN POL ROM AUT
1980 26,2 34,8 42,5 26,8 27,8
1996 26,6 31,1 33,7 30,6 29,6
2006 26,3 32,9 30,5 26,7 32,5
2012 24,4 28,5 27,6 27,5 32,3
Table 1. Smoking prevalence (%) (+15 years old) It is striking that while the
proportion of smokers has decreased in Hungary and Poland, an opposite
tendency may be observed in Austria. Smoking prevalence stagnated in
Romania and the Czech Republic. It is noteworthy that the proportion of
women smokers is high in Austria (28.3%), in Hungary (25.8%) and in Poland
(24.1%). Smoke-free laws were adopted in the beginning of this Century in
North America and Western Europe, and soon resulted in decreasing the
proportion of smokers. Although there were smoking and trade control
laws earlier in the presented countries, effective legislation has only been
promulgated a few years ago and in some countries it hasn’t even been
published. Hungary applies total ban on smoking in enclosed public places
(with the exception of psychiatric units) since 2011. In Poland, a partial ban
is in place, smoking is allowed in certain restaurants. The Czech Republic
exercises a slightly more liberal regulation regarding restaurants. A partial
ban exists in Romania in restaurants and there may be designated smoking
areas in enclosed places where smoking is prohibited. Smoking is allowed in
restaurants in Austria. Smoking is otherwise banned in all other enclosed
places in these countries as well. It is well known that raising the price of
tobacco products is the best tobacco control measure, we therefore compared
tax rates and prices of popular cigarette brands. Although EU member states
must comply with EU tax regulation requirements, recently joined members
are allowed several years to converge, therefore significant differences may
be observed in this manner between discussed countries. Countries generally
apply combined taxation policy on cigarettes in agreement with Article 6
of the WHO Framework Convention on Tobacco Control Guideline: apart
from the value added tax (VAT), the excise duty consists of an ad valorem
and a specific element In 2015, the average 20 piece pack price (in Euro) was
4.6 in Austria, 3 in the Czech Republic, 3.2 in Hungary, 3.2 in Poland and 2.8
in Romania. Regulating the distribution and limiting the access to certain
tobacco products is an important tool in tobacco control, and even more so
in the prevention of youth smoking. The sale of tobacco products to minors
is generally prohibited under 18 years (in Austria, under 16 years), however
there are noteworthy differences where vending machines are concerned,
e.g. in Austria these are allowed to operate. Sale of cigarettes over the
internet is legal in the Czech Republic. Directly accessible distribution of
tobacco products is allowed in Poland and Romania. Hungary applies the
highest degree on distribution restriction: tobacco may only be purchased in
supervised tobacco stores, vending machines and internet sale are prohibited.
Advertising and tobacco industry sponsorship activities are uniformly
forbidden in these countries. Yet another important issue of tobacco control
is the accessibility and financial support of smoking cessation programs.
Austria focuses its efforts on youth smoking prevention, nevertheless
cessation programs are also coordinated nationally. The Czech Republic lays
great effort on disseminating brief intervention practice among physicians
and nurses. Health insurance covers smoking cessation programs, however
pharmacotherapies are excluded. The National Health Fund partially covers
smoking cessation programs in Poland. Romania has established specialized
quit centers whose activities are partially covered by health insurance. In
Hungary, the Methodological Centre coordinates cessation activity in nearly
one hundred pulmonary outpatient clinics around the country, offering
individual and group cessation counseling. Counseling is covered by health
insurance, excluding pharmacotherapy. In addition, telephone counseling
and cessation support is also available free of charge. Regarding e-cigarettes,
diverse regulatory schemes are detected across Europe. In Hungary, the
distribution of nicotine containing e-cigarette cartridges fall under the
drugs act, whereas the same regulation applies to the use as to regular
cigarettes. The latter is observed also in Poland. Promotion and distribution
of e-cigarettes is prohibited in Austria. In the Czech Republic however, both
advertising and distribution is analogues to that of regular cigarettes. The
Association of European Cancer Leagues (ECL) assesses European countries’
efforts in tobacco control every three years using the Tobacco Control Scale
(TCS). The TCS quantifies the implementation of tobacco control policies
based on six strategies described by the World Bank: price increases,
public information campaigns, bans on advertising and promotion, smoke
free work and other public places, health warnings and treatment to help
smokers stop. It is informative to observe the 2013 ranking of the discussed
countries: the Czech Republic had a continuously deteriorating position and
ranked 31 st , while Austria earned the 34 th , Poland the 20 th and Romania the
19 th position among the 34 surveyed countries. Hungary has significantly
improved its position between 2010 and 2013, and due to fierce government
measures in recent years it ranked 11 th as compared to the previous 27 th spot.
References: 1. World Health Organization Framework Convention on Tobacco
Control Implementation Database. 2. Ng, M., et al.: Smoking Prevalence and
Cigarette Consumption in 187 Countries, 1980-2012. JAMA. 2014;311(2):183-192.
doi:10.1001/jama.2013.284692
Keywords: tobacco control policies, smoking prevalence
ED12: REGIONAL TOBACCO CONTROL POLICIES: ADVANCES & CHALLENGES
WEDNESDAY, DECEMBER 7, 2016 - 11:00-12:30
ED12.02 TOBACCO CONTROL: THE TURKISH EXPERIENCE
Nazmi Bilir
Public Health, Hacettepe University, Ankara/Turkey
Turkey has been a tobacco producing country since Ottoman time. At that
time tobacco production mostly was in the hands of foreign companies.
Following the establishment of Turkish Republic in 1923, the State
Monopoly on tobacco was established and tobacco production and sales was
nationalized by the government, therefore production and sales of tobacco
was planned and implemented by the State Monopoly (TEKEL). Only domestic
tobacco products were on sale in the country, and importation and sales of
foreign tobacco products was not allowed. TEKEL provided tobacco products
for the smokers, but did not make any effort to increase its use; i.e. did not
make any advertisement of tobacco. The tobacco monopoly has been the
only responsible body on tobacco production and sales, until 1980’s. In 1984
the law passed at the Parliament allowing importation of foreign cigarettes
into the country, and then tobacco advertisements started. In 1987 Minister
S26 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017