Media monitoring: advertising for e-cigarettes and heated tobacco products in social media in Germany

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Tobacco Prevention & Cessation | Abstract Book
Aim & Scope
Tobacco Prevention & Cessation, (Abbr: Tob. Prev. Cessation; ISSN:2459-3087) is an open access, peer-reviewed online
journal that encompasses all aspects of tobacco use, prevention and cessation that can promote a tobacco free society. The
aim of the journal is to foster, promote and disseminate research involving tobacco use, prevention, policy implementation
at a regional, national or international level, disease development- progression related to tobacco use, tobacco use impact
from the cellular to the international level and finally the treatment of tobacco attributable disease through smoking
cessation.
Full Journal Title: Tobacco Prevention and Cessation
Abbreviated Title: Tob Prev Cessation
ISSN (electronic): 2459-3087
Scientific Society: European Network for Smoking and Tobacco Prevention (ENSP)
Publisher: European Publishing
Publisher Address: Science and Technological Park of Crete, Greece
Editors: See Editorial Board page
Peer Review: Double Blind
Rejection Rate: For 2021, we have a rejection rate of 62%
Publication Frequency: Continuous
Publication Medium: Electronic Only
Publication website: www.tobaccopreventioncessation.com
First Year Published: 2015
Disclaimer: All authors are responsible for the content of their abstracts and retain copyright of their abstract under an
Open Access, Creative Commons License (CC BY 4.0). This abstract book includes the abstracts revised and accepted by
the ENSP-ECTC Scientific Committee. This abstract book has been produced electronically and all English articles are also
available on-line as a special issue at www.tobaccopreventioncessation.com
The contents of this publication represents the views of the authors only and is their sole responsibility; it cannot be
considered to reflect the views of the European Commission and/or the European Health and Digital Executive Agency or any
other body of the European Union.

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8th ENSP European Conference on Tobacco Control
Editorial Board
European Editor-in-Chief
Florin Dumitru Mihaltan, Institute of Pneumology M. Nasta, ROMANIA
Editorial Board
Anne Buttigieg, Oral Rehabilitation and Community Care, Department of Dental Surgery, Faculty of Health Science, MALTA
Andrey Demin Russian Public Health Association, RUSSIA
Anton Kunst Department of Social Medicine, University of Amsterdam-The Academic Medical Center (AMC), THE
NETHERLANDS
Anthony Laverty Public Health Policy Evaluation Unit, Department of Primary Care & Public Health, Imperial College
London, UNITED KINGDOM
Andriy Skipalskyi, Ukrainian Tobacco Control Center, UKRAINE
Antigona Trofor Department of Respiratory Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, ROMANIA
Bertrand Dautzenberg Pitié Salpêtrière Université Hospital APHP, FRANCE
Can Ozturk, Faculty of Medicine, Gazi University, TURKEY
Carlos A. Jimenez-Ruiz, Smoking Cessation Service of Community of Madrid, SPAIN
Christina Gratziou Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens,
GREECE
Christina Kyriakos School of Public Health, Ιmperial College London, UNITED KINGDOM
Coral Gartner NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The
University of Queensland, AUSTRALIA
Filippos Filippidis Department of Primary Care & Public Health, School of Public Health, Imperial College London, UNITED
KINGDOM
Francisco Camarelles, Comité Nacional para la Prevención del Tabaquismo (CNPT), SPAIN
Friedrich Wiebel, Medical Action Group Smoking or Health, GERMANY
Gregory Connolly, Northeastern University, Boston, UNITED STATES
Hein de Vries Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University,
THE NETHERLANDS
Javier Ayesta, Physiology & Pharmacology Department, University of Cantabria, SPAIN
Jose Martinez-Sanchez, Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de
Catalunya, SPAIN
Krzysztof Przewoźniak Department of Cancer Epidemiology and Prevention, Maria Sklodowska-Curie National Research
Institute of Oncology, Warsaw, POLAND
Lekan Ayo-Yusuf Africa Centre for Tobacco Industry Monitoring and Policy Research, Sefako Makgatho Health Sciences
University, SOUTH AFRICA
Lucia Lotrean Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca and AerPur Romania,
ROMANIA
Luke Clancy TobaccoFree Research Institute, IRELAND
Maciej Goniewicz Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park
Cancer Institute, UNITED STATES
Manfred Neuberger Department for Public Health, Medical University of Vienna, AUSTRIA
Marc Willemsen Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht
University, THE NETHERLANDS
Maria Sofia Cattaruzza, Department of Public Health and Infectious Diseases, Sapienza University of Rome and Società
Italiana di Tabaccologia (SITAB), ITALY
Martin Raw International Centre for Tobacco Cessation, Action on Smoking and Health & New York University School of

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Tobacco Prevention & Cessation | Abstract Book
Global Public Health, UNITED STATES
Michal Stoklosa International Tobacco Control Research, University of Illinois at Chicago, UNITED STATES
Narine Movsisyan International Clinical Research Center, Brno, CZECH REPUBLIC
Otto Stoyka Kiev Health Center, UKRAINE
Paraskevi Katsaounou Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of
Athens, GREECE
Pete Driezen International Tobacco Control Policy Evaluation Project, Department of Psychology, University of Waterloo,
CANADA
Sofia Ravara Faculty of Health Sciences, University of Beira Interior, PORTUGAL
Sonia Duffy College of Nursing, Ohio State University and Department of Veterans Affairs Ann Arbor Healthcare System,
UNITED STATES
Sophia Papadakis, Faculty of Medicine, University of Ottawa Heart Institute, CANADA
Sungkyu Lee Korea Center for Tobacco Control Research and Education (KCTCRE), SOUTH KOREA
Thomas Glynn Stanford Prevention Research Centre, School of Medicine, Stanford University, UNITED STATES
Witold Zatoński Division of Cancer Epidemiology & Prevention, Cancer Center & Institute of Oncology, POLAND
Reinskje Talhout, National Institute for Public Health and Environment, THE NETHERLANDS
Journal Advisory Board
Anne Buttigieg, Oral Rehabilitation and Community Care, Department of Dental Surgery, Faculty of Health Science, MALTA
Antonella Cardone, Director, Cancer Patients Europe (CPE), BELGIUM
Audureau Gérard, Président DNF-Pour un Monde ZeroTabac Vice-président Alliance Contre le tabac, FRANCE
Aurelijus Veryga, National Tobacco and Alcohol Control Coalition, LITHUANIA
Clémence Cagnat-Lardeau, Alliance Contre le Tabac, FRANCE
Constantine Vardavas School of Medicine, University of Crete, GREECE
Cornel Radu-Loghin Secretary General, European Network on Smoking and Tobacco Prevention (ENSP), BELGIUM
Cynthia Callard, Physicians for a Smoke-Free Canada, CANADA
Eduardo Bianco, Tobacco Epidemic Research Center, URUGUAY
Francisco Lozano, President, European Network on Smoking and Tobacco Prevention (ENSP), BELGIUM
Fouad M. Fouad Faculty of Health Sciences, American University of Beirut and Syrian Center for Tobacco Studies, SYRIA
George Kotarov, Bulgarian Anti-Tobacco Coalition, BULGARIA
George Bakhturidze FCTC Implementation and Monitoring Center, GEORGIA
Michaela Lovse, Slovenian coalition for Public Health, Environment and Tobacco Control, SLOVENIA
Nazmi Bilir, Institute of Public Health, Hacettepe University, TURKEY
Neil Collishaw, Physicians for a Smoke-Free Canada, CANADA
Nijole Gostautaite Midttun Mental Health Initiative, LITHUANIA
Pierre Gilbert Bizel, Observatoire de la sa Santé - Province du Hainaut, BELGIUM
Ulysses Dorotheo, Southeast Asia Tobacco Control Alliance (SEATCA), PHILIPPINES

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8th ENSP European Conference on Tobacco Control
Increased chances to quit with a smoking cessation specialists ..................................................................................................9
Prevalence of tobacco use in national heart institute ....................................................................................................................9
An end game scenario for young people? Still yet to come ........................................................................................................... 9
Tobacco control in The Gambia: Strategies, results, and Recommendations ............................................................................. 10
Tobacco industry arguments against new laws and regulations ................................................................................................. 10
Electronic nicotine and non-nicotine delivery systems, a global and comparative overview of the tax systems designs and rates,
legislative framework, Big Tobacco’s marketing strategies, and case studies ........................................................................... 11
Environmental impacts of the tobacco industry - a survey of the research situation 2023 ........................................................ 11
Strategy of tobacco industry and heat not burning tobacco ........................................................................................................12
Indoor pollution with fine and ultrafine particles from cigarettes and shisha ............................................................................ 12
Understanding and tracking tobacco industry influence in the UK: the United Kingdom tobacco industry interference index
2021-2023 .....................................................................................................................................................................................12
A willingness to be orchestrated: why are diplomats continuing to undermine public health for the benefit of the tobacco
industry ......................................................................................................................................................................................... 13
Associations between marijuana and tobacco use among Croatian pupils in 2022 Health Behaviour in School-aged Children
(HBSC) survey ............................................................................................................................................................................... 13
The impact of the COVID-19 pandemic on adherence and outcomes of the varenicline-based smoking cessation (STOP FUMAT)
program in Mureș county, Romania ............................................................................................................................................. 14
Tobacco use among Croatian schoolchildren two years after the begging of COVID-19 pandemic ........................................... 14
Enhancing the legislation and implementation of tobacco control policies in Türkiye ............................................................... 14
Achieving a tobacco free Ireland whilst leaving nobody behind: An analysis of smoking and quitting behaviours in people with
mental health disorders in Ireland ............................................................................................................................................... 15
The Italian clinical practice guideline for the treatment of tobacco and nicotine dependence ..................................................15
Teachers against tobacco summarize their project on attitudes to tobacco and nicotine at fairs and political parties’ municipal
days ............................................................................................................................................................................................... 16
Initial validation of the satisfaction and perceived usefulness questionnaires for evaluating smoking cessation interventions
among individuals with diabetes .................................................................................................................................................. 16
Development of a multi-component smoking cessation intervention for individuals living with diabetes ................................17
The history of smoking cessation support in Hungary ................................................................................................................17
Quitting smoking without gaining weight: short- and long-term results from a study of individuals with overweight and
obesity ........................................................................................................................................................................................... 17
Efficiency of smoking cessation programs: results based on a systematic review .................................................................... 18
Tobacco, human rights, and racial health disparities .................................................................................................................. 18
Enhancing tobacco control and business accountability: The potential of the EU Due Diligence Directive ............................... 18
A smoking-free generation ...........................................................................................................................................................19
Switching up the game and tackling the tobacco industry ..........................................................................................................19
Profile of carcinogenic polycyclic aromatic hydrocarbons in relation with smoking status in COPD patients .......................... 20
Assessing reporting patterns and implications of non-compliant electronic cigarettes in the European market: a comprehensive
study .............................................................................................................................................................................................. 20
Examining non-compliance and regulatory implications of flavored electronic cigarettes in the European market ................ 21
Implementation of tobacco-free school policies: A study protocol for a randomized controlled trial ........................................21
Adapting an innovative smoke-free home intervention in Catalonia through a stakeholder-engaged and systematic approach
(IM-Adapt) ..................................................................................................................................................................................... 21
Ukraine is grappling with the consequences of the unregulated promotion of HTPs and vapes ...............................................22
The trends in tobacco product consumption in Serbia in 2023 .................................................................................................... 22
Nicotine pouches perception among its users – in-depth interviews with young Polish adults.................................................23
Smokers’ attitudes on control policies and an overview of the current state in Serbia .............................................................. 23
The smokescreen of tobacco industry’s social responsibility strategies ....................................................................................24
Usage and accessibility of cigarettes, electronic cigarettes, and heated tobacco products among 13-15-year-old students in
Italy: Temporal trend results from the Global Youth Tobacco Survey (GYTS), 2010-2022 ........................................................... 24
Media monitoring: advertising for e-cigarettes and heated tobacco products in social media in Germany ..............................24
Expansion of, compliance with, and enforcement of smoke and aserosol free environments in Europe: Barriers and
opportunities .................................................................................................................................................................................25
Communication supporting strategy of the new SF law enforcement during martial law in Ukraine .......................................25
The economics of tobacco farming in North Macedonia ..............................................................................................................26
Tobacco control in Ukraine in an emergency situation - Russia’s armed aggression ................................................................27
SinHumo App as an adjunct to a smoking cessation videoconferencing-based intervention: preliminary data on intervention
acceptability and satisfaction .......................................................................................................................................................27
EPR schemes and the tobacco industry: A game of cat and mouse in the EU regulatory landscape ........................................28
Challenges of the flavored novel tobacco products control policy in Georgia .............................................................................28
Could TikTok be a promising platform for anti-tobacco communication? – Experiences from Hungary ...................................28
Table of Contents

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Tobacco Prevention & Cessation | Abstract Book
Perceptions towards the adoption of tobacco-related recommendations of the European Code Against Cancer (4th ed.) among
the European Union population: a qualitative study ....................................................................................................................29
Tobacco product waste: typing cigarette butts collected in different areas at Sapienza University of Rome, Italy .................... 29
Using the COM-B model to identify barriers and facilitators in smoking behaviour to support both stop smoking practitioners
and service users at everyone health, England ...........................................................................................................................30
Targeting patients suffering with long term conditions who smoke on their General Practitioner’s Quality Outcomes Framework
(QoF) list, in England.....................................................................................................................................................................30
The healthy schools stop smoking and vaping service provides Catch Your Breath – a school-based smoking and vaping
programme for young people in Cambridgeshire and Peterborough, England .......................................................................... 30
Implementing a tobacco dependency inpatient programme in Staffordshire’s Hospitals (England, UK) ...................................31
Disposable e-cigarette use and associated factors among US middle and high school students in 2021 and 2022 .................31
Tobacco industry interference index Poland 2023 ........................................................................................................................32
Best practices for second-hand smoke and second-hand aerosol protection and evidence supporting the expansion of smoke
and aerosol-free environments: a position paper from the Joint Action on Tobacco Control 2 .................................................32
Remote vs in-person group-based smoking cessation interventions: smokers characteristics and intervention outcomes ... 33
Smoking behaviors and barriers to quit in Spanish young adults: Implications for the design of smoking cessation digital health
interventions ................................................................................................................................................................................. 33
Conflict of interest in research on heated tobacco products: a systematic review ..................................................................... 33
Trends in tobacco and nicotine use among Serbian adolescents ................................................................................................ 34
Project TnT (Transparency and Truth): a moment of truth for Switzerland? ...............................................................................34
Development of a youth adapted Brief Tobacco Intervention plus automated text messaging for high school students ..........35
Cigarette price differentials and their association with infant and neonatal mortality in 140 countries: a longitudinal ecological
study .............................................................................................................................................................................................. 35
Predictors of the past 30-days e-cigarette use among adolescents in Armenia ........................................................................36
Think different, think big: Final solution to nicotine challenge ...................................................................................................36
Civil society as a catalyst for the ratification and implementation of the Protocol to eliminate illicit trade in tobacco products –
an example from Bosnia and Herzegovina ...................................................................................................................................37
Nurses care for nurses ................................................................................................................................................................. 37
Tobacco packaging and labeling in the Americas: progress and gaps ........................................................................................ 37
Heated Tobacco Products (HTPs) regulation in Pakistan: A case study of tobacco industry’s footprints in the policy
formulation ...................................................................................................................................................................................38
Misleading information created by tobacco industry ................................................................................................................... 38
Perceived content, relationship with tobacco and self-reported reasons for e-cigarette use among adolescents in Europe -
findings from ESPAD 2019 ............................................................................................................................................................ 39
Evidence supporting the expansion of smoke-free (indoor, outdoor, public and private) environments: a literature review .... 39
Lung cancer screening, smoking cessation and health behaviors: preliminary results of an Italian pilot study ......................40
Does tobacco consumption impact the risk of developing hepatocellular carcinoma in patients with hepatitis B? – A systematic
review ............................................................................................................................................................................................ 40
Exposure to secondhand smoke and intention to use e-cigarettes among adolescents: findings from a cross-sectional survey ..40
Health promotion in universities: the national university smoke-free network .........................................................................41
Higher smoking and e-cigarette use among young adults with mental health problems: An analysis of wave 4 of growing up in
Ireland, the national longitudinal study of children in Ireland ..................................................................................................... 42
Young adult smoking in Ireland – Initiation, prevalence, cessation, and intervention points .....................................................42
Analysis of the attitude of Ukrainians to smoking during Russia’s large-scale war against Ukraine ........................................ 43
Coalition of healthcare professionals for a tobacco and nicotine future ..................................................................................... 43
Nurses role in tobacco control – workplace health promotion and education ............................................................................ 43
Expert consensus statement on tobacco control sustainability in Poland ..................................................................................44
Factors associated with current e-cigarette use in an Irish university and attitudes to proposed legislative change ..............44
Smoking and the new trends in young women ............................................................................................................................44
Volunteering and health promotion: High school students for a tobacco free generation ......................................................... 45
Impact of tobacco taxation on poverty and inequality in Serbia ..................................................................................................45
Stepped-care approach implementation for dealing with smoking-related problems using Contextual Behavior Science ..... 46
Too little too late - a critical view of Bulgaria’s increased excise tax regime .............................................................................. 46
Gender differences in smoking-attributable mortality (SAM) by region in Portugal ..................................................................46
Breaking barriers: The power of chisquares in seamless web-paper surveys ...........................................................................47
Marketing of heated tobacco products and tobacco - a case study of 5 nightclubs in a major city in Poland ............................47
Implementation of the new smoke free policy in the Kyrgyz Republic ........................................................................................47
Urologists’ perceptions and behaviors related to tobacco use ....................................................................................................48
Newspaper front pages following the announcement of the new Portuguese tobacco bill: what do they say? .........................48
E-cigarette use and the potential risk for bladder cancer ...........................................................................................................49
Impact of smoking status on Health-Related Quality of Life (HRQoL) in cancer survivors ........................................................49
Attitudes and knowledge of Greek midwives on smoking cessation perinatally ......................................................................... 50
Joint Action on Tobacco Control 2 - Strengthening European tobacco enforcement through a holistic approach .................... 50
Tobacco use among the 13-15 y.o. students in San Marino. Results of the latest Global Youth Tobacco Surveys .....................51

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8th ENSP European Conference on Tobacco Control
Roles and leverages of civil society in the field of tobacco and nicotine prevention: the case of the ACT’s call for a ban on puff
bars ............................................................................................................................................................................................... 51
Evaluation of smoke free start initiative .......................................................................................................................................51
Strengthening the implementation of the comprehensive anti-tobacco law in Ukraine ............................................................52
Smoking behaviours in Poland before and after COVID-19 pandemic ........................................................................................ 52
ENSP Youth Group: a new approach for tobacco control in the European Region and beyond...................................................52
Dual and poly-use of novel tobacco products in Europe: A regulatory challenge ....................................................................... 53
From internet to reality: Studying population interest in tobacco and related terms and topics using Google Trends ............ 53
Global Youth Tobacco Survey: prevalence of tobacco use in countries of the WHO European Region........................................54
Changes in the prevalence of regular smokers depending on education in Poland in 1996-2020 ............................................. 54
Novel tobacco products use – preliminary results from the Polish National Quitline ................................................................ 55
Lessons learned from banning menthol cigarettes in Europe: A mixed methods study examining policy implementation and
impact ...........................................................................................................................................................................................55
Progress of Balkan countries on tobacco control. Evidence from the 2023 WHO report on the global tobacco epidemic ........56
Capacity building, national and international cooperation for enhancing tobacco control activities in Romania ...................... 56
Smoking behaviours in Poland before and after COVID-19 pandemic ........................................................................................ 57
Call to achieve a tobacco-free environment and the first European tobacco-free generation by 2030 (ECI-TFE) - The reality of
European citizen initiatives ........................................................................................................................................................... 57
Session proposal: Tobacco control and cessation in Poland: past, present and future .............................................................. 58
GYTS country report from Czech Republic: Current and long-term trends in the use of tobacco and nicotine products among
13-15 years old students by Petra Kamaradova, Czech Republic ............................................................................................... 58
Dual voice on tobacco control in Poland. Inequalities, urgent needs, new challenges ...............................................................58
Prevalence, patterns and trends of tobacco smoking and secondhand exposure by pregnant women in Poland ..................... 59
Implementation of pharmacological interventions to help quit smoking. The progress of western Balkan countries according
to the WHO report on the global tobacco epidemic, 2021 ............................................................................................................ 59
Tobacco, e-cigarette and heated tobacco use in Poland: Findings from the Global Youth Tobacco Survey 1999-2022 .............60
Tobacco use and urological cancers: An overlooked priority .......................................................................................................60
Smoke control activities in Greece. The 2 pillars: 1. School teaching interventions...................................................................61
2. Interventions of oral health professionals ...............................................................................................................................61
The UN treaty against plastic pollution: towards a global filterban? ..........................................................................................61
Current and long-term trends in tobacco product use among 13-15 year old students in Lithuania: GYTS country report and the
control policy context .................................................................................................................................................................... 61
Campaign for tobacco-free kids’ International Legal Consortium with Gezondheidsfondsen voor Rookvrij: Policy and drafting
guidance for e-cigarette and heated tobacco product regulation ...............................................................................................62
Maximizing on UN environmental treaties to advance tobacco endgame ...................................................................................62
Smoking cessation in cancer care ................................................................................................................................................ 63
Evaluating tobacco product flavors using a combination of sensory and chemical analysis ......................................................63
The use of traditional tobacco, e-cigarettes and heated tobacco products among schoolchildren: findings from the recent
Global Youth Tobacco Surveys in Czech Republic, Lithuania, Italy, Poland and San Marino. ......................................................63
Smokingcessationin urinary cancer prevention, screening and treatment ..............................................................................64
Session on tobacco and e-cigarette use and urological cancers: major conclusions on the risk, beliefs and behaviors, preventive
recommendations ......................................................................................................................................................................... 65

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Tobacco Prevention & Cessation | Abstract Book
Increased chances to quit with a smoking
cessation specialists
Meike Pappens1, Laurence Belenger1, Herwig Boudrez1,
Sandrina Schol1
1Vlaamse Vereniging Voor Respiratoire Gezondheidszorg en
Tuberculosebestrijding, Leuven, Belgium
Introduction
The chances of success to quit smoking are highest when
behavioural counselling is combined with pharmacological
aids. In Belgium, behavioural counselling is offered by
Smoking Cessation Specialists (SCS), healthcare providers
additionally trained during a university course to provide
evidence-based counselling to smokers.
Aim
This study investigated the efficacy of SCS-counselling in
Belgium.
Material and Methods
This cross-sectional study compared success rates of
smokers who made a quit attempt in the past year (2020) with
(n = 214) or without (n = 452) SCS-counselling. Self-reported
continuous abstinence (CA, smoke-free since quitdate) and
point prevalence (PP, not smoked in the past 7 days) were
used as outcomes in logistic regression models.
Results
Success rates were higher in those who received SCS-
counselling (CA 52.8%, PP 63.1%) than those who tried to
quit by other means (CA 32.7%, PP 39.8%). Counselling could
significantly predict successful quitting even after controlling
for medical problems, smoking profile, previous quit attempts
and pharmacological aid (ORCA = 2.929 [1.917 – 4.476], Z (1) =
24.678, p < .001; ORPP = 3.190 [2.097 – 4.854], Z (1) = 29.351,
p < .001).
Conclusions
Smokers can increase their chances to quit by receiving SCS-
counselling, regardless of their medical health, smoking
profile, previous attempts and usage of pharmacological aids.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A1
DOI: 10.18332/tpc/172584
Prevalence of tobacco use in national heart
institute
Wael Abd Elmeguid1
1Egypt Health Foundation, Giza, Egypt
Purpose
The study aims to overview the smoking habits, their
prevalence, and their correlation with socio-cultural
determinants by screening smoking in the national heart
institute population.
Methodology
A cross-sectional study was conducted in the form of a face-
to-face survey. The interviews were carried out by a well-
trained team of interviewers, using a survey according to a
stratified random sampling approach. The study design was
mainly about meeting up to about 300 health care workers
and 300 patients visiting the clinics in the national heart
institute. Then, start to gather information from them if they
smoke and learn more about the type of smoking, they do
and their smoking habits. The survey included questions for
smokers about quitting trials and their reasons for sticking to
smoking. After that, the interviewers tried to raise awareness
about the negative impact of tobacco. The next step was to try
to advise these smokers to quit.
Findings
The study cohort was 160 visitors (36%), 82 employee (19%),
76 nurses (17%), 64
patients (14%), 41 physician (9%) and 20 technician (5%).
Regarding the education level, 63% had primary school
education, 17% had a university level, and 15% were illiterate.
Smoking prevalence was 60% of the patients, 45% of the
visitors, and 30% of the health care workers. In the study
sample, smokers were more likely to have diabetes (P0.071),
to be hypertensive (P0.034), and to have a history of heart
disease (P 0.004). They were more likely to be males (P<0.001).
There was no significant difference between smokers
and non-smokers regarding geographical residence or
educational level. Smokers are more likely to be aware of
smoking hazards, including heart problems, COPD, cancer,
and E.D (P<0.001).
Recommendations
This cross-sectional survey study showed only the association,
therefore, the cause, pathogenesis, and effect were not
evaluated. The study recommend further research with pre
specified outcomes.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A2
DOI: 10.18332/tpc/172588
An end game scenario for young people?
Still yet to come
Pierre Gilbert Bizel1, Anne-Marie Vansnick1, Christian
Massot1, Helen Barthe-Batsalle1
1Observatoire de la santé, Province de Hainaut, Belgium
Introduction
The presentation is based on:
- the evolution of tobacco prevalence and control measures
among young people from 1997 to 2020.
- the objectives of the main upcoming measures of the
Belgian inter-federal strategy for 2022-2028.
Taking into account the persistent strong social gradient, it
will be discuss recommendations towards young people.
Background
In Belgium, much of the reduction in the prevalence of tobacco
use in young people can be attributed to general long-term
policies, most of them adopted during the last twenty years
at the federal and regional levels such as :
- legal measures :
• smoking ban in schools, indoor public places, cars when
a minor is present ,
• advertising ban, neutral packaging,
• gradual increase in taxation;
- adoption of health promotion policies encouraging protective
factors related to addiction.
A legal and social process to denormalize tobacco use has
been implemented and produced results in particular for
young people.
Results
Recurrent surveys on teenagers 10 -17 yrs from the Health

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8th ENSP European Conference on Tobacco Control
Observatory of Hainaut (HOH,CSSV network) since 1997
report significant progress towards a smoke-free generation.
For example, although the province of Hainaut has a
disadvantaged context compared to other Belgian provinces,
current smoking prevalence fell to 7.0% in 2020 (age 16)
compared to 30% in 1997.
Moreover, these progresses are not equally distributed among
socio-economic groups:
In 2020, current smoking prevalence among 15-17 yrs old was
12.5% among professional training school , against 2,9% for
general education.
Discussion
New measures included in the inter-federal plan could be
the tool to reach an end-game. Among them : smoking ban
on railway station platform, prohibition at external entrances
to schools, display ban and reduction of sale points, pouches
ban, puffbars ban, automat display ban, increase in taxes ;
etc. ...
Particular attention should be paid to ensure that young
people from disadvantaged socio-economic backgrounds
can benefit from these positive developments.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A3
DOI: 10.18332/tpc/172589
Tobacco control in The Gambia: Strategies,
results, and Recommendations
Kemo Conteh1, Siaka Sawo1, Omar Bah1
1African Network for Information and Action Against Drug
(RAID- The Gambia), Banjul, The Gambia
Background
Recent studies have shown a decline in tobacco use among
students aged 13 to 15 in The Gambia. However, previous
research has revealed interesting findings regarding tobacco
prevalence in different contexts. The STEPS Survey (2010),
a national population-based survey, indicated an increase
in tobacco use among Gambians aged 24 to 64. This survey
found that 16.3% of adults in this age group reported tobacco
use, with 15% being daily users. Daily tobacco use was higher
among men, especially those aged 25-34 and 35-44, with an
average consumption of ten cigarettes per day.
Objective
This study aims to assess the impact of tobacco control
measures implemented in The Gambia and identify key
lessons learned for future initiatives. The specific objectives
are as follows:
1. Evaluate the effectiveness of government interventions and
policies related to tobacco control.
2. Investigate the role of government-civil society relations,
coordination, and media participation in achieving successful
tobacco control outcomes.
3. Assess the importance of involving youth, women’s groups,
and religious leaders in tobacco control initiatives.
3. Examine the impact of increased taxes on tobacco
consumption and public health improvement.
4. Highlight the significance of tobacco advocacy, sensitization,
and awareness campaigns across all age groups.
Methods
This study will deploy a mixed-methods approach, combining
quantitative data analysis and qualitative assessments.
Quantitative data was used to collect data through surveys to
measure changes in tobacco use prevalence and compliance
with tobacco control regulations. Qualitative methods, such
as interviews and focus group discussions, was a explored
perceptions and experiences related to tobacco control efforts
in The Gambia. Additionally, existing literature and reports on
tobacco control activities in The Gambia was reviewed as well.
Results
The preliminary findings of this study indicate several
key lessons learned in tobacco control and public health
improvement:
1. Strong collaboration between the government and civil
society is crucial for effective tobacco control.
2. Coordinated efforts among various stakeholders
significantly contribute to successful outcomes.
3. Media participation plays a vital role in raising awareness
and supporting tobacco control initiatives.
4. The involvement of youth, women’s groups, and religious
leaders is essential for effective tobacco control and public
health campaigns.
5. Increased taxes on tobacco products are fundamental and
necessary for reducing tobacco consumption.
6. Comprehensive advocacy, sensitization, and awareness
campaigns are crucial for all age groups.
Conclusions
Based on the study’s findings, the following conclusions and
recommendations are proposed:
1. Enhance the capacity of tobacco control advocates,
particularly civil society organizations, journalists, and
health journalists, through training and workshops to ensure
effective monitoring and control of tobacco.
2. Strengthen tobacco control advocacy efforts by utilizing
evidence-based research and expertise.
3. Foster increased coordination among civil society tobacco
control advocates, a multi-sectoral working group, and law
enforcement bodies to ensure effective implementation of
The Gambia’s comprehensive tobacco control law.
By implementing these recommendations, The Gambia
can further advance its tobacco control efforts, leading to
improved public health outcomes and a reduction in tobacco-
related harm.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A4
DOI: 10.18332/tpc/172590
Tobacco industry arguments against new
laws and regulations
Danielle Arnold1, Anouk Boerman1
1Health Funds for Smoke Free, Utrecht, The Netherlands
Since the establishment of the National Prevention
Agreement in 2018, several tobacco control measures have
been implemented in the Netherlands to realise a Smokefree
Generation before 2040. Regulations have been drafted, to
which citizens and organisations could respond via online
consultations. The tobacco industry also responded, both
directly and indirectly via related stakeholders.
We wanted to gain insight in the arguments most commonly
used by the tobacco industry. We instructed a research

11
Tobacco Prevention & Cessation | Abstract Book
company to summarise, analyse and systematically organise
the arguments used by the tobacco industry to change, delay
or block regulations, between 2019 and 2022.
From the 4388 public responses to in total 17 online
consultations, 4113 responses contain arguments against
tobacco control regulations. Most responses from the tobacco
industry and its allies follow a specific pattern. They state they
fully support the governmental goal to achieve a Smokefree
Generation, but that they are against the tobacco control
measure in question as a means to achieve this goal. Most
responses contain the argument that the specific measure
is not effective, as well as arguments related to e-cigarettes
and heated tobacco products as a tool to quit smoking. Other
common arguments relate to illicit trade, effects of tobacco
control measures on the economy and technical issues.
Often literature is cited or examples from abroad are given
to substantiate arguments. The tobacco industry tried to
delay certain measures by pleading for a transition period
that provides sufficient time to prepare for the measure.
The consultation regarding the ban on e-cigarette flavours
generated by far the most responses. This seems to be caused
by tobacco industry campaigns to get e-cigarette users and
retailers to speak up.
Insight in the arguments most commonly used by the tobacco
industry can help NGOs to better prepare for industry
interference and improve their advocacy strategies.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A5
DOI: 10.18332/tpc/172591
Electronic nicotine and non-nicotine
delivery systems, a global and comparative
overview of the tax systems designs and
rates, legislative framework, Big Tobacco’s
marketing strategies, and case studies
Claudio Tanca1, Deniece Carrington1, Estelle Dauchy1, Andrii
Skipalskyi2, George Bakhturidze3,4
1Campaign for Tobacco-Free Kids, Washington, United States,
2World Health Organization, Ukraine, 3University of Georgia,
Tbilisi, Georgia, 4The Framework Convention on Tobacco
Control Implementation and Monitoring Center in Georgia,
Georgia
Introduction
Electronic nicotine and non-nicotine delivery systems (ENDS/
ENNDS) are attracting new nicotine users, particularly non-
smokers, and youth. Although the long-term health effects are
uncertain, ENDS contain nicotine—a highly addictive product,
and most of the existing evidence on ENDS/ENNDS shows that
they are not without risks. Moreover, youth and non-smokers
using e-cigarettes are more likely to initiate conventional
cigarettes and start at earlier ages. Furthermore, ENDS
are not very effective as cessation aids and are often used in
combination with conventional tobacco products. The taxation
of ENDS/ENNDS remains a challenge for most governments,
especially in light is the tradeoff between, on the one hand, the
potential that smokers would use ENDS to quit conventional
cigarettes successfully and, on the other hand, the new health
risks that these products pose and the uptake of use by young
people and non-smokers.
Objective
About ENDS/ENNDS, this session will examine, globally and
comparatively, three key areas critical for advocacy: taxation,
legal (non-tax and price) frameworks, and communications
used by manufacturers and vendors.
Material and Methods
First, it will present and evaluate the tax systems used
currently in countries that manufacture or sell ENDS/ENNDS
and compare these systems based on their tax burdens and
designs. Second, it examines the various legal (non-tax and
price) frameworks used in these countries and compares
them with conventional cigarettes. Third, it will present the
media used by manufacturers and vendors of ENDS/ENNDS,
the messages, and the audience they use to promote them.
Finally, the session will present and compare case studies to
provide concrete examples.
Results
There is a significant variation in the types of tax systems
used for ENDS/ENNDS, and most countries impose very low
tax rates on these products compared to cigarettes.
As WHO has concluded, e-cigarettes are “harmful” and
countries that have not banned e-cigarettes should ensure
that “their tobacco control laws and regulations are
comprehensive enough to regulate all forms of novel and
emerging nicotine and tobacco products.”
E-cigarette manufacturers, including the major tobacco
companies, are spending millions of dollars on lobbying
decision-makers in countries around the world to seek
favorable e-cigarette regulation. Further, the industry targets
non-smokers and young people through product design,
nicotine delivery, flavorings, and by marketing on social
media.
Conclusions
Encourage countries to follow WHO recommendations and
impose high taxation for ENDS/ENNDS and regulations that
match those of conventional cigarettes.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A6
DOI: 10.18332/tpc/172598
Environmental impacts of the tobacco
industry - a survey of the research situation
2023
Niclas Malmberg1
1Tobaksfakta, Stockholm, Sweden
Some sectors of the tobacco industry have been keen to
position themselves as active in reducing the negative
environmental impact they cause. All attempts by tobacco
companies to reduce their impact on the environment are of
course welcome. But comparing what the companies say with
a survey of the research of today makes clear the companies
only address a few of their environmental impacts. When
it comes to deforetration, climate change, impoverishment
of agricultural land and impacts on biological diversity, the
tobacco industry have a very negative impact. What stands
clear is that there is no
such thing as environmentally friendly tobacco:
• Tobacco cultivation occupies extensive areas of arable land
better used for food production.

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8th ENSP European Conference on Tobacco Control
• Tobacco cultivation destroys the land by causing erosion,
lowered groundwater levels, nutrient depletion and loss
of important terrestrial organisms.
• The extensive use of pesticides causes health problems for
tobacco growers and affects surrounding agricultural and
aquatic environments, not least in the form of reduced
biological diversity.
• Tobacco growers are at risk of contracting “Green Tobacco
Sickness (GTS)” from skin contact with nicotine. The 1.3
million children under the age of 14 who work in tobacco
farms are particularly vulnerable.
• The utilization of new arable land as well as the use of
firewood for tobacco curing causes extensive deforestation,
and thus also a reduction of biological diversity.
• All stages of tobacco production impact on our climate,
from deforestation to carbon dioxide emissions during
manufacture and transport.
• Production gives rise to large volumes of waste, some of
it hazardous, which risks being handled in substandard
ways when tobacco companies move production facilities
into countries with weak environmental legislation.
• Production involves extensive water consumption, which
among other things depletes groundwater resources in
arid areas.
• Even after a cigarette has been extinguished, there is a
continued release of cotinine and other toxins that form in
thirdhand smoke (created when smoke settles on textiles,
etc.).
• Not only are cigarette butts and other tobacco- related
products the most common litter in our cities, they also
contain a wide range of environmental toxins, such as
cadmium.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A7
DOI: 10.18332/tpc/172623
Strategy of tobacco industry and heat not
burning tobacco
Florin Mihaltan1
1Romanian Society of Pneumology, Bucharest, Romania
Heated tobacco represents a new challenge for current
generations
The tobacco industry is trying new variants of strategies that
are oriented towards a concept of harm reduction combined
with splitting the medical world and proving to the consumer
the interest in his health.
In reality, we unravel these policies whose main objective is
the social reinsertion of smoking, ensuring the continuation
of making profit on the back of the consumer.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A8
DOI: 10.18332/tpc/172624
Indoor pollution with fine and ultrafine
particles from cigarettes and shisha
Manfred Neuberger1, Patabendhi Nipuni1, Anna Lena
Szettele1, Aleksandra Trochanowska1
1Medical University of Vienna, Vienna, Austria
Background
In November 2019 smokefree hospitality industry went
into force in Austria without exceptions for roofed spaces
surrounded by walls >50%. The legislation bans also shisha,
HTPs and e-cigarettes. In Vienna compliance increased at first
from 95% to 99% within one month, but seemed to decrease
again after surveillance authority had stopped controls.
Objective
Therefore we tested air quality repeatedly in a number of
bars, cafes, discotheques, pubs, and restaurants in Vienna
and compared PM10, PM2.5, PM1, and PNC & LDSA of
ultrafines with concentrations found indoors before the ban
and with current outdoor values. 2019-2021 in 39 venues
at identical locations significant declines in both fine and
ultrafine particle concentrations were found in the former
smoking areas for all parameters as well as in the former
non-smoking areas for PM2.5, PM1 and LDSA. 2022 a second
study in 40 Viennese establishments mainly frequented by
young people confirmed earlier results, but some outliers
indicated, that control of compliance has to be continued.
Methods
Sampling strategy and measurements of PM and UFP
had been described before (Mattar & Neuberger. Ultrafine
Particles in Viennese Gastronomy after Introduction of a
National Smoking Ban. Adv Clin Toxicol 2023, 8: 264).
Results and Conclusions
In Linz 9 of 53 measurements indicated that in these venues
cigarettes and/or water pipes were still used in 2021-2022
and the indoor smoking ban had been ignored. In 2023 in
Vienna we selected only enterprises which advertised shisha,
found 11 for unannounced sampling and in 8 cases violation
of the law by indoor smoking at the time of our visit. There
we measured in room air a mean particle (>10nm) number
concentration of 370,241/cm³ and a mean LDSA of 987 µm²/
cm³, which indicate a health hazard. Concentrations were
a magnitude higher than outdoors and increased with the
number of smokers.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A9
DOI: 10.18332/tpc/172626
Understanding and tracking tobacco
industry influence in the UK: the United
Kingdom tobacco industry interference
index 2021-2023
Raouf Alebshehy1, Tom Gatehouse1, Karin Silver1, Louis
Laurence1, Marzia Violini1, Britta Matthes1, Phil Chamberlain1,
Anna Gilmore1
1University of Bath, Bath, United Kingdom
Background and Objective
The Global Tobacco Index (GTI) evaluates government
implementation of Article 5.3 of the World Health Organization
Framework Convention on Tobacco Control (WHO FCTC).
This legally binding Article aims to prevent tobacco industry
influence over public health policy.
Methods
Using a standardised tool of twenty indicators developed
by the South East Asian Tobacco Control Alliance we have
examined the commitment of the UK to its obligations under

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Tobacco Prevention & Cessation | Abstract Book
Article 5.3 of the WHO FCTC. Data has been gathered since
2017 to create a UK chapter within the GTI report. The first
was published in 2019. Data is collected through searches
of the academic literature, media and government websites,
and routine monitoring reported on the Tobacco Tactics
resource. This is supplemented by submission of Freedom of
Information requests and consultation with the UK’s leading
tobacco control advocates.
Results
Data from the period January 2017 to April 2021 (inclusive)
showed that the UK government performance in preventing
tobacco industry interference has declined somewhat. The
lower the score, the more robust a government is in resisting
interference. The UK scored 26 in the 2019 report and 32 in
the 2020 and 2021 reports. Data for the period April 2021 to
March 2023 is currently being collected and analysed and will
be reported at the conference to show changes in the UK`s
performance and identify any specific issues under the seven
areas of assessment.
Conclusions
The UK is a global leader in tobacco control. While it retains
a high ranking in preventing tobacco industry interference
in policy, it has moved being the first ranked in the 2019
Index to third in the 2021 Index. This latest Index will provide
an evidence-based assessment of the UK`s status and a
blueprint for the government to improve its performance.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A10
DOI: 10.18332/tpc/172628
A willingness to be orchestrated: why are
diplomats continuing to undermine public
health for the benefit of the tobacco industry
Raouf Alebshehy1, Karin Silver1, Phil Chamberlain1
1University of Bath, Bath, United Kingdom
Background
The tobacco epidemic is global and addressing it requires
global collaboration. International and national policies have
been adopted to promote collaboration for tobacco control,
including an obligation on diplomatic missions to protect
public health from the vested interests of the tobacco industry.
However, incidents of diplomats lobbying for the benefits of
tobacco industry is still occurring despite these regulations.
This paper presents a case study of a British ambassador
engaging with the tobacco industry, and it points to some of
the challenges researchers face in monitoring such incidents.
Methods
The incident studied in this paper was first identified through
regular media monitoring conducted by the Tobacco Control
Research Group at the University of Bath. The incident was
further investigated by using the tools made available by the
United Kingdom (UK) Freedom of Information Act, including
submitting request, asking for internal review, and submitting
a complaint to the Information Commissioner’s Office.
Results
We identified clear evidence of the UK ambassador to Yemen
opening a cigarette factory, part owned by British American
Tobacco (BAT), in Jordan. Our investigation revealed a lack
of documentation of this and similar incidents of interaction
between diplomats and the tobacco industry. We raise
concerns about the actions of diplomats which contravene
both national and international policies.
Main Conclusions
Monitoring and reporting such activities produces several
challenges. Diplomats’ interactions with the tobacco
industry represent a major concern for public health as such
interactions seem to be systematically repeated. This paper
calls for action to better implement national and international
policies to protect the public health including in low- and
middle-income countries (LMICs).
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A11
DOI: 10.18332/tpc/172592
Associations between marijuana and
tobacco use among Croatian pupils in 2022
Health Behaviour in School-aged Children
(HBSC) survey
Tonka Karin1, Ivana Pavić Šimetin1, Dijana Mayer1, Ivona Keč1,
Maja Valentić1, Ana Ištvanović1, Lara Petković1
1Croatian Institute of Public health, Zagreb, Croatia
Background
Marijuana is mostly used illegal drug among pupils. The
interconnection of cigarette smoking and marijuana smoking
in population of Croatian pupils in 2022 will be presented.
Methods
We analyze the data of HBSC research conducted in 2022
among pupils in Croatia. Sample included 705 boys in the age
of 15 and 840 girls in the age of 15. Person Chi-Square was
used.
Results
12,1% of boys and 12,9% of girls tried marijuana at least once
in lifetime. 2,5% of boys and 0,7% of girls smoked marijuana
already at age 11 or younger, 1,6% of boys and 0,7% of girls
at age 12, 1,7% of boy and 2,3% of girls at age 13, 2,8% boys
and 3,9% girls at age 14, 3,4% boys and 5,3% at age 15. In the
last 30 days 25,5 % of boys and 28,7% girls smoked cigarettes
at least once. Among boys who never tried marijuana, 16,8%
smoked cigarettes at least once in last 30 days, while among
boys who tried marijuana, 77,5% smoked cigarettes at least
once in last 30 days (p<0,001). Among girls who never tried
marijuana, 19,3% smoked cigarettes at least once in last 30
days, while among girls who tried marijuana, 87,7% smoked
cigarettes at least once in last 30 days (p<0,001). Among boys
who never smoked marijuana, even 82,8% never smoked
cigarettes; among boys who smoked marijuana at age 11
or younger, only 25,0% never smoked cigarettes; among
boys who smoked marijuana at age 12-15, 16,7-33,3% never
smoked cigarettes (p<0,001). Among girls who never smoked
marijuana, even 80,6% never smoked cigarettes; among girls
who smoked marijuana at age 11 or younger, only 33,3% never
smoked cigarettes; among girls who smoked marijuana at
age 12-15, 6,7-21,1% never smoked cigarettes (p<0,001).
Conclusion
For the first time since 2002 (first time in 6 survey waives)
in 2022 girls smoke marijuana more frequently than boys.
Cigarette smoking is associated with life time marijuana
smoking and early onset of marijuana smoking.

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8th ENSP European Conference on Tobacco Control
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A12
DOI: 10.18332/tpc/172593
The impact of the COVID-19 pandemic on
adherence and outcomes of the varenicline-
based smoking cessation (STOP FUMAT)
program in Mureș county, Romania
Corina Marginean1, Nimród László1, Alina Chifiriuc, Cristina
Alexandra Man1
1George Emil Palade University of Medicine, Pharmacy,
Science, and Technology of Targu Mures, Mures, Romania
Background
Romania has a high prevalence of adult smoking, necessitating
effective cessation interventions like the STOP FUMAT
program. Recent global events, like the COVID-19 pandemic,
may influence smoking behavior and cessation attempts,
posing challenges for public health interventions.
Objectives
This study aims to investigate the impact of the COVID-19
pandemic on treatment adherence, smoking cessation
outcomes, and reasons for resuming smoking among
participants in the STOP FUMAT program.
Methods
We conducted a retrospective cohort study of 98 participants
who enrolled in the program between 2020 and 2021,
using a phone-based survey. Variables of interest included
demographic factors, health status, smoking behavior,
completion of the smoking cessation treatment, and
perception of the pandemic’s impact on smoking behavior.
Results
Treatment completion was not significantly associated with
demographic or health characteristics. However, those who
completed the treatment were more likely to believe in its
efficacy (68.6% vs. 47.8%, p=0.038). Most patients resumed
smoking within three months of treatment, with a significant
difference between completers (42.1%) and non-completers
(67.5%, p=0.014). Stress and the COVID-19 pandemic were
major reasons for smoking resumption, and those who felt
affected by the pandemic expressed a stronger desire to re-
engage with the program.
Conclusions
The pandemic did not significantly impact treatment
adherence, but it influenced patients’ smoking behavior
and perceptions. The study underlines the importance
of addressing stress-related triggers for smoking and
communicating the benefits of treatment, particularly during
global crises like the COVID-19 pandemic.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A13
DOI: 10.18332/tpc/172594
Tobacco use among Croatian schoolchildren
two years after the begging of COVID-19
pandemic
Lara Petković1, Ivana Pavić Šimetin1, Dijana Mayer1, Ana
Ištvanović1, Ivona Keć1, Maja Valentić1, Tonka Karin1
1Croatian Institute of Public Health, Zagreb, Croatia
Background
The aim was to analyze the association between tobacco
smoking and the impact of COVID-19 on mental health, in
Croatian schoolchildren aged 11, 13 and 15.
Methods
The data of the Health Behaviour in School-aged Children
(HBSC) research conducted in Croatia in spring of 2022. The
sample included 2411 boys and 2589 girls. Pearson Chi-
Square was used.
Results
Frequency of smoking among the youth increases with age.
While the negative COVID-19 impact didn’t vary among boys,
older girls reported a higher impact.
Among 11-year-olds, 6.6% of boys with negative COVID-19
impact on mental health smoked in the last 30 days, alongside
1.6% of boys with neutral/positive COVID-19 impact (p=0,001).
The same goes for 2,0% of girls with negative and 0.7% of
girls with neutral/positive COVID19 impact on mental health
(p=0,171). Among 13-year-old boys, 9,9% with negative and
6,2% with neutral/positive COVID-19 impact on mental health
smoked in the last 30 days (p=0.119). In the same age group,
12,7% of girls with negative and 5,5% of girls with neutral/
positive COVID-19 impact on mental health smoked in the last
30 days (p<0,001).
32.4% of boys with negative and 22.3% of boys with neutral/
positive COVID-19 impact on mental health, aged 15, smoked
in the last 30 days (p=0.015). Meanwhile, 38.1% of girls with
negative and 20,4% of girls with neutral/positive COVID-19
impact on public health, aged 15, also reported smoking at
least once in the last 30 days (p<0,001).
Conclusion
There was an increase in tobacco use in 2022. While 11- year-
old boys smoke more frequently than girls, the difference
disappears with age, with 15- year-old girls notably smoking
tobacco almost more frequently than boys. Cigarette smoking
is associated with perceived negative COVID impact on mental
health in boys aged 11 and 15, and girls aged 13 and 15.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A14
DOI: 10.18332/tpc/172597
Enhancing the legislation and
implementation of tobacco control policies
in Türkiye
Sedef Erçetin Gencosmanoğlu1, Sara Ozhan1, Melis Şahin1
1Turkish Green Crescent Society, Istanbul, Turkey
Turkish Green Crescent Society (TGCS) is an NGO working on
tackling different kinds of addictions; namely tobacco, alcohol,
and drugs, with a particular focus on vulnerable populations.
The work of TGCS can be summarized as conducting
prevention, recovery, rehabilitation, social reintegration,
and advocacy work, and these are based solely on evidence
and science to be able to have a global vision. TGCS carries
out collaborations and partnerships with public and private
entities such as Campaign for Tobacco-Free Kids to enhance
the legislation and implementation of tobacco control policies
in order to raise the protection standards in Türkiye. In this
regard, the presentation of TGCS at the AGM will be focusing
on three sub-topics:

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Tobacco Prevention & Cessation | Abstract Book
First, TGCS’s recent advocacy activities on tobacco control;
which include legislation improvement suggestions to be
submitted to national decision-making bodies. These
suggestions include a better definition of smoke-free places
that fits to the description of FCTC, creating smoke-free
outdoor spaces in neighborhoods of educational facilities,
decreasing the extensity/plurality of point-of-sales of tobacco
products, and limiting the visibility of tobacco products in
point-of-sales where children also have a free entrance.
Secondly, we will be explaining the monitoring project
targeting points-of-sales that TGCS conducts all around
Türkiye via its nationwide branches. We are collecting data
and evidence on the implementation gaps and/or systematic
violations of tobacco control legislation via our workers
and supporters nationwide. These works also constitute a
convincing justification package for legislation improvement
ideas set forth above.
Lastly, the presentation will then include TGCS’s mobile
application on tobacco cessation, which was made available
during the COVID-19 pandemic. We have a solid public health
service that attracts more appeal each day.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A15
DOI: 10.18332/tpc/172599
Achieving a tobacco free Ireland whilst
leaving nobody behind: An analysis of
smoking and quitting behaviours in people
with mental health disorders in Ireland
Maria Deery1, Paul Kavanagh2
1Health Service Executive, Dublin, Ireland, 2Health Intelligence
Unit, Health Service Executive, Dublin, Ireland
Background
While Ireland has made considerable progress in tackling
the harms caused by smoking, 1 in 5 adults (18%) continue
to smoke, and inequalities are widening. People with mental
disorders risk being left behind as Ireland pursues its tobacco
endgame goal, but smoking and quitting behaviour have been
poorly described in this group.
Objectives
1) To quantify and describe tobacco product use patterns
in people with self-reported probable mental disorders
(PMD) in Ireland.
2) To quantify the prevalence of smoking, quitting behaviours
quit aid use in adults with self-reported mental disorders.
3) To quantify contact with health professionals and
stop-smoking care by those with self-reported mental
disorders.
Methods
A secondary analysis of the 2021 Healthy Ireland (HI) survey
dataset was conducted. The HI Survey is conducted annually
with a representative sample of the population aged 15
years and older (n=7,454). Descriptive statistics and logistic
regression compared smoking and quitting behaviours across
those with and without a PMD.
Results
Smoking prevalence was significantly higher in those with
a PMD than those without (26.1%-v-16.9%, p<0.001). There
was no difference in positive intention to quit (p=0.21) and
making a quit attempt in the past 12 months was similar
(p=0.856) across both groups. However, making a successful
quit attempt was higher in those without a PMD compared
to those with a PMD (27.7%-v-24%, p<0.001). This is despite
those with PMD having more frequent contact with healthcare
staff than those without (p<0.001).
Conclusions
While people with PMD have a need and interest in stopping
smoking, these findings underline a gap in the provision of
stop smoking care to this group which means they risk being
left behind as Ireland becomes tobacco-free. This study will
act as a catalyst for greater focus in the fight against the
ongoing epidemic of smoking related harm in Ireland.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A16
DOI: 10.18332/tpc/172601
The Italian clinical practice guideline for
the treatment of tobacco and nicotine
dependence
Renata Solimini1, Simona Vecchi2, Alice Josephine Fauci3,
Antonello Napoletano3, Daniela Coclite3, Luisa Mastrobattista1,
Claudia Mortali1, Ilaria Palmi1, Laura Amato2, Roberta Pacifici1,
Experts Panel Group, Evidence Review Team, Simona Pichini1
1Istituto Superiore di Sanità, National Centre on Addiction
and Doping, Rome, Italy, 2Department of Epidemiology of the
Regional Health Service, ASL Roma 1, Rome, Italy, 3Istituto
Superiore di Sanità, National Centre for Clinical Excellence,
Rome, Italy
Background
Recently, new products have appeared on the market
containing tobacco and/or nicotine (e.g. heated tobacco
cigarettes, electronic cigarettes or other new and emerging
products). In Italy, these new products mainly lead to dual use
or poly-use.
Objectives
The Italian Clinical Practice Guideline (CPG) for the
treatment of tobacco and nicotine dependence includes
both the treatment of conventional tobacco dependence and
the treatment of nicotine dependence, induced by the new
and emerging products containing tobacco and/or nicotine.
The National Centre on Addiction and Doping of the Istituto
Superiore di Sanità defined the objectives and scope of this
updated CPG.
Materials and Methods
A multidisciplinary panel of clinical experts, together with
experts in systematic literature review, identified and
prioritized 9 clinical questions related to the treatment
of tobacco and nicotine dependence. The applied process
was consistent with the Methodological Manual for the
production of CPGs (by the National Centre for Clinical
excellence, National Guidelines System). The Grading of
Recommendations Assessment, Development and Evaluation
(GRADE) methodology was used to assess the certainty of
evidence and make recommendations. The reporting of
the guideline was prepared in accordance with the AGREE
Reporting Checklist (Appraisal of Guidelines for Research
and Evaluation).
Results

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8th ENSP European Conference on Tobacco Control
The guideline included 9 clinical questions, 4 of which
related to behavioral interventions (including brief
advice, counselling and digital interventions), 4 related to
pharmacological interventions (including pharmacological
interventions alone or in association with behavioral support),
and one related to the training of healthcare professionals.
The results of the systematic reviews conducted for each
question were discussed with the multidisciplinary panel and,
by using the GRADE Evidence to Decision (EtD) framework, 29
recommendations for clinical practice, 1 recommendation for
further studies and 8 Good Practice Statements, were issued.
Conclusions
To our knowledge, this is the first CPG that includes the
treatment of nicotine dependence as well as the treatment
of conventional tobacco dependence following a standardized
and internationally recognized methodology.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A17
DOI: 10.18332/tpc/172603
Teachers against tobacco summarize their
project on attitudes to tobacco and nicotine
at fairs and political parties’ municipal days
Björn Sundin1
1Teachers against Tobacco, Stockholm, Sweden
Background and Purpose
Teachers against Tobacco works with influence at fairs and
where politicians gather. Since 2019, questionnaires have been
distributed in connection with a prize competition with some
questions about attitudes to tobacco and nicotine products.
The purpose of the questionnaires is to start a conversation
about tobacco issues, to arouse the respondents’ interest in
the issues and to obtain figures on the attitudes in the various
contexts.
Method
We handed out the survey on an A5 paper. The results were
then compiled in an Excel file.
Results
A majority of respondents want a more restrictive tobacco
policy. However, Liberals and Center Party members are less
negative to a more restrictive tobacco policy.
Conclusions
The respondents request a more restrictive tobacco policy.
The respondents in the political parties are also in favor of a
more restrictive tobacco policy, significantly more than what
is expressed in the parties’ policies in the Riksdag.
Implications
There is every reason to highlight that the political parties
do not represent the views of their members on the tobacco
issue.
Limitations and Future Research
The sample is limited to those who are willing to answer the
survey. On some occasions there are few respondents but the
answers do not differ significantly. More information can be
obtained from materials such as e.g. about men or Women
have different attitudes as well as the attitudes of those who
use tobacco and those who do not.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A18
DOI: 10.18332/tpc/172617
Initial validation of the satisfaction and
perceived usefulness questionnaires for
evaluating smoking cessation interventions
among individuals with diabetes
Joseph Grech1, Ian Norman2, Roberta Sammut1
1Department of Nursing, Faculty of Health Sciences, University
of Malta, Mater Dei Hospital, Msida, Malta, 2Faculty of Nursing,
Midwifery & Palliative Care, King’s College London, London,
United Kingdom
Background
Evidence suggest that individuals with diabetes do not
easily adopt smoking cessation interventions. Assessing
the acceptability of such interventions is crucial before
implementation, yet there are no quantitative measures which
evaluate satisfaction and perceived usefulness of smoking
cessation interventions among individuals with diabetes.
Objectives
Validate and assess the internal consistency of two self-
developed instruments measuring satisfaction and perceived
usefulness of a smoking cessation intervention among
individuals with diabetes.
Methods
The instruments were developed and validated in English,
then translated into Maltese. The satisfaction questionnaire
contained eight statements while the perceived usefulness
questionnaire had fourteen; both rated on a 5-point Likert
scale. Content validation involved five tobacco cessation
facilitators rating item relevance using a 4-point ordinal
rating scale, suggesting improvements, and later assessing
the conceptual equivalence of the translated questionnaires
using a similar scale. Unanimous agreement among experts
was required for item relevance and equivalence. Thirty-
four individuals with type 1 or type 2 diabetes, attending a
diabetes-specific smoking cessation intervention, received
either the Maltese or English versions of the questionnaires.
Internal consistency was measured using Cronbach’s alpha
scores.
Results
Two rounds of content validation resulted in minor changes to
the questionnaires, including removing one item and adding
another to the perceived usefulness questionnaire. Experts
unanimously agreed on item relevance and conceptual
equivalence. Fifteen participants completed the Maltese
versions of the questionnaires, while sixteen completed the
English versions. Cronbach’s alpha scores were 0.87 and
0.91 for the Maltese and English versions of the satisfaction
questionnaire, and 0.94 and 0.96 for the Maltese and English
versions of the perceived usefulness questionnaire. All item-
scale correlations were >0.4.
Conclusions
These findings provide initial validation for utilizing the
developed instruments to assess satisfaction and perceived
usefulness of smoking cessation interventions among
individuals with diabetes. Further validation with a larger
sample and factor analyses is recommended.
Conflicts of interest
The authors have no conflicts of interest to disclose.

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Tobacco Prevention & Cessation | Abstract Book
Tob. Prev. Cessation 2023;9(Supplement 2):A19
DOI: 10.18332/tpc/172621
Development of a multi-component smoking
cessation intervention for individuals living
with diabetes
Joseph Grech1, Ian Norman2, Roberta Sammut1
1Department of Nursing, Faculty of Health Sciences, University
of Malta, Mater Dei Hospital, Msida, Malta, 2Faculty of Nursing,
Midwifery & Palliative Care, King’s College London, London,
United Kingdom
Background
Smoking cessation is an integral aspect of diabetes
management. Given the diabetes-specific challenges faced
by individuals with diabetes in attempting to quit smoking,
the provision of tailored smoking cessation support has been
recommended. However, there has been limited research on
the development of tailored smoking cessation interventions
for this cohort.
Objectives
Develop a diabetes-specific smoking cessation intervention,
based on evidence and the needs of individuals with diabetes.
Methods
A scoping review of the literature on smoking cessation
interventions for individuals with diabetes, and on the
challenges and barriers to quitting was carried out to
identify the most promising smoking cessation methods for
this cohort. This was followed by a systematic review and
intervention component analysis of the identified smoking
cessation methods, for identifying the most effective smoking
cessation elements. Additionally, a qualitative descriptive
study was held amongst 20 Maltese former and current
smokers with diabetes to explore their needs to quit smoking
and views on the identified intervention components.
Results
Based on the reviews and the qualitative descriptive
study’s findings, a multi-component smoking cessation
was developed. This consists of three to four behavioural
support sessions (about 30 minutes each) and a six-week
provision of Nicotine Replacement Therapy. To address the
documented need for more impactful communication about
tobacco-related harm, the intervention includes three brief
video clips featuring a person with diabetes who experienced
tobacco-associated diabetic complications. Participants
from the qualitative descriptive study also expressed the need
for smoking cessation support in local diabetes practice,
presenting an opportunity to integrate the smoking cessation
intervention into local diabetes education initiatives.
Conclusions
This study reports on the development of a unique multi-
component smoking cessation intervention based on evidence
and the needs of individuals with diabetes. The intervention
will now be piloted as part of local diabetes education efforts.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A20
DOI: 10.18332/tpc/172629
The history of smoking cessation support in
Hungary
Zsuzsa Cselkó1, Márta Fényes1
1National Korányi Institute of Pulmonology, Budapest,
Hungary
Background
Tobacco use remains the greatest preventable cause of death
in Hungary, with a smoking-related death rate (2019: 360/100
000 age-standardized death rate) among the highest in the
WHO European Region. Despite WHO FCTC-defined tobacco
control measures in place, smoking prevalence is high (2019:
27%) and has not decreased since 2014.
Objectives
This study attempts to summarize the progress of smoking
cessation support in Hungary aiming to identify strengths and
areas for improvement to lessen the toll caused by smoking.
Methods
A literature search was conducted using the Hungarian Digital
Archives Database. After 2012, the data has been derived
from the National Methodology Center for Cessation Support
(Center) reports.
Results
The National Korányi Institute of Pulmonology (NKIP)
established the first organized network of cessation counseling
services in 1987 at outpatient pulmonary clinics (OPCs)
sponsored by a State Insurance tender. By 1999, individual
behavior counseling with medication was accessible at 130
healthcare providers thanks to pharmaceutical company
support. Since 2005, the National Health Insurance Fund has
supported, albeit at a low value, behavior counseling at OPCs.
The Center at NKIP was established in 2012 and entrusted with
the following: education of healthcare workers in cessation
support (2430 persons between 2012-2023), operation of the
national quitline (on average 1000 persons counseled per
year), formulation of relevant guidelines, and coordination of
cessation support programs. Having recognized that OPCs
are overburdened by the organizational tasks of cessation
support and funding was intermittent, from 2020 counseling
service has steadily transferred to the existing network of
health promotion offices, although without specific funding
for cessation programs and communication.
Conclusions
To achieve tobacco control advances, adequate and regular
funding for established counseling services and nicotine
withdrawal treatment is essential. Furthermore, the role of
healthcare professionals in reducing the tobacco epidemic
toll is outstanding, therefore individual responsibilities should
be recognized.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A21
DOI: 10.18332/tpc/172633
Quitting smoking without gaining weight:
short- and long-term results from a study of
individuals with overweight and obesity
Andrea Krotter1, Ángel García-Pérez2, Gema Aonso-Diego3,
Amalia Udeanu3, Gloria García-Fernández3
1Addictive Behaviors Research Group, Department of
Psychology, University of Oviedo, Oviedo, Spain, 2University of
Leon, Castilla and Leon, Spain, 3University of Oviedo, Oviedo,
Spain

18
8th ENSP European Conference on Tobacco Control
Background
Post-cessation weight gain, which has been estimated as 4-5
kilos (kg) after one year of abstinence, is a major barrier for
smoking cessation.
Objectives
To analyze the efficacy of an intervention for smoking cessation
and weight gain prevention among smokers with overweight
or obesity at the end of the treatment (EOT) and follow-ups in
terms of rates of seven-day point prevalence abstinence, days
of continuous abstinence, and weight change among quitters.
Methods
120 smokers (MBMI=31.75; SD=4.31; 54.16% female) were
randomly assigned to cognitive behavioral therapy for smoking
cessation and weight gain prevention (CBT; n=60) or CBT plus
contingency management for smoking cessation (CM; n=60).
Individuals completed an assessment at baseline, at EOT, and
at follow-up sessions (1, 3, 6, and 12 months after the EOT).
Abstinence was biochemically confirmed (CO levels ≤4 ppm
and cotinine levels ≤80 ng/ml), and weight was measured in
kg with a calibrated medical scale. Abstinence rates were
examined following the intention-to-treat analysis, and no
imputation of weight missing data was performed.
Results
Abstinence rates in the total sample were 70%, 49.17%,
37.5%, 33.33%, and 25% at EOT and 1-, 3-, 6-, and 12-month
follow-ups, and mean days of continuous abstinence were
13.35±10.27, 22.22±25.10, 36.68±50.99, 54.98±86.55, and
83.51±153.44. No differences were found between groups
in abstinence rates at any assessment (all p-values ≥.073)
or in days of continuous abstinence (all p-values ≥ 254).
Quitters gained 1.07±1.88, 2.16±3.43, 2.91±4.54, 2.92±3.43,
and 3.7±4.70 kg respectively at each time point (all p-values
<.001). Weight change was similar in both groups (all p-values
≥.229).
Conclusions
Abstinence rates were higher than found in previous studies
with this population. CM for smoking cessation did not improve
smoking cessation outcomes at any time point. Although
quitters gained weight, the increase was lower than reported
in prior interventions without weight gain prevention.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A22
DOI: 10.18332/tpc/172635
Efficiency of smoking cessation programs:
results based on a systematic review
Laure Fillette1, Isabelle Varescon2
1Université Paris Cité, Boulogne Billancourt, France,
2Université Paris Cité, Laboratoire de Psychopathologie et
Processus de Santé, Boulogne Billancourt, France
For decades, health professionals have actively promoted
smoking cessation. Nicotine replacement therapy has proven
its efficiency in treating the physiological aspect of the
addiction but, to this day, it is still unclear what variables are
involved in the treatment of the psychological and behavioral
aspects of the addiction. For the past fifty years, therapeutical
programs have been created but, due to the huge diversity
of protocols, interventions and evaluations, it is still unclear
what variables are in fact involved in the efficiency of a
smoking cessation program.
Therefore, the purpose of this communication is to show the
main results based on a systematic analysis of the literature
from the first smoking cessation programs in the 70’ to
2023. Using the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) method, 49 articles
were included in the review with, overall, results showing a
positive association between the personalization of a smoking
cessation program and its efficiency.
The results of this work highlight the importance for health
professionals, when determining which intervention is best,
to consider which smoker is faced in order to adapt the
indication. When most of the existing programs offer one
single form of intervention for all users, it appears necessary
for future programs to offer a variety of interventions. And it
is important, when evaluating the efficiency of a program, not
only to observe the variables of the program itself, but also the
characteristics of the users such as their sociodemographic
profile as well as their motivational status and their smoking
background. Therapeutical interventions in the field could
benefit from a systematical review of those characteristics.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A23
DOI: 10.18332/tpc/172636
Tobacco, human rights, and racial health
disparities
Kelsey Romeo-Stuppy1
1Action on Smoking and Health, Washington, United States
Tobacco negatively impacts the right to health. In many
countries, tobacco also contributes to health inequalities, as
vulnerable populations are targeted by tobacco companies,
often smoke at higher rates, and are provided with less
cessation support. Participants will learn how to use human
rights arguments at a local, national, and international level.
Participants will learn how to engage with the human rights
treaty body, the Committee on the Elimination on Racial
Discrimination, on the upcoming general recommendation on
the right to health. The general recommendation provides an
opportunity to ensure that tobacco is included in the work of
human rights bodies, as well as provides support for tobacco
control advocacy at the local and national level.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A24
DOI: 10.18332/tpc/172638
Enhancing tobacco control and business
accountability: The potential of the EU Due
Diligence Directive
Grazia Scocca1
1University of Salerno, Fisciano, Italy
This abstract examines the potential of the EU due
diligence directive in contributing to tobacco control
policies and enhancing the right to health for EU citizens.
The implementation of mandatory due diligence measures
plays a crucial role in holding businesses accountable for
their impact on environmental and human rights issues. The
tobacco industry, in particular, requires rigorous scrutiny due

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Tobacco Prevention & Cessation | Abstract Book
to its detrimental effects on public health. By incorporating
the EU due diligence directive, the tobacco control policies
can be strengthened, ensuring that tobacco companies
operate responsibly and transparently.
The directive serves as a framework for tobacco businesses to
assess and manage the social, environmental, and health risks
associated with their operations, supply chains, and products.
It enables the identification and prevention of practices that
compromise the right to health as well as the right to a
healthy environment, promoting greater transparency and
accountability within the industry. Furthermore, the directive
provides a platform for collaboration between governments,
civil society organizations, and tobacco companies to
collectively address the challenges posed by tobacco use.
The integration of the EU due diligence directive into tobacco
control policies offers multiple benefits. It facilitates the
enforcement of stricter regulations and encourages the
adoption of evidence-based measures to reduce tobacco
consumption. By emphasizing business accountability, the
directive supports the protection of EU citizens’ right to health
by curbing tobacco-related harms. Additionally, it promotes
the dissemination of information and awareness campaigns
to educate the public about the risks associated with tobacco
use.
In conclusion, the EU due diligence directive has the potential
to significantly impact tobacco control policies, enhancing the
right to health for EU citizens. The integration of due diligence
measures paves the way for a healthier and more informed
society, promoting the well-being of EU citizens.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A25
DOI: 10.18332/tpc/172639
A smoking-free generation
Emanuela Oana Costin1,2, Camelia Pescaru2, Andrei Pescaru2
1Tallaght University Hospital, Dublin, Ireland, 2Victor Babes
Clinical Hospital, Timisoara, Romania
Tobacco use and exposure is the most common cause of
preventable death and disease around the world, claiming
more than 8 millions of lives every year.
The majority of current smokers report that the most
defenseless age for future nicotine addiction is the
adolescence, when youth are very vulnerable, with a faster
progression to smoking dependence and an exposure which
raise critical concerns.
Tobacco use disorder arises from a complex interaction
of neurobiological, behavioral, and social-environmental
factors. Furthermore, almost 40% of children with ages up
to 11 are regularly exposed to secondhand smoking in United
States and data shows that these rates are increasing yearly.
Helping youth to quit tobacco is extremely important. There
are many interventions for tobacco cessation around young
generation and continuous research is needed. Some studies
claimed that healthcare providers should advise people to
stop smoking in front of their children. While almost half of
our children breathe a tobacco polluted air and more than
65000 young people die every year because of second-hand
smoke related illnesses, prevention is considered to be the
key to protect the youth.
There are several recommendations for pediatricians about
limiting and treating nicotine dependence among children
and adolescents. The US Public Health Service advocates
tobacco screening as primary psychosocial assessment
among teenagers. Stopping smoking initiation among youth
it is much easier than treating it. Education and counseling
school-aged children could be the key to decrease the rates
for tobacco user and disorders.
Moreover, pharmacotherapy could be considered as a part
of the treatment for smoking cessation even for younger
age groups, but the challenge comes with enrollment and
treatment adherence.
Furthermore, the new devices called e-cigarettes which can
contain nicotine or not are extremely harmful and undoubtedly
unsafe. These products are very dangerous for our health,
even though their exact long-term effects are not known
completely.
While tobacco companies are taking steps ahead with new
e-cigarettes and vaping devices, health organizations and
multi-disciplinary medical teams around the world need to
work together for developing a smoking free generation.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A26
DOI: 10.18332/tpc/172641
Switching up the game and tackling the
tobacco industry
Louise Johansson1, Shannelle Sahlin1
1A Non Smoking Generation, Stockholm, Sweden
Background
We got comfortable. As tobacco usage declined in Sweden,
we took a breath, and the tobacco industry plotted a big
comeback. They did not intend to accept their losses. Instead,
they closely studied youth. And since 2016, the industry has
used clever tactics to recruit a new generation.
Objectives
With marketing strategies exploiting feminism, activism,
environmental consciousness and ethics – the number of
young tobacco users has once again skyrocketed. This leaves
us wondering: will we be hunting the tobacco industry forever?
In our oral presentation, we will cover four strategies
implemented by the tobacco industry in Sweden to recruit
youth: health-washing, fem-washing, green-washing, and
ethics-washing. We aim to inspire the implementation of
proactive and sustainable solutions when regulating all forms
of tobacco.
Methods
If the tobacco industry is rapid and innovative - shouldn’t
we be as well? It took Sweden five long years to somewhat
regulate new nicotine products (such as white snus) after
launching in 2016. This new law is both a victory and a loss; the
legislators want to “figure out the exact health implications
before regulating them”. Meanwhile, thousands of young
people have and will enter a life-long nicotine addiction via
the strategies mentioned.
Results
Once again, lawmakers have fallen for the tobacco industry’s
narrative of harm reduction, i.e., health-washing. The tobacco
industry’s interference extended the length of the process and

20
8th ENSP European Conference on Tobacco Control
influenced the regulations. And what’s even worse: we can
already see the industry circumventing the new laws just one
year after implementation.
Conclusions
To prevent the tobacco industry from repeating history over
and over again, should we keep trying to predict the industry’s
next move, or should we employ entirely new approaches?
Perhaps by learning from history, we can take more long-
term actions before it’s too late and become the movement
that ends the tobacco epidemic – once and for all.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A27
DOI: 10.18332/tpc/172642
Profile of carcinogenic polycyclic aromatic
hydrocarbons in relation with smoking
status in COPD patients
Antigona Trofor1, Ioana Buculei1, Mona Elisabeta Dobrin2,3,
Cristina Vicol1, Daniela Robu Popa1,3, Oana Elena Melinte1
1University of Medicine and Pharmacy Grigore T. Popa din Iași,
Iași, Romania, 2Medical Science Department, Iuliu Hațieganu
University of Medicine and Pharmacy, Cluj-Napoca, Romania,
3Clinical Hospital of Pulmonary Diseases, Iași, Romania
Introduction
Polycyclic aromatic hydrocarbons (PAHs) are a class of complex
organic substances, consisting of carbon and hydrogen atoms
that contain at least two benzene rings. Six PAHs have been
classified as possible carcinogenic compounds to humans:
benzo(a)anthracene (BaA), benzo(b)fluoranthrene (BbFlu),
benzo(k)fluoranthrene (BkFlu), benzo(a)pyrene (BaPy),
dibenzo(a,h)anthracene (DahA) and indeno1,2,3-cd-pyren
(IPy). It is known that PAHs compounds, such as benzopyrene,
anthracene and acenaphthylene, are capable of producing
toxic, mutagenic and carcinogenic effects, being an important
risk factor for respiratory diseases, such as lung cancer and
COPD.
Material and Methods
This observational study aimed to evaluate the serum
concentration of carcinogenic PAHs (BA, B(b)Flu, B(k)Flu,
BaPy, D(a,h)A, IPy) according to smoking status (smoker, non-
smoker/ex-smoker) and to smoking consumption (number
of packs-years, PY) in 52 patients diagnosed with COPD in
different stages of disease severity.
Results
BaPy was significantly higher in the group of smokers
diagnosed with COPD (mean concentration = 1.21 ng/mL)
and was higher than in the group of former smokers (mean
concentration of 0.56 ng/mL), but also compared to the group
of non-smoker patients (mean concentration = 0.87 ng/mL).
The regression summary for the dependent variable showed
an important correlation between BaPy concentration and
PY. The factorial analysis applied to the data set generated
3 factors with a variance of 52% represented by carcinogenic
PAHs, such as BaA, DahA, B(b,k)Flu and BaPy.
Conclusions
The accumulation of pollutants according to smoking status
showed higher serum concentrations of carcinogenic PAHs in
smokers (ΣPAHs = 6.76 ng/mL) compared to non-smokers and
ex-smokers COPD patients. The most abundant carcinogenic
PAHs were BaPy in smokers, DahA for non-smokers, and B(b)
Flu for former smokers.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A28
DOI: 10.18332/tpc/172643
Assessing reporting patterns and
implications of non-compliant electronic
cigarettes in the European market: a
comprehensive study
Irmina Michałek1,2, Florentino Luciano Caetano dos Santos3,
Monika Durzynska1, Marta Manczuk1, Pawel Koczkodaj1,2
1Maria Sklodowska-Curie National Research Institute of
Oncology, Warsaw, Poland, 2Medical Research Agency,
Warsaw, Poland, 3Harvard Business School, Harvard
University, Boston, United States
Background
Given the increasing prevalence of e-cigarette usage and
potential risks associated with non-compliant products,
understanding their reporting patterns is crucial for public
health regulation.
Objectives
The aim of this study was to investigate the extent to which
non-compliant electronic cigarettes, which are being sold in
the European market, are being reported in relation to the
prevalence of e-cigarette usage.
Methods
We conducted a comprehensive search using the EU Rapid
Information System for dangerous non-food products,
commonly referred to as Rapex, to identify instances of non-
compliant e-cigarettes reported between the years 2005 and
2022. This system encompasses data from 28 current and
former member states of the European Union (EU-28). To
determine the fraction of individuals who have ever used
e-cigarettes, we accessed the latest Eurobarometer survey
conducted in 2020. Additionally, we obtained population data
for each country in 2020 from the World Bank. Subsequently,
we computed an index for each country, namely the number
of alerts per 100,000 ever e-cigarette smokers, hereafter
referred to as the “alert index.”
Results
During the period from 2005 to 2022, a total of 150 alerts
were recorded for violations of electronic cigarette legislation
within the EU-28 region. Among the member states, Ireland
exhibited the highest alert index of 4.2, followed by Bulgaria
with 3.2 and Lithuania with 1.3. In 16 out of the EU-28 states, the
alert index remained at 0.0 per 100,000 individuals who have
ever smoked e-cigarettes. Notably, four of these 16 states,
namely Italy, Germany, the United Kingdom, and Poland, were
identified as the countries of origin for the reported products.
Conclusions
In conclusion, our findings highlight the need for stricter
enforcement and monitoring of non-compliant electronic
cigarettes in the European market.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A29
DOI: 10.18332/tpc/172646

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Tobacco Prevention & Cessation | Abstract Book
Examining non-compliance and regulatory
implications of flavored electronic
cigarettes in the European market
Paweł Koczkodaj1,2, Florentino Luciano Caetano dos Santos3,
Monika Durzynska1, Marta Manczuk1, Irmina Michałek1,2
1Maria Sklodowska-Curie National Research Institute of
Oncology, Warsaw, Poland, 2Medical Research Agency,
Warsaw, Poland, 3Harvard Business School, Harvard
University, Boston, United States
Background
Flavored electronic cigarettes have gained popularity in
the European market; however, concerns have been raised
regarding their compliance with regulations and the potential
need for policy revisions.
Objectives
The primary objective of this research was to conduct
a thorough investigation into the reported instances of
violations associated with non-compliant flavored electronic
cigarettes, specifically those being marketed and sold within
the European market.
Methods
We conducted an extensive search using Rapex, the
EU Rapid Information System for dangerous non-food
products, to identify reported violations of non-compliant
flavored e-cigarettes between 2005 and 2022. We thoroughly
reviewed complete reports and accompanying photographic
documentation to assess the presence of characterizing
flavors. Descriptive statistics were utilized to present mean,
standard deviation (SD) for numeric variables, and numbers/
percentages for categorical variables.
Results
Between 2005 and 2022, a total of 110 alerts were recorded,
with 78 (70.9%) related to flavored e-cigarettes and 32 (29.1%)
to refills. Safety information deficiencies accounted for 87
alerts, while volume violations comprised 33 alerts. Seventeen
alerts indicated exceeding permitted nicotine concentration.
Among these, 10 cases were identified based on producers’
declarations, with an average nicotine concentration of
48.40 mg/ml (SD 12.20). Laboratory tests conducted on eight
reported products revealed an average nicotine concentration
of 31.09 mg/ml (SD 8.45).
Conclusions
In light of the substantial number of alerts associated with
flavored e-cigarettes and the identified safety information
deficiencies, volume violations, and excessive nicotine
concentrations, our findings underscore the necessity for
a reassessment of EU legislation to include a prohibition
on flavored e-cigarettes, similar to that implemented for
conventional cigarettes.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A30
DOI: 10.18332/tpc/172647
Implementation of tobacco-free school
policies: A study protocol for a randomized
controlled trial
Pierre Laloux1, Nora Mélard1, Vincent Lorant1
1Institute of Health and Society, Catholic University of Louvain,
Louvain-la-Neuve, Belgium
Background
In Europe, more than half of smokers started before 18.
Tobacco-free school policies (TFSP) were implemented
as school plays a decisive role in smoking. Yet, there is
inconclusive evidence that such policies are effective, as there
are few well-designed and long-term experimental studies.
In this study protocol, we describe the ADHAirE Project that
aims to improve the implementation and effectiveness of
TFSP.
Methods
We will conduct a randomized controlled trial with 10 secondary
schools in the experimental group and 10 secondary schools
in the control group to test the effectiveness of the project
on different smoking outcomes. The project will take place
in the Hainaut province, which has the lowest income level
and one of the highest smoking prevalence in Belgium. It
is composed of three main components: regular evaluation
of the school’s situation regarding its tobacco policy and
adolescent smoking, creation of an advocacy coalition, and
support provision regarding the implementation of the policy.
Collaboration with smoking cessation programs will also be
provided. A survey will be conducted among school staff and
students at baseline, one-year, and two-year follow-up to
collect data on smoking status and perceived smoking norm
at school.
Discussion
The project aims to make TFSP a social norm that is shared
and enforced by a large coalition of school stakeholders,
improve its implementation fidelity, and, ultimately, prevent
and decrease adolescent smoking. The advocacy coalition
will allow to gather stakeholders like principals, teachers
and students to share reasons and beliefs to move toward a
new “non-smoking norm”. As smoking is socially embedded,
adolescents have to feel that they do not act alone when
changing a common behavior. Similarly, school staff has to
feel confident to enforce the TFSP. Findings from this project
will contribute to the existing literature on school-based
interventions and on adolescent smoking prevention.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A31
DOI: 10.18332/tpc/172648
Adapting an innovative smoke-free
home intervention in Catalonia through
a stakeholder-engaged and systematic
approach (IM-Adapt)
Olena Tigova1,2,3,4, Nathália Rosa5, Laura Anton1,2,4, Maria
Fernandez6, Esteve Fernández1,2,3,4, Cristina Martínez1,2,3,4,7
1Centre for Biomedical Research in Respiratory Diseases
(CIBERES), Madrid, Spain, 2Catalan Institute of Oncology,
Barcelona, Spain, 3University of Barcelona, Barcelona, Spain,
4Bellvitge Biomedical Research Institute, IDIBELL, Hospitalet
de Llobregat, Barcelona, Spain, 5Department of Medicine and
Life Sciences, University Pompeu Fabra, Barcelona, Spain,
6Center for Health Promotion and Prevention Research,
School of Public Health, University of Texas Health Science
Center at Houston, Houston, United States, 7University of
California, San Francisco, United States
Background

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8th ENSP European Conference on Tobacco Control
A few evidence-based interventions exist that have
demonstrated effectiveness in promoting smoke-free homes
yet have not been widely adopted and implemented. The
purpose of this study was to adapt the “Some things are
better outside” smoke-free homes intervention in Catalonia.
Methods
We used a modified approach to Intervention Mapping
(IM-Adapt) to guide adaptation. We used mixed methods
approaches to better understand the factors that might
influence smoke-free home policies in Catalonia. We convened
an expert group comprised of researchers, representatives of
local public health organisations, communitary health and
participative research experts. The group performed an initial
review of the intervention materials, mapping the intervention
components and comparing them to local needs. In-depth
interviews were conducted with intervention implementers
and potential program participants. Further, focus groups
were conducted to review and discuss the materials with the
potential users. The expert group discussed preferences for
various materials including the design elements, language,
and look, and reached a consenus about the modifications to
be made.
Results
Overall, key stakeholders and potential users of the
intervention reported a good fit of the intervention in
terms of messaging and images although there were
some specific recommendations to better respond the
local cultural characteristics (e.g., photos of local people,
housing characteristics, etc.). The most common adaptations
included tailoring, refining, changing packaging, adding,
and substituting. The major goals of the modifications were
addressing cultural factors, increasing reach, improving the
fit with users, and reducing cost. Stakeholders had many
suggestions about implementation through schools in
Catalonia and believed it would be an effective way to reach
parents allowing smoking in homes.
Conclusions
A systematic mixed methods approach involving key
stakeholders of the intervention implementation was
important for adapting a smoke-free home intervention to the
Catalan context. We recommend the use of this participative
approach to guide intervention adaptations.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A32
DOI: 10.18332/tpc/172649
Ukraine is grappling with the consequences
of the unregulated promotion of HTPs and
vapes
Dmytro Kupyra1
1Advocacy Center LIFE, Kyiv, Ukraine
Background
Until January 1, 2021, there were no restrictions on the sale and
promotion of HTPs, HTP devices, e-cigarettes, and e-liquids
in Ukraine, except for prohibiting smoking e-cigarettes in
designated public places. The tobacco industry aggressively
promoted the concept of alternative tobacco and nicotine
consumption, leading to a staggering increase in e-cigarette
use among 13-15 y. o. children. In 2017, the GYTS survey
revealed an 18.4% prevalence of e-cigarette smoking in that
age group.
The decline in tobacco use has halted among the adult
population, and there is a concerning trend of increasing
tobacco and nicotine consumption, particularly among youth
and women.
Objective
Control over advertising and using HTPs and e-cigarettes.
Methods
The public has appealed to the WHO FCTC policies, its guiding
principles, decisions made by FCTC parties, and Directive
2014/40/EU.
Through collaborative efforts between the public and tobacco
control advocates in Parliament, a comprehensive anti-
tobacco law, Law No. 1978-IX, was successfully passed.
Results
As of June 1, 2022, HTP products were classified as tobacco
products, subject to corresponding requirements such as
health warnings and advertising and promotion bans. Textual
health warnings were also mandated for e-cigarettes and
liquids.
From July 11, 2022, smoking HTP in designated places,
including all public premises, was prohibited, with airports
being the only exception.
From July 11, 2023, a new set of measures to protect the
population from tobacco and ENDS will come into effect:
the ban on selling flavored e-liquids, cigarettes and rolling
tobacco.
the ban on advertising of HTP devices, e-cigarettes, and
e-liquids
e-cigarette, e-liquid content requirements in accordance with
Directive 2014/40/EU.
Conclusions
Research shows that cafés, bars, and restaurants comply with
the ban on smoking HTPs and e-cigarettes indoors. Ukraine
is confidently moving towards reducing the popularity of HTP
and ENDS, especially among children and youth.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A33
DOI: 10.18332/tpc/172653
The trends in tobacco product consumption
in Serbia in 2023
Boban Nedeljković1, Jovan Zubović1
1Institute of Economic Sciences, Belgrade, Serbia
Background
This study represents a 2023 update of our continuous
tracking of tobacco product use in Serbia.
Objectives
We aimed to explore the frequency of use of traditional
(manufactured and roll-your-own) and novel (heated and
vaping) products in tobacco users as well as the transitions in
use of these products. Also, we explored whether the products
used were purchased (il)legally.
Methods
To address the aims, we conducted the field survey on 1000
adult participants aged between 18 and 87. The sampling
procedure was probabilistic and included the individuals who
use any of the products: manufactured and roll-your-own

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Tobacco Prevention & Cessation | Abstract Book
cigarettes, heated tobacco products, and vaping products.
The participants were also asked whether they had used each
of the products in the past and about the place of the purchase
of the products they currently use.
Results
The results showed that the use of manufactured (83.3%) and
roll-your-own (13.6%) cigarettes is the most frequent, while
the use of heated tobacco products (3.0%) and vaping products
with (2.1%) and without nicotine (1.0%) is less frequent. The
total overlap of the product consumption among the users
was 3.0% (i.e., 30 out of 1000 used more than one product).
Considering the transition between the products, we observed
that former users of manufactured cigarettes comprise the
majority of current users of roll-your-own cigarettes (62.5%),
heated tobacco products (76.7%), and vaping products with
nicotine (76.2%). The manufactured cigarettes (over 99%),
heated tobacco (100%), and vaping products (100%) were
almost entirely purchased legally, while more than 60% of
roll-your-own tobacco was purchased illegally.
Conclusions
Although manufactured cigarettes are still the most frequently
used tobacco product, there is an evident transition to roll-
your-own tobacco and heated and vaping products, which
aligns with our previous findings.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A34
DOI: 10.18332/tpc/172654
Nicotine pouches perception among its
users – in-depth interviews with young
Polish adults
Lukasz Balwicki1, Olga Kalinowska-Beszczynska1, Agnieszka
Wojtecka1, Malgorzata Basinska1
1Medical University of Gdansk, Gdansk, Poland
Background
Nicotine pouches (NPs) are gaining popularity. These are
small, white sacs, which include nicotine in the form of salts
enriched with several types of additives, mainly different types
of flavors. Lack of tobacco in the NPs is an important factor
that is used in communication strategies of its producers.
Despite the above characteristics, there is still insufficient
data on patterns of use, motivations, as well as perceptions
of this new, emerging product.
The aim of the study was to broaden the knowledge on
perceptions of NPs among its users in relation to other
tobacco products.
Methods
Qualitative approach was utilized. In December 2022 there
were seventeen structured In-depth Interviews (IDIs)
conducted. The sample included of adults aged 18-22, both
male and female.
Results
We found that from NPs users’ perspective, these products
are seen as a better alternative to other tobacco products.
The arguments were: they do not produce smoke, so they do
not smell nor affect/bother other people. Because of lack of
smoke or vapor, they are seen as are healthier than traditional
cigarettes or electronic ones. They can be hidden while using,
so are ideal for those who want to be discrete, ex because are
ashamed of their nicotine addiction. NPs are also seen as
products for smarter/clever people who take care of health or
want to be physically active while continuing addiction.
Conclusions
Nicotine pouches image is superior to other tobacco
products. They are seen as healthy way of nicotine intake.
Such perception can speed up their popularity.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A35
DOI: 10.18332/tpc/172655
Smokers’ attitudes on control policies and
an overview of the current state in Serbia
Olivera Jovanovic1, Jovan Zubovic1
1Institute of Economic Sciences, Belgrade, Serbia
Background
Serbia is one of the countries with the weakest tobacco use
control policy (e.g., smoking indoors is allowed in restaurants
and bars; the promotion is not entirely banned), relatively low
prices, and consequently a high prevalence of smoking and
smoking-related diseases.
Objective
In this research, we examined how tobacco product users
would react to health-promoting non-price and price policy
measures: indoor smoking and vaping bans and tobacco
product price increases. Also, we explored the current state
of exposure to tobacco product commercials.
Methods
For this purpose, we analyzed the data from a large-scale
field survey conducted on a sample of 1000 adult participants
(56.% males, 43.5% females), representative of the Serbian
population of tobacco product users.
Results
The results showed that 40.4% of participants would
support the complete smoking and vaping ban indoors,
and if such a policy were to be implemented, 26.2% would
reduce smoking, and 3.9% would probably quit. The support
for a 20% increase in tobacco product prices was 13.6%;
however, 40.3% of participants would support that measure
if the governmental revenues from such an increase were
redistributed for healthcare, education, and social welfare
services. The exposure to various types of traditional cigarette
commercials ranged from 2.1% (seeing special discounts on
tobacco products) to 14.8% (seeing printed logos and brand
names on t-shirts, pencils, or lighters). The participants
were even more exposed to commercials on heated or vaping
tobacco products, whereby the exposure ranged from 5.2%
for noticing gifts or discounts on other products up to 14% of
them who were exposed to promotions in a restaurant or cafe.
Conclusion
The share of tobacco product users who would support
the measures of indoor bans and price increases seems
encouraging. On the other hand, a high level of tobacco
product promotion exposure could be seen as alarming.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A36
DOI: 10.18332/tpc/172656

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8th ENSP European Conference on Tobacco Control
The smokescreen of tobacco industry’s
social responsibility strategies
Laura Graen1
1German Cancer Research Center, Heidelberg, Germany
Most countries in the European region still allow corporate
social responsibility (CSR) activities of the tobacco industry1.
Throughout the region, tobacco companies and related
entities engage in disaster relief, social welfare, cultural and
environmental projects. They manage to involve policymakers
and governmental institutions in their activities, build
relationships with non-governmental actors and achieve
media coverage. In 2020 to 2022, Philip Morris International
alone spent USD42 million on donations in the European
region2.
CSR strategies are central to the tobacco industry’s (and
other harmful industries’) business model as part of
their reputational management practices3. They enhance
legitimacy and credibility towards the public, consumers and
policymakers.
Tobacco corporations use CSR to gain access to policymakers
at all levels and across various government sections.
Furthermore, CSR projects are a way to polish up their
public reputation and divert attention away from their deadly
products and practices. They also aim at influencing norms
and promoting voluntary solutions as opposed to statutory
regulation.
This presentation will give examples from various European
countries and industry actors. It aims at raising awareness
of corporate strategies and counter-strategies, including
regulatory opportunities and FCTC guidelines.
Conflicts of interest
The author has no conflicts of interest to disclose.
References
Graen L. European Tobacco Industry Interference Index
2021. Smoke Free Partnership. Published November 2,
2021. https://www.smokefreepartnership.eu/our-policy-
work/position-papers-briefings-reports/european-tobacco-
industry-interference-index-2021
Philip Morris International (PMI). 2020 Social Contributions
at a Glance. Published 2021. https://pmidotcom3-
prd.s3.amazonaws.com/docs/default-source/pmi-
sustainability/2020-social-contributions.pdf
Gilmore, Anna B., Alice Fabbri, Fran Baum, Adam Bertscher,
Krista Bondy, Ha-Joon Chang, Sandro Demaio, et al. 2023.
‘Defining and Conceptualising the Commercial Determinants
of Health’. The Lancet 0 (0). https://doi.org/10.1016/S0140-
6736(23)00013-2
Tob. Prev. Cessation 2023;9(Supplement 2):A37
DOI: 10.18332/tpc/172657
Usage and accessibility of cigarettes,
electronic cigarettes, and heated tobacco
products among 13-15-year-old students
in Italy: Temporal trend results from the
Global Youth Tobacco Survey (GYTS), 2010-
2022
Valentina Minardi1, Federica Asta1, Laura Timelli2, Lorenzo
Spizzichino2, Giuseppe Gorini3, Benedetta Contoli1, Maria
Masocco1
1National Centre for disease prevention and health promotion,
Istituto Superiore di Sanità, Rome, Italy, 2Ministry of Health,
Rome, Italy, 3Oncologic network, prevention and research
institute (ISPRO), Florence, Italy
Background
In Italy, tobacco smoking among adolescents is highly
prevalent and has been increasing in recent years. Introduction
of alternative products has led to a shift in smoking habits
among younger, which needs to be monitored.
Objectives
To assess the temporal trends in the use and accessibility of
cigarettes, electronic cigarettes (e-cig), and heated tobacco
products (HTPs) among 13-15-year-old students enrolled in
Italian schools.
Methods
Data from four editions of GYTS were used: from 2010 to 2022,
for a total of 6,602 adolescents.
Results
Prevalence of current cigarette users among 13-15-year-
olds decreased from 21% in 2010 (19% for boys and 22% for
girls) to 15% in 2022 (13% vs 17%). Ever cigarette smokers
followed a similar trend. For e-cig, considered from 2014, the
prevalence of current users was 8% in 2014 (11% for boys and
6% for girls), and it increased to 20% in 2022, 21% for girls and
18% for boys. HTPs were ever used by 23% of adolescents in
2022 (20% for boys and 27% for girls) and currently used by
14% (12% vs. 16%).
In 2022, 24% of smokers obtained cigarettes directly from
tobacco shops (compared to 49% in 2010), and among current
smokers who attempted to purchase cigarettes from a store,
73% reported no refusal from the seller due to their underage
status (compared to 92% in 2010). 15% of adolescents (9% of
boys and 20% of girls) purchased e-cig directly from retailers,
and only one in four experienced a sales refusal due to their
age.
Conclusions
Italy has seen an increase in e-cig use, especially among
girls, and a decrease in traditional cigarette use. HTPs are
widespread and will require continued monitoring in the
coming years. Monitoring tobacco and nicotine consumption
among adolescents is strategic to support policies against
tobacco and nicotine use.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A38
DOI: 10.18332/tpc/172659
Media monitoring: advertising for
e-cigarettes and heated tobacco products in
social media in Germany
Katrin Schaller1, Christopher Heidt1, Nobila Ouedraogo1,
Sarah Kahnert1, Jana Seiler1
1German Cancer Research Center, Heidelberg, Germany
Background
In the European Union, advertising for tobacco products and
e-cigarettes is banned on TV, radio, print and Internet. Some
social media platforms have voluntary self-regulation for
products that are harmful to health, such as tobacco.
Objectives
To our knowledge, no data on the extent, forms and content
of advertising for e-cigarettes and heated tobacco products

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Tobacco Prevention & Cessation | Abstract Book
(HTPs) in German social media is currently available. The
goal of this project is to detect whether there is advertising
for e-cigarettes and HTPs in German social media and to
describe how it is designed.
Methods
Social media such as Instagram, Facebook, Pinterest und
Tiktok is being monitored by using an automated social
media analytical tool. Search strategies for e-cigarettes and
HTPs were established. Results were restricted to German
language and categorized.
Results
From February to March 2023, we found 1.159 relevant
posts for e-cigarettes. 79 % were on Instagram, 13 % on
Facebook and 6 % on Pinterest. More than 600 posts were
on e-cigarettes, over 100 posts on liquids. More than 100
brands were being advertised. Most advertising was posted
by commercial accounts (996 posts), 114 posts were from
influencers.
From February to April 2023, we found 241 relevant posts
for HTPs, mostly on Instagram (55 %), Facebook (36 %) and
Pinterest (8 %). Most advertising was posted by commercial
accounts (220 posts), 11 posts were from influencers. In
general, the heaters were shown without tobacco sticks.
Advertising portrayed themes like lifestyle and partnership.
Conclusions
Despite being banned, there is advertising for e-cigarettes
and HTPs in social media. A large part of the advertising
is made by producers and retailers. The data can serve as
a basis for strengthening the implementation of existing
policies to effectively protect adolescents from advertising
for e-cigarettes and HTPs.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A39
DOI: 10.18332/tpc/172675
Expansion of, compliance with, and
enforcement of smoke and aserosol free
environments in Europe: Barriers and
opportunities
Melinda Pénzes1,2, Dolors Carnicer-Pont3,4,5, Anna Mar Lopez
Luque4, Esteve Fernández3,4,5,6,7
1Health Services Management Training Centre, Semmelweis
University, Budapest, Hungary, 2National Korányi Institute
of Pulmonology, Budapest, Hungary, 3Catalan Institute of
Oncology, Barcelona, Spain, 4Bellvitge Biomedical Research
Institute, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain,
5CIBER in Respiratory Diseases, CIBERES, Madrid, Spain,
6University of Barcelona, Barcelona, Spain, 7JATC2-WP8 group
Background
Despite recent advances on smoke-free environments in
the European Union (EU), there are important gaps in the
current legislation and its implementation. Some European
countries started the extension of Smoke and Aerosol-Free
Environment (SAFE) policies to some outdoor places and
private indoor places, but both enforcement and compliance
are poor.
Objective
The aim of this study is to explore barriers and opportunities
for the expansion, compliance, and enforcement of SAFE
policies in Europe.
Methods
Within the Joint Action on Tobacco Control 2, Work Package
8 launched an experts’ consultation about SAFE policies. We
invited 110 experts from 31 European countries to complete
an online quali-quantitative questionnaire between June
21st and September 12th 2022 (response rate: 57% from
29 countries). We assessed barriers and opportunities for
the expansion of, the compliance with or the enforcement of
SAFE policies.
Results
Near half of the respondents identified the lobbying and
funding activities of the Tobacco and Nicotine Industry (TNI)
as the main barrier to the expansion of SAFE, while the main
opportunity was expanding SAFE policies to outdoor public
places. Regarding the compliance/enforcement, the main
identified barrier was the lack of human/financial resources
to apply sanctions, while powerful competent authorities
with increased capacities were recommended as the main
opportunity to enforce SAFE policies. Near half of respondents
believed that TNI largely interfere with the expansion of
SAFE policies, but perceived large TNI interference with the
enforcement was low.
Conclusions
Comprehensive regulation of TNI interference and dedicating
human/financial resources to SAFE policy enforcement
should be a priority to expand the EU SAFE policies.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A40
DOI: 10.18332/tpc/172660
Communication supporting strategy of the
new SF law enforcement during martial law
in Ukraine
Oksana Levytska1, Olesia Kozlova1
1Advocacy Center LIFE, Kyiv, Ukraine
Introduction
Approximately 13 000 Ukrainian non-smokers die as the
result of being exposed to second-hand smoke.
Anti-tobacco law 1978-IX regulating e-cigarettes and HTPs
was adopted in December 2021. Its smoke-free provision
came to force in July 2022 (public spaces and workplaces
are 100% exempt from any secondary tobacco and nicotine
emissions).
Due to the military full scale invasion of Russia into Ukraine,
conducting smoke-free implementation communication
support for the Government was very challenging.
Objectives
Raise awareness of new SF regulations (incl. SF for HTPs).
Build supporting environment for new SF law enforcement.
Methods
PHC of the MOH of Ukraine, NGO Life and Vital Strategies
conducted the multi-channel integrated mass-media
campaign “No smoking friendly. Taking care of your health is
your contribution to victory”.
The campaign incorporated SF messaging to warn about
harms of SHS, new SF regulations, complaining service
nosmoking.phc.org.ua and strong supportive messages
which resonate with Ukrainians during martial law.

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8th ENSP European Conference on Tobacco Control
Sociological agency KIIS conducted the end line survey among
Ukrainian smokers and nonsmokers aged 18-55 to evaluate
the knowledge and attitudes towards the SF regulations and
the effectiveness of the mass-media campaign.
Results
Estimated, the “No smoking friendly” campaign reached 20
million people on TV, street posters, Indoor and social media
despite a very limited budget and martial law.
Some of the sociological survey conclusions:
48% know about new anti-tobacco measures
78% responders would take some measures in case someone
smokes in a place where it is prohibited
85% agreed that the materials were easy to understand
According to public monitoring (end of 2022) about 80% of
cafes, bars and restaurants in Ukraine comply with the ban
on smoking indoors.
Conclusions
Mass media communication is an integral effective component
to support the TC law implementation. Strategic partnership
between government, domestic and international public
health non-for-profit organizations and private companies
was a key to success. During the war it is especially important
to continue strong TC activities to save the life and health of
Ukrainians.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A41
DOI: 10.18332/tpc/172678
The economics of tobacco farming in North
Macedonia
Bojana Mijovic Hristovska1, Tamara Mijovic Spasova1, Marija
Trpkova-Nestorovska, Biljana Tashevska, Borce Trenovski,
Kristijan Kozeski
1Analytica think tank, Skopje, North Macedonia
Tobacco leaf cultivation occupies around 3.2 percent of total
arable land in North Macedonia. North Macedonia is the
second largest producer of oriental-type tobacco leaf after
Turkey. In 2021, the total production of tobacco was 24,329
tons from 15,457 hectares of land, with an average yield per
hectare of 1,574 kilograms. North Macedonia ratified the
Framework Convention on Tobacco Control (FCTC) in 2006,
which introduced a legal commitment for the reduction of
tobacco production and consumption as well as to help those
who are employed in the tobacco sector to find alternative
viable livelihoods. The process of EU integration will require
the reduction of crop-specific subsidies, likely leading to less
income to tobacco farmers and an eventual reduction in the
area harvested. The Government adopted a new Strategy for
Tobacco Production (2021–2027) in which there is envisaged
indirect support for tobacco farmers, but preparations will
be made with education and counseling for future change to
other crops.
Tobacco farming traditionally has been supported by the
Government of the Republic of North Macedonia. However,
there is not enough research on the economic livelihood of
tobacco farmers. Тo fill this gap and to provide results to
support evidence-based policy and decision-making, a survey
with a nationally representative sample was conducted.
The survey comprises 806 farming households from 14
municipalities (urban and rural) in the top tobacco- producing
regions in North Macedonia. Target groups (categories of
respondents) for the survey are the following: 1. tobacco
farmer (the respondent is a farmer who grew tobacco in
2021); 2. former tobacco farmer (the respondent is a farmer
who grew tobacco in any year before 2021 and now cultivates
other agricultural crops); and 3. never tobacco farmer (the
respondent is a farmer who cultivates any agricultural crop
other than tobacco and never cultivated tobacco previously).
Survey results:
- Around half of tobacco farmers are not turning a real profit.
While most tobacco farmers believe they achieve positive
“perceived” profits (excluding the value of household
labor), with only a few households perceiving negative
profits, around half of the households actually achieved
negative “real” profits.
- Most farmers struggle financially, living with an average
monthly income below the average net monthly wage and
below the value of the minimum household consumer
basket.
- Pensions and remittances are one of the most important
components for maintaining an adequate level of income
and standard of living for tobacco farmers’ families.
Although they spend the most time in the field, current
tobacco farmers have a higher incidence of poverty
compared to former and never tobacco farmers.
- Compared to former tobacco workers or never tobacco
workers, the median current tobacco farmer devotes more
time to growing crops. The median male farmer worked
1400 hours on tobacco cultivation, while the median male
former and never tobacco farmers worked 1000 hours and
1260 hours, respectively.
- Тhe children of tobacco farmers are more involved in
farming relative to other farmers’ children. Children’s
help in the harvesting of tobacco is 2.3 times more
common compared to children’s help in harvesting other
crops; however, no farmer reported hiring children to help
with tobacco cultivation and children do not appear to
be engaged in potentially harmful activities related to
pesticide/ herbicide application.
- Compared to other crop activities, tobacco cultivation
typically requires significantly more pesticide. Pesticides
are related to persistent health challenges for farmers
and damage the environment through contamination of
groundwater and watersheds.
- Tobacco farmers show signs of green tobacco sickness, a
form of acute nicotine poisoning.
- Current tobacco farmers are more likely to rent land for
farming compared to former and never tobacco farmers.
In the survey, 22.2 percent of current tobacco farmers and
13.7 percent of former tobacco farmers stated that they
rent land from others.
- The vast majority of farmers reported having a contract
with a leaf buyer. Survey results shows that almost all
tobacco farmers (94 percent) in all major tobacco-growing
regions have signed contracts with tobacco leaf buyers.
More than half (57 percent) of the tobacco farmers say
they are satisfied with the concluded tobacco agreement,
while 36 percent are not.
Tobacco cultivation is not as profitable as the government

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Tobacco Prevention & Cessation | Abstract Book
suggests. Thus, highlighting tobacco as a highly profitable crop
is unfounded. This research indicates it would be much better
for tobacco farmers, in terms of labor and economic efficiency,
to reorient and grow another crop or pursue other economic
activities in their local economy (such as wage work or small
business). Around half of tobacco farmers are not turning
a real profit. The opportunity cost for unpaid family labor
makes growing tobacco unprofitable. Revenues of tobacco
farmers decrease significantly when the opportunity costs are
calculated. Household members could better allocate their
labor to other tasks that earn money; not doing so results in
significant economic loss for those tobacco families. Poverty
rates among tobacco farmers are slightly higher than the
nationwide poverty rate. Current tobacco farmers have the
highest incidence of poverty when considering per capita
income. Despite their high poverty rate, only a small share
of tobacco farmers use some form of social assistance. Input
costs for growing tobacco are typically very high, particularly
compared to most other crops.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A42
DOI: 10.18332/tpc/172679
Tobacco control in Ukraine in an emergency
situation - Russia’s armed aggression
Nataliia Hryb1, Ira Soroka2, Daryna Krenytska1
1Center for Public Health of the Ministry of Health of
Ukraine, Kyiv, Ukraine, 2Department of Prevention of Non
Communicable Diseases, Center of Public Health of the
Ministry of Health of Ukraine, Kyiv, Ukraine
Russia’s armed aggression has had a substantial influence on
many aspects of Ukrainian society. Tobacco control is one of
these sectors, which need systematic solutions and effective
services to address tobacco addiction. We will discuss three
significant breakthroughs that aid in the support and control
of tobacco addiction in Ukraine, even in extremely difficult
situations.
Prior to the conflict, Ukraine established a smoking cessation
program, which included a helpline and a professional
website. The website has important information about
quitting smoking, and the hotline counselors offer expert
assistance to individuals who wish to quit. Despite the difficult
circumstances surrounding the emergency, we are dedicated
to restarting the helpline and the website to assist smokers
in overcoming their addiction.
The Ministry of Health of Ukraine registered an order on
groups of medical warning packets on smoking tobacco
products as part of the reforms in anti-tobacco laws. These
new health warnings meet EU regulations and encompass
65% of the package space with graphic pictures on the two
largest sides. Each set includes a QR code that links to the
website of the stop smoking service stopsmoking.org.ua,
where smokers may get the necessary help and information.
To strengthen tobacco control in Ukraine, a site for
monitoring anti-tobacco law infractions was established at
nosmoking.phc.org.ua. Citizens can use this service to report
legal infractions and make complaints. The portal allows
individuals to participate in monitoring the execution of anti-
tobacco laws and streamlines the complaint-filing procedure.
This improves the efficacy of Ukraine’s tobacco control system
by strengthening interaction between citizens and regulatory
authorities (executing state authorities).
Despite the emergency conditions, Ukraine is nevertheless
actively engaged in tobacco control and meeting its duties
under the WHO Convention on Tobacco Control. The creation
of stop smoking support programs, the application of cigarette
labeling requirements, and the enhancement of the system
for monitoring anti-tobacco law infractions are all essential
stages in Ukraine’s battle against tobacco addiction.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A43
DOI: 10.18332/tpc/172681
SinHumo App as an adjunct to a smoking
cessation videoconferencing-based
intervention: preliminary data on
intervention acceptability and satisfaction
Carmela Martínez-Vispo1, Ana López-Durán1, María Barroso-
Hurtado1, Daniel Suárez-Castro1, Elisardo Becoña1
1University of Santiago de Compostela, A Coruña, Spain
Background
The development of psychological interventions addressing
smoking behaviour based on information and communication
technologies (ICTs) has been growing in recent years.
Specifically, mobile Apps to quit smoking have shown
promising results. However, scarce research has explored
real-time videoconferencing-based interventions using Apps
as an adjunct to quit smoking.
Objectives
The present study has two folds: (1) to describe the blended
videoconferencing-based intervention combined with the
“SinHumo” App; and (2) to examine preliminary data on
acceptability and satisfaction with the intervention.
Methods
The psychological intervention design was constructed on
evidence-based cognitive-behavioural techniques to quit
and scientific literature regarding smoking cessation Apps.
The blended intervention was implemented in 52 seeking
treatment smokers (53.8% female; Mage = 45.18; SD = 11.68).
Acceptability and satisfaction with the intervention were
assessed through a questionnaire filled out by participants at
the end of the intervention.
Results
The intervention consists in eight-sessions in group format
through a videoconferencing system and an adjunct App
designed to be available during the sessions and the one-year
follow-up period. The App includes components like cigarette
use self-tracking, an autogenerated list of reasons to quit
smoking, a tool for setting weekly tobacco reduction goals,
and motivational notifications. During follow-ups, users can
access personalized components according to their smoking
status (smoker, abstinent or relapsed). Satisfaction with the
blended intervention was high (92.7%) and most participants
reported that the App helped them quit smoking (87.8%).
Qualitative comments indicated high acceptability overall.
Conclusions
The present blended intervention based on ICTs showed good
acceptance and was considered helpful for most participants.

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8th ENSP European Conference on Tobacco Control
These findings have significant clinical implications, as
previous studies have shown that acceptability predicts
and explains outcomes, including user engagement and
the effectiveness of digital health interventions. These
preliminary results suggest that digital technologies could
be an opportunity for reaching smokers considering quitting
smoking.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A44
DOI: 10.18332/tpc/172684
EPR schemes and the tobacco industry: A
game of cat and mouse in the EU regulatory
landscape
Chloé Momas1
1Smoke Free Partnership, Brussels, Belgium
As the EU moves towards implementing more comprehensive
Extended Producer Responsibility (EPR) schemes for tobacco
products, the tobacco industry is likely to respond in ways
that minimize the impact on their revenues. This presentation
will explore potential industry strategies, including product
redesign, lobbying, and the use of EPR funds for sustainable
product development, and discuss the challenges these
present for effective tobacco control. It will also explore
hypothetical scenarios of how the industry can leverage EPR
to undermine WHO FCTC provisions for all tobacco products
waste, including novel products.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A45
DOI: 10.18332/tpc/172685
Challenges of the flavored novel tobacco
products control policy in Georgia
Tamar Abuladze1, George Bakhturidze1, Lela Sturua2
1The University of Georgia, Tbilisi, Georgia, 2Non-
communicable Diseases Department, the National Center
for Disease Control and Public Health, Tbilisi, Georgia
Introduction
Excessive tobacco consumption is an important public health
problem in Georgia. 28.2% of the Georgian population are
smokers and 11,400 people die annually from tobacco-related
diseases. In 2017, tobacco control(TC) legislation strengthened
significantly, although novel products (HTPs, ENDS/ENNDS -
shown in the Georgian market since 2019), remained outside
of some regulations. In recent years Georgia has become
a favorable market for the novel tobacco product industry
attracting young using different marketing means, especially
the flavorings.
Objectives
To analyze existing tobacco control policy in Georgia regarding
flavored novel tobacco products from the perspective of EU
approaches.
Methods
Descriptive legal research, historical analysis, comparative
analysis methods, and the methodology of policy inquiry were
used.
Results
There are no restrictions or limitations on using flavorings/
additives in any type of tobacco in Georgia. Only the
concentration of emitted substances in cigarettes and amount
of nicotine in e-cigarette liquid is limited, but compliance
with these requirements was never checked. There is no
local laboratory that tests any kind of tobacco product and
no samples have ever been sent to any laboratory abroad.
ENNDS appeared as a big policy challenge, as they are
not considered as tobacco products, and no TC legislative
requirements apply to them. Given the alarmingly high index
of tobacco industry interfere in the country, it is likely that
introduction of the control policies on novel product will be
met with great resistance, especially since no research has
yet been conducted to reveal rates of novel tobacco products
use by youth.
Conclusions
Georgia is far from the EU regulations regarding control of
the flavored tobacco products. But this momentum can be
the biggest incentive for Georgia to introduce a strict policy
of controlling flavored novel tobacco products as according to
the EU Association Agreement Georgia is obliged to get closer
to the EU legislation.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A46
DOI: 10.18332/tpc/172687
Could TikTok be a promising platform for
anti-tobacco communication? – Experiences
from Hungary
András Kulja1, Tamás Joó1, Melinda Pénzes1
1Data-driven Health Division of the National Health Security
Laboratory, Health Services Management Training Centre,
Semmelweis University, Budapest, Hungary
Background
TikTok is one of the most popular video-based social media
platform with significant potential for professional health
communicators to share health-related contents, including
anti-tobacco messages. To date, little is known about the
visibility and audience engagement of anti-tobacco contents
on TikTok, especially in Central Europe.
Objective
The aim of this study is to explore the reach and engagement
of anti-tobacco video posts on a popular TikTok health
communicator page authored by a Hungarian, macro-
influencer physician.
Methods
The TikTok page @andras.doktor posted five anti-tobacco
videos (about Elf Bar, heated tobacco products, snus, hookah,
and an Elf Bar announcement video) in May–June, 2022
(baseline). TikTok’s built-in account analytics was used to
evaluate views, mean video length, retention rates at 10-, and
30 seconds, engagement (likes, comments, shares), like rate,
and engagement rate of videos from baseline to the end of
June, 2023 (follow-up).
Results
At baseline, the platform had 150,000 followers, which
increased up to 300,000 followers at follow-up. Out of the
five tobacco-related posts, 3 were sponsored (paid by the
Hungarian Focal Point for Tobacco Control) and 2 were non-
sponsored. The overall views of the 5 videos were 4,122

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Tobacco Prevention & Cessation | Abstract Book
million. The most popular video was the effects of Elf Bar
with 1,4 million views. In overall, the mean video length was
79.4 seconds (range 26–132 seconds), the mean view was
824,400 (range 314,000–1.4 million), and the average like
rate was 8.3% (range 6.1%–9.0%). Non-announcement videos
showed 42–44% retention rate at 10 seconds, while 30–34% at
30 seconds. The engagement rate of the 5 videos was 8.45%
(range 6.2–10.3%).
Conclusions
TikTok could be a promising platform for posting anti-tobacco
contents by authentic health communicators. In-depth
analysis of video metrics is necessary to achieve success in
influencing a broad audience.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A47
DOI: 10.18332/tpc/172688
Perceptions towards the adoption of
tobacco-related recommendations of the
European Code Against Cancer (4th ed.)
among the European Union population: a
qualitative study
Ariadna Feliu1, Paweł Koczkodaj2, Patricia Pinto3, Marga Pla4,
Helena Vučković5, Carolina Espina1
1International Agency for Research on Cancer, Lyon, France,
2Maria Skłodowska-Curie National Research Institute of
Oncology, Warsaw, Poland, 3Liga Portuguesa Contra o Cancro,
Lisbon, Portugal, 4University of Barcelona, Barcelona, Spain,
5Croatian League Against Cancer, Zagreb, Croatia
Background
Cancer is a major public health problem. Tobacco is linked
to 80% of lung cancer deaths and associated with 16 other
cancers, all of which could be prevented. The European Code
Against Cancer (ECAC, 4thed.) is a health education tool
aimed at raising awareness about evidence-based actions
to prevent cancer. It reports 12 recommendations to reduce
individuals’ cancer risk, including “not smoking or using any
form of tobacco” and “making your home smoke-free and
supporting smoke-free policies”.
Objectives
To explore perceived barriers towards the adoption of tobacco-
related cancer prevention actions recommended by the ECAC
in 7 European countries.
Methods
The COM-B model of behaviour change was used as a
framework for the design and analysis of the study since it
identifies factors (capability, opportunity, motivation) that
need to be present for any behaviour to occur. We designed an
exploratory research qualitative study by means of in-depth
semi-structured interviews among adults with no previous
cancer diagnose. Participants were selected using a quota
sampling strategy according to sex, age and education level
(N=18/country). Interviews were conducted in their native
language by trained researchers. We conducted a thematic
content analysis to identify common topics.
Results
Participants who smoked reported that their main barrier to
quit smoking was not being capable to overcome their nicotine
addiction. Other reported barriers were not knowing where to
find professional help, peer pressure, living with someone
who also smokes, and lack of a support network. As a main
barrier for second-hand smoke (SHS), participants declared
not having control among others’ behaviours, however, they
recognized smoke-free laws importance.
Conclusions
Understanding how the ECAC recommendations are perceived
by EU citizens and the barriers they encounter to take action
to reduce their cancer risk from tobacco and SHS is key to
promote adoption of the recommendations and improve
supportive societal structures to overcome these barriers.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A48
DOI: 10.18332/tpc/172690
Tobacco product waste: typing cigarette
butts collected in different areas at
Sapienza University of Rome, Italy
Martina Antinozzi1, Maria Assunta Donato1, Francesco
Mondera1, Maria Sofia Cattaruzza1
1Department of Public Health and Infectious Diseases,
Sapienza University of Rome, Rome, Italy
Background
Tobacco smoking is the first avoidable cause of death in the
world. In Italy 74.4% of smokers started smoking between the
age of 15 and 20, with a mean age of 17.7 for men and 19.4 for
women (ISS-DOXA 2023).
Italy is working on developing a smoke-free campus network
and the Tobaccology Unit (UNITAB) at Sapienza University of
Rome has been specifically working towards this goal lately.
In particular, every year UNITAB creates youth-targeted
campaigns for multiple occasions throughout the year, to
raise awareness on the damages that tobacco products cause
on people’s health and on the environment.
Objectives
In October 2022 the UNITAB team collected tobacco waste
smoked on campus, to type the different kinds of cigarette
butts present in different areas of the campus.
Methods
We identified three areas to sample next to scientific,
humanistic and convivial places. From 24th to 27th of October
2022, all kinds of cigarette butts - traditional cigarettes,
heated-tobacco products (HTPs), roll-your-own (RYO) -
were discreetly collected in the afternoon, when students’
attendance is low, so that our presence interfered as little as
possible with their behaviors.
Results
3394 pieces of cigarette butts from different origins were
collected: 1262 (37.2%) coming from RYOs, 1246 (36.7%)
from HTPs and 886 (26.1%) from traditional cigarettes. In
addition to “legal tobacco products” we found 58 pieces of
butts coming from weed smoking.
Conclusions
Our results show that HTPs’ use among young people seems
to have exceeded traditional cigarettes. However, we should
consider that these products are often smoked together with
traditional ones, transforming smokers into dual users. This
evidence and the lack of clear and reliable data on HTPs’
health impact, has to be considered for further investigation,

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8th ENSP European Conference on Tobacco Control
in order to protect young generations from the tobacco-
related health risks.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A49
DOI: 10.18332/tpc/172692
Using the COM-B model to identify barriers
and facilitators in smoking behaviour to
support both stop smoking practitioners and
service users at everyone health, England
Elizabeth Gilbert1, Caroline Kenny1
1Everyone Health Limited, England, United Kingdom
Background
The COM-B model of behaviour is a simple and easy framework
that can be translated effectively for many purposes, including
in the delivery of public health interventions, such as stop
smoking services.
Objectives
Training and a tailored tool to support the implementation of
the COM-B model in intervention delivery was developed, to
increase and improve application of the model and service
user outcomes.
Methods
Everyone Health include training on the COM-B model as
part of their mandatory training for all practitioners across
all services. In addition, a pre/post evaluated workshop to
translate the theory into practice was developed, including a
tool for practitioners to use to identify barriers and facilitators
for service users when planning behaviour change and
achievement of their goals.
Results
Everyone Health’s Stop Smoking Practitioners feel better
equipped to support service users to identify barriers
and facilitators to achieve their behaviour change goals.
Provisional evaluation shows that by providing Stop Smoking
Practitioners with simple and effective tools to implement the
COM-B model has increased their confidence and competence
in using the model and has improved service user outcomes.
For example, if barriers are identified in Physical and Social
Opportunity, such as someone trying to make a quit attempt
but they associate breaktimes at work with smoking, which
would be a barrier in these areas, a change to overcome these
barriers would be to use their NRT (an inhalator) and go for
a walk during their breaktime, as opposed to standing with
work colleagues in the smoking area.
Conclusions
Everyone Health have adapted and tailored the COM-B model
to intervention type and have demonstrated that it can easily
be translated to stop smoking delivery and can improve
outcomes for service users and Stop Smoking Practitioner
confidence in delivery.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A50
DOI: 10.18332/tpc/172693
Targeting patients suffering with long term
conditions who smoke on their General
Practitioner’s Quality Outcomes Framework
(QoF) list, in England
Caroline Kenny1, Elizabeth Gilbert1
1Everyone Health Limited, England, United Kingdom
Background
All General Practitioners hold a register of smokers within
their practice. The have incentivised targets (QOF Points) to
collect their patients’ smoking status and offer stop smoking
support or health based education if they decline the offer of
support.
Objectives
Assist GPs to reach their QoF targets for smoking
denominators and also to increase referrals into community
Smoking Cessation services.
Methods
Stop Smoking Practitioners help to achieve these targets
by either making telephone calls to patients on their QoF
register whilst in-house at the GP surgery who update
smoking status and offer community smoking cessation
services to the patients. Alternatively, supplying practices
with seasonal/condition relevant text templates to send out
in bulk to patients on their QoF registers.
Results
Provisional results show that via the SMS template referral
service, 59% of self-referrals had been reached by this
method in North East London. In addition, GP surgeries are
able to achieve their QoF point targets as the SMS would
constitute as an offer of support.
Conclusions
Everyone Health have rolled this approach out to our wider
services due to the success of increasing referrals and building
good relationships and reputation with local GP services.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A51
DOI: 10.18332/tpc/172694
The healthy schools stop smoking and
vaping service provides Catch Your
Breath – a school-based smoking and
vaping programme for young people in
Cambridgeshire and Peterborough, England
Caroline Kenny1, Elizabeth Gilbert1
1Everyone Health Limited, England, United Kingdom
Background
There has been a rise in the number of students in
Cambridgeshire and Peterborough identifying themselves
as regular vape users, an increase from 2% in 2021 to 5% in
2022. The programme aims to reverse the trend over the next
two years.
The ‘Catch Your Breath’ offer has been developed to support
young people aged 11 – 18 who are known to be smokers/
vapers and is delivered free of charge.
Objectives
• Referral pathways for any young person who wishes to
quit smoking or vaping or would benefit from some advice
on the potential risks of these behaviours.
• Reverse the upward spiral of young people vaping (as
evidenced by the data collected through the Health Related
Behaviour Survey).
Methods

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Tobacco Prevention & Cessation | Abstract Book
Educational sessions focusing on prevention, with universal
delivery to students via an interactive workshop, and
prevention assemblies. Training is delivered within the
schools to pupils and teachers. We then equip teachers with
the skills, knowledge and materials to continue providing
evidence-based information relatable to the age of the year
group. By supporting staff to self-deliver, we can then move
onto new schools to continue the work in a sustainable way.
Results
Between May 2022 and May 2023, we have had participation
from 1520 primary pupils and 15,462 secondary pupils. From
the data assimilated between September ’22 – May ’23, 966
pupils said “No” to smoking at the beginning of the session,
compared with 1003 by the end. Likewise, 772 pupils said
“No” to vaping at the beginning of the session compared with
851 at the end. Indicating a promising reversal in perception.
Conclusions
The Catch Your Breath programme has received interest
from over 50 schools outside this area and over 35 requests
from local authorities proving a need for wider spread vaping
education and support.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A52
DOI: 10.18332/tpc/172695
Implementing a tobacco dependency
inpatient programme in Staffordshire’s
Hospitals (England, UK)
Caroline Kenny1, Elizabeth Gilbert1
1Everyone Health Limited, England, United Kingdom
Background
The NHS is under pressure regarding hospital admissions
and treatment of smoking related illnesses. The NHS Long
Term Plan includes mandating identification and an opt-out
community referral process upon discharge for smoking
cessation.
Objectives
Staffordshire Hospitals commissioned Everyone Health as
the local community provider to implement an inpatient
identification and support service in 2022, which is now fully
embedded.
Methods
Smokers are identified by medical staff and referred to
Everyone Health Stop Smoking Practitioners to visit whilst
they are an inpatient. Whilst an inpatient, they are given
the opportunity to have NRT to support them while they are
unwell and unable to smoke. They are discharged with a two
week supply of NRT and a referral is made to community
services upon discharge, where their care, and treatment is
continued for 12 weeks.
Results
An increase has been seen in referrals to community smoking
clinics. On average 61% of clients accept the offer of inpatient
treatment and community referrals post discharge to maintain
their abstinence. 68% of this population go on to achieving a
smoke free status 28 days post discharge. We hope to see
the impact on hospital admissions due to smoking related
illnesses in the future.
Conclusions
The approach has been effective and well-received by the
local community, patients and the NHS.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A53
DOI: 10.18332/tpc/172696
Disposable e-cigarette use and associated
factors among US middle and high school
students in 2021 and 2022
Daniel Chen1, Filippos Filippidis2
1University of Oxford, Oxford, United Kingdom, 2Imperial
College London, London, United Kingdom
Background
Disposable e-cigarettes have emerged in the market and
gained significant popularity, especially among adolescents.
This has raised concerns about the potential addiction to
nicotine and the associated health effects among this age
group.
Objectives
This study aims to investigate the prevalence of disposable
e-cigarette use among middle and high school children in
the United Stated, and to identify potential factors associated
with usage and increased frequency of use in order to identify
potential regulatory interventions.
Methods
Data from 48,704 U.S. middle and high school students in the
2021 and 2022 National Youth Tobacco Survey (NYTS) were
pooled to estimate disposable e-cigarette use. Multivariable
logistic and ordinal regression models were used to assess
demographic and psychosocial factors related to disposable
e-cigarette use and frequency of use (low, medium, and high).
All analyses were weighted to represent the national student
sample.
Results
The prevalence of current disposable e-cigarettes increased
from 3.9% (n=744) in 2021 to 5.1% (n=1,443) in 2022 and were
the most common type of e-cigarette used in both years. The
modelling results indicated that, among all respondents, girls
were 1.57 (95% CI:1.29-1.91) times more likely to be disposable
e-cigarette users than boys, and high school students had
5.14 (95% CI: 3.96-6.67) times higher odds of being users
than middle school students. Students of Hispanic, Black,
Asian, and other ethnicities were less likely to use disposable
e-cigarettes compared to White students (OR between
0.42 to 0.61). Among current disposable e-cigarette users,
higher frequency of use was associated with self-identifying
as LGBTQ+ (OR 1.41; 95% CI: 1.00-2.00 in comparison to
straight), higher family affluence (OR 1.77; 95% CI: 1.16-2.71
in comparison to low), lower academic performance (OR 2.16;
95% CI: 1.15-4.07; self-reported grades of D’s in comparison
to A’s), and experiencing severe psychological distress (OR
1.49; 95% CI: 1.05-2.11 in comparison to non-distress).
Conclusions
These findings underscore the need for enhanced and
targeted prevention and regulatory measures to address the
rising prevalence of disposable e-cigarette use among youth
and curb nicotine addiction.
Conflicts of interest
The authors have no conflicts of interest to disclose.

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8th ENSP European Conference on Tobacco Control
Tob. Prev. Cessation 2023;9(Supplement 2):A54
DOI: 10.18332/tpc/172697
Tobacco industry interference index Poland
2023
Paulina Dera1, Julia Opania2, Maria Banach2, Jakub
Majchrzak2, Łukasz Balwicki3
1First Doctoral School, Medical University of Gdansk, Gdansk,
Poland, 2Faculty of Medicine, Medical University of Gdansk,
Gdansk, Poland, 3Department of Public Health and Social
Medicine, Medical University of Gdansk, Gdansk, Poland
Background
Interference of tobacco industry is noticeable in many
countries. Monitoring of such activities in order to strengthen
the protective actions of governments is important.
Objectives
To assess the influence of tobacco industry companies on the
government’s public health policies in Poland.
Methods
This study makes an assessment of the intensity, frequency,
and severity of incidents of tobacco industry interference
reported in Poland between I January 2020 and 31 March
2023 and the government’s response to these incidents. The
research is based on a questionnaire developed by SEATCA
for its Tobacco Industry Interference Index (TIII) and scoring
guidelines. To complete TIII of 20 indicators under seven key
themes for Poland, five reviewers separately searched for
evidence. This report was written by a scoping review of i.a.:
the legal basis, Polish media websites, the Polish government
and local government websites, and also social media of
tobacco industry companies.
Results
The government and individual governmental entities accept
cooperation and sign agreements with representatives of
tobacco companies in the fight against tobacco smuggling.
In addition, government initiates a space for discussion - the
Excise Forum, where consultation and recommendations
are held regarding, among others, excise duty policy.
Tobacco industry supports several public schools in terms
of workshops, offering internships and demonstrating the
production processes. Moreover, one of the former Director of
Gambling’s Regulation Department in the Ministry of Finance
now is working in Philip Morris Distribution Polska.
Conclusions
The results of the study suggest that tobacco companies
have a considerable impact on public health policies.
The government should take a more careful approach
to its relations with the tobacco industry. All invitations to
meetings could be more filtered for possible connections.
Independence is recommended in several important matters
related to the fight against illegal cigarette smuggling. In
addition, it is important to prepare documents that would
present appropriate regulations in connection with data
transfer procedures, meetings or other interactions.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A55
DOI: 10.18332/tpc/172699
Best practices for second-hand smoke
and second-hand aerosol protection and
evidence supporting the expansion of smoke
and aerosol-free environments: a position
paper from the Joint Action on Tobacco
Control 2
Dolors Carnicer-Pont1,2,3, Irene Possenti4, Silvano Gallus4,
Alessandra Lugo4, Anna Mar López-Luque1,2, Esteve
Fernandez-Muñoz1,2,3,5,6
1Tobacco Control Unit and WHO Collaborating Center for
Tobacco Control, Catalan Institute of Oncology, L’Hospitalet
de Llobregat, Spain, 2Bellvitge Biomedical Research Institute
(IDIBELL), L’Hospitalet de Llobregat, Spain, 3Consortium for
Biomedical Research in Respiratory Diseases (CIBERES),
Madrid, Spain, 4Istituto di Ricerche Farmacologiche Mario
Negri IRCCS, Milan, Italy, 5School of Medicine and Health
Sciences, University of Barcelona, Barcelona, Spain, 6JATC2-
WP8 working group
Objective
To assess and create the framework for the expansion of
smoke- and aerosol-free environments (SAFE) in Europe,
including outdoor areas and some private settings.
Background
Comprehensiveness and enforcement of smoke-free
legislation vary among European Union (EU) member states
(MS). Moreover, emerging products like electronic cigarettes
(e-cig) and heated tobacco products (HTP) lack adequate
regulation.
Methods
Within the frame of Joint Action on Tobacco Control 2 (JATC-
2) a consultation was conducted on best practices for SAFE
implementation. Based on its results and the evidence from
the scientific literature, we present this position paper.
Results
The main barriers against the expansion and enforcement
of SAFE include tobacco industry interference, government
reluctance, resistance from specific settings and public
misinformation. Opportunities include extending policies to
outdoor places, improving attitudes, conducting campaigns,
promoting transparency and funding, and aligning legislation.
Recommendations
Ensuring healthier environments and protecting individuals
from the harmful effects of second-hand smoke requires
a comprehensive approach. To achieve this, the following
recommendations are crucial for EU MS:
• Implement and enforce complete smoke-free legislation
for indoor and outdoor
o public and private workplaces,
o hospitality venues,
o public transport,
o cars,
o settings frequented by minors,
o sports settings,
o healthcare facilities,
o parks, forests, and beaches;
• Promote voluntary smoke-free homes;
• Equalize regulations for emerging tobacco products, such
as e-cigs and HTPs, to that of conventional cigarettes.
Conclusions
Comprehensive smoke-free regulations covering indoor and
outdoor settings, along with advocating for voluntary smoke-

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Tobacco Prevention & Cessation | Abstract Book
free homes, are essential steps. Additionally, equalizing
legislation for emerging tobacco products with conventional
cigarettes is crucial for public health protection. By addressing
barriers and capitalizing on opportunities, collaborative
efforts can create healthier environments.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A56
DOI: 10.18332/tpc/172701
Remote vs in-person group-based
smoking cessation interventions: smokers
characteristics and intervention outcomes
Carmela Martínez Vispo1, Ana López-Durán1, Daniel Suárez-
Castro1, María Barroso-Hurtado1, María Ramos-Carro1,
Elizabeth Moss-Alonso1, Elisardo Becoña1
1University of Santiago de Compostela, A Coruña, Spain
Background
During the last decade Telemedicine has experienced
a prominent growth, providing new opportunities to
address physical and mental health problems, including
smoking cessation. Using technology such as interactive
videoconferencing, to provide smoking cessation treatments
could increase the probability that smokers who are reluctant
or experience barriers to seeking in-person smoking
cessation treatments can access effective interventions.
Objectives
The aim of this study is twofold: 1) to examine the differences
in the characteristics of smokers seeking in-person vs.
remote interventions; and 2) to compare abstinence rates
between both groups.
Methods
The sample consisted of 641 daily smokers who sought
psychological treatment to quit smoking at the Smoking
and Addictive Disorders Unit of the University of Santiago de
Compostela (Spain) from 2015 to 2022. Of the total sample,
43.4% received an in-person cognitive-behavioral intervention
to quit, while 56.6% received the same intervention remotely
through videoconference.
Results
Smokers assisting to the remote intervention had university
studies (54.3% vs 39.9%; p < 0.001) and were actively working
(67.5% vs 57%; p = 0.007) in a higher proportion, compared
to those receiving the in-person format. Regarding mental
health, a significantly higher proportion of smokers receiving
the remote intervention reported depression treatment
history (53.2% vs 42.8%; p = 0.009).
Concerning smoking cessation outcomes, no significant
differences were found in abstinence percentages between
the in-person vs remote intervention at the end of treatment
(59.7% vs. 65.3%, respectively; p = 0.148); and at 3-month
follow-up (34.2% vs. 39.4%, respectively, p = 0.311).
Conclusions
Using videoconference systems shows promising results, as
abstinence outcomes were similar to the conventional delivery
format for smoking cessation interventions. Findings suggest
that remote interventions could reduce access barriers as
travel costs or time availability of potential users. Further
research is warranted.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A57
DOI: 10.18332/tpc/172702
Smoking behaviors and barriers to quit in
Spanish young adults: Implications for the
design of smoking cessation digital health
interventions
Carmela Martínez Vispo1, Andrea Perez Rivas1
1University of Santiago de Compostela, A Coruña, Spain
Background
Smoking remains the leading preventable cause of death
worldwide. Effective smoking cessation treatments are
currently available, and increasing literature suggests
that digital interventions offer promising results. A high
percentage of young adults smoke, a population group that
underuse evidence-based interventions to quit. Young adults
suppose a relevant public health target as early cessation can
reduce the long-term harms of smoking.
Objectives
This study aims to describe the smoking characteristics of
young adult smokers, including perceived barriers to quitting,
and examine their opinion on digital interventions for smoking
cessation.
Methods
An ad hoc questionnaire was used to collect sociodemographic
and smoking-related variables, including tobacco products
used (i.e., rolled tobacco), tobacco dependence, past quit
attempts, barriers to quitting and seeking specialized
support, and opinions and perceived barriers towards digital
interventions to quit. The survey was conducted in a sample of
94 daily smokers aged 18-25 years (61.7% female).
Results
Results showed that most participants used rolled tobacco
(73.4%), conventional cigarettes (58.5%), or a combination
of both (29.8%). In addition, participants had a low tobacco
dependence level and smoked an average of nine cigarettes
per day. The most commonly mentioned barriers to quitting
included struggling with cravings, losing a strategy to
cope with anxiety and having friends that smoke. The most
relevant barriers to seeking professional support to quit were
admitting they needed help, lack of time and having to go to
the quitting service. Only 4.6% of the sample had used digital
tools to quit smoking, citing perceived utility and the absence
of professional guidance as the main barriers.
Conclusions
Findings have clinical implications, highlighting the need
to develop digital smoking cessation interventions tailored
specifically to young smokers. This could increase the
likelihood of early smoking cessation, thereby preventing the
persistence of smoking in later adulthood and the subsequent
health consequences.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A58
DOI: 10.18332/tpc/172704
Conflict of interest in research on heated
tobacco products: a systematic review
Silvano Gallus1, Chiara Stival1, Marco Scala1, Carlotta Micaela

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8th ENSP European Conference on Tobacco Control
Jarach1, Alessandra Lugo1
1Istituto di Ricerche Farmacologiche Mario Negri IRCCS,
Milan, Italy
Background
Tobacco companies are investing massive amounts of money
to support research on heated tobacco products (HTP) and
tobacco harm reduction (THR).
Objective
To quantify the proportion of research on HTP funded by
the tobacco industry and to assess any association between
the funding by the tobacco industry -and the corresponding
presence of conflicts of interest (COI)- and how the authors
interpreted findings of their studies.
Methods
We conducted a systematic review of the literature through
23rd February 2022 in Pubmed/Medline, Embase and the
Cochrane Library to identify all publications focusing on
HTPs (PROSPERO 2020: CRD42020137394). For each study,
reported tobacco industry related COI was identified based
on authors’ affiliations, acknowledgements, funding, and COI
disclosure. Two trained reviewers, blinded to information
on authors, independently evaluated the conclusions of the
abstracts to categorize them as anti-HTPs/THR (providing
conclusions against or strongly against HTPs or THR); neutral;
or pro-HTPs/THR (providing conclusions in favour or strongly
in favour to HTPs or THR).
Results
Out of 498 included eligible studies, 192 (38.6%) had tobacco-
related COIs. Five studies with a declared COI were among
the 194 studies assessed as anti-HTPs/THR (2.6%), 20 studies
with COI were among 94 neutral studies (21.3%), and 167 were
among the 210 studies evaluated as pro-HTPs/THR (79.5%).
The adjusted odds ratio of being pro-HTPs/THR was 23.3 (95%
confidence interval: 11.6 to 46.7) for studies with a COI.
Conclusions
The existing body of published research on HTPs is dominated
by studies conducted or supported by the tobacco industry,
with evidence of bias in their conclusions. The large majority
of COI-free studies oppose HTPs. There is an urgent need
to fund and sustain independent research on novel tobacco
products.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A59
DOI: 10.18332/tpc/172705
Trends in tobacco and nicotine use among
Serbian adolescents
Biljana Kilibarda1, Jelena Gudelj Rakic1, Verica Jovanovic1,
Mirjana Tosic1, Milena Vasic1,2
1Institute of Public Health of Serbia, Belgrade, Serbia, 2Faculty
of Dentistry, Pancevo, Serbia
Background
In the past decade, the presence of various nicotine-containing
products increased in many countries leading to the change
in prevalence and patterns of nicotine use among youth. The
aim of this analysis was to explore changes in prevalence of
tobacco use among Serbian adolescents between 2018-2022.
Methods
The data used for this analysis were obtained through
Health Behavior in School-aged Children Survey (HBSC)
implemented in Serbia by the Institute of Public Health of
Serbia among school children. The surveys were conducted
at the nationally representative samples of students 11,13
and 15 years old (4028 students in 2018 and 3962 in 2022).
Trend and/or prevalence of cigarette, e-cigarette, waterpipe
and snus was analyzed to determine potential changes and
determine emerging issues for interventions.
Results
Data show no statistically significant change in prevalence of
cigarette smoking between 2018 and 2022 (9.5% and 10.2%
respectively) among 11,13- and 15-years old students and
significant decrease in waterpipe smoking (16.6% in 2018 and
7,1% in 2022) among students 15 years old. In 2022, questions
on e-cigarette, heated tobacco products and snus use were
included in the survey and results show high popularity of
these products. Among 15- year old students, 19.9% were
current e-cigarette users, 4.9 % currently used snus and 6.4%
heated tobacco products. The prevalence of experimentation
with these products was higher, especially for e-cigarettes,
that were used by 30.1% of 15-year-old students at least once
in the lifetime.
Conclusions
Results show high popularity of emerging nicotine and tobacco
products among youth in Serbia and steady prevalence of
cigarette use. High prevalence of e-cigarette use, snus and
heated tobacco products stress the importance of urgent
measures that would limit exposure to the marketing,
promotion and availability of these products to the youth.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A60
DOI: 10.18332/tpc/172706
Project TnT (Transparency and Truth): a
moment of truth for Switzerland?
Pascal Diethelm1, Cédric Gumy2
1OxySuisse, Geneva, Switzerland, 2Swiss Tobacco Control
Fund, Bern, Switzerland
Background
Despite substantial financial possibilities, Swiss tobacco
control is weak and ranks second to last on both the
Tobacco Control Scale Europe 2021 and on the Global
Tobacco Industry Interference Index 2021. Switzerland has
not ratified the WHO/FCTC. Two major tobacco companies
use Switzerland as their global sanctuary. The tobacco
industry has transformed the country’s main economic trade
organizations into unconditional allies and secured strong
support from politicians.
Objectives
In 2018, the Swiss Tobacco Control Fund organized a
workshop bringing together teenagers and tobacco control
experts, asking them to propose innovative tobacco control
measures. The Transparency and Truth (TnT) project was one
of their most consensual - quasi unanimous - proposals: It
is a measure aimed at exposing the actions and tactics of the
tobacco and nicotine lobby to defend its commercial interests
and influence public health policy. The project aligns itself
on the CDoH (commercial determinants of health) approach
and on the FCTC Guidelines for Implementation of Article 12.

35
Tobacco Prevention & Cessation | Abstract Book
Methods
TnT is currently developed by two institutions and a task
force of experts selected and managed by OxySuisse, a
Swiss tobacco control NGO. Its main approach consists in
the development of thematic modules “describing the facts
and setting the record straight on various issues where the
tobacco industry does not act transparently and truthfully.”
Multi-thematic integration is encouraged, as messages can
be mutually reinforced by connecting them with other topics
(global warming, alcohol, sugar). The themes to be developed
are discussed, chosen by the task force and then developed by
partners. The approach is essentially fact-based.
Results
Currently developed or in progress themes include
“Greenwashing”, “New tobacco and nicotine products”, “New
marketing methods”, “Human rights”, “How the industry
targets adolescents”, “Voluntary and preemptive measures”,
“Corruption of science and scientific research”, “PMI’s
FSFW: Yet another smokescreen?”, “The real economic cost
of tobacco”, “The rhetoric of the tobacco industry”, etc. The
development of the modules is accompanied by a multi-
faceted communication strategy.
Conclusions
Effective tobacco control will only be possible in Switzerland
when the influence of the tobacco industry on political
decisions is stopped. The first step is to fully and factually
expose its practices and tactics. TnT is the first governmental
project ever aimed at doing exactly that, in the spirit of article
5.3 of the FCTC and its implementation guidelines. This is an
important paradigm shift for Switzerland.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A61
DOI: 10.18332/tpc/172707
Development of a youth adapted Brief
Tobacco Intervention plus automated text
messaging for high school students
Melissa Little1, Kara Wiseman1, Indika Mallawaarachchi1
1University of Virginia, Virginia, United States
Background
While substantial evidence demonstrates long-term
effectiveness of youth cigarette smoking prevention and
cessation programs, the evidence for non-cigarette youth
tobacco prevention and cessation programs is limited.
Objectives
The current study reports on the development of a theory-
based universal group delivered Youth Brief Tobacco
Intervention (Y-BTI) plus automated text messaging to
prevent tobacco initiation and promote cessation among high
school youth.
Methods
This study used a sequential, multi-method research design
to develop the interventions. In Phase 1, 347 students
completed a survey and discussion activity. A facilitator
asked 6 open-ended questions about perceptions of tobacco
use. Students then wrote their responses and placed them
on a board. The responses were summarized, and the
facilitator elicited discussion. Class discussions were coded
for themes. Students also provided preferences for timing
and frequency of receiving text messages. In Phase 2, 336
students watched video content for the Y-BTI and ranked each
video (e.g., relevance, believability, concern and impact). They
also completed pretest and posttest surveys that assessed
changes in harm perceptions, addictiveness, and willingness
to use tobacco.
Results
In Phase 1, students’ discussions mapped to the constructs
of the Health Belief Model and the Theory of Planned
Behavior. Thus, in Phase 2, anti-tobacco videos were
selected that aligned with these theoretical constructs. The
video messages appeared to be effective. Willingness to use
tobacco decreased across all tobacco products from pretest to
posttest (p’s<0.001). Additionally, the percentage of students
who reported ‘Don’t know’ to questions about tobacco harm
and addictiveness decreased across all tobacco products
from pretest (11.9%) to posttest (6.9%).
Conclusion
Results from this study will be used to develop a universal
tobacco control program for high school youth addressing
all forms of tobacco, which is significant given the changing
tobacco landscape and the increased benefits of cessation at
a younger age.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A62
DOI: 10.18332/tpc/172709
Cigarette price differentials and their
association with infant and neonatal
mortality in 140 countries: a longitudinal
ecological study
Olivia Bannon1, Márta Radó1, Filippos Filippidis2
1Karolinska Institutet, Stockholm, Sweden, 2Imperial College
London, London, United Kingdom
Background
Exposure to cigarette smoke is a serious global public health
concern that leads to tens of thousands of preventable infant
and neonatal deaths globally each year, most of which occur
in low- and middle-income countries. Raising tobacco taxes
to increase cigarette prices is an effective measure to reduce
smoking but is undermined by tobacco companies’ differential
pricing strategies that maintain budget cigarette prices.
Larger price differentials between premium and budget
cigarettes are associated with increased infant mortality in
the European Union, but this association is not understood
globally.
Objectives
To increase understanding of the association between
cigarette price differentials and infant and neonatal mortality
globally.
Methods
Fixed-effect panel regression models were used to assess the
association between cigarette price differentials and infant
and neonatal mortality globally and by country-level income
group using country-level aggregated data on 140 (41 high
income and 99 low- and middle-income) countries between
2014 and 2020.
Results
A 10% cigarette price differential increase was associated

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8th ENSP European Conference on Tobacco Control
with 0.76% increased infant mortality (95% CI: 0.2%-1.3%)
and 0.78% increased neonatal mortality (95% CI: 0.2%-1.4%)
globally. Decreasing price differentials by 10% was associated
with 29,373 averted infant deaths (95% CI: 7,729-50,244),
including 18,454 averted neonatal deaths (95% CI: 4,732-
33,122), globally in 2020, 98.4% of which in low-and middle-
income countries.
Conclusion
Higher cigarette price differentials are associated with
increased infant and neonatal mortality globally. Associations
by income group were not detected.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A63
DOI: 10.18332/tpc/172710
Predictors of the past 30-days e-cigarette
use among adolescents in Armenia
Zhanna Sargsyan1, Zaruhi Grigoryan1, Varduhi Hayrumyan1,
Tsovinar Harutyunyan1, Varduhi Petrosyan1
1Turpanjian College of Health Sciences, American University
of Armenia, Yerevan, Armenia
Introduction
We explored the predictors for past 30-days e-cigarette use
among adolescents in Armenia, with the goal of informing
evidence-based interventions and regulatory measures
to address the emerging public health concern of youth
e-cigarette use.
Methods
We conducted a survey in the capital Yerevan and an adjacent
region in February 2023. Study participants were 15-17 years
old students of private and public high schools. The instrument
contained items on adolescents’ socio-demographics, ever
and past 30-days e-cigarette use, and main reasons for ever
using e-cigarettes. Multivariable regression explored the
association between past 30-days e-cigarette use (categorized
as used/not used) and the most common three reasons for
ever using, while adjusting for gender, parental employment,
school type, and residency area.
Results
Overall, 366 adolescents completed the survey. The majority
were females (64.4%), living in Yerevan (71.3%), and studying
in public schools (77.0%). About 96.5% had employed fathers,
while only 76.2% had employed mothers. Ever e-cigarette
users (41.7%) reported the main reasons for using as flavors
(37.7%), curiosity (33.1%), and friends’ use (18.5%). Majority
of ever users (53.7%) used e-cigarettes for at least one day
in the past 30 days. In the multivariable logistic regression,
those who reported flavors as the main reason for ever using
e-cigarettes had higher odds of using them in the past 30-
days than those who did not (OR=3.97, p=0.008). Being male
vs female (OR=4.21, p=0.004) and attending public vs private
school (OR=3.67, p=0.038) were also significantly associated
with past 30-days e-cigarette use in the adjusted analysis.
Conclusions
Our study links past 30-days e-cigarette use in Armenian
adolescents to being male, attending public schools, and
reporting flavors as the main reason for ever using. To
address the escalating youth e-cigarette use in the country,
targeted interventions should prioritize male students in
public schools and consider banning flavored e-cigarette
products.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A64
DOI: 10.18332/tpc/172711
Think different, think big: Final solution to
nicotine challenge
David Chalom1
1Doctors Against Tobacco Sweden, Sweden
Introduction
The tobacco industry continuously launches new nicotine
delivery methods. These products are marketed with
hundreds of tastes and attractive packaging, leading children
to believe are safe to consume but contain strongly addictive
nicotine increasing young nicotine addiction alarmingly.
Nicotine, a psychotropic substance and highly addictive drug
is detrimental to health and fulfills WHO’s criteria for being
classified as a narcotic drug.
It should be because:
-Research shows harmful effects on fetuses, teenage brain,
cardiovascular system,
-Nicotine affects blood vessels causing tissues to degenerate
faster,
-Nicotine addiction drives cigarette use. One billion people
smoke worldwide causing six million deaths/year,
-New nicotine products create addiction at much higher
extent. The industry’s looking for ways to introduce into more
countries, and
-Nicotine opens for other addictive drugs’ abuse.
Objective
Solve the nicotine challenge in order to eliminate its threat to
the health of coming generations.
Material and Methods
Focusing on eliminating the source of the problem, investigate
how to best solving it: by studying the process for the
classification of narcotic drugs and their control.
Results
Based on set criteria, the WHO’s Expert Committee on Drug
Dependence assesses narcotic drugs and psychotropic
substances, and may then advise the UN’s Commission on
Narcotic Drugs to schedule them for international control.
This process is initiated by:
-Notification to the Secretary General of the UN from a
country/party to the UN conventions on narcotic drugs and
psychotropic substances, or by
-Information brought to WHO’s attention that a substance is a
serious threat to public health.
Conclusions
The tobacco prevention community can help policymakers/
governments focus on the heart of the problem in order to
finally solve the tobacco/nicotine challenge and notify the
UN’s Secretary General or the WHO on the necessity of
assessing nicotine to protect our children.
Conflicts of interest
The author has no conflict of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A65
DOI: 10.18332/tpc/172713

37
Tobacco Prevention & Cessation | Abstract Book
Civil society as a catalyst for the ratification
and implementation of the Protocol to
eliminate illicit trade in tobacco products –
an example from Bosnia and Herzegovina
Samir Ibisevic1
1Association PROI, Sarajevo, Bosnia and Herzegovina
Introduction
The illicit trade in tobacco products poses significant public
health and economic challenges globally. Bosnia and
Herzegovina facing a complex political landscape, which
exacerbates such challenges. Recognizing the importance of
addressing this issue in line with the EU acquis, PROI works on
creating a sustainable partnership between government and
civil society organizations (CSOs) and enhancing social and
economic reforms particularly those related to the Protocol.
Objectives
This presentation intends to highlight the unprecedented and
unique role played by NGO PROI, which stands as a unique
case in the Balkans region. The aim is to illustrate PROI’s
significant collaborative initiatives with the government and
international bodies, specifically targeted at combating the
illicit trade in tobacco products. Additionally, this presentation
seeks to provide an in-depth overview of the level of initiatives
undertaken to combat illicit trade in Bosnia and Herzegovina,
setting an example for the broader region.
Material and Methods
In preparation for this presentation, a qualitative analysis
was conducted, involving policy documents, media reports,
and non-structured interviews with key stakeholders from
the government, CSOs, and international partners engaged
in tobacco control. Strategic approaches and advocacy efforts
employed by civil society to drive the process of ratification
and implementation are also investigated.
Results
Civil society played a pivotal role in facilitating the ratification
of the Protocol. Their advocacy, public awareness campaigns,
and strategic engagement with policymakers and the
public resulted in increased support for the protocol’s
implementation. Evidence suggests that civil society
influence was a key driver in the successful enactment of
comprehensive tobacco control measures.
Conclusions
The successful work of the Association PROI underscores the
influential role of CSOs in advancing tobacco control policy
in Bosnia, but also in the Balkans region. The recent project
demonstrates how cooperation between government, CSOs,
and international bodies can contribute to the ratification
and implementation of the Protocol to Eliminate Illicit
Trade in Tobacco Products. It also exemplifies the potential
for civil society to drive reform, improve accountability and
transparency, and enhance the rule of law, even in complex
political environments.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A66
DOI: 10.18332/tpc/172719
Nurses care for nurses
Yvonne Bergmark Bröske1, Sofia Shakibi1
1Swedish Nurses Against Tobacco, Stockholm, Sweden
Introduction
Tobacco control and cessation is one of the most cost-effective
healthcare interventions in which nurses and midwives hold
a key position. The NGO “Swedish Nurses Against Tobacco”
(SNAT) was established in 1992. The aim was to build a
national network of nurses and midwives and enhance their
role in tobacco control and cessation. In 2000, SNAT took the
initiative to build an international network “European Nurses
and Midwives against Tobacco”.
Objectives
SNAT aims is to build a strong network to increase nurses’
and midwives’ roles in tobacco control and cessation and
also by a special counceling method help heavy tobacco using
nurses and midwives to be tobacco free.
Material and Methods
SNAT has trained nurses in counseling tobacco prevention and
cessation methods since 1996. SNAT has since 2007 helped
heavy tobacco using nurses and midwives to be tobacco-
free. This has been a win-win situation. In cooperation with
other health professionals, SNAT has been active in the global
Tobacco Endgame project. In 8th European Conference on
Tobacco or Health (ECToH) in Germany 2020, interest in the
international network was reawakened and “The Coalition
of Nurses and Health Professionals Against Tobacco and
Nicotine” took shape. In November 2020, SNAT participated
in the virtual18th German Conference on Tobacco Control
and presented “Good Practice from Sweden”. During the 9th
European Conference on Tobacco or Health (ECToH) in Spain
2023, the coalition met again. One of the subjects discussed
at the meeting was finding initiatives for decreasing not just
the consumption of tobacco but also other nicotine products
which has become popular between children and young
adults.
Results and Conclusions
With a large network of nurses and midwives who work with
tobacco control, there will be a big chance to reach bigger
populations such as parents, children, and young people. It is
not time to give up the focus off European Cancerplan to reach
a “Tobacco/Nicotine-Free Generation” in Europe, where less
than 5% of the population uses tobacco.
Conflicts of interest
The authors have no conflict of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A67
DOI: 10.18332/tpc/172721
Tobacco packaging and labeling in the
Americas: progress and gaps
Ernesto Marcelo Sabrie1, Eric Crosbie2, Olufemi Erinoso2,
Sara Perez2
1Campaign for Tobacco-Free Kids, Washington, United States,
2University of Nevada Reno, Reno, United States
Introduction
The World Health Organization (WHO) Framework Convention
on Tobacco Control (FCTC) Article 11 recommends provisions
on packaging and labeling for tobacco products, including
health warning labels (HWLs), constituents and emissions
information, removal of misleading information, and plain
packaging to reduce tobacco consumption.
Objective
The objective of this study was to assess the adoption of

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8th ENSP European Conference on Tobacco Control
tobacco products packaging and labeling policies based on
the FCTC’s Article 11 guidelines in the WHO Region of the
Americas (AMRO).
Material and Methods
We reviewed data on the regulatory environment of tobacco
packaging and labeling in AMRO. Data was extracted from
Tobacco Control Laws (www.tobaccocontrollaws.org), a
database developed and maintained by legal advisors at
the International Legal Consortium from the Campaign for
Tobacco-Free Kids in collaboration with in-country lawyers.
We analyzed four sub-policy areas for smoked and smokeless
tobacco products: 1) HWLs (e.g., size), 2) constituents and
emissions (e.g., message content), 3) misleading information
(e.g., brand descriptors), and 4) other requirements (e.g.,
standardized/plain packaging).
Results
Of 35 countries in AMRO, 31 have tobacco packaging and
labeling laws. Twenty-six countries require pictorial HWLs,
24 require warnings printed on at least 50% of the front and
back of the packs, and 24 rotate a single or multiple (from
2 to 16) warnings within a specified period (from 5 up to 24
months). Only 21 countries require descriptive messages on
toxic constituents and emissions information. Twenty-seven
countries ban brand descriptors with references to implied
harm reduction (e.g., “light”), 24 ban figures, colors, and
other signs, but only 13 prohibit emission yields printed on the
packs. Only Canada and Uruguay have adopted standardized
tobacco packaging while Uruguay also requires a single
presentation (one brand variant) per brand family.
Conclusions
Many countries in AMRO have made good progress in
adopting multiple, rotating, large pictorial HWLs and banning
misleading brand descriptors. However, there needs to be
greater attention on other tobacco packaging and labeling
provisions with a focus on implementing standardized tobacco
packaging.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A68
DOI: 10.18332/tpc/172722
Heated Tobacco Products (HTPs)
regulation in Pakistan: A case study of
tobacco industry’s footprints in the policy
formulation
Waseem Iftikhar Janjua1
1Sustainable Development Policy Institute, Islamabad,
Pakistan
The tobacco industry (TI) seeks to undermine the public health
ministry/department’s leadership role in tobacco control by
engaging in lobbying activities, either defeating or diluting
policies, and by its presence on the policymaking table. TI
(PMI) has also been pushing for the promotion and sale of
Heated Tobacco Products (HTPs). Besides, significant, and
growing evidence suggests that TI fiercely resists tobacco
control measures, causing delays in implementation,
especially in Low-and-Middle-Income-Countries (LMICs).
One of the top recommendations of the WHO was to outright
ban electronic nicotine products, ensuring the regulation of
HTPs as any other tobacco product.
Unregulated electronic tobacco devices and nicotine pouches
permeated the Pakistani market in 2019 and rapidly spread
across the country. In December 2022, the Ministry of Health
issued a Statutory Regulatory Ordinance SRO 2304(I)/2022,
also called “HTPs (Heat-not-burn, Printing of Warning) Rules,
2022”. An exclusion of tobacco control stakeholders, and civil
society organizations from the preparation/promulgation
processes raised concerns regarding the intent and efficacy
of this SRO.
Foregoing in view, this research critically examines this SRO
and finds evidence of TII in promulgation discourse. This
analysis further signposts the text-book tactics adopted by
TI to dilute the regulatory intensity of this regulation, leaving
gaps in taxation, and warnings, besides other MPOWER
measures.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A69
DOI: 10.18332/tpc/172712
Misleading information created by tobacco
industry
Dilek Aslan1,2, Elif Dagli2, Tanzer Gezer2
1Department of Public Health, Faculty of Medicine, Hacettepe
University, Ankara, Turkey, 2Health Institute Association,
Turkey
Introduction
Infodemic defined as too much information including
false or misleading information in digital and/or physical
environments, is a global public health threat as it causes
confusion, risk taking behaviors, etc. Fortunately, awareness
on infodemic management increased among global scientific
community since the COVID-19 pandemic. Misleading
information is also a tactic used by transnational tobacco
companies (TTCs) for market expansion. This study aims to
investigate the infodemic content which TTCs use in public
communication.
Material and Methods
Top seven TTCs by net sales (in 2021) have been searched.
Seven TTCs were determined through the statista.com
website list. Search was limited to the websites and the social
media channels of the companies. Missions, visions, news,
announcements, future directions of the companies, content
of the social media channels were investigated.
Results
TTCs websites and social media channels included misleading
information. Major tactics used by TTCs in communication
with public were as follows:
a) Release of false positive messages and promises like
“smoke free”, “better”, “better future”, “better tomorrow”
b) Websites designs were to attract young generations.
c) Majority of the websites had information misleading
the public.
d) Misinformation on potential health the risks influence
the public.
e) Use of scientific innovation and transformation
concepts create to instill trust.
f) Use of social media channels to reach large
audiences.
Conclusions

39
Tobacco Prevention & Cessation | Abstract Book
TTCs use different well-known tactics to deceive public which
the tobacco control advocates have been aware for many
years. This paper gives us remarkable clues on how the TTCs
use misleading information to promote the use of tobacco.
Social media is used to deliver mis/disinformation to large
audience and speedy communication increases almost all the
risks. In this regard, tobacco control advocates should adopt
infodemic management strategies in their tobacco control
efforts to repel TTCs intrigue.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A70
DOI: 10.18332/tpc/172714
Perceived content, relationship with tobacco
and self-reported reasons for e-cigarette
use among adolescents in Europe - findings
from ESPAD 2019
Biljana Kilibarda1, Sonia Cerrai2,3, Elisa Benedetti2, Jelena
Gudelj Rakic1, Verica Jovanovic1, Mirjana Tosic1
1Institute of Public Health of Serbia, Belgrade, Serbia,
2National Research Council, Institute Of Clinical Physiology,
Pisa, Italy, 3Department Of Epidemiology, Care And Public
Health Research Institute (Caphri), Maastricht University,
Maastricht, The Netherlands
Introduction
A substantial number of e-cigarette users worldwide are
adolescents and for many of them e-cigarette is the first
contact with nicotine, often because their attractiveness. The
objective of this analysis is to explore the reasons for trying,
perceived content of e-cigarette and the relationship with
tobacco at the onset of use among adolescents in Europe.
Material and Methods
Data were obtained from European School Survey Project on
Alcohol and Other Drugs (ESPAD) conducted in 2019 in 35
European countries on a total sample of 102,484 students
born in 2003.
Results
In 2019, almost every fourth (23%) 16 years old student in
ESPAD countries never used tobacco but tried e-cigarettes.
This indicator shows high variations across countries with
the highest prevalence in Cyprus and Monaco (39%) and
Spain and Lithuania (35%) and the lowest in Norway (11%)
and North Macedonia and Montenegro (12%), Serbia (13%)
and Croatia (14%). Significantly lower percentage (4.2%)
of students regularly used tobacco when they first tried
e-cigarette. Curiosity was the reason for trying e-cigarette
for 30% of the total sample of students, and for 1.7% it was
to stop smoking. Almost every third student (33%) in the total
sample of students from 13 ESPAD countries that included
this question in the survey, thought that the e-cigarette they
used contained nicotine. The risk perception of e-cigarettes
is low, with 6% of students perceiving trying e-cigarettes once
or twice as a great risk.
Conclusions
The results indicate that e-cigarettes are rarely used by
adolescents to reduce harm and stop smoking and at the
same time point out low risk perception and knowledge on
e-cigarette content. Results call for interventions that would
reduce attractiveness, raise awareness on the evidence-
based findings about these products and at minimum restrict
marketing and promotion of e-cigarette to ensure it is aimed
at adults.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A71
DOI: 10.18332/tpc/172716
Evidence supporting the expansion of
smoke-free (indoor, outdoor, public and
private) environments: a literature review
Sotiria Schoretsaniti1, Angeliki Lambrou1, Efstathios
Papachristou1, Anna Mar López2,3, Dolors Carnicer-Pont2,3,4,
Esteve Fernandez2,3,4,5
1Directorate of Epidemiology and Prevention of Non-
Communicable Diseases and Injuries, National Public Health
Organization, Athens, Greece, 2Tobacco Control Unit and WHO
Collaborating Center for Tobacco Control, Catalan Institute
of Oncology, L’Hospital et de Llobregat, Spain, 3Bellvitge
Biomedical Research Institute (IDIBELL), L’Hospital et
de Llobregat, Spain, 4Center for Biomedical Research in
Respiratory Diseases (CIBERES), Madrid, Spain, 5School
of Medicine and Health Sciences, University of Barcelona,
Barcelona, Spain
Introduction
Even though there has been great progress in the
implementation of Article 8 of WHO FCTC to protect citizens
from secondhand smoke (SHS) and aerosols (SHA) from
tobacco/nicotine products, still most of the world population
remains exposed.
Objective
To assess and create the framework for the expansion of
Smoke- and Aerosol-Free Exposure legislation in Europe,
within the workpackage 8 of the JATC2.
Material and Methods
Review published papers in peer-reviewed journals.
The search was conducted in PubMed and Science Direct
databases (2010 to 2022).
Results
After screening, 83 papers were included. These papers
indicate a high SHS-SHA exposure at public and private,
indoor and outdoor settings and at indoor locations adjacent
to outdoor smoking areas. Social inequalities in SHS-SHA
exposure clearly exists across the EU, between and within
countries. Indoors SHS-SHA exposure in hospitality venues
dramatically decreased after the implementation of national
smoke-free legislation while smoking outdoors at cafes/pubs/
bars increased indicating allocation of smoking to outdoor
spaces. High SHS levels at some outdoor smoking areas and
at adjacent smoke-free indoor areas were also registered.
There is compelling evidence of SHS exposure at university
and hospital campuses, school outdoor entrances, children’s
playgrounds, parks and beaches, and that SHS from outdoors
settings of building entrances drifts to adjacent places
indoors. SHS-SHA exposure remains a public health problem
in major airports across Europe specifically related to the
presence of smoking rooms. Furthermore, ban on smoking in
public places, prompted more homes to become smoke-free,
though exposure to SHS and SHA at home is high for non-
smokers cohabiting with smokers. Almost 2/3 of smokers

40
8th ENSP European Conference on Tobacco Control
across Europe have a voluntary smoking ban for cars in the
presence of children.
Conclusions
Implementing comprehensive smoke-free legislation,
including private vehicles, and ensuring its strict enforcement
should be the way forward for EU MS and beyond. Expanding
interventions to prompt smoke-free homes is also needed.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A72
DOI: 10.18332/tpc/172717
Lung cancer screening, smoking cessation
and health behaviors: preliminary results of
an Italian pilot study
Jasmine Giovannoli1, Serena Checcacci1, Giuseppe Cavallo1,
Enrica Stancanelli2, Margherita Zeduri3, Anna Odone3,
Giuseppe Gorini1
1Oncologic Network, Prevention and Research Institute,
Florence, Italy, 2Medical Specialization School of Hygiene and
Preventive Medicine, University of Florence, Florence, Italy,
3Department of Public Health, Experimental and Forensic
Medicine, University of Pavia, Pavia, Italy
Introduction
Participation in lung cancer screening (LCS) is a favorable
‘teachable moment’ to promote smoking cessation (SC). This
Italian pilot study provides low-dose computed tomography
in combination with brief advice, followed by referral to SC
center (SCC).
Objective
The aim was to assess participants’ psychological
characteristics related to SC and health behaviors.
Material and Methods
LCS participants completed two questionnaires to assess the
stage of change according to the transtheoretical model, and
time perspective, a predictor of individual behavior.
Results
Out of 290 participants in the Florence area, 263 (90.7%)
were smokers (52.1% females; mean age: 63.4 years; 46.8
pack-years) and 27 (9.3%) were ex-smokers (33.3% females;
mean age: 63.8 years; 50.9 pack-years). 143 (54.4%) smokers
were referred to the SCC. 140 smokers completed the
questionnaires and 7.9% were in precontemplation, 34.3% in
contemplation, 12.1% in preparation, and 2.1% in the action
stage of change. 6.4% of the smokers were simultaneously
in precontemplation and contemplation while 5.7% were
simultaneously in precontemplation and preparation.
Moreover, smokers compared to the Italian population, tend
to be less fatalistic (mean score: 15.0; range: 15.6-22.9) and
nearly more hedonistic (mean score: 21.7; range: 14.5-22.7).
Future orientation was consistent with the Italian population
(mean score: 31.7; range: 25.9-35.7).
Conclusions
These preliminary results confirm that LCS can be a teachable
moment to think about SC and that a negative correlation
exists between a fatalistic attitude and health behaviors.
Indeed, all smokers who completed the questionnaires joined
the LCS program, about 50% were considering changing their
smoking status and more than 50% were referred to SCC.
Furthermore, a hedonistic attitude at the upper limits of the
norm emerges, indicative of a tendency to be self-indulgent
pleasure-seekers.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A73
DOI: 10.18332/tpc/172720
Does tobacco consumption impact the risk
of developing hepatocellular carcinoma in
patients with hepatitis B? – A systematic
review
Jerina Jaho1
1Scientific Research Center for Public Health, Ismail Qemali
University of Vlore, Vlore, Albania,
Does tobacco consumption impact the risk of developing
hepatocellular carcinoma in patients with hepatitis B? – A
systematic review
Hepatitis B is a major global public health concern. The disease
has a huge impact on healthcare systems as its chronicity in
liver cirrhosis or hepatocellular carcinoma. Globally, World
Health Organization estimates that 296 million people were
living with chronic hepatitis B infection in 2019. The aim of
this study was to identify if cigarette smoking is a potential
risk factor for hepatocellular carcinoma initiation, partially
through interaction with hepatitis B virus. The Systematic
electronic search for articles published without a time
limit included online articles of PubMed, Google Scholar,
Medline with Full Text and Medscape, discussing the study
aim. A total of 12 studies were identified using key word as
Hepatitis B infection, liver cancer, hepatocellular carcinoma,
smoking, cigarette, tobacco consumption. The categorization
was done for the first author and year of article publishing,
methodology and results. Based on the results of studies
mediation modeling further indicated that viremia levels,
may play a key mediating role in the path between smoking
and HCC, in patients with hepatitis B infection. One of the
studies included in the review, analyzed various dimensions of
cigarette smoking, and the results all support the hypothesis
that chronic smoking increases viremia/ALT levels. The
finding that both former and current smokers were more
likely than nonsmokers to have higher viral load suggests
that smoking-induced immune changes can persist even
after smoking cessation. In summary, tobacco consumption is
an important cause of some diseases. Specifically, our study
highlights the effect of smoking on the risk of Hepatitis B
Virus related Hepatocellular carcinoma. We strongly suggest
that healthcare practitioners should educate and train patient
with chronic hepatitis B to quit smoking, in order to avoid the
onset of liver cancer.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A74
DOI: 10.18332/tpc/172725
Exposure to secondhand smoke and
intention to use e-cigarettes among
adolescents: findings from a cross-sectional
survey
Varduhi Hayrumyan1, Zhanna Sargsyan1, Zaruhi Grigoryan1,
Tsovinar Harutyunyan1, Varduhi Petrosyan1

41
Tobacco Prevention & Cessation | Abstract Book
1Turpanjian College of Health Sciences, American University
of Armenia, Yerevan, Armenia
Introduction
Adolescence is a critical developmental period, and the
initiation of e-cigarette use during this phase can seriously
impact future tobacco-related behavior. Secondhand smoke
exposure (SHSe) has been linked to increased e-cigarette
initiation among adolescents. This study aims to investigate
the relationship between SHSe and e-cigarette use intention
in adolescents in Armenia, adjusting for socio-demographic
factors.
Material and Methods
A cross-sectional survey was conducted among 15-17-year-
old adolescents attending private (n=1) and public (n=3) high
schools in Yerevan (the capital) and one randomly selected
province in Armenia in February 2023. The survey assessed
socio-demographics, past 30-days SHSe, as well as intention
to use and actual use of e-cigarettes. E-cigarette use
intention was scored from 0 (definitely not) to 3 (definitely
yes). Multivariable regression explored the association
between e-cigarette use intention and SHSe while adjusting
for gender, school type, parental employment, and living in
the capital vs. region.
Results
A total of 366 adolescents participated in the survey, with 64.4%
of them being females, 71.3% residing in Yerevan, and 77.0%
attending public schools. About 96.5% of adolescents had
employed fathers, while only 76.2% had employed mothers.
Among those who never used e-cigarettes (59.3%), the
average intention score was 0.84 out of possible 3. Majority of
adolescents (68.3%) were exposed to SHS from any source for
at least one day within the past 30 days. The primary sources
of SHSe were friends (44.6%), fathers (37.2%), and other
relatives (29.7%). In the multivariable regression analysis,
the intention score was positively associated with SHSe, after
adjusting for socio-demographic characteristics (β=0.33,
p=0.014).
Conclusions
This study highlights a significant association between the
intention to use e-cigarettes and SHSe among adolescents
in Armenia. Given the high prevalence of SHSe in Armenia,
further exploration of this relationship is essential to inform
public health policies and interventions targeting adolescents.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A75
DOI: 10.18332/tpc/172726
Health promotion in universities: the
national university smoke-free network
Laura Campo1, Michele Riva2, Franca Barbic3, Francesco
Donato4, Andrea Moriondo5, Simona Villani6, Anna Lisa Cristini7,
Maria Sofia Cattaruzza8, Massimo Corradi9, Filippo Merusi10,
Antonio Paoli11, Maria Paola Monaco12, Laura Chiarantini13,
Elena Barbieri14, Lory Santarelli14, Lucia Paoloni15, Ada Maria
Florena16, Silvia Fustinoni17,1
1Dipartimento Scienze Cliniche e di Comunità, Università
degli Studi di Milano, Milano, Italy, 2Dipartimento di Medicina
e Chirurgia, Università di Milano Bicocca, Milano, Italy,
3Dipartimento di Scienze Biomediche, Humanitas University,
Pieve Emanuele, Italy, 4Dipartimento di Specialità Medico-
Chirurgiche, Scienze Radiologiche e Sanità Pubblica
dell’Università degli Studi di Brescia, Italy, 5Dipartimento di
Medicina e Chirurgia, Università degli Studi dell’Insubria,
Italy, 6Dipartimento di Sanità Pubblica, Medicina Sperimentale
e forense, Università di Pavia, Italy, 7Dipartimento di
Scienze Economiche, Università degli Studi di Bergamo,
Italy, 8Dipartimento di Sanità Pubblica e Malattie Infettive,
Sapienza Università di Roma, Italy, 9Dipartimento di Medicina
e Chirurgia, Università degli Studi di Parma, Italy, 10U.O.
Ambiente, Sostenibilità e Sicurezza (Prevenzione e Protezione),
Università degli Studi di Parma, Italy, 11Dipartimento di
Scienze Biomediche, Università degli Studi di Padova, Italy,
12Dipartimento di Scienze Giuridiche, Università degli Studi
di Firenze, Italy, 13Dipartimento di Scienze Biomolecolari,
Università degli Studi di Urbino Carlo Bo, Italy, 14Dipartimento
di Scienze Cliniche e Molecolari, Università Politecnica delle
Marche, Italy, 15Ente Regionale Per Il Diritto Allo Studio,
Ancona, Italy, 16Dipartimento Promozione della Salute,
Materno-Infantile, di Medicina Interna e Specialistica di
Eccellenza G. D’Alessandro, Università degli Studi di Palermo,
Italy, 17Medicina del Lavoro, Clinica del Lavoro, Fondazione
IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano,
Italy
Introduction
With the aim of implementing common policies of health
promotion to counter the use of tobacco cigarettes and new
products and e-cig at university, the UNIVERSITY SMOKE-
FREE network was set up in Italy.
Objective
The main objectives of the network are: to update and
uniform the university regulations; to investigate exposure
of students and staff to active and passive smoking by means
of a multicentre survey; to implement initiatives for helping
students to stop smoking; to produce information and
teaching materials.
Material and Methods
With the involvement of the university governments, a
network was set up comprising 14 universities: Milan La
Statale (UNIMI), Milan-Bicocca, Milan-Humanitas, Brescia,
Insubria, Pavia, Bergamo, Rome Sapienza, Parma, Padua,
Florence, Urbino, the Polytechnic University of Marche, and
Palermo. In order to carry out the survey, a questionnaire
was developed and validated1, investigating active cigarette
smoking, use of new products, exposure to passive smoking,
knowledge of the health effects of smoking, and knowledge
of, and agreement on regulations.
Results
All network universities have started to review and update
their smoke-free regulations. The survey protocol, developed
at UNIMI, was shared among the universities for approval by
their respective Ethics Committees.
The survey was completed in 2021 by the University of Milan
La Statale, and in May-July 2023 by the Universities of Brescia
and Urbino, while it will be conducted in the other universities
in 2024. To date, more than 10000 students participated in the
survey (11-25% of students). First results show differences
among universities and scientific and humanistic faculties, in
terms of active and passive smoking, and awareness of risks
of smoking2.

42
8th ENSP European Conference on Tobacco Control
Conclusions
The establishment of the UNIVERSITY SMOKE-FREE network
is an important step to counter smoking at university.
Conducting a multicentre survey may be useful to develop
information material and implement common policies.
Conflicts of interest
The authors have no conflicts of interest to disclose.
References
Campo L, et al. Validation of a Questionnaire to Assess
Smoking Habits, Attitudes, Knowledge, and Needs among
University Students: A Pilot Study among Obstetrics Students.
Int J Environ Res Public Health. 2021 12;18(22):11873.
Campo L, et al. Assessing Smoking Habits, Attitudes,
Knowledge, and Needs among University Students at the
University of Milan, Italy. Int J Environ Res Public Health. 2022
30;19(19):12527.
Tob. Prev. Cessation 2023;9(Supplement 2):A76
DOI: 10.18332/tpc/172730
Higher smoking and e-cigarette use among
young adults with mental health problems:
An analysis of wave 4 of growing up in
Ireland, the national longitudinal study of
children in Ireland
Joan Hanafin1, Salome Sunday1, Luke Clancy1
1TobaccoFree Research Institute Ireland, Technological
University Dublin, Dublin, Ireland
Introduction
Worsening youth mental health has been an increasing public
health concern particularly during Covid-19. Associations
between mental health problems (MHP) and tobacco use are
well-established and linked with inequalities but whether
similar patterns exist for e-cigarette use is less clear.
Objective
We examine smoking and e-cigarette use in Irish 20 years
olds with doctor-diagnosed MHP.
Material and Methods
We use data from 5,190, 20 year-olds from Wave 4 of Growing
Up in Ireland Child Cohort, the national longitudinal study of
children and young people. MHP were assessed using 20-year-
olds’ self-reports who had been diagnosed by a doctor,
psychologist, or psychiatrist. Young adults also self-reported
their ever and current smoking, and ever and current use of
e-cigarettes. Frequencies and cross-tabulations analyses
were performed using STATA version 16.1.
Results
Among Irish 20-year-olds, 19.4% (n=1,008) reported having
been diagnosed with a MHP. The majority of these (n=949)
reported depression or anxiety. Young adults with MHPs
reported higher prevalence for all measures of smoking and
e-cigarette use than did those without MHP, and findings
were statistically significant for all 4 measures. Almost half
of those with MHP were current smokers (47%; n=474 vs.
35.2%; n=1472 without MHP). Almost four out of five were
ever-smokers (78.3%; n=789 vs. 72.8%; n=3018). E-cigarette
ever-use was 56.9% (n=574) compared with 45.5% (n=1886)
in those without MHP and e-cigarette current use was 16.6%
(n=168) compared with 12.5% (n=522).
Conclusions
Among young adults, similar associations with MHP exist
for e-cigarette use as have been shown to exist for smoking.
Our data do not include other mental health problems not
reported or not doctor-diagnosed. However, for 20 year-olds
with depression and anxiety, a need exists for education and
cessation interventions to address their significantly higher
rates of smoking and e-cigarette use which likely exacerbate
further the health inequalities among this vulnerable group.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A77
DOI: 10.18332/tpc/172734
Young adult smoking in Ireland – Initiation,
prevalence, cessation, and intervention
points
Joan Hanafin1, Salome Sunday1, Luke Clancy1
1TobaccoFree Research Institute Ireland, Technological
University Dublin, Dublin, Ireland
Introduction
Young adult smoking initiation and subsequent smoking
patterns receive less attention than teenage initiation and
patterns, being perceived to be less problematic despite 20-
34 year-olds having the highest smoking prevalence of any
age group.
Objective
We set out to establish prevalence of ever-smoking, former,
current and daily smoking in 20-year-olds in Ireland, and
most common ages of initiation into smoking, and examine
motivations for smoking, and reported difficulty with
cessation.
Material and Methods
We use data from 5,190, 20 year-olds from Wave 4 of Cohort
’98 (Child Cohort) of Growing Up in Ireland, a nationally
representative longitudinal study of children and young
people. All analyses were performed using STATA version
16.1.
Results
Ever-smoking among 20 year-olds was 74% (n=3,807) and
current smoking was 37.5% (n=1,946). Among ever-smoked,
35.5% (n=1,347) were occasional smokers and 15.5% (n=592)
were daily smokers. Reported reasons for smoking were
“because friends smoke” (29.7%, n=1,082); “enjoy it” (20.9%,
n=762); and “helps cope with stress” (15%, n=547). Only 2%
(n=74) reported smoking because they “can’t give it up”.
However, 12.8% (n=488) said that they had tried to give up
cigarettes but found that they couldn’t. More than half of
ever-smokers had started smoking between the ages of 17
and 19 (age 17 – 16.4%, n=669; age 18 – 23.1%, n=885; age
19 – 13.6%, n=520).
Conclusions
Smoking rates are high among 20 year olds with three-
quarters of respondents reporting that they had ever-smoked.
More than 1 in 8 had tried to stop smoking but were unable
to. The ages between 17 and 19 were vulnerable ones for
smoking initiation, perhaps indicative of young adults leaving
school, starting higher education and jobs, and moving away
from home. Of all initiation ages analysed (11-20 years), age
18 was the most frequently reported age suggesting needs
for prevention and cessation for older teens and young adults.
Conflicts of interest

43
Tobacco Prevention & Cessation | Abstract Book
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A78
DOI: 10.18332/tpc/172737
Analysis of the attitude of Ukrainians to
smoking during Russia’s large-scale war
against Ukraine
Otto Stoyka1
1Kyiv City Center for Disease Control and Prevention, Kyiv,
Ukraine
Introduction
The outbreak of Russia’s full-scale war against Ukraine,
triggered a national humanitarian crisis, with millions of
people falling victim. This led to the impact of severe stress
on the entire population of Ukraine.
Objective
Assess the attitude of Ukrainians to smoking during the War.
Material and Methods
The analysis was based on the data of the All-Ukrainian survey
“”Tobacco use practices among the population of Ukraine
and attitudes towards anti-tobacco measures”” (the Kyiv
International Institute of Sociology in May 2022) by interviews
among a national sample aged 18+.
Results
Data analysis shows how the war is changing the attitude of the
Ukrainian population toward smoking. Thus, the consumption
of any tobacco and nicotine products amounted to 27.4% (44.0%
of men and 13.7% of women). Which corresponds to the level
of smoking before the War. The structure of consumption of
tobacco and nicotine products also did not change: 22.2%
used cigarettes, 3.3% (4.2% of men and 2.5% of women) –
e-cigarettes, 3.0% (3.4% of men and 2.7% of women) – HTPs,
2.6% – hookah with tobacco. 42.3% of smokers answered that
the beginning of a full-scale war in Ukraine did not affect the
intensity of their consumption of tobacco or nicotine. 40.2%
indicated that they began to use slightly more or significantly
more tobacco or nicotine and 12.6% reported that they began
to consume less or significantly less.
Conclusions
The results show that, in general, the population did not
change their habits of smoking tobacco and nicotine and did
not start smoking anymore due to significant socio-economic
and political changes. The study also demonstrates that
among the smokers themselves, the consumption structure
of various products has not changed. Among smokers, less
than half began to use tobacco and nicotine more, which
also indicates the constancy of dependence, which even with
increasing stress does not change significantly.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A79
DOI: 10.18332/tpc/172724
Coalition of healthcare professionals for a
tobacco and nicotine future
Christa Rustler1, Yvonne Bergmark Broske2
1German Network for Tobacco-free Healthcare Services,
Germany, 2Swedish Nurses Against Tobacco, Sweden
Introduction
At the European Conference on Tobacco or Health, ECToH
2020 in Berlin, there was a great interest among the session
speakers and participants about the role of nurses especially
in tobacco initiatives such as quit lines, cessation support
in healthcare settings and taking an advocacy role in the
reduction of tobacco, e-cigarette and snus use, community
health promotion and cancer prevention.
Objective
The key outcome of the session was a proposal to establish a
European-wide network of healthcare professionals against
tobacco and nicotine products use. It was led by European
Oncological Nurses Society EONS until 2022.
Material and Methods
In collaboration with the key members of the Coalition, a
concept paper was developed in 2020 with following objectives:
To support Healthcare Professionals to become smoke free
and to support population approaches of tobacco control by
sharing information and benchmarking best practice across
Europe, that involve healthcare professionals. The Coalition
presented the concept paper and objectives in a symposium at
the German Conference on Tobacco Control in 2020. Coalition
members from Ireland, Swedish Nurses against Tobacco,
Eastern Europe Centre of Excellence in Tobacco Control (EE-
COE), the National Korányi Institue of Pulmonology and from
Germany presented “good practice” of national and regional
experiences. In the next meeting at ECToH 2023 in Madrid,
future structure and activities were discussed.
Results
The participants confirmed the existing concept paper
in Madrid 2023 and after a fruitful exchange, the future
collaboration with ENSP, as interprofessional and european-
wide active organization, was decided. The Coalition will hold
a workshop in the European Conference on Tobacco Control
ECTC 2023 to present the concept paper with future activities
and practice examples from members.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A80
DOI: 10.18332/tpc/172727
Nurses role in tobacco control – workplace
health promotion and education
Christa Rustler1
1German Network for Tobacco-free Healthcare Services,
Germany
Introduction
Nursing counseling is effective in tobacco cessation (Rice,
Stead, 2013). Unfortunately, up to 50 % nursing students in
Germany smoke. Any intervention to reduce tobacco use in
nursing helps to improve individual health and to strengthen
the role of nurses in tobacco cessation. Nurses also have
an important role to support the strategy for a tobacco-free
Germany 2040, according to which less than five percent of
adults and less than two percent of adolescents should use
tobacco products or e-cigarettes (dkfz 2021).
Objective / Methods
To reduce tobacco consumption, a nursing education program
was developed that includes workplace health promotion,
healthy lifestyle, stress prevention, and tobacco cessation.
The implementation is funded by the sickness insurance DAK-
Gesundheit. Funding is based on implementation research

44
8th ENSP European Conference on Tobacco Control
findings and schools must follow program quality criteria
when applying for it. An implementation team is set up and the
program will be integrated in the school curriculum. Teachers
are trained and supported in a systematic implementation
process over several months. Quality and effects of the
program are evaluated via surveys and workshops.
Results
The intervention can successfully be implemented in nursing
schools and was rewarded with the WHO World No Tobacco
Day Award 2021. Program evaluation show 50 % of students
participate in cessation courses. Results are a significant
decrease in smoking prevalence (51 % to 46 %) and increase
in motivation to quit (28 % to 36 %). Interesting is also that
quitters use more healthy stress management strategies
compared to continued smokers (Bühler et al.). The results
provide arguments for a norm shaping campaign within the
nursing profession in Germany towards tobacco free care and
to develop health protecting work conditions. To support this
improvement, participation, exchange and development of
good practice in regional networks as well as interprofessional
and international networks will be established.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A81
DOI: 10.18332/tpc/172731
Expert consensus statement on tobacco
control sustainability in Poland
Marta Miller1, Łukasz Balwicki2, Magdalena Cedzyńska3, Irena
Przepiórka3, Jarosław Pinkas4, Wioleta Tomczak2, Tomasz
Zdrojewski5
1Medical University of Gdansk, Gdansk, Poland, 2Department
of Public Health and Social Medicine, Medical University of
Gdansk, Gdansk, Poland, 3Maria Sklodowska-Curie National
Research Institute of Oncology, Warsaw, Poland, 4Centre of
Postgraduate Medical Education in Warsaw, Warsaw, Poland,
5Department of Hypertension and Diabetology, Medical
University of Gdansk, Gdansk, Poland
Introduction
Tobacco use poses a significant public health threat in Poland,
with high rates of consumption and detrimental effects on
individuals. Tobacco is responsible for one-third of all cancer
deaths in Poland. This study aimed to develop an expert
consensus statement on tobacco control sustainability in
Poland.
Material and Methods
An expert consensus hybrid meeting was conducted, gathering
national tobacco control experts from various fields. The
meeting utilized the Index of Tobacco Control Sustainability
(ITCS) to identify critical indicators for a sustainable national
tobacco control program.
Results
Key recommendations include developing a comprehensive
tobacco control strategy and program, establishing inter-
governmental coordination, strengthening civil society
involvement, creating a dedicated Tobacco Control Unit,
allocating government annual funding for tobacco control
operations, and strengthening organizational resistance to
tobacco industry interference.
Conclusions
Poland needs to build the institutional capacity and address
sustainable financial resources on an annual basis to
effectively organize sustainable tobacco control.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A82
DOI: 10.18332/tpc/172733
Factors associated with current e-cigarette
use in an Irish university and attitudes to
proposed legislative change
Catherine Hayes1, Niall Kennedy1, Darin Poon1, John Frain1,
Anderson Lee1, Chi Lee1, Martina Mullin1
1Trinity College Dublin, Dublin, Ireland
Introduction
In 2022, 11% of Irish adults <25 years reported current use
of e-cigarettes. Of particular concern is the increase in
under 18s from 10-18% between 2015-19. A government bill
to ban the sale of nicotine inhaling products to under 18s
was approved in May 2023. We examined the prevalence of
e-cigarette use among university students and staff, socio-
demographic factors associated with current vaping, and
attitudes to the proposed ban.
Material and Methods
A cross-sectional study anonymous online survey was sent
to 18,871 students over 18 years and 3,491 staff at Trinity
College Dublin in March 2023. Primary outcome was the
current use (in the past 30 days) of e-cigarettes. Attitudes to
restricting outdoor vaping on campus and to the forthcoming
ban were sought.
Results
2,683 (14.2%) answered the questionnaire. Complete data
were ascertained for 2359 (87.9%); (1676 undergraduates
(71.1%), 357 postgraduates (15.1%), staff 318 (13.5%) and 4
other (0.3%). 838/1506 (55.6%) reported vaping in the previous
30 days (640 undergraduates (83%) 86 postgraduates (11.2%)
and 42 staff (5.5%), (Chi2 =10.8, d.f. 2, p=0.005). Current
vaping was strongly associated with increasing agegroup
(18-23, 24-28, 39-77 years, (Chi2 =15.7, d.f. 2, p<0.001 and was
much higher in females (61.9%) than males (33.9%) or those
who preferred not to declare a gender (4.2%). (Chi2 =7.23, d.f.
2, p=027). 320/768 (41.7%) of current vapers had also smoked
cigarettes in the previous seven days (Chi2 =95.8, d.f. 1,
p<0.001). 1369/2385 (51%) supported restricting e-cigarettes
on campus to a small number of designated outdoorareas.
40% supported a government ban on disposable vapes for all
adults and a further 35% for under 18s only.
Conclusions
Vaping prevalence is extremely high among undergraduate
and female students. Dual e-cigarette and cigarette use is
common. Positive support for action on vaping locally and at
national policy level needs to be undertaken.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A83
DOI: 10.18332/tpc/172735
Smoking and the new trends in young
women
Marise Sabato1, Maria Assunta Donato1, Teresa Bonarrio1,

45
Tobacco Prevention & Cessation | Abstract Book
Francesco Rosiello1, Martina Antinozzi1, Maria Sofia
Cattaruzza1
1Department of Public Health and Infectious Diseases,
Sapienza University of Rome, Rome, Italy
Introduction
Smoking and use of new products among young people
is increasing in Europe. The Tobaccology Unit of Sapienza
University of Rome (Italy) organises a yearly survey on
Women’s day (the 8th of March) to gain a deeper knowledge
into the habits and attitudes of young women towards
smoking in order to devise new prevention methods to help
young people stop or avoid smoking.
Material and Methods
Since 2021, UNITAB has conducted three anonymous cross-
sectional surveys on Google Forms administered to young
people present at the time of social events organised on
the University campus. Each survey consisted of 2 different
sections aimed at collecting socio demographic data and
studying people’s use and opinions on new tobacco products
(especially Heated Tobacco Products (HTPs).
Results
These surveys were completed by 663 young women with
mean age 22.5 years. Preliminary findings showed that
respectively in 2021, 2022, 2023, the percentage of smoking
and/or using new products was quite stable (33.8%, 35.0%
and 34.2%), while the percentage of women who reported
to have tried HTPs increased from 18.4% in 2021, to 24.9%
in 2022 and to 62.7% in 2023. The main reason to try these
products was reported to be curiosity (24.2%, 36.1% 59.0%
respectively in 2021,2022, 2023). Also, young women seem
to use a great variety of products: traditional cigarettes, roll
your own cigarette, electronic cigarette, and HTPs altogether.
Interestingly, in 2023 puff bars were specifically reported
among products used.
Conclusions
The use of new products is spreading, especially among young
people. From a Public Health perspective, it is important to
monitor trends and reasons for their use since the health
impact is still to be assessed.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A84
DOI: 10.18332/tpc/172740
Volunteering and health promotion:
High school students for a tobacco free
generation
Darius Lotrean1, Natalia Rednic2, George Coșbuc2
1European Network for Smoking and Tobacco Prevention
Youth Group, Brussels, Belgium, 2National College, Cluj-
Napoca, Romania
Introduction
Volunteering includes a wide range of activities which
contribute to the achievement of a shared goal in Tobacco
Control, a Tobacco Free Generation by 2040. Voluntary Youth
Engagement is crucial for reaching that goal.
Objective
This study aims to evaluate the opinion of students, professors
and parents on volunteering and activities to promote health,
presenting an activity to promote health organized by high
school students and analyzing trends in the romanian
population.
Material and Methods
7 high school students from George Coșbuc National College
chose to support the European Citizen Initiative: CALL TO
ACHIEVE A TOBACCO-FREE ENVIRONMENT AND THE FIRST
EUROPEAN TOBACCO-FREE GENERATION BY 2030 by filming
a presentation video. The activity was presented at school
days. A multiple-choice question form has been disseminated
among parents, teachers and students to assess their opinion
on volunteering, activities to promote health and the factors
that influence the choice to partake. Frequency tables and
bivariate correlations (significance considered at p<0.05) in
JASP were used. Google Trends has been used to assess
topics of interest in the romanian population (2016-2023). RSV
(Relative Search Volume) is the measure that indicates the
popularity of a topic (1-lowest- to 100 -highest).
Results
Out of 44 participants (27 Students, 7 Teachers and 10 Parents)
the vast majority (88.63%) agreed totally that volunteering is
important for self-development. Both parents and teachers
were more likely to consider the influence of Parents on their
children/students higher than the students themselves. Data
from Google Trends showed that Nature and Health are more
popular topics than Smoking and Electronic cigarettes, while
volunteering had the lowest RSV compared to those topics.
Conclusions
Volunteering is considered beneficial and topics such as
Health and Nature are popular in Romania. To consider
students’ interests, popular topics and trends is important
for youth mobilization.
Conflicts of interest
The authors have no conflict of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A85
DOI: 10.18332/tpc/172741
Impact of tobacco taxation on poverty and
inequality in Serbia
Aleksandar Zdravkovic1, Jovan Zubovic1, Boban Nedeljkovic1
1Institute of Economic Sciences Belgrade, Belgrade, Serbia
Introduction
While tobacco taxation has proven to be the most effective
measures to reduce the demand for tobacco, it might affect
well-being of the poor population. Therefore, consideration of
any change in taxation policy requires comprehensive insight
of the effects that policy measures have on the change in
poverty and inequality.
Objective
The main research objective is to assess how an increase in
tobacco taxation affects poverty and inequality in Serbia. More
specifically, the study estimates change in basic FGT poverty
indices (headcount ratio, poverty gap and poverty severity)
and change in progressivity of income redistribution following
the increase in cigarette prices.
Material and Methods
The methodological framework consists of two building
blocks: i) scenario analysis to simulate the effects of tobacco
taxation on poverty; ii) scenario analysis to simulate the effects
of tobacco taxation on inequality in Serbia. The consumption
dominance curve approach is used to estimate changes in the

46
8th ENSP European Conference on Tobacco Control
poverty indicators. The concentration curve and the Kakwani
progressivity index are used as indicators of tobacco taxation
progressivity.
Results
The same two scenarios of increase in tobacco taxation are
applied to both poverty and inequality analysis: i) an increase
in specific tax for 25%, and ii) an increase in specific tax for
50 %. In both scenarios, increase in tobacco taxation leads to
increase in poverty across all three FGT indices. Regarding
inequality, tobacco expenditures are regressive relative to the
income, but increase in tobacco taxation is progressive, which
is confirmed by the Kakwani progressivity index.
Conclusions
Increase in tobacco taxation in Serbia is progressive but
poverty-enhancing. Therefore, it is necessary to redistribute
additional government revenues into subsidizing goods and
services which have higher price elasticity than tobacco
products and at the same time improves well-being of poor
population (such as out-of-pocket health costs).
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A86
DOI: 10.18332/tpc/172742
Stepped-care approach implementation
for dealing with smoking-related problems
using Contextual Behavior Science
Maria Karekla1
1University of Cyprus, Nicosia, Cyprus
Stepped care is a structured approach to healthcare service
delivery, wherein interventions are arranged in a hierarchical
manner based on their level of intensity, invasiveness,
and expense. The selection of intervention intensity is
determined by considering factors such as practicality, cost,
the seriousness of the case, and the preferences of both the
individual in need and the professional. This presentation will
illustrate how the use of digital technologies can be harnessed
to achieve such a stepped care approach. Examples from our
ACThealthy laboratory projects will demonstrate how this can
be applied in action.
Conflicts of interest
The author has no conflict of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A87
DOI: 10.18332/tpc/172743
Too little too late - a critical view of
Bulgaria’s increased excise tax regime
Pavel Antonov1, Vladislav Velichkov1
1BlueLink Foundation, Sofia, Bulgaria
In December 2023 Bulgaria’s Parliament approved a higher
excise tax on tobacco products.The move followed a long
lasting battle by Bulgaria’s tobacco control movement
represented by the Bulgarian Coalition for Smokefree Life
(BCSL), and a heated public debate.
The Parliament’s decision envisages a gradual increase
in excise duty from March 1, 2023 to January 1, 2026. As a
result over the next 4 years the prices of cheap cigarettes are
expected to rise more than those of expensive cigarettes -
about 20-30 cents per pack per year for mass cigarettes and
13-14 cents for the more expensive ones. The biggest increase
will be for smokeless products, which should increase in
price by 40 cents per year. The price of a package of smoking
tobacco, which currently sells for about BGN 10, will rise by
70-80 cents a year.
How did the policy change of tobacco taxation meet BCSL’s
demands? How does the new tobacco taxation regime
contribute to FCTC’s goals? The proposed paper will try to
respond analytically to these questions and provide a critical
assessment of Bulgaria’s new tobacco taxation policy from
the perspective of the tobacco control movement.
For this purpose the authors will trace the policy demands,
arguments and demands that shaped the public and political
debate in Bulgaria during 2022. It will outline the efforts
taken by the BCSL and examine their effects, in the Bulgarian
context.
Using comparative analysis of scientific and political
arguments exchanged as well as semi-structured interviews
and other action research methods, the authors conclude
that in spite of their positive direction, the new policy measure
are more likely a compromise in favour of tobacco industry’s
interest, rather than a victory for public health.
Conflicts of interest
The presenting author is a Board Member of the Coalition for
Smoke-free Life in Bulgaria.
Tob. Prev. Cessation 2023;9(Supplement 2):A88
DOI: 10.18332/tpc/172744
Gender differences in smoking-attributable
mortality (SAM) by region in Portugal
Sofia Ravara1,2,3, Julia Rey-Brandariz4, Esther López-
Vizcaíno5, María Isolina Santiago-Pérez6, Alberto Ruano-
Raviña4, Cristina Candal4, Leonor Varela4, Nerea Mourino4,
Pedro Aguiar3, Mónica Pérez-Ríos4
1Health Science Research Centre CICS-UBI, University of Beira
Interior, Covilhã, Portugal, 2Centro Hospitalar Universitário
da Cova da Beira, Covilhã, Portugal, 3Public Health Research
Centre CISP, National School of Public Health, Nova University
Lisbon, Lisbon, Portugal, 4Preventive Medicine and Public
Health, University of Santiago de Compostela, Santiago de
Compostela, Spain, 5Galician Statistics Institute, Santiago de
Compostela, Spain, 6Epidemiology Department, Directorate-
General of Public Health, Galician Regional Health Authority,
Santiago de Compostela, Spain
Background/Objectives
Although smoking-associated mortality (SAM) is a crucial
health indicator, research is limited in Portugal. We sought to
estimate SAM by region in 2019 in the Portuguese population
≥35 years, highlighting gender differences.
Material and Methods
A SAM independent-prevalence method was used. Observed
mortality was obtained from Portugal Statistics; lung cancer
mortality rates in smokers/never-smokers from the Cancer
Prevention Study I-II; relative risks from five US cohorts. SAM
was estimated for each region by sex, age, and cause of death.
Results
In 2019, tobacco use caused 12.3% of all deaths in Portuguese
adults ≥35 years (men: 17.6%; women: 7.1%). Data broken
down by NUTS-II regions show that SAM varies widely by region
and gender. Azores depicts the highest SAM, both in males
(52.7%) and females (26.8%); the lowest was observed in the

47
Tobacco Prevention & Cessation | Abstract Book
Centre among males (24.1%) and in Alentejo among females
(9.6%). Regardless of the cause of death and age-group, the
highest men-to-women ratios (3-1) were observed in Madeira
and Alentejo. SAM specific rates increase with age among
males in all regions, whereas among females this pattern is
also observed, except in Madeira. According to sex, cancers
were the leading cause of death among men in all regions,
especially in the North (51.0%); while cardiovascular diseases
ranked first among women in all regions, particularly in the
Azores (50.7%). Lung cancer was the main specific-cause of
death in men, and also among women in Lisbon and Algarve
regions. Respiratory diseases caused more deaths among
females in the other regions.
Conclusions
SAM is high and greatly varies by region, gender and age. SAM
by gender shows a specific pattern in all regions, although
with regional differences among women, suggesting different
tobacco epidemic stages by region. There is a need for
engendering tobacco control policy-making while monitoring
and implementing policies, at national and local level.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A89
DOI: 10.18332/tpc/172772
Breaking barriers: The power of chisquares
in seamless web-paper surveys
Israel Agaku1, Lungile Nkosi1
1Chisquares, South Africa
Introduction
Conducting effective web surveys while ensuring
representation of diverse demographics has become
increasingly challenging. Traditional web survey platforms
may not fully capture certain populations, such as those
without internet access or the elderly. To address this, a hybrid
approach, using both web and paper surveys, has emerged as
a promising solution. However, the manual processes involved
in merging paper and web data can be time-consuming and
tedious. We aim to showcase how advanced AI technologies
on the Chisquares scientific platform have revolutionized the
integration of paper and web surveys, drastically reducing the
time and effort required.
Material and Methods
The Chisquares platform uses Optical Character Recognition
(OCR) technology to extract data from scanned paper
questionnaires. The extracted data is then seamlessly
combined with web-collected data from the same survey.
Sequential numbering is employed to accurately match the
paper and web versions of the questionnaires. This ensures
precise data extraction and tracking of printed survey copies.
The Chisquares platform offers automatic and project-
specific assignment of serial numbers to avoid repetition
within a project.
Results
The Chisquares platform offers two key functionalities for
web surveys: (1) Directly uploading a word document-based
questionnaire to the survey environment, saving time and
effort. (2) Allowing participants to complete a paper-based
questionnaire that can be automatically extracted using OCR
technology.
Conclusions
Chisquares utilizes innovative AI technologies to streamline
the process of conducting hybrid web-paper surveys, making
data collection easier and more reliable. The platform holds
great promise for researchers and public health practitioners,
showcasing the potential of cutting-edge technologies in
enhancing survey methodologies and making a meaningful
impact.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A90
DOI: 10.18332/tpc/172774
Marketing of heated tobacco products and
tobacco - a case study of 5 nightclubs in a
major city in Poland
Julia Nowicka1, Łukasz Balwicki1
1Department of Public Health and Social Medicine, Medical
University of Gdansk, Gdansk, Poland
Introduction
The tobacco industry is constantly launching new generation
products to attract new customers. In particular, heated
tobacco products are aimed at young people due to their simple
design and association with electronics. These products are
advertised in social gathering places, such as nightclubs,
where young adults socialize.
Objectives
To conduct a case study of tobacco marketing in 5 nightclubs
in the city of Gdansk, a major city in Poland.
Material and Methods
Observation of tobacco marketing was carried out at 5
nightclubs in the city of Gdansk during the 2022 summer
vacation. Two independent observers collected data on
tobacco advertising and promotion according to a developed
observation form. They made photographs of visible forms of
marketing such as points of sale, tobacco brand logo signs,
branded accessories, free samples and gadgets.
Results
The case study found that tobacco marketing was intensive
and consisted of various forms of promotion. Large point-
of-sale displays, illuminated tobacco brand logo signs and
numerous types of brand logo accessories were present.
Heated tobacco products were more frequently advertised
and promoted in the investigated establishments than
cigarettes. Representatives of tobacco brands were observed
encouraging people to try and purchase a tobacco product.
Conclusions
Tobacco marketing is aggressively carried out in nightclubs,
which are places where young people gather. In addition,
advertisements for heated tobacco products that target young
people are also dominant. These types of settings should
be controlled by relevant authorities and tobacco marketing
that reaches vulnerable groups should be monitored and
restricted.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A91
DOI: 10.18332/tpc/172775
Implementation of the new smoke free

48
8th ENSP European Conference on Tobacco Control
policy in the Kyrgyz Republic
Chinara Bekbasarova1, Olga Knorre2
1Republican Center for Health Promotion and Communication
with Media, Ministry of Health of the Kyrgyz Republic, Bishkek,
Kyrgyzstan, 2Campaign for Tobacco free kids, Washington,
United States
Introduction
The 1st National Tobacco Control Law (Old TCLaw) was
adopted on 21.08.2006, however, it didn’t regulate indoor
tobacco smoking in public and working places through water
pipes and heated tobacco (HT), use of electronic nicotine
delivery systems (ENDS).
Objectives
To implement of measures for ensuring the protection of
health and the rights of citizens to clean air, free from ambient
tobacco smoke and aerosol.
Material and Methods
To develop and promote to adoption and implementation of
the WHO FCTC smoke free policy in the legislation of the
KR in the field of protecting the health of citizens from the
consequences of tobacco, nicotine consumption, and effects
of ambient tobacco smoke and aerosol.
Results
The Law of the KR “On protection of the health of citizens
of the Kyrgyz Republic from the consequences of tobacco,
nicotine consumption and impact of ambient tobacco smoke
and aerosol” (NewTCL) was adopted by September 15, 2021.
According to Article 13 of the Law, it is prohibited to smoke
tobacco and nicotine, including using water pipes (hookah),
systems for heating tobacco and other smoking accessories,
as well as the use of ENDS inside of the buildings and
premises in all public and workplaces, also at outdoor child
playgrounds, at public transport stops and in open areas
during the period of mass cultural, sports events, meetings,
actions, within the boundaries of the territories of beaches,
with the exception of places specially designated for smoking.
The requirement and procedure for placing new “”No
smoking sign”” were developed and adopted for enforcement
of tobacco and nicotine smoking ban in buildings and objects.
Conclusions
According new TCL, smoking all tobacco products, including
HT, through water pipes, HT and ENDS in buildings and
premises of the working and public places were banned.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A92
DOI: 10.18332/tpc/172776
Urologists’ perceptions and behaviors
related to tobacco use
Richard Matulewicz1
1Memorial Sloan Kettering Cancer Center, New York, United
States
Introduction
Tobacco use is a causative or exacerbating risk factor for
benign and malignant urologic disease. However, urologists
have not traditionally been active as frontline clinicians in
the treatment of tobacco use. Understanding urologists’
contemporary perceptions and behaviors can allow for
intervention design to overcome barriers to optimal care.
Objectives/Methods
We seek to review the extent literature related to urologists’
perceptions, behaviors, and norms related to tobacco use
assessment and treatment. A literature search was performed
alongside relevant published works by the presenting author.
Results/Conclusions
Most urologists recognize the importance of tobacco use
assessment and treatment as well as the relationship between
tobacco use and urologic disease. However, few urologists
report delivery of guideline concordant care, which includes
routine screening for use and evidence-based treatment
(pharmacologic and behavioral counseling), in the outpatient
setting. Reported barriers to screening and treatment in the
urology clinic include a lack of time, training, and comfort with
recommended processes. Differences among training and
country/region exist. Overcoming these barriers with multi-
level implementation efforts can improve tobacco screening
and treatment in the urology setting which will translate into
better patient outcomes.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A93
DOI: 10.18332/tpc/172777
Newspaper front pages following the
announcement of the new Portuguese
tobacco bill: what do they say?
Sofia Ravara1,2,3, Francisca Pulido Valente4, Sara Travassos5,
Inês Subtil6, Hilson Cunha-Filho1, Paulo Corrêa7
1University of Beira Interior, Covilhã, Portugal, 2Centro
Hospitalar Universitário da Cova da Beira, Covilhã, Portugal,
3Public Health Research Centre, National School of Public
Health, NOVA University of Lisbon, Lisbon, Portugal, 4Public
Health Unit of Amadora, Amadora, Portugal, 5Public health
Unit of Santa Maria da Feira, Santa Maria da Feira, Portugal,
6Public Health Unit of the Community Health Center Group
of Loures-Odivelas, Lisbon, Portugal, 7Federal University of
Ouro Preto, Minas Gerais, Brazil
Background/Objectives
On May 2023, the Ministry of Health of Portugal announces
to the official Portuguese news agency that the “Government
proposes a law to transpose the European Directive and
strengthen the protection of people from exposure to tobacco
smoke” aiming to achieve a “Tobacco-free Generation by
2040.” This new tobacco bill included a robust package of
measures: 1) extending the smoking/vaping ban to outdoor
places such as splanades, terraces, bus stops, university and
healthcare services campus, etc; 2) comprehensive restriction
of tobacco point of sales (POS) and vending machines. 3)
reinforcement of TAPS ban and prohibition of POS at musical
and youth festivals 4) transposition of the EU Directive on
heated tobacco. This announcement created a strong media
debate. We aimed to analyse the press contents focusing on
the newspaper front pages.
Material and Methods
Description and thematic analysis of the titles and contents of
the front pages depicted in the main Portuguese newspapers.
Results
Newspapers highlight the opposition, instead of promoting
health education and public acceptance, elucidating about the

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Tobacco Prevention & Cessation | Abstract Book
public health evidence supporting the policies: adjectivated
speech such as “Undesirable… Government’s persecution
of smokers”; warnings about economic losses (hospitality
industry and tobacco retailers associations); individual
freedom and smokers’ rights discourse; several policy-
makers speaking out against the tobacco supply restriction
and the outdoor smoking ban, considering these “abusive
and intrusive” or “too restrictive”; violating “the principle of
proportionality”. The arguments used, as well as the front
groups are identified with the tobacco industry’s main tactics
and the industry allies trying to weaken tobacco control. After
this strong media opposition, the bill was discussed in a whole
Government meeting and suffered changes that weakened
the initial package, particularly the POS restriction.
Conclusions
The media opposition messages suggest strong tobacco
industry interference and may have contributed to the tobacco
bill setback. This interference should be exposed.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A94
DOI: 10.18332/tpc/172790
E-cigarette use and the potential risk for
bladder cancer
Marc Bjurlin1
1The University of North Carolina at Chapel Hill, North
Carolina, United States
Introduction
Use of electronic cigarettes (e-cigarettes) has rapidly
increased despite unclear longitudinal health effects. Once
thought to be a safer alternative to tobacco smoke, it is possible
that e-cigarettes expose the user to similar carcinogenic
byproducts during the vaping process, potentially placing
users as risk for bladder cancer.
Objectives
To characterize the institutional data, population weighted
studies, as well as translational and basic science findings
of e-cigarette use as it relates to the potential risk of bladder
cancer.
Methods
Literature review.
Results
Up to 8% of bladder cancer survivors use e-cigarettes. Cancer
survivors commonly perceive e-cigarettes to be as much or
more harmful than traditional cigarettes. Six carcinogens that
have a known strong link to bladder cancer have been identified
in the urine of e-cigarette users (pyrene, naphthalene,
fluorene, phenanthrene, o-toluidine, and 2-naphthylamine).
Untargeted metabolomics of the urine of e-cigarette users
have demonstrated the cancer related biomarker Me-Fapy
and genotoxic MNPB in the urine of e-cigarettes users at
levels higher than non-user controls. Patterns in methylation
appears to be altered in vaped mice within tumor suppressor
genes (protocadherin gene cluster), potentially leading to gene
silencing which may play a fundamental role in precipitating
the development of bladder cancer.
Conclusions
Long-term implications of chronic urothelial exposure to
urinary carcinogens of e-cigarette users are unknown and
will require long-term follow-up. However, the current data
and literature provides a useful scientific rationale to consider
the carcinogenic-specific aspects of using e-cigarettes.
The malignant potential of e-cigarettes for bladder cancer
remains unknown and is likely less than that of combustible
cigarettes.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A95
DOI: 10.18332/tpc/172791
Impact of smoking status on Health-Related
Quality of Life (HRQoL) in cancer survivors
Jose Ignacio Nolazco1,2, Bernard Rosner3, Emily Roebuck4,
Cristiane Decat Bergerot5, Elke Rammant6, Geetha Iyer7,
Yuzhe Tang8, Ra’ad Al-Faouri9, Dejan Filipas1,10, Michael
Leapman11, Matthew Mossanen1,12, Steven Lee Chang1,13
1Division of Urological Surgery, Brigham and Women’s
Hospital, Harvard Medical School, Boston, United States,
2Servicio de Urología, Hospital Universitario Austral,
Universidad Austral, Pilar, Argentina, 3Channing Division
of Network Medicine, Department of Medicine, Harvard
Medical School, Boston, United States, 4Wake Forest School
of Medicine, Carolinas Medical Center/Atrium Health,
Charlotte, United States, 5Centro de Câncer de Brasília,
Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas,
Brasília, Distrito Federal, Brazil, 6Department of Human
Structure and Repair, Ghent University, Ghent, Belgium,
7Division of Pharmacoepidemiology and Pharmacoeconomics,
Department of Medicine, Brigham and Women’s Hospital
and Harvard Medical School, Boston, United States, 8Urology
Department, Beijing Tsinghua Changgung Hospital, School
of Clinical Medicine, Tsinghua University, Beijing, China,
9Department of Surgery, Division of Urology, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston,
United States, 10Department of Urology, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany, 11Yale
School of Medicine, Department of Urology, New Haven,
United States, 12Department of Radiation Oncology, Brigham
and Women’s Hospital, Boston, United States, 13Lank Center
for Genitourinary Oncology, Dana-Farber Cancer Institute,
Boston, United States
Introduction
The Health-Related Quality of Life (HRQoL) often declines
among cancer survivors due to many factors. Some cancer
patients who smoke before the cancer diagnosis continue this
harmful habit, potentially contributing to a more significant
decline in their HRQoL. Therefore, this study investigates the
association between smoking status and HRQoL in cancer
survivors.
Material and Methods
We conducted a cross-sectional study utilizing self-reported
cancer history from 39,578 participants of the Behavioral Risk
Factor Surveillance System (BRFSS) database, leveraging
2016 and 2020 year questionnaires. A multidimensional
composite outcome was created to assess HRQoL, integrating
four distinct dimensions - general health, mental health,
physical health, and activity limitations. After accounting for
the complex survey design, logistic regression models were
used to analyze the association between smoking status and

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8th ENSP European Conference on Tobacco Control
poor HRQoL, adjusting for demographic, socioeconomic, and
health-related confounders.
Results
Our study found that, after adjusting for potential confounders,
current smokers exhibited a significantly poorer HRQoL than
never smokers (OR 1.65, 95%CI 1.40-1.93). Furthermore,
former smokers showed a poorer HRQoL than never smokers;
however, this association was not as strong as current
smokers (OR 1.22, 95%CI 1.09-1.38).
Conclusions
Our findings highlight the adverse association of smoking
with poor HRQoL in cancer survivors, underscoring the
importance of healthcare professionals prioritizing smoking
cessation and providing tailored interventions to support this
goal.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A96
DOI: 10.18332/tpc/172792
Attitudes and knowledge of Greek midwives
on smoking cessation perinatally
Paraskevi Katsaounou1, Taxiarchoula Delakovia2, Athina
Diamanti2
1Department of Pulmonary Medicine and Critical Care,
Medical School of the National and Kapodistrian University,
Athens, Greece, 2Department of Midwifery, University of West
Attica, Athens, Greece
Introduction
During the perinatal period, exposure to firsthand,
secondhand and thirdhand tobacco smoke is the most
significant preventable cause for a number of unfavorable
pregnancy outcomes. Midwives who are constantly in contact
with women during pregnancy and postpartum period have a
direct role in helping them quitting smoking.
Material and Methods
The research was conducted between December 2022 and
July 2023. An anonymous questionnaire was filled in by 150
midwives. The midwives that participated were either working
in Health Centers and hospitals of 1st and 2nd Health District
or working as freelancers.
Results
86,7% of midwives believed that smoking cessation support is
an important part of their professional role.
77% of them reported the need for training in smoking
cessation.
22% of midwives had partial education about smoking
cessation.
Only 24% of the midwives who answered the questionnaire,
reported that they know “motivational interviewing” and only
9% know the “5As Model” for smoking cessation.
28% of midwives reported that they are aware of the allowable
use of Nicotine Replacement Therapy during pregnancy.
62% of midwives reported that pregnant women were not
well informed about the risks of firsthand, secondhand and
thirdhand smoking exposure during pregnancy.
65,4% of midwives reported that they feel capable to provide
smoking cessation support to pregnant and women in
postpartum period but only 8% of them answered correctly
all the relevant questions on the effects of smoking during
pregnancy.
Conclusions
The results of the survey highlight the importance of training
midwives in the techniques and methods of smoking
cessation. Although, most of the midwives believe that they
can efficiently help pregnant women to quit smoking, actually
they lack the necessary knowledge to do so. These findings
underline the necessity of having specially trained midwives
and the need for maternity hospitals and health centers in
Greece to implement smoking cessation programs.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A97
DOI: 10.18332/tpc/172795
Joint Action on Tobacco Control 2
- Strengthening European tobacco
enforcement through a holistic approach
Frances O’Donovan-Sadat1
1Joint Action on Tobacco Control 2
The Joint action on Tobacco Control 2 (JATC2) takes a
Eurocentric approach to supporting Member States with
harmonising the implementation of the tobacco products
directive. The EU funded project brings together 21 countries,
36 institutions and over 170 tobacco control experts with the
aim of strengthening the cooperation on tobacco control
between Member States.
JATC2s pooling of resources from multiple Member States
enables the national competence authorities reap the
benefits of JATC 2 research, policy recommendations and
best practice strategies that would otherwise not be available
to them. In this way the JATC 2 project acts as an instrument
to bring together experts and unique competences with
the aim of developing comprehensive research and making
that research available to Member States at all levels of
government and the EU commission.
Over the course of 3 years JATC2 will work to:
• Increased data sharing and collaborations between EU
Member States on tobacco product regulatory practices.
• Enhanced collaborations between EU Member States
to develop sustainable policy recommendations for the
expansion of smoke-free environments.
• Develop a common approach on handling tobacco
regulation across EU Member States, within the context of
their national legislative approach and with consideration
to structural setup of each Member States.
• Develop comprehensive research on the applicability of
Tobacco Advertising Directive.
• Develop sustainable tobacco endgame strategies that are
implementable for all Member States, consideration to
different tobacco control contexts and capacities.
• To facilitate the exchange of good practices between
Member States in order to improve implementation of the
Tobacco Products Directive and related implementing and
delegated acts.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A98
DOI: 10.18332/tpc/172797

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Tobacco Prevention & Cessation | Abstract Book
Tobacco use among the 13-15 y.o. students
in San Marino. Results of the latest Global
Youth Tobacco Surveys
Andrea Gualtieri1, Angela Ciobanu2, Elena Sacchini1
1Health Authority of San Marino, San Marino, 2World Health
Organization
The widespread availability of tobacco products, coupled with
aggressive marketing tactics, poses a considerable threat
to the youth by encouraging tobacco use initiation. From
2018 to 2022, the prevalence of overall tobacco product use,
combustible tobacco product use, cigarettes, e-cigarettes,
and the use of smokeless tobacco products have increased
among 13-15 y.o. students in San Marino. The increase was
larger among girls than boys.
To assess the prevalence of nicotine and tobacco use among
13-15 y.o. students in San Marino, data from the latest two
national Global Youth Tobacco Surveys (GYTS) were analyzed.
In 2022, 13.7% of students (11.5 of boys and 16.2% of girls)
used any tobacco product compared with 7.4% of students
(7.3% of boys and 7.4% of girls) in 2018. E-cigarettes have
become the most popular product among the youth followed
by cigarettes. The current use of e-cigarettes has increased
from 8.9% (9.9% of boys and 7.6% of girls) in 2018 to 16.1%
(14.6% of boys and 17.8% of girls) in 2022. The use of
smokeless tobacco products has also increased, especially
among boys. In 2022, 1.6% of students (2.4% of boys and 0.7%
of girls) currently used smokeless tobacco compared to 0.6%
(0.7% of boys and 0.4% of girls) in 2018.
There is an urgent need to strengthen the implementation
of tobacco control policies in line with the WHO Framework
Convention on Tobacco Control. Robust and comprehensive
tobacco control policies that cover novel and emerging nicotine
and tobacco products have to be adopted and appropriately
enforced.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A99
DOI: 10.18332/tpc/172798
Roles and leverages of civil society in the
field of tobacco and nicotine prevention: the
case of the ACT’s call for a ban on puff bars
Marion Catellin1, Loïc Josseran1, Martin Drago1, Astrid
Billard1, Ellen de Guiran1
1Alliance Contre le Tabac: ACT, Paris, France
The aim of this session is to present the roles and levers
available to civil society in the field of nicotine and tobacco
prevention. To illustrate the tools that can be mobilized, this
session aims to present the mechanisms that have been put
in place by ACT – Alliance Contre le Tabac to combat a new
product developed by the tobacco industry: “”Puff bars””.
Puff bars are disposable e-cigarettes, available in a wide
variety of sweet and fruity flavours (e.g. marshmallow), with a
packaging that is particularly attractive to young people. The
rapid spread of the use of puffs among teenagers, especially
in secondary schools, despite the ban on sales of this product
to minors in France raises fears of an epidemic of nicotine
addiction. To approach this new concern, our association has
developed three main complementary lines of action on the
subject (research and studies, advocacy and communication
through awareness campaigns) that will be presented in the
session.
First of all, we wanted to gain a better understanding of the
phenomenon, which is why ACT and BVA, an international
research group, have been the first to survey French
teenagers aged 13 to 16 about their perception and use of
these flavored disposable e-cigarettes. This survey confirmed
the sense of a sudden craze for these products among very
young teenagers: 13% of them have already tested puff bars
and 9% say they have already bought it.
This study enabled us to promote advocacy actions among
French decision-makers, by supporting the introduction
of a cross-party bill to ban these disposable electronic
cigarettes. We also met with European decision-makers and
representatives of the European Commission’s Directorate-
General for Health.
The environment was also an essential lever for mobilizing civil
society more broadly in this battle, which is why we launched
a public awareness campaign in June 2023 alongside the
environmental association Surfrider Foundation, showing
that tobacco and new nicotine products are ecotoxic bombs
for our planet.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A100
DOI: 10.18332/tpc/172802
Evaluation of smoke free start initiative
Edward Murphy1, Aishling Sheridan1
1Health Service Executive, Dublin, Ireland
Introduction
Smoking in pregnancy is a leading public health challenge.
National and international studies highlight the urgent need
to improve stop smoking care in pregnancy. This care gap was
highlighted in the National Maternity Strategy (2016–2026)
and an evidence-based care pathway was established in new
National Stop Smoking Clinical Guidelines (2022). A pilot
implementation of the new care pathway was undertaken in
two Irish maternity hospitals.
Interventions included
Local implementation teams; dedicated trained and certified
stop smoking midwives; implementation of QUITManager (an
electronic stop smoking care record); Making Every Contact
Count training for midwives; routine breath carbon monoxide
tests (BCOT) with opt-out referral to stop smoking care for
women who smoke. COVID-19 meant that routine BCOT was
paused for infection control reasons.
Material and Methods
This is a mixed methods evaluation, where both quantitative
and qualitative data were used; the quantitative data provided
service activity and outcome data from QUITManager and
the qualitative data provided insights to the experiences
of pregnant women who used the services and the health
professionals who provided the services, through semi-
structured telephone interviews.
Results
In total, 691 women were referred to specialist Stop Smoking
Midwives; 2.8% and 7.0% of births in each pilot site. Referrals
were accepted by 81.6% of women, 23.4% set a quit date
and 18.2% were quit at 4 weeks (intention to treat analysis),

52
8th ENSP European Conference on Tobacco Control
with 14.5% of women delivering a smoke-free baby. The
qualitative research highlighted the importance of a non-
judgemental approach in both recruitment to the programme
and engagement with women in the programme.
Conclusions
The new pathway was generally positively received by women
and midwives; however, the importance of communication, and
the contrast for women between fear of judgement up-front
versus experience of sensitive and non-judgmental support
were key themes relevant to wide-spread implementation.
Proof-of-concept and lessons learned will inform and support
national roll-out, including BCOT to improve referrals.
Conflicts of interest
The authors have no conflict of interest to disclose.
Additional text
See Sláintecare Smoke Free Start: An Evaluation (2022)
https://www.hse.ie/eng/about/who/tobaccocontrol/
research/smoke-free-start-evaluation.pdf
Tob. Prev. Cessation 2023;9(Supplement 2):A101
DOI: 10.18332/tpc/172803
Strengthening the implementation of the
comprehensive anti-tobacco law in Ukraine
Olha Masna1
1Advocacy center LIFE, Kyiv, Ukraine
Introduction
December, 16 2021 Ukrainian Parliament adopted the anti-
tobacco law №1978-ІХ — one of the most important laws in
health care sphere. July, 11 2023 The Comprehensive Anti-
tobacco Law entered into force in Ukraine.
Objective
- Ensure a high level of awareness and implementation of new
anti-tobacco legislation among the population and entities;
- To intensify work of the State Service of Ukraine on Food
Safety and Consumer Protection on informing entities about
entry into force of anti-smoking law;
- To ensure extensive media coverage of key norms that come
into force.
Material and Methods
- Developing infographics with clear explanations of key
norms of the Law and
the easiest ways to submit a complaint about a violation of
the Law;
- Organization of the briefing and performance in cooperation
with MPs and enforcement authorities;
- Organization of the press conferences;
- Preparation of the expert`s articles about the importance of
the Law and and its enforcement;
- Cooperation with the enforcement authorities that control
the implementation of the law and members of Parliament;
- Ensuring extensive media coverage.
Results
- More than 100 medias spread information about new bans
including our infographics;
- We ensured a high level of awareness of new anti-tobacco
legislation;
- We intensified work of the State Service of Ukraine on
Food Safety and Consumer Protection and the Ministry of
Healthcare.
Conclusions
Our team works for strengthening the implementation of the
comprehensive anti-tobacco law in Ukraine was successful
and contributed to activation of the enforcement authorities
that control the implementation of the law. We provided a
high level of familiarization with new bans on numerous
Ukrainians. It is so important to reduce the prevalence of
smoking in Ukraine.
Conflicts of interest
The author has no conflict of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A102
DOI: 10.18332/tpc/172810
Smoking behaviours in Poland before and
after COVID-19 pandemic
Joanna Aleksandra Didkowska1, Urszula Wojciechowska2,
Krzysztof Przewoźniak2
1Maria Sklodowska-Curie National Research Institute of
Oncology, Warsaw, Poland, 2National Research Institute of
Oncology, Warsaw, Poland
Introduction
Some studies indicate that tobacco use rates may increase
during the SARS-Cov-2 (COVID-19) pandemic. This study
aims to assess if the use of traditional tobacco products,
e-cigarettes and heated tobacco has substantially changed
during the pandemic in Poland.
Material and Methods
The study presents Internet survey data from the National
Health Test of Poles that was conducted in 2020 (before
pandemic) and 2023(after pandemic) by Internet portal
onet.pl in representative group of adult (aged 18 and older)
Internet users. In each survey more than 200,000 people
took part in the study. Results of the study were weighted to
adult population in Poland with adjustment to gender, age,
education and number of inhabitants in place of living.
Results
The 2023 study results show that proportion of adult men and
women who use daily traditional tobacco products reaches
the same level of 21%. Comparison of data from 2020 and
2023 indicates that there are no substantial changes among
tobacco users in daily use of traditional tobacco products
between 2020 and 2023 (68% in 2020, 62% in 2023), also in
age groups. However, the use of e-cigarettes and heated
tobacco has dramatically increased at that time among young
adult tobacco users (aged 18 to 44), in particular among the
youngest segment of analysed population (among aged 18 to
24 from 59% to 79% for e-cigarette use and from 20% to 52%
for heated tobacco use).
Conclusions
Dramatic increase in proportion of e-cigarettes and heated
tobacco users among young Polish tobacco users requires
undertaking immediate and comprehensive counter-
activities. These activities should be mostly addressed to
teenagers and young adults and take into account both
legislative and socio-economic tobacco control instruments.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A103
DOI: 10.18332/tpc/172812
ENSP Youth Group: a new approach for

53
Tobacco Prevention & Cessation | Abstract Book
tobacco control in the European Region and
beyond
Zaruhi Grigoryan1, Karina Mocanu1
1European Network for Smoking and Tobacco Prevention,
Brussels, Belgium
Introduction
The importance of youth engagement in tobacco control is
vastly recognized. It provides a dual opportunity on the one
hand to protect the youth itself by raising their awareness of
the tobacco epidemic and on the other hand to encourage the
influx of innovative and creative minds and bring an original
perspective to diverse aspects of tobacco control.
Material and Methods
Starting in 2018, the European Network for Smoking Prevention
(ENSP) established a working group of young ENSP members
to mark the start of the youth-oriented approach to tobacco
control in the European Region. Since its conception, 65 total
members of the Youth Group have been engaged in an overall
37 events: online (19) and face-to-face (14) meetings, and
capacity-building (4) activities that aimed to accelerate youth
engagement in tobacco control.
Results
Currently, the group expanded throughout the region to include
37 active young leaders and advocates for tobacco control in
total 24 countries in 2 continents. Throughout the years, this
multidisciplinary group of young leaders embarked on the
consolidation of the three pillars of the ENSPNext activity,
i.e. research and capacity building, advocacy and policy, as
well as communication and collaboration. Activities include
the development of materials (35), presentation of abstracts
submitted to different conferences (23), implementation
of multi-country digital campaigns (6), participation in
international scientific conferences (9), recruitment
campaigns (4), events organized (10), and signed official
partnerships with international youth organizations (2).
Conclusions
The early outcomes of the ENSP Youth Group reaffirm the
importance of youth-oriented initiatives and signify the
potential impact of youth engagement in tobacco control
across the involved countries. Future concerted youth-
oriented efforts must be deployed in order to expand and
enhance the reach of youth initiatives and eventually elevate
the ENSP Youth Group’s impact to a larger scale.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A104
DOI: 10.18332/tpc/172824
Dual and poly-use of novel tobacco products
in Europe: A regulatory challenge
Daniel Chen1
1University of Oxford, Oxford, United Kingdom
Introduction
Europe faces a significant challenge with tobacco-related
mortality, accounting for over 700,000 deaths annually.
Alongside the persistent prevalence of smoking in some
countries, the emergence of novel nicotine and tobacco
products such as e-cigarettes and heated tobacco products
(HTPs) has added complexity, leading to a landscape of dual
and poly-product use and posing new challenges for public
health policies and regulations.
Objective
This study aimed to analyse the prevalence and patterns of
dual and poly-use of both conventional and novel nicotine and
tobacco products in Europe, with a focus on understanding
the associated regulatory challenges. It also sought to
offer evidence-based recommendations for comprehensive
tobacco control policies to tackle increasing dual- and poly-
product use.
Material and Methods
A narrative review of recent studies was conducted, focusing
on the prevalence of smoking and dual and poly-use of
tobacco products across European countries by geographic
regions. The study also reviewed current tobacco control
policies, regulatory environments, and the impact of novel
products on the market.
Results
The results revealed a varying prevalence of smoking across
Europe, with the highest percentages in the Central and
Eastern regions. Novel products are gaining popularity,
leading to a high prevalence of e-cigarette users and HTP users
engaging in dual use, especially in Western and Northern
European regions. The study identified regulatory gaps that
could be strengthened to prevent the tobacco industry from
exploiting marketing opportunities and highlighted the need
for stricter controls on packaging, labelling, advertising, and
taxation of products.
Conclusions
The growing market for novel nicotine and tobacco products
threatens existing tobacco control measures and adds
complexity to the public health landscape. Implementing
comprehensive, evidence-based policies that encompass all
novel products is critical to reducing overall and dual and poly-
product use. The findings call for Europe-wide monitoring,
extended smoking bans, cessation support, and enforcement
of advertising and taxation policies to safeguard population
health and reduce the burden of non-communicable diseases.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A105
DOI: 10.18332/tpc/172827
From internet to reality: Studying
population interest in tobacco and related
terms and topics using Google Trends
Darius Lotrean1, Teresa Bonarrio2, Martina Antinozzi2, Gema
Aonso-Diego3, Adena Alahverdian4, Valentina Vukmirović5,
Jorgjia Bucaj6, Zhanna Sargsyan4, Tonka Karin7, Karina
Mocanu8, Cornel Radu-Loghin8
1European Network for Smoking and Tobacco Prevention Youth
Group, Brussels, Belgium, 2Department of Public Health and
Infectious Diseases, Sapienza University of Rome, Rome,
Italy, 3University of Oviedo, Oviedo, Spain, 4Turpanjian College
of Health Sciences, American University of Armenia, Yerevan,
Armenia, 5Institute of Economic Sciences, Belgrade, Serbia,
6Paediatric Resident Medical University of Tirana, Tirana,
Albania, 7Croatian Institute of Public Health, Zagreb, Croatia,
8European Network for Smoking and Tobacco Prevention,
Brussels, Belgium
Introduction

54
8th ENSP European Conference on Tobacco Control
Substantiating data shows a growing inclination among the
population to utilise the internet as a principal resource for
acquiring information and knowledge pertaining to diverse
health behaviours and conditions, including smoking and
tobacco use. In this regard, the utilisation of Google Trends
as a tool within the concept of infodemiology allows health
researchers to explore and use non-clinical data, such
as simple internet searches, to evaluate and assess the
population’s interest in health-related issues, with particular
emphasis on Google platforms. This study aims to analyse the
interest of the population of: Romania, Italy, Croatia, Armenia,
Albania, Spain and Serbia using the relative search volume
(RSV) of Google Trends.
Material and Methods
The RSV was calculated and extracted from Google Trends
for the terms: IQOS, Elfbar and Vape and for the topics:
Camel (Cigarette brand), Marlboro (Cigarette brand), Cancer,
Smoking, Electronic Cigarette, Cigarette and Smoking
Cessation. Using SPSS 26 descriptive statistics and bivariate
correlations were calculated.
Results
Descriptive statistics showed similarities between mean
RSV(mRSV) among these countries. “IQOS” had the highest
mRSV compared to other terms among all countries except
Spain, where “Vape” had the highest mRSV. The lowest mRSV
across all countries presented the term “Elfbar”. The topic
“Cancer” had highest mRSV in Albania, Croatia and Serbia,
while Italy and Spain presented the lowest mRSV. “Smoking”
had the highest RSV in Romania and Spain. Moreover,
“Smoking cessation” had the lowest RSV in Armenia and
Albania. “Marlboro” had the highest mRSV in Italy and the
lowest mRSV in Romania. “Camel” in Serbia and Croatia
showed the lowest mRSV in comparison to other countries.
Conclusions
Using Google Trends, we examined the popularity of terms
and topics across 7 European nations. Our study unveiled
both commonalities and disparities, requiring deeper
investigations into underlying determinants of these
similarities and differences.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A106
DOI: 10.18332/tpc/172832
Global Youth Tobacco Survey: prevalence
of tobacco use in countries of the WHO
European Region
Angela Ciobanu1, Yelena Tarasenko2, Elizaveta Lebedeva1
1World Health Organization Regional Office for Europe,
2Georgia Southern University, Statesboro, Georgia
As a crucial part of the Global Tobacco Surveillance
System, the Global Youth Tobacco Survey (GYTS) enables
monitoring tobacco use among students aged 13-15 years
and implementation of key tobacco control indicators. The
GYTS has been conducted in over 180 countries worldwide,
including more than 35 countries and territories in the WHO
European Region.
Tobacco use among youth remains to be a significant public
health concern in the Region. Despite decreases in tobacco
use in some European countries, there are places where
more students aged 13 to 15 are using tobacco as evident
from the latest GYTS round compared to the previous one.
Cigarettes remain the most commonly used tobacco products
in the European countries. However, novel and emerging
nicotine and tobacco products have been gaining popularity
among 13 to 15-year-olds. In some countries of the Region,
the prevalence rates of e-cigarette use are equal to or even
higher than cigarette use rates. For instance, in San Marino
(2022), 16.1% of students currently use e-cigarettes and
10.8% currently smoke cigarettes; in Italy (2022) 19.3% of
students currently use e-cigarettes and 14.9% currently
smoke cigarettes.
Cigarettes remain to be easily accessible to students in
almost all countries. In more than half of the countries
with GYTS data, over half of young students who currently
smoke cigarettes were able to purchase or obtain them from
various sources, and more than two-thirds of students who
tried to buy cigarettes had not been deterred from doing so
considering their age.
A limited number of countries in the Region have tailored
tobacco-dependence treatment for youth. More than 50% of
young people in most of the surveyed countries tried to stop
smoking in the past year. However, the proportion of those
who received support to quit smoking from a programme
or professional was low ranging from the highest of 29.4%
in Kyrgyzstan (2019) to the lowest of 3.4% in Slovenia (2017).
Although smoking in educational facilities is prohibited
in most countries by smoke-free laws, their enforcement
has been challenging. The proportion of students who saw
people smoking on school premises varies from 80.5% in
Bulgaria (2015) to 14.5% in Tajikistan (2019). Exposure to
tobacco advertisements is yet another challenge, with more
than half of students taking notice of tobacco advertisements
on television, or in videos and movies in surveyed countries.
The data from GYTS in the WHO European Region show the
urgent need to implement bold, comprehensive, and multi-
sectoral measures to curtail tobacco use in youth. These
measures should be aligned with the guidance provided by
the WHO Framework Convention on Tobacco Control and be
strictly enforced. School-based prevention programs should
be implemented as part of the national tobacco control
strategy to prevent youth experimentation and smoking
initiation.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A107
DOI: 10.18332/tpc/172834
Changes in the prevalence of regular
smokers depending on education in Poland
in 1996-2020
Urszula Wojciechowska1, Joanna Didkowska1
1Maria Sklodowska-Curie Research Institute of Oncology,
Warsaw, Poland
Introduction
Over the past two decades, there has been a gradual decline in
smoking rates among adults in Poland. According to Statistics
Poland survey conducted in years 2019, the prevalence of
current smokers among adults aged over 15 years of both
sexes was 20%, compared to 35% in 1996. The decline varies

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Tobacco Prevention & Cessation | Abstract Book
depending on education from 14 to 24 percentage points.
Material and Methods
The study presents results of surveys from Statistics Poland
in the years 1996, 2004, 2009, 2014, 2019, and 2020. The
surveys were carried out by Eurostat recommendations
(European (EHIS). Data on current smokers (daily and
occasional smokers) in the adult population (aged 15 and
over) by education and gender were included in the analysis.
The survey carried out in 2020 for the first time includes
heated tobacco and e-cigarettes.
Results
In the years 1996-2019, a decrease (from 14 to 24 pp) in the
percentage of daily smokers of both sexes was observed in all
education groups: university - from 27% to 12%, secondary -
from 35% to 20%, vocational - from 50% to 26%, primary and
lower – from 29% to 15%.
A decrease in the percentage of current smokers in 2009-
2019 is also observed in all education groups depending on
gender (men 10-13 pp, women 4-10 pp). The survey carried
out in 2020 that includes heated tobacco shows an increase
in the proportion of daily smokers with a university degree in
both sexes.
Conclusions
The decreasing trend in the frequency of smoking traditional
cigarettes observed in years 1996-2019 was stopped after the
introduction of heated tobacco and e-cigarettes on the Polish
market, which is visible in the 2020 study. The percentage of
regular smokers with higher education increased compared
to 2019, which may be related to the message promoted by
tobacco industries about the less harmfulness of smoking
new tobacco products.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A108
DOI: 10.18332/tpc/172835
Novel tobacco products use – preliminary
results from the Polish National Quitline
Irena Przepiorka1, Marta Manczuk1, Magdalena Cedzynska1
1Maria Sklodowska-Curie National Research Institute of
Oncology, Warsaw, Poland
Introduction
Compared to 2020, changes were observed in smoking
behaviors among adults in Poland. In 2020, 23.7% of adults
reported daily smoking, and in 2022 as much as 28.8%. Most
smokers use traditional cigarettes (62.1%), but e-cigarettes -
4.8% and heated tobacco products (HTP) - 4.0% are becoming
more popular.
Objectives
Characteristics of the Quitline customer population using
e-cigarettes and HTP who want to quit smoking, including
factors impacting the decision to quit.
Methods
Analyzed data were collected from 842 Quitline callers. HTP
and e-cigarette use questions were added to the standard
questionnaire. The study is ongoing.
Results
Among Quitline callers, there are 6.5% of novel tobacco
product users, 3.7% of HTP, and 2.8% of e-cigarettes.
65.7% of HTP users were highly addicted, 35% preferred
menthol flavor, 35% attempted to quit. 35% began smoking
using heated tobacco. 41% believe HTPs are healthier;
however, 64.7% want to quit because of health concerns.
70.8% of e-cigarette users were highly addicted. The
preferred flavors were menthol and fruity. 16% declared they
began smoking with e-cigarettes. 45.8% use “”because it’s
cheaper,”” and 29.1% use “”because it’s healthier.”
Conclusions
The increase in e-cigarettes and HTP use can be attributed to
the belief that these products are less harmful, have attractive
prices, and are available in flavors that are prohibited
in traditional cigarettes. There is a need to strengthen
educational activities and introduce legal regulations
identical to traditional cigarettes: price increase, taxation,
and elimination of flavor additives. It is crucial to develop
treatment recommendations for people addicted to novel
tobacco products.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A109
DOI: 10.18332/tpc/172799
Lessons learned from banning menthol
cigarettes in Europe: A mixed methods
study examining policy implementation and
impact
Christina Kyriakos1, Geoffrey Fong2,3,4, Pete Driezen2,3, Marc
Willemsen5,6, David Hammond3, Ernesto Sebrié7, Filippos
Filippidis1
1Department of Primary Care and Public Health, School of
Public Health, Imperial College London, London, United
Kingdom, 2Department of Psychology, University of Waterloo,
Waterloo, Canada, 3School of Public Health Sciences, Faculty
of Health, University of Waterloo, Waterloo, Canada, 4Ontario
Institute for Cancer Research, Toronto, Canada, 5Department
of Health Promotion, Maastricht University, Maastricht, The
Netherlands, 6Trimbos Institute, Netherlands Expertise
Centre for Tobacco Control, Utrecht, The Netherlands,
7Campaign for Tobacco-Free Kids, Washington, United States
Introduction
Europe is a global leader in banning flavours, including
menthol, in cigarettes. The 27 European Union member
states, the United Kingdom, Moldova, and Turkey banned
menthol as a characterising flavour in cigarettes in May 2020.
Objectives
As other countries aim to ban flavours of tobacco products it
is critical to understand the lessons learned from Europe to
ensure regulations are maximised. This mixed methods study
examined implementation and impact of European menthol
cigarette bans.
Material and Methods
Quantitative data came from the International Tobacco
Control (ITC) Project Surveys among adults who smoke in the
Netherlands (2020) and youth who smoke in England (2021).
Qualitative data came from review of policy documents, as well
conducting semi-structured interviews with key informant
stakeholders in Moldova and Turkey. Outcomes examined
included: factors influencing policy implementation, quitting
behaviours, illicit purchasing, use of flavour accessories, and
health equity.

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8th ENSP European Conference on Tobacco Control
Results
Key factors that were perceived by stakeholders in Moldova
and Turkey to influence implementation of the menthol ban
included: social climate, institutional capacity and operational
effectiveness, political commitment, and tobacco industry
interference. Findings from the Netherlands indicate that
the menthol ban resulted in 17.3% additional quit attempts
and 12.0% additional quitting among adults who smoked
menthol cigarettes compared to non-menthol, while not
increasing illicit purchasing. However, one-quarter of youth
who smoke in England reported using menthol accessories,
with disproportionately higher use among youth identifying
as Black (60%). Use of ‘non-menthol’ replacement cigarette
brands were also popular in England and the Netherlands.
Conclusions
The experiences of European countries in implementing
menthol cigarette bans can support other countries in taking
measures to ban products known to facilitate smoking initiation
and regular use. Menthol regulations may be strengthened by
banning all additives with sensory and flavour properties, as
well as flavour accessories.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A110
DOI: 10.18332/tpc/172800
Progress of Balkan countries on tobacco
control. Evidence from the 2023 WHO report
on the global tobacco epidemic
Enkeleint Mechili1,2, Charis Girvalaki3, Christina Kyriakos4,
Sonila Nika5, Jorgjia Bucaj6, Neada Cakerri1, Marjola Muhaj1
1Department of Health Care, Faculty of Health, University
of Vlore, Vlore, Albania, 2School of Medicine, University of
Crete, Heraklion, Greece, 3European Network for Smoking
and Tobacco Prevention, Brussels, Belgium, 4Department
of Primary Care and Public Health, School of Public
Health, Imperial College London, London, United Kingdom,
5Department of Nursing, Faculty of Health, University of
Vlora, Vlora, Albania, 6Mother Tereza University Hospital,
Tirana, Albania
Introduction
Tobacco consumption remains one of the main factors of
morbidity and mortality with more than 8 million deaths
globally each year. Secondhand smoking is also a key factor
that provokes the death of more than 1.3 million deaths
annually. Despite the fact that many Balkan countries have
adopted strong tobacco control policies, in many cases there
is a lack of implementation. The current study aimed to assess
the progress of the Balkan countries.
Material and Methods
Data came from the 2023 WHO report on the global tobacco
epidemic. for11 Balkan countries (Albania, Bosnia and
Herzegovina, Bulgaria, Croatia, Greece, Montenegro, North
Macedonia, Romania, Serbia, Slovenia and Türkiye). Countries
were compared on adoption and implementation of tobacco
taxation and tobacco-free places, as well as in comparison
to 2012 levels.
Results
In 2022, tobacco prevalence ranged in the Balkan countries
from 18% in Albania and Slovenia to 33% in Serbia. Croatia has
the highest taxation level (86.0% of retail price) while Albania
has the lowest (66.7%). Cigarettes were less affordable in
2022 compared to 2012 in Montenegro, North Macedonia
and Serbia. Bans of tobacco use were reported to be in place
in healthcare facilities (in all countries except Bosnia and
Herzegovina), in government facilities (in all countries except
Bosnia and Herzegovina and Slovenia) and pubs and bars
(in all countries except Bosnia and Herzegovina, Croatia,
Montenegro, Serbia and Slovenia). The compliance level
ranged across countries.
Conclusions
Tobacco prevalence is still high in the Balkan countries in
comparison to western and northern European countries.
Some progress has been made since 2012 in some Balkan
countries, however more efforts are needed for adoption and
implementation of tobacco control measures.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A111
DOI: 10.18332/tpc/172801
Capacity building, national and international
cooperation for enhancing tobacco control
activities in Romania
Lucia Maria Lotrean1,2, Marius Eremia1, Monica Marc3, Ioana
Trifescu1, Constantine Vardavas4, Viktoria Vivilaki5, Cornel
Radu-Loghin6
1Asociatia Aer Pur Romania, Romania, 2Iuliu Hatieganu
University of Medicine and Pharmacy, Cluj-Napoca, Romania,
3University of Medicine and Pharmacy, Timisoara, Romania,
4School of Medicine, University of Crete, Heraklion, Greece,
5University of West Attica, Athens, Greece, 6European Network
for Smoking and Tobacco Prevention, Brussels, Belgium
Introduction
Recruiting, training, motivating and maintaining well qualified
people in the field of tobacco control is a challenge, but an
important pillar for long term and sustainable strategies in
this field.
Objectives
This study aims to present examples from Romania with regard
to activities for capacity building in the field of tobacco control
developed in the period 2019-2023, giving a special attention
to the role of national and international cooperation between
academia, non-governmental organizations, public health
and educational institutions, professional organizations.
Material and Methods
This is a narrative review based on data from literature as well
as information and experience gained by the authors during
their involvement in this field.
Results
The results cover the following domains: 1.Graduation thesis
and PhD thesis 2.Research and health promotion projects
3.Training and scientific events organization and participation
For each domain, there are presented several activities,
underlying their potential for capacity building and to which
extent networking and cooperation made them possible or
enhanced their effects.
Examples of such activities are development, implementation
and evaluation of research and health promotion projects
for smoking prevention and cessation as well as reduction of

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Tobacco Prevention & Cessation | Abstract Book
electronic cigarettes use among different population groups,
organization of different training and scientific events,
such as the participation in the Eurest-Rise project and the
organization in 2023 of the workshop Innovative Techniques
and Interdisciplinary and Interinstitutional Collaboration to
Improve Health Status at the Population Level.
Conclusions
The study presents several examples from Romania with
regard to capacity building in the field of tobacco control,
underlining the lessons learned and making recommendations
for future activities in this field.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A112
DOI: 10.18332/tpc/172804
Smoking behaviours in Poland before and
after COVID-19 pandemic
Joanna Didkowska1, Urszula Wojciechowska1, Krzysztof
Przewoźniak1
1National Research Institute of Oncology, Warsaw, Poland
Introduction
Some studies indicate that tobacco use rates may increase
during the SARS-Cov-2 (COVID-19) pandemic. This study
aims to assess if the use of traditional tobacco products,
e-cigarettes and heated tobacco has substantially changed
during the pandemic in Poland.
Material and Methods
The study presents Internet survey data from the National
Health Test of Poles that was conducted in 2000 and 2003
by Internet portal onet.pl in representative group of adult
(aged 18 and older) -Internet users. In each survey more than
200,000 people took part in the study. Results of the study
were weighted to adult population of Internet users in Poland
with adjustment to gender, age, education and number of
inhabitants in place of living.
Results
The 2023 study results show that proportion of adult men and
women who use daily traditional tobacco products reaches
the same level of 21%. Comparison of data from 2020 and
2023 indicates that there are no substantial changes among
tobacco users in daily use of traditional tobacco products
between 2020 and 2023 (68% in 2020, 62% in 2023), also in
age groups. However, the use of e-cigarettes and heated
tobacco has dramatically increased at that time among young
adult tobacco users (aged 18 to 44), in particular among the
youngest segment of analysed population (among aged 18 to
24 from 59% to 79% for e-cigarette use and from 20% to 52%
for heated tobacco use).
Conclusions
Dramatic increase in proportion of e-cigarettes and heated
tobacco users among young Polish tobacco users requires
undertaking immediate and comprehensive counter-
activities. These activities should be mostly addressed to
teenagers and young adults and take into account both
legislative and socio-economic tobacco control instruments.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A113
DOI: 10.18332/tpc/172806
Call to achieve a tobacco-free environment
and the first European tobacco-free
generation by 2030 (ECI-TFE) - The reality
of European citizen initiatives
Raquel Fernández Megina1, Cornel Radu-Loghin2, Francisco
Rodriguez Lozano3
1Nofumadores.org, Madrid, Spain, 2European Network for
Smoking and Tobacco Prevention, Brussels, Belgium, 3Cancer
Patients Europe, Brussels, Belgium
Introduction
Given the need to stop the introduction of tobacco and nicotine
consumption by new generations, the Spanish association
Nofumadores.org involves ENSP, and a large part of its
members, in the registration of the European citizen initiative
“CALL TO ACHIEVE A TOBACCO-FREE ENVIRONMENT AND
THE FIRST EUROPEAN TOBACCO-FREE GENERATION
BY 2030” (ECI-TFE), which is accepted by the European
Commission in August 2022.
Objectives
The ECI-TFE has six objectives:
1. Promote the first tobacco-free European generation,
ending the sale of tobacco and nicotine products to citizens
born since 2010.
2. Create an European Net of tobacco-free and butts-free
beaches and riverbanks, making this spaces more healthy
and environmentally sustainable.
3. Establish an European Net of tobacco-free and butts-free
National Parks making them more healthy and reducing
contamination and risk of fires.
4. Extend outdoor smoke and vapor free spaces, especially
those frequented by minors (parks, swimming pools, sports
events and centers, shows and restaurants terraces).
5. Eliminate tobacco advertising and presence in audiovisual
productions, social media, specially addressing covert
advertising through influencers and product placement.
6. Finance R&D projects for diseases caused by tobacco use
to improve their prognosis and make them curable.
Material and Methods
Ongoing collection of 1 million signatures from European
Citizens from at least 7 different countries of the EU. The
signatures are collected on line through the European
Commission Central online collection system until January
16th, 2024 (12 months since the beginning of collection
starting date).
Results
A new European legislations/directive which address the six
objectives of the initiative and to put Tobacco Control in the
agenda of all Politic Parties the year before to the European
parliament Elections.
Conclusions
Although the European Commission presents the European
Citizens’ Initiatives as a unique way for EU citizens to propose
new laws, the reality is that, since it is not accompanied by
any type of budget, it is very difficult and almost impossible
for ordinary citizens to be able to spread their initiatives to the
rest of Europeans to collect the necessary 1 million signatures.
Only with a sufficient budget to hire communication agencies
is it possible to reach all citizens, which is only within the reach
of large companies or organisations. This is not something
that can be achieved only with voluntary work.

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8th ENSP European Conference on Tobacco Control
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A114
DOI: 10.18332/tpc/172807
Session proposal: Tobacco control and
cessation in Poland: past, present and
future
Witold Zatoński1,2, Kinga Janik-Koncewicz1,2, Aleksandra
Herbeć3,2, Robert West4, Nancy Rigotti5, Susan Michie6,
Krzysztof Przewoźniak7,8
1Institute - European Observatory of Health Inequalities, Calisia
University, Kalisz, Poland, 2Health Promotion Foundation,
Nadarzyn, Poland, 3Calisia University, Kalisz, Poland, 4Institute
of Epidemiology and Healthcare at University College London,
London, United Kingdom, 5Tobacco Research and Treatment
Center, Division of General Internal Medicine and Mongan
Institute, Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston, United States,
6Centre for Behaviour Change, University College London,
London, United Kingdom, 7National Research Institute of
Oncology, Warsaw, Poland, 8Institute of Family Health, Calisia
University, Kalisz, Poland
Poland is a country of successful tobacco control history. In
early 2000. the World Health Organization labelled the Polish
law as an ‘example to the rest of the world’. It was a hub of
anti-tobacco measures in Central and Eastern Europe. Apart
from establishing successful educational and intervention
campaigns, Poland also significantly contributed to research
on treatment of tobacco dependence. It was a pioneering
country conducting first clinical trial on cytisine confirming its
effectiveness and safety in quitting smoking. Currently, such
studies are being conducted all over the world.
Unfortunately, in the last years some distressing and alarming
changes have been observed in Poland. In 2015 the “National
programme to reduce health consequences of tobacco
smoking” was suspended. Economic policy of tobacco ceased
to be effective. Tobacco affordability increased. Declining
trend of cigarette consumption reversed. About 7 million
people still smoke in Poland, however if no immediate action
is taken, the burden of tobacco-related diseases will start to
increase.
During this session, we would like to discuss current
challenges for tobacco control in Poland at the background
of its historical achievements. In the face of rising trends
of cigarette consumption, we would like to underline the
role of cytisine as potential “aspirin” for smoking cessation
by summarizing studies on cytisine around the world and
discussing the future of clinical practice and research on
treatment of tobacco dependence, including the power of AI
and machine learning.
After the session we would like to prepare an appeal to Polish
government to undertake immediate action against rising
trends of cigarette sale in Poland and return to the effective
“National programme to reduce health consequences of
tobacco smoking”. We would like to ask participants of the
conference, tobacco control leaders and scientific experts for
their support and be a warning for other European countries.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A115
DOI: 10.18332/tpc/172808
GYTS country report from Czech Republic:
Current and long-term trends in the use of
tobacco and nicotine products among 13-15
years old students by Petra Kamaradova,
Czech Republic
Petra Kamaradova1
1National Institute of Public Health, Vinohrady, Czech Republic
The results of GYTS 2022 in the Czech Republic show that
almost half of students (47.3 %) reported ever used tobacco.
Total of 16.4 % students reported current tobacco use,
currently smokes cigarettes 11.2 %. By comparison, in 2002,
34.6% of students reported currently smoking cigarettes. On
the other hand, e-cigarette use has increased from 11.2%
since 2016 to 21.4 % in 2022 and it is becoming more popular
among the young people.
Czech Republic adolescents are faced with the double burden
of cigarette use and the use of other forms of tobacco products
such as chewing tobacco, nicotine pouches, e-cigarettes,
heated tobacco products etc.
Due the aforementioned reason, the Czech Republic started
policy-making processes aimed at limiting the accessibility of
these products to the young population.
The results are also considered in proposed interventions or
further examination.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A116
DOI: 10.18332/tpc/172809
Dual voice on tobacco control in Poland.
Inequalities, urgent needs, new challenges
Krzysztof Przewoźniak1,2, Andrzej Wojtyła2, Cezary Wojtyła2,
Marek Przybył2
1National Research Institute of Oncology, Warsaw, Poland,
2Calisia University, Kalisz, Poland
Introduction
Enforcement of the comprehensive tobacco control policies
in Poland in mid-1990s contributed to substantial decrease
in tobacco smoking and lung cancer mortality. However,
there are still gaps, social inequalities, urgent needs and new
challenges in tobacco control to be addressed and solved.
Objectives
To identify and evaluate current inequalities, urgent needs
and new challenges in tobacco control in Poland.
Material and Methods
1/ Analysis of cigarette sale in Poland (1923-2022); 2/ Results of
nation-wide surveys conducted in youth and adult population
in Poland (1974-2019); 3/ Values of tobacco excise taxes and
cigarette prices in Poland (2000-2019); 4/ Scores of Tobacco
Control Scale (TCS) for Poland and selected countries (2003-
2021).
Results
Analyses show that production of cigarettes in Poland (and
its value) has constantly increased since 2002 to almost 150-
160 billions cigarettes a year but most of cigarettes are now
exported. After long-time decline, cigarette sale currently
again grows. It is mainly caused by substantial decrease in

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Tobacco Prevention & Cessation | Abstract Book
real tobacco taxes and prices, gaps in other comprehensive
tobacco control measures, programs and services, over two
times increase in cigarette smoking among women living in
rural area and dramatic increase in the use of e-cigarettes
(ENDS) by teenagers and young adults. GYTS data indicates
that current ENDS use in Poland is the highest one in Europe
both among boys and girls. Gender differences in cigarettes
smoking among adults and teenagers tend to substantially
decrease in Poland. By now, education and household income
are key predictors for tobacco use. Comparison of TCS scores
shows that Poland is year by year at lower position on TCS
ranking list.
Conclusions
Tobacco control in Poland needs in particular to 1/ have
effectively enforced long-term comprehensive strategy and
action plan for tobacco endgame, 2/ close major gaps in
enforcing tobacco control measures (i.e. introduce complete
smoking ban in public places, plain packaging, tobacco
advertising and promotion ban in points of sale), 3/ raise
tobacco taxes and prices over inflation rate, 4/ raise funds for
tobacco control research, programs and smoking cessation
services according with present and future needs, 5/ create
comprehensive system for monitoring and evaluation of
tobacco use, its health, social and economic consequences,
and effectiveness of tobacco control program and policies,
with special focus on new emerging tobacco and nicotine
products.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A117
DOI: 10.18332/tpc/172811
Prevalence, patterns and trends of tobacco
smoking and secondhand exposure by
pregnant women in Poland
Krzysztof Przewoźniak1,2, Cezary Wojtyła1, Paulina Wojtyła-
Buciora1, Marek Przybył1
1Calisia University, Kalisz, Poland, 2National Research
Institute of Oncology, Warsaw, Poland
Introduction
Smoking and secondhand exposure to tobacco smoke during
pregnancy is well-known health risk factor for pregnant
woman, fetus, newborn and small child. Smoking also
determines children’s health in further stages of his life and
through epigenetic modifications may influence on the health
of future generations.
Objectives
To evaluate prevalence, patterns and trends of tobacco
smoking among pregnant women in Poland.
Material and Methods
Population-based questionnaire studies on health beliefs
and behaviors of pregnant women are carried out in Poland
since 2009. They were conducted by trained sanitary-
epidemiological inspectors in gynecological and maternity
wards and based on study concept and questionnaire used in
the Pregnancy Risk Assessment Monitoring System (PRAMS),
a surveillance project of the Centers for Disease Control and
Prevention (CDC). In order to make comparable analysis,
presented paper is based on study results from 2013 (N=2913)
and 2017 (N=3451). Both studies were coordinated by the
Chief Sanitary Inspectorate and financed from the Swiss-
Polish Cooperation Program.
Results
In 2017, 33.8% of Polish pregnant women smoked tobacco
before or during pregnancy. 11,9% of them quit smoking
before and 15.7% during pregnancy whereas 5.9% continued
smoking when were pregnant. Prevalence of current smoking
during pregnancy is at highest level among the least educated
women and women from households with the lowest income.
Average number of cigarettes smoked daily tends to be
twice reduced during pregnancy – from 6,6 cigarettes a day
3 months before pregnancy to 3,3 cigarettes a day just before
delivery. Results of the 2017 study also show that 33% of
pregnant women is exposed to secondhand smoke (SHS) at
home (18% at daily basis) and 16% at worksite (9,8% at daily
basis). Comparison of the 2013 and 2017 study results indicate
that both active and passive smoking among pregnant women
were substantially decreased in Poland.
Conclusions
Tobacco smoking and SHS exposure during pregnancy is still
at high level in Poland. Although it was reduced in last decade,
additional tobacco control activities are recommended to
strengthen this trend. In particular, there is a need to: 1/
implement hospital-based tobacco control and smoking
cessation programs, including brief intervention, for pregnant
women treated in all gynecological and maternity clinics, 2/
organize trainings on the risk of tobacco use during pregnancy
and treatment of tobacco dependence for gynecologists,
pediatricians and midwives, 3/ incorporate recommendations
on smoking cessation and treatment of tobacco dependence
into gynecological and obstetric guidelines, 4/ conduct media
and social campaigns on the risk of smoking before, during
and after pregnancy, with focus on children’s health and
epigenetic consequences.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A118
DOI: 10.18332/tpc/172813
Implementation of pharmacological
interventions to help quit smoking. The
progress of western Balkan countries
according to the WHO report on the global
tobacco epidemic, 2021
Jorgjia Bucaj1, Boban Nedeljković2, Valentina Vukmirović2,
Lorena Sila1, Melisa Qosja3
1Pediatric Department, Mother Teresa University Hospital,
Tirana, Albania, 2Institute of Economic Sciences, Belgrade,
Serbia, 3Pediatric Department, Primary Healthcare Centre
No.3, Elbasan, Albania
Introduction
More than 60% of tobacco users report wanting to quit,
and over 40% have made at least one attempt in the last 12
months. Cessation medications and professional support can
double the chances of successfully quitting. Pharmacotherapy
interventions include Nicotine Replacement Therapy (NRTs),
as well as medications such as Bupropion, Varenicline, and
similar. According to studies, the quit rate increased from 6%
for a single type of NRT to almost 15% for Varenicline. This
study aims to assess the progress of Western Balkan (WB)

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8th ENSP European Conference on Tobacco Control
countries in the pharmacotherapy use for tobacco cessation.
Material and Methods
Data has been extracted from the WHO report on the global
tobacco epidemic 2021 in Albania, Bosnia and Herzegovina,
Montenegro, North Macedonia, and Serbia. Despite the
improvement in the legislation of these countries (due to their
aspiration to join the EU), tobacco prevalence remains high.
Results
Albania, Bosnia and Herzegovina, North Macedonia, and
Serbia offer NRT and/or some cessation services (at least one
of which is cost-covered). In none of these countries is a toll-
free telephone quit line/help line with a live person available
to discuss cessation with callers. In Serbia, North Macedonia,
and Bosnia and Herzegovina, NRTs are sold legally and can be
easily purchased in pharmacies without Rx, while in Albania
and Montenegro, NRT products are not sold legally. In Bosnia
and Herzegovina, both Bupropion and Varenicline are sold
legally in pharmacies with Rx, in Serbia only Bupropion is
available, while in other countries none of these medications
are available. Except for Montenegro, in all other countries,
there are health clinics or other primary care facilities that
offer support for smoking cessation.
Conclusions
Despite the efforts of the WB countries to provide smoking
cessation therapies in the WB countries, their availability
still remains a big issue. In some countries, NRTs or other
medications are not available, while in those countries that
can be accessed, they mostly are not reimbursed. We strongly
recommend that pharmacotherapy should be available and
fully/partially reimbursed by the national health authorities.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A119
DOI: 10.18332/tpc/172814
Tobacco, e-cigarette and heated tobacco use
in Poland: Findings from the Global Youth
Tobacco Survey 1999-2022
Krzysztof Przewoźniak1, Paweł Koczkodaj1, Marta Mańczuk1,
Joanna Didkowska1
1National Research Institute of Oncology, Warsaw, Poland,
Introduction
The Global Youth Tobacco Survey (GYTS) is a global CDC and
WHO coordinated survey that is aimed to monitor the use of
tobacco and new emerging products by schoolchildren and
their knowledge, beliefs and attitudes toward tobacco and
tobacco control policies.
Objectives
To evaluate prevalence and trends of the use of tobacco
(smoked and smokeless), ENDS and HT in Poland and identify
major tobacco control challenges in youth population.
Material and Methods
GYTS includes a two-stage (school and classes) sample
design with schools selected with a probability proportional
to enrollment size. GYTS is a cross-sectional, nationally
representative school-based self-administered questionnaire
survey of school students aged 13 to 15 years. In Poland, GYTS
sample sizes of 13-15 years old students count from 3,000 to
4,000 respondents. Current analysis of data on tobacco use,
beliefs and attitudes are based on all five GYTS rounds (1999,
2003, 2009, 2016 and 2022), while data on ENDS and HT use
refer to GYTS data from 2016 and 2022.
Results
In 2022, 17.1% of Polish students used any tobacco products,
12.5% currently smoked tobacco and 11.7% currently smoked
cigarettes. Currently use of ENDS was at substantially
higher level (21.2%) than tobacco products and two times
more frequent than for cigarettes and HT (10%). The lowest
proportion of current tobacco products use was observed for
smokeless tobacco (4.5%). GYTS Poland results show that
prevalence of cigarette smoking has decreased from 20%
in 2016 to 11.7% in 2022. On other side, there is observed a
sharp increase in prevalence of ENDS use among teenagers
after 2009.
Conclusions
There is a need to adapt Polish tobacco control activities
addressed to youth to current challenges. These activities have
to include: 1/ limitation of tobacco, ENDS and HT availability
and affordability among youth, 2/ implementation of national
school-based tobacco control program, 3/ enforcement of
complete ban on tobacco, ENDS and HT use in public places, in
particular pubs, night and disco clubs, sport objects, children
playgrounds and youth entertainment venues, 4/ development
of social media campaigns and mobile applications to prevent
and quit youth smoking, 5/ implementation of population-
based system for monitoring youth tobacco use, beliefs and
attitudes.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A120
DOI: 10.18332/tpc/172815
Tobacco use and urological cancers: An
overlooked priority
José Ignacio Nolazco1
1Harvard Medical School, Boston, United States
Introduction
Tobacco smoking is the leading cause of preventable death
worldwide. It causes or exacerbates most of the top ten
leading malignancies, including bladder, upper urinary tract,
kidney, and prostate cancer. Unfortunately, many patients
are unaware of these associations. Furthermore, the critical
role of urologists in facilitating tobacco cessation throughout
target counseling interventions remains vastly underutilized.
This presentation examines the association between tobacco
smoking and urological cancers and discusses urologists’
role in tobacco cessation efforts.
Material and Methods
A comprehensive literature review examined the association
between smoking and urological cancers and urologists’ role
in tobacco cessation counseling.
Results
Smoking is associated with aggressive tumors, advanced
cancer stage, higher risk of recurrence and progression,
surgical complications, worse treatment outcomes, and
increased cancer-specific mortality in urological cancers.
Furthermore, it is associated with other health problems, such
as cardiovascular events, lung disease, impaired immune
function, poor wound healing, and diminished quality of life.
However, few urologists are engaged in tobacco cessation

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Tobacco Prevention & Cessation | Abstract Book
practice.
Conclusions
Urologists are paramount in addressing tobacco use and
providing tobacco cessation support to all patients. Urologists
should incorporate screening, patient education, and tobacco
cessation counseling into routine practice to reduce the
tobacco-related disease burden.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A121
DOI: 10.18332/tpc/172816
Smoke control activities in Greece. The 2
pillars: 1. School teaching interventions
2. Interventions of oral health professionals
Eleana Stoufi1, Vergina Konstantina Vyzikidou1, Panagiotis
Behrakis1
1Hellenic Cancer Society, Athens, Greece
Tobacco use accounts for 25% of all cancer deaths globally
and kills more than 8 million people each year, including 1.3
million non-smokers who are exposed to second-hand smoke
(WHO, 2023).
WHO’s Framework on Tobacco Control recommends that
all health-care professionals (HCPs) become advocates for
tobacco control by offering help to people who use tobacco.
The main objective of the SmokefreeGreece initiative is to
raise a smokefree generation, enhance youth awareness on
the risks of tobacco addiction. The initiative coordinates a
series of actions, with friendly approach based on positive
messages and colorful images and from September of 2022
is fully supported by the NGO Hellenic Cancer Society.
The SmokefreeGreece educational program includes:
• School-based interventions. From 2014 more than 75.000
students have participated in 2.183 interventions.
• Train the trainer workshops. From 2010, over 2,500
teachers and healthcare professionals have completed
the seminars.
• Educational material for students, teachers, parents,
health professionals.
• Annual Panhellenic Student conferences. Since 2010, more
than 8.000 students have participated with educational
activities in 12 conferences.
• Student Competitions. 9 Annual Panhellenic Student
Competitions since 2013, with more than 3.000
participations.
• Collaborations with other NGOs
• Social media activity
On May 4 2022, SmokefreeGreece was rewarded by the
European Commission, with first place in the “”2021 EU
Health Award on Cancer Prevention”” competition, as the
most successful cancer prevention campaign in Europe and
on May 25 2023, professor Panagiotis Behrakis was awarded,
by the WHO for his offer to reduce smoking on youth in Greece.
FDI (World Dental Federation) has created protocols to educate
and train Dentists, to support their patients effectively to quit
using tobacco-nicotine products with short interventions.
In Greece, the Greek Dental Association, and the
SmokefreeGreece initiative have organized nationwide
seminars for Dentists, based on FDI’s protocols.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A122
DOI: 10.18332/tpc/172817
The UN treaty against plastic pollution:
towards a global filterban?
Danielle van Kalmthout1
1Belgian Alliance for a Smoke Free Society, Brussels, Belgium
Plastic pollution is a global problem and an urgent one.
Cigarette butts are single-use plastics and a big part of this
problem, being the most polluted item in the world. Moreover,
cigarette butts contain toxic chemicals that leach into the
(aquatic) environment. According to cigarette manufacturers,
the filter was introduced to limit the harmful impact of
cigarettes on health. However, research shows that the
introduction of filter has only made cigarettes more and not
less harmful. Cigarette filters should therefore be banned
to protect public health and the environment by recognizing
them as ‘problematic and avoidable plastics’ under the UN
Convention Against Plastic Pollution which is currently being
negociated. Belgium’s Supreme Health Council already
advised in favour of banning cigarette filters. The session
will introduce participants to the health and environmental
arguments on the filterban, the negotiations on the UN
Convention Against Plastic Pollution, the Belgian advice to
ban cigarette filters and how participants can influence their
national delegations working on this convention.
Conflicts of interest
The author has no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A123
DOI: 10.18332/tpc/172822
Current and long-term trends in tobacco
product use among 13-15 year old students
in Lithuania: GYTS country report and the
control policy context
Nijole Gostautaite Midttun1,2, Antanas Gostautas3
1Mental Health Initiative, Vilnius, Lithuania, 2Lithuanian
Tobacco and Alcohol Control Coalition, Vilnius, Lithuania,
3Union of Lithuanian Health Psychologists, Vilnius, Lithuania
Introduction
Tobacco smoking in Lithuania among adolescence is highly
prevalent but has been decreasing over the past 20 years.
There have been major tobacco control policy changes
during the same period in Lithuania, with varied degree of
implementation, which contributed to changes in smoking
patterns. Failure of control policy to prohibit access of
e-cigarettes has led to increased prevalence among
adolescents.
Objectives
To assess changes in prevalence of smoking and accessibility
of cigarettes among 13-15-year-old students in the GYTS
sample for 2001-2022.
Methods
Data from five editions of GYTS were used: from 2001 to 2022.
Results
Prevalence of current tobacco users in GYTS 2001 to 2022
samples show a reduction from 33.8 % (2001) to 22.6 % (2018)
to 14.2 % (2022), with no difference in prevalence among boys
and girls in the latest samples. E-cigarette use, which has

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8th ENSP European Conference on Tobacco Control
been assessed for the first time in Lithuanian GYTS sample
was reported at total 23 % for current use (19 % of boys and
27 % girls), comparable with other studies in Lithuania.
The e-cigarette prevalence is accompanied with a lower
prevalence of cessation attempts and willingness to quit
among adolescence. Results show positive changes in young
people exposure to second hand smoke and access to tobacco
products: 65.8 % of respondents in 2001 bought tobacco in
stores, while only 10.9 % did the same in 2022, exposure to
smoking at home fell from 47.0 % to 35.2%.
Conclusions
There is a long-term trend in Lithuania for lower prevalence
of tobacco use among adolescents, especially for traditional
cigarettes. There is a very high prevalence of e-cigarette
use, especially among girls. Monitoring tobacco and nicotine
consumption among adolescents helps inform tobacco
control and public health policies.
Tob. Prev. Cessation 2023;9(Supplement 2):A124
DOI: 10.18332/tpc/172823
Campaign for tobacco-free kids’
International Legal Consortium with
Gezondheidsfondsen voor Rookvrij: Policy
and drafting guidance for e-cigarette and
heated tobacco product regulation
Deniece Carrington1, Daniëlle Arnold2
1Campaign for Tobacco-Free Kids, Washington, United States,
2Gezondheidsfondsen voor Rookvrij, Utrecht, The Netherlands
Target Audience
This workshop is intended for lawyers and other individuals
involved in proposing, drafting, and adopting tobacco control
policy, including advocates, government regulators, and
policymakers.
Description
This workshop will guide participants through some aspects
of a decision-making process for drafting policies to
regulate e-cigarettes and heated tobacco products (HTPs).
Participants will review and understand common drafting
issues and solutions to ensure that these products are
adequately covered using WHO FCTC measures.
Background
The WHO has concluded that e-cigarettes are harmful and
that countries that have not banned the sale of e-cigarettes
should ensure that their tobacco control measures are
“comprehensive enough to regulate all forms of novel and
emerging nicotine and tobacco products.” This is consistent
with the general obligations of the WHO FCTC, which require
Parties to the Convention to implement measures for
preventing and reducing nicotine addiction. Regarding HTPs,
Parties to the WHO FCTC have recognized that consumption
of and exposure to any tobacco product causes death, disease,
and disability and have adopted as a guiding principle the
need “to decrease the consumption of tobacco products in
any form.” In 2018, Parties to the WHO FCTC agreed that
they should “regulate, including restrict, or prohibit” novel
and emerging tobacco products such as HTPs, including “the
devices designed for consuming such products.”
The tobacco industry has framed a false narrative around
HTPs and e-cigarettes, both by conflating the two products
around the term “vaping” and by marketing these products as
“reduced risk” or “reduced harm”. All available independent
evidence shows that these products are harmful and should
be subjected to strict regulation if allowed on the market, and
yet the industry is using the confusion over them to confound
regulators and policymakers from doing so.
This workshop will present a framework for crafting strong,
effective, and WHO FCTC-compliant policies on these products.
The workshop will take participants through the factors that
must be considered when preparing to regulate, including
whether and which products have entered the market,
current prevalence data, the country’s institutional capacity
to regulate and monitor the market, and the definitional
considerations to ensure all parts of these products are
regulated. The workshop will provide drafting tips and best
practices to ensure policies are sufficiently comprehensive to
protect populations from both existing and future products.
The workshop will share advocacy experiences in regulating
emerging products in the Netherlands. A first-hand account
of the challenges encountered and successes achieved
throughout the process will be provided.
Objectives
By the end of this workshop, participants will understand:
• What factors should be considered when determining
how emerging products such as e-cigarettes and heated
tobacco products should be regulated;
• The differences in defining and regulating heated tobacco
products versus e-cigarettes;
• What type of policy framework may be the best fit for their
country’s context;
• How to draft legal measures to ensure all emerging
products are adequately covered by WHO FCTC measures
(regardless of whether the products are banned or
regulated); and
• Examples of countries implementing strong WHO FCTC
measures regulating e-cigarettes and HTPs.
Results
Participants will take part in a drafting exercise concerning
emerging products.
Tob. Prev. Cessation 2023;9(Supplement 2):A125
DOI: 10.18332/tpc/172825
Maximizing on UN environmental treaties to
advance tobacco endgame
Laurent Huber1
1Action on Smoking and Health, London, United Kingdom
The product cycle of the commercial tobacco industry is a
major contributor to environmental degradation causing the
loss of 600 million trees and the production of large amounts
of plastic waste including plastic wrappers, electronic
cigarette components and cigarette filters which particularly
problematic, as they take many years to biodegrade and are
the most discarded waste item worldwide. Participants will
learn how to engage with UN environmental processes like the
Framework Convention on Climate Change, the Convention to
Combat Desertification and particularly the negotiations for a
UN international legally binding Treaty to End Global Plastic
Pollution with the aim of phasing out cigarette filters.
Tob. Prev. Cessation 2023;9(Supplement 2):A126
DOI: 10.18332/tpc/172830

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Tobacco Prevention & Cessation | Abstract Book
Smoking cessation in cancer care
Antonella Cardone1, Maria Sofia Cattaruzza2, Michelle
Halligan3, Stephanie Land4, Mahdi Sheikh5, Caroline
Silverman3, Graham Warren6, Charis Girvalaki7, Cornel Radu
Loghin7, Saverio Caini8, Sara Gandini9, Yannick Romero10,
Rebekka Aarsand11, Dongbo Fu11
1Cancer Patients Europe, Brussels, Belgium, 2Italian Society
against Tobacco, Italy, 3Canadian Partnership Against Cancer,
Toronto, Canada, 4National Institutes of Health, Maryland,
United States, 5International Agency for Research on Cancer,
Lyon, France, 6Medical University of South California, Los
Angeles, United States, 7European Network for Smoking and
Tobacco Prevention, Brussels, Belgium, 8Institute for the Study
and Prevention of Cancer, Florence, Italy, 9European Institute
of Oncology, Milano, Italy, 10Union for International Cancer
Control, Geneva, Switzerland, 11World Health Organization,
Switzerland
It is well documented that tobacco use is strongly associated
with a number of malignancies. There are over 60 carcinogens
in tobacco smoke that lead to development of cancers in the
lung and at least 19 other sites.
Strong evidence indicates smokers can reduce their risk for
developing cancer by quitting smoking. Even after developing
cancer, patients may benefit from quitting smoking.
Accumulating evidence indicates quitting vs. continued
smoking after cancer diagnosis is associated with 30% to
50% lower risk of death and disease progression.
Several mechanisms have been suggested by which smoking
can reduce survival in patients with cancer; cigarette
smoke contains many carcinogens and mutagens that can
directly affect tumor cells and increase their proliferation
and migration, smoking can impair the immune response to
malignant growth, smoking can affect the response to and
complications from some cancer treatments and accelerate
other illnesses including cardiovascular and other chronic
diseases in patients with cancer.
However, up to 50% of patients who were smoking before
a cancer diagnosis continue to smoke during treatment.
Healthcare professionals can optimize the management of
cancer if they understand the impact of smoking cessation
on cancer treatment share this information with patients
and provide support to quit. Smoking cessation interventions
should be offered to cancer patients in a systematic way, using
evidence-based guidelines. Pharmacological interventions
combined with cognitive and behavioral interventions
currently provide the best opportunity for long-term cessation
of smoking in cancer patients and should be part of the patient
navigation process.
This session will focus on:
• The importance of smoking cessation after a cancer
diagnosis – The evidence on different cancers and
outcomes
• The evidence of the economic benefit of the healthcare
systems
• Initiatives from Canada, USA, and Europe
• A patient’s view/experience
Tob. Prev. Cessation 2023;9(Supplement 2):A127
DOI: 10.18332/tpc/172831
Evaluating tobacco product flavors using
a combination of sensory and chemical
analysis
Constantine Vardavas1, Alexander Vardavas1, Zinovia Plyta1,
Ioanna Lagou1, Valia Marou1, Manolis Tzatzarakis1, Aristidis
Tsatsakis1
1Laboratory of Toxicology, Medical School, University of Crete,
Heraklion, Greece
Introduction
By covering up the unpleasant taste and odor of tobacco,
flavors in tobacco products can make smoking or other types
of tobacco use more acceptable to users. This may facilitate
inhalation for users and raise the risk of addiction. Additionally,
flavors might increase the social acceptability of smoking
and other tobacco use, especially among young people who
may be more prone to experimenting with flavored tobacco
products. The Tobacco Products Directive (TPD) in Europe
is responsible for regulating flavors in tobacco products.
To make tobacco products less appealing to young people,
the TPD lays forth a number of prohibitions on the use of
flavors in these products. A set of reference tobacco products
against which test items would be judged was necessary
since, in accordance with the TPD, tobacco products that
impart a distinguishing flavor other than that of tobacco are
not permitted on the EU market.
Material and Methods
123 goods were subjected to a thorough sensory and chemical
evaluation as part of the development of a reference space for
tobacco products utilizing the specified standard operating
procedures. Through descriptive profiling, the sensory
qualities of each product were evaluated. The average old
intensity for each individual characteristic assigned by all
12 assessors was obtained for each of the three test sample
replicates. Within the stage, each product was rated by 12 train
sense recesses in triplicate for 51 probable odor attributes.
Results
Principal component analysis (PCA) and the presentation of
confidence ellipses were used to further perform sensory
assessment. After the sensory evaluation, gas chromatography
mass spectrometry (GC-MS analysis) was used to analyze
all samples chemically and produce a chemical profile for
each product. After the thorough evaluation, some tobacco
products were eliminated, leaving 121 items on the final list of
boxed and roll-your-own tobacco goods in the reference area.
Conclusions
Overall, evaluating tobacco flavors is a crucial step in the
regulation of tobacco products. By combining sensory and
chemical analyses, it is possible to compare the flavor
characteristics of test tobacco products to those of tobacco
products that have been determined not to have a distinctive
flavor.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Tob. Prev. Cessation 2023;9(Supplement 2):A128
DOI: 10.18332/tpc/172652
The use of traditional tobacco, e-cigarettes
and heated tobacco products among
schoolchildren: findings from the recent
Global Youth Tobacco Surveys in Czech

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8th ENSP European Conference on Tobacco Control
Republic, Lithuania, Italy, Poland and San
Marino.
1National Research Institute of Oncology, Warsaw,
Poland
2National Institute of Public Health, Praque, Czech
Republic
3Lithuanian Tobacco and Alcohol Control Coalition,
Vilnius, Lithuania
4National Centre for Disease Prevention and Health
Promotion, Rome, Italy
5Health Authority, San Marino
6Office on Smoking and Health, CDC, Atlanta, GA, USA
7WHO Regional Office for Europe, Copenhagen,
Denmark
Background
Tobacco and nicotine use among European teenagers still
remains a major public health concern. In the whole WHO
European Region, including five selected countries, the
prevalence of tobacco use by teenagers substantially varies.
Objectives
1/ To overview the picture of tobacco, e-cigarette and heated
tobacco use in Europe among 13-15 years-old schoolchildren;
2/ to evaluate and compare the prevalence and trends in the
use of above products in selected European countries; 2/ to
identify major tobacco control challenges in youth population
in analyzed countries.
Material and Methods
The presented research findings are based on results of
the Global Youth Tobacco Survey. GYTS is a cross-sectional,
nationally representative school-based self-administered
questionnaire survey of school students aged 13 to 15 years.
GYTS includes a two-stage (school and classes) sample
design with schools selected with a probability proportional
to enrollment size.
Results
GYTS data from four analyzed countries show a substantial
decrease in cigarette smoking and the use of other traditional
tobacco products and, at the same time, a sharp increase in the
use of novel and emerging tobacco and nicotine products, in
particular e-cigarettes, among 13-15 years-old adolescents.
Only in San Marino the prevalence of any tobacco products
use tends to increase, comparably to increase in e-cigarette
and heated tobacco use. In all analyzed countries, current use
of e-cigarettes is at higher level than the use of traditional
tobacco products. Additional challenges are associated with
the increase of dual use of cigarettes and e-cigarettes or
heated tobacco among adolescents and a rapid uptake of
novel and emerging tobacco and nicotine products by young
girls. In some countries, the prevalence of e-cigarette use
among girls now exceeds that of boys.
Conclusions
The GYTS data from the WHO European Region show a sharp
increase in the use of e-cigarettes, heated tobacco and dual
product use among young people, and underscores the
urgent need to implement bold, robust, comprehensive and
multi-sectoral tobacco control strategy. This strategy should
include population and school-based preventive programs,
the creation of tobacco-free environments, the provision of
youth tobacco cessation services, and the implementation of
legislative measures. These measures should be aligned with
the guidance provided by the WHO Framework Convention on
Tobacco Control and be strictly enforced.
Tob. Prev. Cessation 2023;9(Supplement 2):A129
DOI: 10.18332/tpc/173177
Smokingcessationin urinary cancer
prevention, screening and treatment
Krzysztof Przewoźniak1
1National Research Institute of Oncology, Warsaw,
Poland
Background
The 2019 Global Burden of Disease Study shows that
approximately 25% of deaths and 20% of DALYs due to cancer
was as a result of active or passive exposure to smoking.
Tobacco smoking is also well-known risk factor for bladder
and kidney cancer, and findings from some epidemiological
studies suggest a positive association between tobacco
smoking and prostate cancer risk.
Objective
To review the scientific evidence on the role and effectiveness
of tobacco cessation in urinary cancer prevention, screening
and treatment.
Methods:A narrative review of papers published since
2000 in peer-review scientific journals and monographs
or research reports of highly respected research institutes
or international health organizations such as the National
Cancer Institute in Bethesda, MD, USA and the International
Agency for Research on Cancer in Lyon, France. The search
was done using PubMed, Medline, Web of Science and other
Internet-available scientific or medical platforms.
Results
Both long-term prospective and case-control epidemiological
studies prove that cessation of smoking is beneficial at every
stage of life. There is also enough evidence, including clinical
trials that smoking cessation effectively prevents the risk of
lung, head or neck cancers and improves effectiveness of the
cancer treatment. However, the scientific knowledge on the
impact of smoking cessation on prevention, screening and
treatment of urinary cancers is still limited and conclusions
are not so clear as for lung, oral or laryngeal cancer. There
are only few studies that analyze specific methods of smoking
cessation, such as brief intervention based on 5As, in the
context of cancer prevention, treatment and recurrence,
including bladder cancer. This paper refers to major clinical
and epidemiological studies where these associations and
procedures are analyzed.
Conclusion
Urologists may play an essential role in motivating and
helping their patients cease smoking. It could decrease
incidence of urinary cancers and improve the cancer survival
rates. Unfortunately, most urologists still do not incorporate
smoking cessation into their routine medical practice when
diagnosing and treating at-risk urinary cancer patients.
It mainly results from lack of clear scientific evidence on
the effectiveness of smoking cessation in prevention and
treatment of urinary cancers, lack of knowledge of urologists
on treatment of tobacco dependence and lack of standardized
tobacco prevention and cessation methods in clinical
guidelines for urologists and urological oncologists.
Tob. Prev. Cessation 2023;9(Supplement 2):A130

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Tobacco Prevention & Cessation | Abstract Book
DOI: 10.18332/tpc/173178
Session on tobacco and e-cigarette use and
urological cancers: major conclusions on
the risk, beliefs and behaviors, preventive
recommendations
Krzysztof Przewoźniak1, Jose Nolazco2, Marc Bjurlin3,
Richard Matulewicz4, Jacqueline Daly5, Francesco
Soria6
1National Research Institute of Oncology, Warsaw,
Poland
2Harvard University, Boston, MA, USA
3University of North Carolina, NC, USA
4Memorial Sloan Kettering Cancer Center, New York,
NY, USA
5Cancer Patients Europe, Brussels, Belgium
6University of TorinoSchool of Medicine, Torino, Italy
The 2019 Global Burden of Disease Study shows that global
deaths attributed to tobacco smoking increased from 1.5
million in 1990 to 2.5 million in 2019. Cigarette smoking
is a well-known risk factor for urinary cancers, with well-
established positive association between smoking and the
cancer of bladder and kidney and presumable connection
with increased risk of morbidity and mortality from prostate
cancer.
This paper aims to summarize major conclusions made
by American and European scientists, researchers and
representatives of the European Association of Urologists
and the Cancer Patients Europe network on the special
session during the ENSP Conference on Tobacco Control
in Florence (October 10-12, 2023). The session has the
following objectives: 1/ to sum up the recent evidence on
the association between tobacco smoking and e-cigarette
and the risk of urological cancers (bladder, kidney and
prostate); 2/ to evaluate knowledge, beliefs and behaviors
of urologists to the cancer risk and on the role of tobacco
prevention and cessation in prevention and treatment of
urological cancers; 3/ to assess recommended preventive and
cessation procedures, programs and services that could be
used by urologist, urological oncologists and cancer patients
to decrease morbidity and mortality from urological cancers.
The session concludes on strong relationship between
cigarette smoking and bladder and kidney cancer and
suggested association between tobacco smoking and prostate
cancer. It also indicates on the serious health problem of
smoking continuation in urological cancer patients after
diagnosis. Results of the new epidemiological studies
show that well-known carcinogens of bladder cancer, such
as polycyclic aromatic hydrocarbons and volatile organic
compounds, are also present in the urine of e-cigarette users.
These findings suggest the urgent need for additional data
collection and further clinical and epidemiological studies
on the association between e-cigarette use and urological
cancers. American research reports on beliefs and behaviors
of urologists indicate, on the one side, that urologists recognize
the importance of tobacco use assessment and treatment and
relationship between tobacco smoking and urologic disease,
but, on other side, very rarely include routine screening
for tobacco use and evidence-based treatment of tobacco
dependence. It takes a place despite scientific evidence
that tobacco prevention and cessation decreases the cancer
risk, incidence and mortality, also for urological cancers. It
happens despite tobacco cessation counselling, including
brief intervention based on 5As, is well-established and cost-
effective method for improvement of the cancer prevention,
treatment and overall cancer survival after diagnosis. It
results, as urologists say, from a lack of time for incorporating
these procedures in routine medical practice, loopholes in
their training on tobacco dependence diagnosis and treatment,
and limited comfort with recommended procedures. It is
also not very clear how smoking cessation programs can
be systematically embedded into cancer treatment. There is
a need to comprehensively train urologists in treatment of
tobacco dependence, motivate them to systematically lead a
brief intervention in their medical work, set up standardized
smoking cessation programs and services for smoking cancer
patients, incorporate tobacco prevention and cessation
procedures into clinical guidelines for urologists and
urological oncologists, create a multi-stakeholder network
of tobacco control specialists and advocates, urologists and
cancer patients.
Tob. Prev. Cessation 2023;9(Supplement 2):A131
DOI: 10.18332/tpc/173179

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8th ENSP European Conference on Tobacco Control

8th ENSP European Conference on Tobacco Control
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