Improved Monitoring in Support of Policies to Tackle Inequalities in Smoking in the European Union (IMSPTIS) Anton E. Kunst Johan P. Mackenbach

European network on health inequalities  Research on socio-economic inequalities in mortality and morbidity in Europe  Five international research projects since 1991  Participants from nearly all ‘old’ members states of the EU, and about 5 ‘new’ member states

The European network: main findings  Large socio-economic inequalities in mortality and morbidity in all European countries  In many countries, smoking is the largest single contributor to health inequalities among men  North-south gradients in inequalities in smoking, with persistent inequalities in north and emerging inequalities in the south

The first smoking inequalities project (1)  General objectives:  to describe trends in smoking inequalities in the EU  to identify policies that have the potential to reduce smoking among lower groups  Publications  Final report in early 2004  “Brochure” for policy makers in autumn 2004  About 6 papers for international journals

The first project: main results on smoking  In the late 1990’s, inequalities in smoking existed in all ‘old’ member states  These inequalities were largest in the north, but yet small in the southern fringe  Inequalities increased over time among women, and were stable among men  Inequalities existed in relation to both smoking initiation and smoking cessation

% smoking by level of education women in 7 countries in 1985 and 2000

The first project: main results on policies  Many tobacco control measures can be effective among lower socio-economic groups, including: - rising tobacco tax - banning smoking from the work place - help with smoking cessation  Up to the present, no European country has fully implemented all these measures  Often these measures have not been targeted at lower social groups, and tailored towards their situation

Price elasticities England and Wales by gender and level of education based on trends in

Price elasticities Italy by gender and level of education based on trends in

Price elasticities Seven countries combined by gender and level of education based on trends in

IMSPTIS (1) General objective To support policies that aim to tackle socioeconomic inequalities in smoking, and to reduce smoking among disadvantaged groups, by developing recommendations for the monitoring of smoking inequalities and tobacco control policies in the European Union

IMSPTIS (2) Organisation  Period: April 2005 – March 2006  Partners  main beneficiary = Erasmus MC Rotterdam  associated beneficiaries = four partners at Rome, Barcelona, Scotland, and Stockholm/Estonia  Expected output:  papers for international journals  final report

IMSPTIS (3) Eight “actions”  Monitoring of inequalities in smoking 1.inventory of practices 2.analyses of data on smoking initiation and cessation 3.comparative analyses of data for ‘new’ member states 4.recommendations  Monitoring of tobacco control policies 5.inventory of practices 6.selection of indicators of reach among lower groups 7.analyses of relation with smoking inequalities 8.recommendations

IMSPTIS (4) Data sources for monitoring of smoking inequalities  Analyses of smoking initiation and cessation (action 2): - international data set (ca. 5 western countries) - detailed data from Italian and Dutch studies  Analyses of inequalities in eastern Europe (action 3) - World Health Survey (circa 7 countries) - national surveys (e.g. Poland, Hungary)

IMSPTIS (5) Data sources for monitoring of tobacco policies  Analyses of reach among lower groups (action 6): - British surveys (national, local) - possible indicators: exposure at work, stage of chance, # quit attempts, use of cessation services  Analyses of relation to smoking inequalities (action 7) - Spanish data (national, local) - focus on price of tobacco; smoking cessation services