FRESHER 3RD WORKSHOP ON DRIVERS & TRENDS

OF THE FUTURE DEVELOPMENTS OF NON-COMMUNICABLE DISEASES

LISBON, OCTOBER 26TH 2015

 TOBACCO AND ALCOHOL
RISK FACTORS AND FORESIGHTS

Renata Solimini
Istituto Superiore di Sanit
(National Institute of Health of Italy)
 TOBACCO USE IN EUROPEAN UNION
European survey on tobacco use (2012), prevalence of
smoking in the 27 Member States:

28% are smokers;

21% are ex-smokers;
51% have never smoked

(Attitudes of Europeans towards Tobacco. Eurobarometer 2012.

http://ec.europa.eu/health/tobacco/docs/eurobaro_attitudes_towards_tobacco_2012_en.pdf)
The age group with the most smokers is 25 to 39 years (37% of
respondents), the one with the least is the over 55 age group (17%).
One out of four youngsters between 15 and 24 years are
smokers.
 Smoking prevalence in Italy according to DOXA surveys
between 1975 and 2015

60.0
Variability 2014-2015
Men - 0,3
53.2
Women - 2,0
50.0 Total - 1,2

40.0
38.3
34,0
32,0 34.8
31.1 33.2
28.9 30.0 29.3 27.9 28.9
30.0 27.6 28.6
26.6 26.2 26.4 23.9 26.0 24.6 26.2 25.4 25.1
25.9 25.6 24.3 23.5 25.4
22,0 21.7 20.6 22,0
22.7 20.8 20.8
20.0 23.6 22.5 22.5
22.3 22.1 22.3
20.3 19.3 19.7 19.6
17.9 18.9
16.3 17.2 16.9
15.3
10.0

0.0
1975 1990 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Survey DOXA-ISS 2015

 RISK FACTORS IN ITALY
Why do people start smoking?

Muttarak et al. Eur J Cancer Prev. 2013 Mar;22(2):181-6.

 INTERVENTIONS
The majority of men and women started smoking because of the influence of friends. Antismoking
campaigns should consider social influence and the dimension of self-esteem;

Antismoking Helpline The telephone number is placed on cigarettes packets (since 2012,
by decree of Ministry of Health): phonecalls significantly increased, including young people (age 18-25);

Smoking cessation centers: present in all regions of Italy;

Legislation: Smoking ban in all public places including school courtyards. Purchase of tobacco products by
minors aged less than 18 years is prohibited. Increased the price of cigarettes.

New antismoking law decree (October 2015)

Packets with less than 20 cigarettes are prohibited. RYO tobacco packet must contain not less than 30
grams;
Smoking ban in cars with children or pregnant women;
Strong images and text on packets (already adopted in 10 EU countries including France, UK, Spain)
aimed at warning people of the dangers of smoking.
Ban on smoking in the vicinity of paediatric hospitals and clinics and of gynaecology, paediatric, obstetric
and neonatal wards;
Tougher penalties for people caught selling or serving tobacco, electronic cigarettes
or tobacco and nicotine next-generation products to minors.

The provisions should become law by Christmas.

EUROPEAN DIRECTIVE ON TOBACCO PRODUCTS
(APRIL 3, 2014)
Make all countries uniform regarding
tobacco control, including warnings and
images pictorials on the packets.
Aims at reducing consumption among young
people: 94% of smokers begin before the
age of 25 and about 50% die prematurely, on
average 14 years earlier than non-smokers.
WHO goal of a 40% reduction in global
smoking prevalence within 2025.
SMOKING PREVENTION IN YOUNG PEOPLE
Cochrane systematic review

Programmes to prevent young people starting

to smoke. Are they are effective?
49 randomised controlled trials (over 140,000
school children) of interventions aiming to
prevent children who had never smoked from
becoming smokers, were selected.
Results
Interventions which taught young people to
develop personal ability to resist the offer of
smoking and to recognize and distance
themselves from peers pressure showed a
significant effect at one year and at longest
follow-up.
Programmes led by adults may be more
effective than those led by young people.
Further research is required.
 FORESIGHTS
BETTER PRIMARY PREVENTION SHOULD BE PRIORITISED

EU policy to develop more smoke-free areas and increase the price of

cigarettes (approved by WHO) in order to reduce morbidity and
mortality from smoking 20 years hence and beyond
Smoking cessation therapy should be reimbursed completely in all
European countries (UK model)
Effectiveness of the Antismoking helpline for attracting young people
Young people are moving in Europe, antismoking laws should be
uniform in all the countries
Antismoking programmes for young people, according to EBM
interventions
Fight against smuggling and online sale.
ALCOHOL IN EUROPEAN UNION
Alcohol consumption is responsible
for 3.8% of all deaths in Europe and it
is the second leading cause of
disease and premature mortality.
The EU is the Region with the highest
level of alcohol consumption
worldwide: 11 liters of pure alcohol
per adult per year.
12.000 premature deaths per year:
1 out of 7 men and 1 out 13 women;
6,5% of deaths is caused by alcohol-
related chronic diseases.
 TRENDS IN CONSUMPTION

Status Report On Alcohol And Health In 35 European Countries 2013

http://www.euro.who.int/__data/assets/pdf_file/0017/190430/Status-Report-on-Alcohol-and-Health-in-35-European-Countries.pdf?ua=1
 TREND OF ALCOHOL CONSUMPTION IN EUROPE AND ITALY

In 2010 and for the third consecutive year, Italy turned out to be the one with the
lowest value of average consumption per capita among all 28 EU countries.

Source: Scafato et al. Epidemiology and alcohol-related monitoring in Italy and in the Regions. Evaluation of the
National Observatory on Alcohol-CNESPS on the impact of the alcohol consumption in support for the implementation
of the activities of the National Alcohol and Health Plan. Report 2015.
Different alcohol socialization process in Mediterranean and Nordic drinking culture
A qualitative research showing
the ways children and young
people get acquainted with
alcohol
The differences between
Italy and Finland are due to
specific drinking cultures.
Italy: socialisation into
alcohol (wine) occurs
gradually during childhood
within the family context and
it is connected to positive
values; it could be a
protective factor.
Drinking in order to reach
intoxication is not the main
drinking motive among
young Italians.
In Finland, often first
experiences of drinking
overlap with the first
experiences of intoxication.
 ALCOHOL RISK FACTORS
Early use. The younger you were when you first started
drinking alcohol, the higher your risk for alcohol problems
later as an adult.

Use of other substances. You are more likely to abuse

alcohol if you abuse other things, such as tobacco, illegal
drugs, or prescription medicines.

Environment. If you live in an area where alcohol is easy to

get, people drink a lot, or heavy drinking is accepted as part
of life, you are more likely to drink.

Friends. Your friends may influence you to drink by directly

urging you to or by drinking when you're around them.
 ALCOHOL IN ITALY
In 2014 the percentage of population aged 11 and over
who had consumed at least one alcoholic drink during
the year was 63%. This rate has slightly decreased if
compared to the previous year (63.9%).
From 2005 to 2014 the number of daily consumers
decreased from 31% to 22.1%.
The number of people consuming alcohol at least once
outside mealtimes has been increasing (from 25.7% in
2005 to 26.9 in 2014) and also the number of
occasional consumers (from 38.6% in 2005 to
41% in 2013).
 RISK BEHAVIOR IN ITALY
The most common risk behavior among young
people is the consumption of alcoholic drinks
between meals.
2014
22 % boys and 8,7% girls (age18-24)
21,5% boys and 17,3% girls (age 11-17)
Binge drinking: 21,0% boys and 7,6% girls
(age18-24). This age group represents almost
all of the overall risk.
 LEGISLATION IN ITALY
Drink Drive
Legal limit for blood alcohol 0.5
For New Drivers 0.0
For professional drivers 0.0
Random breath testing Yes
Restrictions on advertising
Youth protection policy in Radio, Tv, Cinema, Print media, Billboards, Sales
promotions and ban advertising for spirits in Radio, TV, Cinema
No restrictions at sports events
Taxation on spirits, beer, alcopops
No pricing policy (no minimum prices)
No health warnings or nutrition information on label
Forbidden to sell alcohol to minors (under the age of age 18)
No serving of alcoholic beverages from 3 to 6 am
Ban on consumption in educational buildings
 RECOMMENDATIONS

Ministry of Health recommends to never exceed

the amount defined lower-risk drinking:
2 alcohol units a day for men
1 alcohol unit a day for women
1 alcohol unit a day for people 65 years and
over
zero unit for minors (under 18 years)
EBM Interventions to prevent alcohol misuse in young people
 EBM Interventions to prevent alcohol misuse in young people (1)

Cochrane systematic reviews (2011)

53 well-designed experimental studies examined the effectiveness of school-

based universal programs for the prevention of alcohol misuse in young people.
Current evidence suggests that certain generic psychosocial and prevention
programs can be effective: Life Skills Training Program, the Unplugged
program, and the Good Behaviour Game.

20 randomised controlled trials that examined the effectiveness of universal

multi-component programs (interventions in multiple settings, for example in
both school and family settings) for the prevention of alcohol misuse in young
people. There is some evidence that multi-component interventions for
alcohol misuse prevention in young people can be effective.

12 randomised controlled trials examined the effectiveness of family-based

universal programs for the prevention of alcohol misuse in young people.
Universal prevention is based on the development of parenting skills including
parental support, nurturing behaviours, establishing clear boundaries or rules,
and parental monitoring. Social and peer resistance skills, the development of
behavioural norms and positive peer affiliations can also be addressed with a
universal family-based preventive program. The effects of family-based
prevention interventions are small but generally consistent and also
persistent into the medium- to longer-term.
 AMPHORA MANIFESTO ON ALCOHOL
(33 ORGANIZATIONS FROM 14 EUROPEAN COUNTRIES)

To reduce EUs drinking problem: we drink more than twice the worlds
average
All European consumers should be adequately informed about the
risks of alcohol
European consumers should be adequately warned that alcohol
causes multiple diseases and medical conditions
Price of alcoholic beverages should be increased immediately
through taxation throughout the European Union
Minimum price per gram of alcohol should be accepted
Alcohol should be less easy to get in a whole variety of ways
All forms of commercial communications on alcohol should be
banned
Advice and treatment should be better delivered to those who drink
too much or who are dependent on alcohol
About 120.000 deaths in EU can be prevented by increase price,
reduce availability, and ban advertising.