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Improved Monitoring in Support of Policies to Tackle Inequalities in Smoking
in the European Union (IMSPTIS)
Anton E. Kunst
Johan P. Mackenbach
European network on health inequalities
Research on socio-economic inequalities in mortality and
morbidity in Europe
Five international research projects since 1991
Participants from nearly all ‘old’ members states of the EU,
and about 5 ‘new’ member states
The European network: main findings
Large socio-economic inequalities in mortality and morbidity
in all European countries
In many countries, smoking is the largest single contributor
to health inequalities among men
North-south gradients in inequalities in smoking,
with persistent inequalities in north
and emerging inequalities in the south
The first smoking inequalities project (1)
General objectives:
to describe trends in smoking inequalities in the EU
to identify policies that have the potential to reduce
smoking among lower groups
Publications
Final report in early 2004
“Brochure” for policy makers in autumn 2004
About 6 papers for international journals
The first project: main results on smoking
In the late 1990’s, inequalities in smoking existed in all ‘old’
member states
These inequalities were largest in the north, but yet small in
the southern fringe
Inequalities increased over time among women, and were
stable among men
Inequalities existed in relation to both smoking initiation and
smoking cessation
% smoking by level of education womenin7 countriesin 1985and 2000
0
5
10
15
20
25
30
35
1985 2000
% sm
oker
s
Low Mid-low Mid-high High
The first project: main results on policies
Many tobacco control measures can be effective among
lower socio-economic groups, including:
- rising tobacco tax
- banning smoking from the work place
- help with smoking cessation
Up to the present, no European country has fully
implemented all these measures
Often these measures have not been targeted at lower
social groups, and tailored towards their situation
Price elasticities
England and Wales
by gender and level of education based on trends in 1985-2000
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
Men Women
Low
High
Price elasticities
Italy
by gender and level of education based on trends in 1985-2000 -0.6
-0.4
-0.2
0
0.2
0.4
0.6
Men Women
Low
High
Price elasticities
Seven countries combined
by gender and level of education based on trends in 1985-2000
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
Men Women
Low
High
IMSPTIS (1) General objective
To support policies that aim
to tackle socioeconomic inequalities in smoking,
and to reduce smoking among disadvantaged groups,
by developing recommendations for the monitoring
of smoking inequalities and tobacco control policies
in the European Union
IMSPTIS (2) Organisation
Period: April 2005 – March 2006
Partners
main beneficiary = Erasmus MC Rotterdam
associated beneficiaries = four partners at Rome,
Barcelona, Scotland, and Stockholm/Estonia
Expected output:
papers for international journals
final report
IMSPTIS (3) Eight “actions”
Monitoring of inequalities in smoking
1. inventory of practices
2. analyses of data on smoking initiation and cessation
3. comparative analyses of data for ‘new’ member states
4. recommendations
Monitoring of tobacco control policies
5. inventory of practices
6. selection of indicators of reach among lower groups
7. analyses of relation with smoking inequalities
8. recommendations
IMSPTIS (4) Data sources
for monitoring of smoking inequalities
Analyses of smoking initiation and cessation (action 2):
- international data set (ca. 5 western countries)
- detailed data from Italian and Dutch studies
Analyses of inequalities in eastern Europe (action 3)
- World Health Survey (circa 7 countries)
- national surveys (e.g. Poland, Hungary)
IMSPTIS (5) Data sources
for monitoring of tobacco policies
Analyses of reach among lower groups (action 6):- British surveys (national, local)- possible indicators: exposure at work, stage of chance, # quit attempts, use of cessation services
Analyses of relation to smoking inequalities (action 7)- Spanish data (national, local)- focus on price of tobacco; smoking cessation services
Recommended