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The prevalence of smoking in Indonesia is one of the highest in the world. Since 2007, some tobacco control policies have been implemented by the Indonesian government. However, evidence on the effectiveness of such policies at reducing tobacco use in Indonesia is scarcely available. Using both cross-sectional and longitudinal analysis of individual and household data from two waves of the Indonesia Family Life Survey (IFLS), this study explored changes in smoking patterns among Indonesian adults between 2007 and 2014 controlling for sociodemographic factors. Overall, there was no statistically significant change in the prevalence of smoking between 2007 and 2014. However, cigarettes became more affordable. Smokers in 2014 consumed more cigarettes (β: 0.95; 0.73, 1.17) and spent more money on cigarettes (β: IDR 2,775; IDR 1,124, IDR 4,426) compared to those in 2007. Males, individuals <55 years old and those with lower levels of education had a higher likelihood of being smokers in 2014. Respondents with lower education levels and those under 26 years of age had higher odds of initiating smoking during the study period. Similarly, smoking cessation between 2007 and 2014 was more likely among respondents with higher levels of education and aged above 40 years. In conclusion, the implementation of tobacco control measures does not appear to have had a positive impact on smoking behaviours among adults in Indonesia between 2007 and 2014. Instead, cigarette consumption increased differentially across socio-demographic groups. Hence, tailored tobacco control interventions targeting the most socially disadvantaged population may be necessary in Indonesia.

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

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INTRODUCTION Electronic cigarette (e-cigarette) use has grown significantly in some European Union (EU) Member States (MS). A better understanding of the exposure to secondhand e-cigarette aerosols (SHA) is necessary to develop and implement comprehensive regulations on e-cigarette use in public places. This study aims to assess the observation of e-cigarette use in public places, the self-reported exposure to SHA, and the level of users’ comfort using e-cigarettes in the presence of others. METHODS This is a cross-sectional study of the Wave 1 International Tobacco Control 6 European Countries Survey recruiting adult smokers (n=6011) across six EU MS: Germany, Greece, Hungary, Poland, Romania, and Spain, within the EURESTPLUS Project. A descriptive analysis was conducted to estimate the prevalence (%) of observed e-cigarette use in different places, frequency of self-reported exposure to SHA, and level of comfort using e-cigarettes in the presence of others. RESULTS In all, 31.0% of smokers observed others using e-cigarette in public places, 19.7% in indoor places where smoking is banned, and 14.5% indoors at work. Almost 37% of smokers reported to be ever exposed to SHA, ranging from 17.7% in Spain to 63.3% in Greece. The higher prevalence of observed e-cigarette use and passive exposure to SHA was reported by smokers of younger age, of higher educational level and those being current or former e-cigarette users. Part (8.8%) of the smokers who were also e-cigarette users reported feeling uncomfortable using e-cigarettes in the presence of others. CONCLUSIONS A third of smokers from six EU MS reported being exposed to SHA. Prevalence differences were observed among the countries. In the context of scarce evidence on long-term health effects of exposure to SHA, precautionary regulations protecting bystanders from involuntary exposure should be developed.

European countries have made significant progress in implementing tobacco control policies to reduce tobacco use; however, whether socioeconomic status (SES) of a country may influence the implementation of such policies is unknown. The aim of this study is to assess the association between country-level SES and the implementation level of tobacco control policies in 31 European countries. An ecological study using data from Eurostat, Human Development Reports on several SES indicators and the Tobacco Control Scale (TCS) of 2016 was conducted to measure country-level tobacco control policies. We analysed the relationship between SES indicators and the TCS by means of scatter-plots and Spearman’s rank correlation coefficients (rsp) and multivariable linear regression analysis. In Europe, no statistically significant association was found between SES factors and the level of implementation of tobacco control policies. Only public spending on tobacco control was associated with all SES factors, except for Gini Index (an income inequality index). The strongest associations of TCS scores for this policy domain were found with the Human Development Index (rsp = 0.586; p < 0.001) and the Gross Domestic Product per capita (in Euros) (rsp = 0.562; p = 0.001). The adjusted linear regression model showed an association of tobacco control policy implementation with countries’ geographical location (Western Europe, β = − 15.7; p = 0.009, compared to Northern Europe). In conclusion, no association was found between SES factors and the level of implementation of tobacco control policies in 31 European countries; policymakers should be aware that tobacco control policies could be successfully implemented despite socioeconomic constraints, especially when these policies are of low cost and cost-effective (i.e., smoke-free bans and taxation).

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