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Cigarette Smoking and Control in Europe
Smoking Culture

For many years, European countries have been thought of as friendly places for cigarette smokers to visit and to reside. In many European countries, smoking is perceived to be fashionable and even desirable for men and women, despite the fact that much of the rest of the developed world views smoking as being detrimental to one’s health and even repulsive. Even today, in many European countries it is possible to smoke in public locations such as hospitals, airports, theaters, buses, taxis, bars, restaurants, schools, and indoor workplaces 1. Despite the pro-smoking perception of Europe, the top five cigarette consuming countries are not located in Europe 2. Moreover, in recent years, many Western European countries have led the way in trying to control the use of tobacco in Europe. Many countries have banned smoking in public places, have regulated advertising, have created anti-smoking policies or have implemented anti-smoking campaigns. Despite these actions, critics claim that many European countries are just paying lip service to the anti-smoking movement and are not really enforcing the policies and restrictions they have imposed.

Smoking Statistics

It is difficult to estimate smoking statistics in Europe due to the fact that there are many definitions for the boundaries of the continent. Furthermore, there are computational challenges in determining the statistics because data is sometimes not collected in all of the countries during the same year or data is not collected in some countries at all. Nonetheless, the World Health Organization provides statistics regarding estimates of the overall prevalence of smoking and mortality attributed to smoking in the European Union. The World Health Organization estimates between 2002-2005 smoking prevalence was approximately 23% for females, 34% for males, totaling 28.5%. It is estimated that in 2000, 23% of male deaths of all ages in the European Union were smoking related whereas 6% of female deaths of all ages in the European Union were smoking related. Overall 14.5% of deaths among individuals of all ages in the European Union were smoking related in 2000 3.

European Habits & Attitudes about Smoking

Many people across the world have presumed to know how Europeans feel about smoking. In January 2006, the European Commission released a report about individuals’ habits and attitudes regarding smoking which many individuals may find surprising. The data for this report was obtained by surveying adults in European Union countries. The survey responses indicated that smoking had declined sharply in the European Union since the previous survey in 2002. Furthermore, the survey indicated that smoking habits vary greatly across Europe. Overall, smoking is more prevalent in Central and Eastern European countries than in Western European countries. Most self-reported smokers claimed to smoke on a regular basis and only a few smokers reported smoking occasionally. Even though the majority of respondents said they were not bothered by tobacco smoke in their daily lives, over 80% of respondents wanted to ban smoking in workplaces and in indoor facilities. Over 50% of individuals surveyed wanted to ban smoking in restaurants, bars and pubs. Perhaps the desire to ban smoking in public places is the due to the fact that three quarters of individuals surveyed are aware of the health risks associated with smoking 4.

Measuring Smoking Control

There are many different ways to measure a country’s effectiveness at controlling cigarette smoking. In 2006, a new smoking control scale report was released which takes into account the following factors: •	price increases due to increased “sin taxes” •	bans in workplaces and in public facilities •	consumer information and awareness •	advertising bans and compliance •	warning labels on products •	access to smoking cessation treatment According to this scale, Ireland, the UK, Norway, Iceland and Malta have the best scores respectively. Conversely, Luxemburg, Romania, Latvia, Austria and Spain had the lowest scores respectively. Although, this new scale is not a perfect measurement tool, it gives an overview of how well a country is controlling cigarette smoking 5.

Recent Developments in Smoking Control

Throughout Europe, there are several countries that are making great strides in controlling cigarette smoking. For example, Ireland was the first country in the Northern Hemisphere to ban smoking in all enclosed places where people work such as bars, restaurants, hospitals and hotels. The ban took effect March 29, 2004 and is intended to protect workers and customers from second hand smoke exposure 6. A study to determine the impact of the smoking ban in Ireland was conducted in 2006. The study revealed that second hand smoke was almost entirely eliminated in bars and restaurants. Additionally, the majority of the public facilities were reported to be complying with the ban. Furthermore, the study revealed that some individuals actually stopped smoking as the result of the ban. Even more surprisingly, there is an increase in the number of private homes where smoking is being prohibited 7. Ireland’s success is being emulated around the world as other countries adopt or consider adopting smoking bans in workplaces and other public locations. Norway soon followed Ireland and banned smoking in bars, clubs and restaurants in June 2004. As of January, 2005, Italy also followed suit and banned smoking in all public places and in workplaces. Since the beginning of 2006, Spain, Scotland and England have followed in Ireland’s footsteps respectively and have banned smoking in enclosed places 8.

German Resistance

Germany is a prominent country in Western Europe that considered to have very weak legislation regarding cigarette smoking. In Germany it is not unusual to see companies defying bans on cigarette advertising and restrictions on sales to minors. Nonetheless, there are smoking bans in the workplace. However, there are no restrictions on smoking in public places such as theaters, hospitals, hotels, bars or restaurants 9. It remains to be seen when or if Germany will take further action to improve smoking control. However, Germany’s resistance to smoking legislation or support for smoking initiatives may have a substantial impact on members of the European Union since the European Union votes by consensus.

Organizational Involvement in Smoking Awareness and Control

There are many organizations in Europe involved with tobacco cessation and control. Foremost is the World Health Organization. The European Region of the World Health Organization estimates that that if Europe does not take action, it is at risk to face one third of all tobacco related disease in the world even though only 15% of the world’s population resides in Europe. The World Health Organization has developed a strategy for European countries to help divert a public health crisis. Their strategy includes supporting initiatives that raise taxes on cigarettes and promoting initiatives that regulate exposure to environmental tobacco smoke by limiting where individuals can smoke. Furthermore, the World Health Organization is involved in helping individuals cease smoking by supporting widespread dependence treatments such as nicotine replacement therapies and by providing personal support through the use of support mechanisms such as telephone hotlines. Additionally, the World Health Organization is also encouraging as well as training primary care providers to become involved in treating individuals with tobacco addictions 10. In addition, in 2003, 192 countries adopted an international treaty on tobacco control which is under the auspices of the World Health Organization. Many European countries have signed the treaty but many have yet to ratify it. The Framework Convention for Tobacco Control treaty requires adopters to restrict tobacco smuggling by passing legislation, sponsor smoking cessation efforts, protect people from second-hand smoke, restrict tobacco advertising and require tobacco to be properly labeled with warnings. Moreover, the World Health Organization collects, monitors and, distributes a plethora of data regarding smoking in all European countries so that information regarding the status of smoking in Europe is readily available 11.

Over one hundred not-for-profit organizations are part of the European Public Health Alliance. The organization serves to protect and promote the health of all individuals living in Europe. Furthermore, it facilitates communication regarding public health policies and monitors such policies. Tobacco and smoking is only one aspect of health the European Public Health Alliance monitors. On their website, the European Public Health Alliance provides information on new developments and events related to tobacco control 12.

The European Network for Smoking Prevention is a non-profit organization that is dedicated to coordinating actions between organizations promoting tobacco control in Europe. By coordinating actions between organizations, the European Network for Smoking Prevention intends to facilitate more comprehensive and effective tobacco control efforts, to allow for information exchange as well as to facilitate communication between organizations. The European Network for Smoking Prevention has been in existence since 1997 and since that time, the organization has approximately 700 members in over 30 countries. Furthermore, the European Network for Smoking Prevention provides general resources on European tobacco control on at no cost on their website for interested parties 13.

Future of Smoking in Europe

Currently there are many positive smoking initiatives ongoing in Europe. However, many more initiatives are needed to curb smoking even more. Initiatives are especially needed in Central and Eastern Europe. Unfortunately, countries in Central and Eastern Europe are not participating in smoking control efforts like countries in Western Europe. Western Europe has the opportunity to set an example for other European countries and perhaps Western Europe will be able to assist Central and Eastern Europe once smoking is under control in their region.

Sources:

1 WHO. (2003). WHO European Country Profiles. 1-282. http://www.euro.who.int/Document/E80607.pdf

2 WHO (2004). Tobacco Atlas. Cigarette Consumption. 31. http://www.who.int/tobacco/en/atlas8.pdf

3 WHO (2006). Tobacco Control Database http://data.euro.who.int/tobacco/

4 European Commission (2006). Eurobarometer: Attitudes of Europeans towards Tobacco. 1-103. http://ec.europa.eu/health/ph_information/documents/ebs_239_en.pdf

5 Joossens, L., & Raw, M. (2006). The Tobacco Control Scale: a new scale to measure country activity 10.1136/tc.2005.015347. Tob Control, 15(3), 247-253.

6 Mulcahy, M., Evans, D. S., Hammond, S. K., Repace, J. L., & Byrne, M. (2005). Secondhand smoke exposure and risk following the Irish smoking ban: an assessment of salivary cotinine concentrations in hotel workers and air nicotine levels in bars 10.1136/tc.2005.011635. Tob Control, 14(6), 384-388.

7 Fong, G. T., Hyland, A., Borland, R., Hammond, D., Hastings, G., McNeill, A., et al. (2006). Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey 10.1136/tc.2005.013649. Tob Control, 1(suppl_3), iii51-58.

8 Radke, P. W., & Schunkert, H. (2006). Public smoking ban: Europe on the move 10.1093/eurheartj/ehl266. Eur Heart J, 27(20), 2385-2386.

9 Schumann, A., John, U., Thyrian, J. R., Ulbricht, S., Hapke, U., & Meyer, C. (2006). Attitudes towards smoking policies and tobacco control measures in relation to smoking status and smoking behaviour 10.1093/eurpub/ckl048. Eur J Public Health, 16(5), 513-519.

10 WHO (2004). Cessation for Smoking Strategy Policy 1-45. http://www.euro.who.int/Document/E80056.pdf

11 WHO. (2005) WHO Framework Convention on Tobacco Control. 2-42. http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf

12 European Public Health Alliance (2006). http://www.epha.org/r/38?var_recherche=smoking

13 European Network for Smoking Prevention (2006). Mission. http://www.ensp.org/enspnetwork/mission