Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.
J Epidemiol Community Health. 2019 Aug;73(8):759-767. doi: 10.1136/jech-2018-211935. Epub 2019 Jun 18.
This study investigated the cross-national and longitudinal associations between national tobacco control policies and current smoking in 28 European Union (EU) member states between 2009 and 2017. It also examined the interaction between tobacco control policies and occupational status.
We used data from four waves of Eurobarometer (2009, 2012, 2014 and 2017). The total sample size was 105 231 individuals aged ≥15 years. Tobacco Control Scale (TCS) scores (range 0 to 100) for years 2005, 2007, 2012 and 2014 measured the strength of country-level tobacco control policies. Logistic multilevel regression analyses with three levels (the individual, the country-year and the country) were performed with current smoker as the dependent variable.
Across the EU, average smoking prevalence fell from 29.4% (95% CI 28.5% to 30.2%) in 2009 to 26.3% (95% CI 25.4% to 27.1%) in 2017. We confirmed that cross-nationally, strong national tobacco control policies are significantly associated with a low probability of smoking. A one-point increase in TCS score was associated with lower odds of smoking (OR=0.990; 95% CI 0.983 to 0.998), but longitudinally (within-country) increases in TCS were not associated with current smoking (OR=0.999; 95% CI 0.994 to 1.005). Compared with those in manual occupations, the cross-national association was stronger in the upper occupational group (conditional OR for the interaction=0.985; 95% CI 0.978 to 0.992) and weaker in the economically inactive group (conditional OR for the interaction=1.009; 95% CI 1.005 to 1.013).
Differences in tobacco control policies between countries were associated with the probability of smoking but the changes in TCS within countries over time were not. Differences between countries in tobacco control policies were found to be most strongly associated with the likelihood of smoking in the highest occupational groups and were found to have only a weak association with smoking among the economically inactive in this sample.
本研究调查了 2009 年至 2017 年间 28 个欧盟成员国的国家烟草控制政策与当前吸烟之间的跨国和纵向关联，并检验了烟草控制政策与职业地位之间的相互作用。
我们使用了四轮欧洲民意调查（2009 年、2012 年、2014 年和 2017 年）的数据。总样本量为 105231 名年龄≥15 岁的个体。2005 年、2007 年、2012 年和 2014 年的烟草控制量表（TCS）评分（范围为 0 至 100）衡量了国家一级烟草控制政策的强度。以当前吸烟者为因变量，采用个体、国家-年份和国家三级的逻辑多层回归分析。
在整个欧盟，平均吸烟率从 2009 年的 29.4%（95%CI 28.5%至 30.2%）下降到 2017 年的 26.3%（95%CI 25.4%至 27.1%）。我们证实，在跨国层面上，强有力的国家烟草控制政策与吸烟概率较低显著相关。TCS 评分每增加 1 分，吸烟的可能性就会降低（OR=0.990；95%CI 0.983 至 0.998），但在纵向（国家内），TCS 的增加与当前吸烟无关（OR=0.999；95%CI 0.994 至 1.005）。与从事体力劳动的人相比，在较高职业群体中，这种跨国关联更强（交互作用的条件比值=0.985；95%CI 0.978 至 0.992），而在经济不活跃群体中则较弱（交互作用的条件比值=1.009；95%CI 1.005 至 1.013）。
国家间烟草控制政策的差异与吸烟概率有关，但随着时间的推移，各国 TCS 的变化与吸烟无关。在本研究中，发现国家间烟草控制政策的差异与最高职业群体吸烟的可能性最密切相关，而与经济不活跃群体吸烟的关联较弱。
