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Pricing Policies And Control of Tobacco in Europe (PPACTE) project: cross-national comparison of smoking prevalence in 18 European countries

Gallus, Silvanoa; Lugo, Alessandraa,b; La Vecchia, Carloa,b; Boffetta, Paolod,h; Chaloupka, Frank J.e; Colombo, Paoloc; Currie, Lauraj,k; Fernandez, Estevel,m,n; Fischbacher, Colino; Gilmore, Annap; Godfrey, Fionar; Joossens, Luks; Leon, Maria E.i; Levy, David T.g; Nguyen, Lient; Rosenqvist, Gunnart,u; Ross, Hanaf; Townsend, Joyq; Clancy, Lukek

European Journal of Cancer Prevention: May 2014 - Volume 23 - Issue 3 - p 177–185
doi: 10.1097/CEJ.0000000000000009
Research Papers: Lifestyle

Limited data on smoking prevalence allowing valid between-country comparison are available in Europe. The aim of this study is to provide data on smoking prevalence and its determinants in 18 European countries. In 2010, within the Pricing Policies And Control of Tobacco in Europe (PPACTE) project, we conducted a face-to-face survey on smoking in 18 European countries (Albania, Austria, Bulgaria, Czech Republic, Croatia, England, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Poland, Portugal, Romania, Spain and Sweden) on a total of 18 056 participants, representative for each country of the population aged 15 years or older. Overall, 27.2% of the participants were current smokers (30.6% of men and 24.1% of women). Smoking prevalence was highest in Bulgaria (40.9%) and Greece (38.9%) and lowest in Italy (22.0%) and Sweden (16.3%). Smoking prevalence ranged between 15.7% (Sweden) and 44.3% (Bulgaria) for men and between 11.6% (Albania) and 38.1% (Ireland) for women. Multivariate analysis showed a significant inverse trend between smoking prevalence and the level of education in both sexes. Male-to-female smoking prevalence ratios ranged from 0.85 in Spain to 3.47 in Albania and current-to-ex prevalence ratios ranged from 0.68 in Sweden to 4.28 in Albania. There are considerable differences across Europe in smoking prevalence, and male-to-female and current-to-ex smoking prevalence ratios. Eastern European countries, lower income countries and those with less advanced tobacco control policies have less favourable smoking patterns and are at an earlier stage of the tobacco epidemic.

aDepartment of Epidemiology, IRCCS – Istituto di Ricerche Farmacologiche ‘Mario Negri’

bDepartment of Clinical Sciences and Community Health, University of Milan

cDOXA Institute, Worldwide Independent Network/Gallup International Association (WIN/GIA), Milan, Italy

dIchan School of Medicine at Mount Sinai, Institute for Translational Epidemiology and Tisch Cancer Institute, New York, New York

eDepartment of Economics, University of Illinois at Chicago, Chicago, Illinois

fIntramural Research Department, American Cancer Society, Atlanta, Georgia

gDepartment of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA

hInternational Prevention Research Institute

iSection of Environment and Radiation, International Agency for Research on Cancer, Lyon, France

jDivision of Population Health Science, Royal College of Surgeons in Ireland

kTobaccoFree Research Institute Ireland, Dublin, Ireland

lTobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia – ICO

mCancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge – IDIBELL, L’Hospitalet de Llobregat

nDepartment of Clinical Sciences, University of Barcelona, Barcelona, Spain

oInformation Services Division, NHS National Services, Edinburgh, Scotland

pDepartment for Health & UK Centre for Tobacco Control Studies, University of Bath, Bath

qDepartment of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK

rIndependent Legal Consultant in Public Health, Luxembourg city, Luxembourg

sAssociation of the European Cancer Leagues & Foundation Against Cancer, Brussels, Belgium

tCentre for Health and Social Economics – CHESS, National Institute for Health and Welfare (THL)

uDepartment of Finance and Statistics, Hanken School of Economics, Helsinki, Finland

Correspondence to Carlo La Vecchia, MD, Department of Epidemiology, IRCCS – Istituto di Ricerche Farmacologiche ‘Mario Negri’, Via Giuseppe La Masa 19, 20156 Milan, Italy Tel: +39 023 901 4527; fax: +39 023 320 0231; e-mail:

Received September 2, 2013

Accepted September 18, 2013

© 2014 Lippincott Williams & Wilkins, Inc.