| Summary: | Introduction
Most studies use the prevalence of current smoking as an indicator
to quantify the burden of smoking. However, length and intensity of smoking, as
well as time since cessation for former smokers are also known to impact smokingrelated
health risks. The aim of this study was to quantify and compare the burden
of smoking across the European Union (EU) using a range of smoking burden
indicators.
Methods
We conducted a cross-sectional analysis using data from the March 2017
Eurobarometer 87.1 (n=27901, people aged ≥15 years) in 28 European Union
Member States (EU MS) and the Tobacco Control Scale. We defined five indicators
of smoking burden including the prevalence of current and ever smoking, length
of smoking, pack-years, and discounted pack-years, and ranked EU MS by each
indicator. Two-level linear and logistic regressions were performed to assess the
association between these indicators and sociodemographic and tobacco policy
factors.
Results
Wide variations across the EU countries were observed in all smoking
burden indicators. While some MS ranked consistently high (e.g. Greece, France)
or consistently low (e.g. Ireland, United Kingdom) in all indicators, we found
substantial discrepancies in ranking depending on the indicator used for MS such
as Malta, Denmark, Finland and the Netherlands. All indicators of smoking burden
were lower among women and respondents without financial difficulties; however,
the magnitude of those inequalities varied two-fold among the different indicators.
Conclusions
Using a range of smoking burden indicators can be more informative
than relying on prevalence alone. Our analysis highlights the limitations of relying
solely on prevalence of current smoking to estimate the burden of smoking and
the potential value of more nuanced indicators. We recommend that multiple and
more nuanced indicators that consider former smokers, intensity and duration of
smoking should be utilized to monitor tobacco use and evaluate tobacco control
policies.
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