Tobacco Control Research in Greece

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					Tobacco Control Research in Greece and the
     Necessity for Future Intervention

          Prof. Anthony Kafatos

        Preventive Medicine and Nutrition Clinic
                Department of Medicine
              University of Crete, Greece



                    2005 ISPTID Conference
                    30 Sept – 2 Oct, Athens
Tobacco Consumption Percentages (WHO)
   Country       %
   Greece           45
   Portugal       44,5
   Latvia           42
   Czech R          36
   Germany        35,5
   Luxemburg      34,5   Country     male   female
   Estonia          34
                         Australia       25      20
   Denmark        33,5
                         Turkey          51      11
   Spain          31.5
   Cyprus         30,5
                         Usa             20      16
   Austria          29   Greece          51      39
   Netherlands    28,5   Cyprus          46      15
   Norway           26
   Poland           26
   Uk               26
   France           25
   Switzerland    24,5
   Belgium          24
   Malta          23,5
   Finland          23
   Italy          20,5
   Russia           20
   Iceland          19
   Ireland        18,5
   Sweden        17,75
   Romania         6,5
           0
               10
                    20
                         30
                              40
                                   50
                                        60
    Austria
    Belgium
    Cyprus
   Czech R
   Denmark
    Estonia
    Finland
    France
  Germany
    Greece
    Iceland
     Ireland
                                             Male




       Italy
     Latvia
Luxemburg
     malta
                                             Female




Netherlands
   Norway
    poland
                                                          Percentages (1)




   portugal
   romania
     russia
      Spain
   Sweden
                                                      Male and Female Smoking




Switzerland
        Uk
Male and Female Smoking
    Percentages (2)
             60

             50

             40
Percentage




                                                                     male
             30
                                                                     female
             20

             10

             0
                  Australia   Turkey     Usa       Greece   Cyprus
                                       Countries
                       Consumption of cigarettes
                          per year in Greece

    35000000

    30000000

    25000000

    20000000

    15000000

    10000000

     5000000

            0
                1938 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001




I.Mitrouska Department of thoracic medicine,
University hospital of Crete, Greece
        Per capita consumption of cigarettes in Greece
                            (by persons of 15 years and over)



         4000
         3500
         3000
         2500
         2000
         1500
         1000
           500
             0
                 1938 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001




I.Mitrouska Department of thoracic medicine,
University hospital of Crete, Greece
     Education Program on Cretan Health
                and Nutrition
  1992, 1st to 6th grade primary children
  Intervention Group         n = 4171
  Control Group        n = 1510

10 year follow up          smoking habits
 10 year follow up                          smoking habits


Intervention Group               602 children and their parents
Control Group                    444 children and their parents
για τοσς μαθητές της 1ης Δημοτικού
           ΠΑΝΕΠΙ΢ΣΗΜΙΟ ΚΡΗΣΗ΢
                Σμήμα Ιατρικής
           Σομέας Κοινωνικής Ιατρικής
   Κλινική Προληπτικής Ιατρικής και Διατροφής

               ΗΡΑΚΛΕΙΟ 2003
 Child smoking after 10 years follow-up


  Control group             12.5%
  Intervention group         7.1%


Parental smoking       Indoor smoking
Father           55%   Father         84%
Mother           38%   Mother         92%
       Tobacco Policy in Greece
and the Necessity for Future Intervention



           Constantine Vardavas

         Preventive Medicine and Nutrition Clinic
                 Department of Medicine
               University of Crete, Greece


                  2005 ISPTID Conference
                   30 Sept – 2 Oct, Athens
1st place in adult smoking in Europe




3rd place worldwide



                                       WHO global InfoBase
  51 % of men smoke* (2001)

  39 % of women* (2001)

       Same smoking habits by men  Greece
       and women ages 16-24        Portugal               **




*Epidemiology of cardiovascular risk factors in Greece: aims, design and baseline characteristics of the ATTICA
study. BMC Public Health. 2003 Oct 20;3(1):32
** Educational inequalities in smoking among men and women aged 16 years and older in 11 European
countries. Huisman et al. Tob Control. 2005; 14: 106-113
School Students
(13-18 years old)*                    20.8 %


University Students
Male (n=674)                    44%
Female (n=794)                   42.5%


      *Substance use among high school students in Greece: outburst of illicit drug use in a
      society under change Drug Achool Depend. 2000 Feb 1;58 (1-2):181-8
      **Trends in Smoking, Diet, Physical Exercise, and Attitudes toward Health in European
      University Students from 13 Countries, 1990–2000 Prev. Med. (2002) 35, 97–104
       3rd year Medical students
12 year follow up (1989-2000)                                                 n = 849

Male                 33%                              Mean consumption
Female                28%                             13/day



“Consult your doctor, he or she can help you quit smoking”


  Cigarette smoking, alcohol consumption and serum lipid profile among medical students in
  Greece. Eur J Publ Health. 2003 Sep;13(3):278-82
  Current Interventions / Policy 1

   Product labeling EU Directive 2001/37/EC
      Greek males*                       indifferent.            “pointless”         “invasive”

 Health warnings on tobacco advertisements
 Tobacco companies are banned at sponsoring
  events *EU Directive 2003/33/EC
 Banning of television and radio advertisements




Targeting smokers via tobacco product labelling: opportunities and challenges for Pan European health promotion.
E Devlin et al Health Promot Int 2005 Mar;20(1):41-9.
    Current Interventions / Policy 2

 Ban on smoking in Educational Institutes, Hospitals and in
Public Offices Law 76017/1-8-2002
 Designated areas in restaurants and cafeterias for smokers
 Ban on smoking in the workplace (August 2003 )
 Illegal to promote cigarettes
 Forbidden to sell tobacco products to minors
    Current Interventions / Policy 3

Scientific Contribution
   Seminars open to the public
   Public Education
   Teaching in primary and secondary education
   Smoking cessation clinics
                Number of outpatient smoking
                 cessation clinics in Greece
    50
    45
    40
    35
    30
    25
    20
    15
    10
     5
     0
             1999           2000           2001           2002           2003       2004   2005

I.Mitrouska Department of thoracic medicine, University hospital of Crete, Greece
            Success rate at 2 and 12 months




I.Mitrouska Department of thoracic medicine, University hospital of Crete, Greece
  Why do current
interventions fail ?
   Socially accepted habit
  Peer pressure
  Tolerance by school teachers
   in Secondary Education
  Advertisements
  Childhood addiction from
   ETS
   February through to May 2004
   1761 children enrolled in 67 preschools                 1189 children accepted (68%)
   938 agreed to answer the questionnaire
   258 of those children had parents that both smoke
   270 had parents that did not.

   15% of those children (n  80)                         Serum cotinine levels



   Smoker parents                                         Non smoker parents
   0 - 12 ng/ml.                                          0 - 3.9 ng/ml
   (3.6 ± 3 ng/ml)                                        (0.5 ± 0.8 ng/ml)




Unpublished data. University of Crete. Vardavas C.I, Tzatzarakis M, Linardakis M, Tsatsakis A, Kafatos A
             Childhood addiction
   Becklake, Ghezzo & Ernst

           Salivary cotinine levels are
           an independent predictor of
           becoming a teenage smoker



Childhood predictors of smoking in adolescence: a follow-up study of Montreal
Schoolchildren CMAJ 2005; 173(4):377-379
                         High cotinine
                         levels in children



As adults, increase in                           Independent predictor
                                                 of becoming a teenage
parental smoking
                                                 smoker




                         Increase in number of
                         adolescents who
                         smoke
                     Future
1)   Increase in the price of tobacco products
2)   Heavier taxes
3)   Total ban on smoking in public.
4)   Enforcement of the law
5)   Total ban on tobacco advertisements
     (August 2005)
6)   Photos on cigarette packets
EU Directive 2003/641/EC
7)   Further school health education
     (180 school health programs)

8)   Funding into cessation clinics and
     research



      για τοσς μαθητές της 1ης Δημοτικού
                 ΠΑΝΕΠΙ΢ΣΗΜΙΟ ΚΡΗΣΗ΢
                      Σμήμα Ιατρικής
                 Σομέας Κοινωνικής Ιατρικής
         Κλινική Προληπτικής Ιατρικής και Διατροφής

                     ΗΡΑΚΛΕΙΟ 2003
„Προλαμβάνειν κρείττον του θεραπεύειν‟
        (prevention is better than treatment)
Thank you for your attention…

				
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