Knowledge of the health risks of smoking and impact of cigarette warning labels among tobacco users in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys.

INTRODUCTION: The aim of this study was to examine knowledge of health effects of smoking and the impact of cigarette package warnings among tobacco users from six European Union (EU) Member States (MS) immediately prior to the introduction of the EU Tobacco Products Directive (TPD) in 2016 and to explore the interrelationship between these two factors. METHODS: Cross-sectional data were collected via face-to-face interviews with adult smokers (n=6011) from six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) between June-September 2016. Sociodemographic variables and knowledge of health risks of smoking (KHR) were assessed. Warning salience, thoughts of harm, thoughts of quitting and foregoing of cigarettes as a result of health warnings were assessed. The Label Impact Index (LII) was used as a composite measure of warning effects. Linear and logistic regression analyses were used to examine sociodemographic predictors of KHR and LII and the inter-relationship between knowledge and LII scores. RESULTS: The KHR index was highest in Romania and Greece and lowest in Hungary and Germany. While the majority of smokers knew that smoking increases the risk for heart diseases, lung and throat cancer, there was lower awareness that tobacco use caused mouth cancer, pulmonary diseases, stroke, and there were very low levels of knowledge that it was also associated with impotence and blindness, in all six countries. Knowledge regarding the health risks of passive smoking was moderate in most countries. The LII was highest in Romania and Poland, followed by Spain and Greece, and lowest in Germany and Hungary. In almost all countries, there was a positive association between LII scores and higher KHR scores after controlling for sociodemographic variables. Several sociodemographic factors were associated with KHR and LII, with differences in these associations documented across countries. CONCLUSIONS: These data provide evidence to support the need for stronger educational efforts and policies that can enhance the effectiveness of health warnings in communicating health risks and promoting quit attempts. Data will serve as a baseline for examining the impact of the TPD.

Identifying gender differences among Romanian non-smoking junior high school students.

OBJECTIVES: The purpose of this study was to assess gender differences regarding perceptions of smoking between Romanian non-smoking boys and girls, to facilitate the development of effective smoking prevention programmes. METHODS: Cross-sectional data were obtained in 2006 by means of written questionnaires among 981 non-smoking school students aged 13-14 years from Cluj-Napoca, Romania. RESULTS: The results reveal that girls were more convinced than boys that smoking would result in several positive outcomes such as helping them getting more attention and becoming easier part of the crowd. Moreover, girls declared lower self-efficacy in refraining from smoking when friends smoke or offer them a cigarette. Parental norms regarding smoking seem to be less restrictive for boys than for girls. CONCLUSIONS: The gender differences found in our study do not warrant specific smoking prevention programmes for boys and girls, but it is advisable to include gender-specific issues in prevention activities targeting Romanian adolescents aged 13-14 years.

Gender differences regarding the alcohol-tobacco relationship among Romanian adolescents--a longitudinal study.

BACKGROUND: The objective of this study was to assess cross-sectional and prospective relations between alcohol and tobacco use among Romanian adolescents, giving special attention to possible gender differences. METHODS: The data were obtained from a two-wave 1-year longitudinal study carried out among 403 Romanian high school students aged 15-17 years (mean age 15.9; SD = 0.3). Questionnaires were used to assess smoking behaviour and alcohol use. Both behaviours were classified into two categories, that of adolescents who used the substance (at least once/month) and that of those who did not use the substance or used it less than monthly. Logistic regression was used to determine which substance was the best predictor of the subsequent use of the other substance. RESULTS: Alcohol and cigarette use were found to be linked reciprocally and this interrelationship differed across genders. Among girls smoking predicted alcohol use better than the converse, while for the boys it was the other way around. CONCLUSION: It is important for future studies of adolescent substance use to systematically investigate the gender differences in the tobacco-alcohol relationship.

Smoking among Romanian adolescents: do the gender differences exist?

A cross-sectional research study was carried out among Romanian adolescents to identify gender differences in beliefs and behaviour regarding smoking. A written survey was conducted among 473 students aged 15-17 years from 5 senior high schools in Cluj-Napoca, Romania. All students filed in a questionnaire which assessed their smoking-related behaviour. The results show that one quarter (24.5%) of the subjects were smokers, a significant differences was noticed, regarding the prevalence of smoking between boys (32.2%) and girls (20.9%). Smoking behaviour served a stronger function for smoking girls to remain slim, while smoking boys had stronger beliefs that smoking helped them to relax. Self-efficacy expectations to handle emotional situations without smoking were significantly lower in smoking girls than in smoking boys. Moreover, in comparison with non-smoking boys, non-smoking girls reported low self-efficacy to maintain their non-smoking status when upset, depressed or nervous, and a stronger intention to start smoking than non-smoking boys. Non-smoking boys reported stronger pressures to smoke from their peers in the same school year. These findings have several implications for smoking prevention and reduction activities in Romania. First, smoking prevention programs should strengthen positive attitudes towards non-smoking, resistance against peer influences and enhance self-efficacy beliefs. Second, smoking prevention and reduction activities should address the fact that smoking is seen by Romanian girls as a way to control their weight, and as a way to relax by boys, and thus need to offer other healthier alternatives to realize these outcomes. Additionally, they need to address strategies to cope with emotional situations, in particular for girls.

Tobacco use among Romanian youth.

This paper reviews data published between 1990 and 2006 regarding smoking prevalence as well as individual and contextual influences on the smoking behavior among Romanian young adults. Highlights include a consideration of multiple levels of influence, from intra-individual factors, such as demographic and cognitive factors, to social influences, such as families and peers, to the more macro, societal/cultural levels of influence, including advertising and tobacco-related policies The source of data is represented by articles and short information published in journals or in electronic format, legislation, statistics and are illustrated with pictures. Based on these data, recommendations for future smoking prevention and reduction actions for Romanian youth are taken.

Tobacco use among Romanian youth

Se revisan datos publicados entre 1990 y 2006 sobre prevalencia de tabaquismo, así como influencias individuales y contextuales respecto al hábito de fumar entre adultos jóvenes rumanos. Los hallazgos incluyen una consideración de múltiples niveles de influencia, desde factores intraindividuales (por ejemplo, demográficos y cognitivos), influencias sociales (como familia y pares), hasta niveles de influencia macro sociales/culturales (publicidad y políticas relacionadas con el tabaco, entre otros). La fuente de datos incluye artículos y notas breves publicadas en revistas científicas o en formato electrónico, leyes, estadísticas, y se ilustran con imágenes. Con base en estos datos, se establecen recomendaciones para acciones futuras de prevención y reducción del consumo de tabaco en jóvenes rumanos.