The association between tobacco control policy implementation and country-level socioeconomic factors in 31 European countries

Abstract

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).

Thi̇rdhand Smoke: Are Parents Aware of İt?

“…However, manipulation on the part of the powerful tobacco industry also encouraged women to smoke as a supposed symbol of freedom and gender equality [26]. Smoking rates across the world are still higher among men than women [27]. Starting smoking at a young age is directly correlated with low income, low education levels, and membership of the working class [28].…”

Smoke-free spaces: a decade of progress, a need for more?

“…38 A recent ecological study assessed the association between country-level socioeconomic status and the implementation level of tobacco control policies in 31 European countries and found no association between socioeconomic status factors and the level of implementation of tobacco control policies indicating that, despite socioeconomic differences at country level, tobacco control policies can be successfully implemented, at least among high and upper middle-income countries. 39 While it is an incredible achievement that comprehensive protection from SHS has increased from just 10 countries with a population of 0.2 billion in 2007 to cover 1.8 billion people or 23% of the global population in 2020, 37 the fact that over three in four people on the planet are likely to be exposed to SHS at some stage in their daily working, travel or leisure activity clearly presents the tobacco control community with a significant and continuing challenge.…”

“…Research has examined country-level factors that influence implementation of tobacco control policies, with results suggesting that strong and transparent governance is key to ensuring that effective tobacco control policies are implemented 38. A recent ecological study assessed the association between country-level socioeconomic status and the implementation level of tobacco control policies in 31 European countries and found no association between socioeconomic status factors and the level of implementation of tobacco control policies indicating that, despite socioeconomic differences at country level, tobacco control policies can be successfully implemented, at least among high and upper middle-income countries 39…”

Global market trends of flavor capsule cigarettes and menthol (non-capsule) cigarettes: An ecological analysis using commercial data across 78 countries, 2010–2020

“…Also, fixed effects model controls for all time-invariant factors and therefore its estimated changes in market outcome will not be biased by the variation in time-invariant factors between countries. We examined predictor variables that have been found to be associated with FCC and MNCC use at the individual level, as well as country-level variables that have been associated with other tobacco-related outcomes 5,12,18,[22][23][24][25]27,28 . Predictor variables were added into the model in incremental steps and no major changes in the magnitude or significance of coefficients were observed during this model fitting process.…”

“…Ecological analyses can provide such insight and may inform tobacco control strategies. Previous studies have examined ecological factors, such as socio-economic factors (Gross Domestic Product 27 , unemployment rate 27 , 28 ), cigarette smoking prevalence 27 , and implementation of MPOWER measures 27 , 28 , on country-level tobacco-related outcomes (e.g. prevalence of electronic cigarette use 27 ; tobacco policy implementation 28 ).…”