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