Recommendations on how to achieve tobacco-free nations in Europe
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Department of Health Promotion, Maastricht University, Maastricht, Netherlands
Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, Netherlands
Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Heinrich-Heine- University Düsseldorf, Düsseldorf, Germany
College of Medicine and Veterinary Medicine, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
Marc C. Willemsen   

Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
Publish date: 2019-07-18
Submission date: 2019-02-08
Final revision date: 2019-06-28
Acceptance date: 2019-07-10
Tob. Prev. Cessation 2019;5(July):24
European countries vary widely in the development and implementation of effective tobacco-control programs and policies. Why some countries lag behind others is inherently a political matter. National-level policymakers struggle between the need to protect public health and the need to recognize economic and ideological considerations. Within this context, use of scientific evidence plays an important role in the policy making process. Articles 20 and 22 of the World Health Organisation’s Framework Convention of Tobacco Control (FCTC) oblige countries to develop and coordinate research on aspects of tobacco control and require of them to facilitate knowledge transfer and capacity building between countries. This paper considers various ways how EU and national policy makers may accomplish this. We conclude that progress in three areas is needed: 1) generation of more scientific evidence relevant for each country; 2) facilitation of policy learning between countries; and 3) building capacity and collaborations between researchers and tobacco-control advocates to bridge the gap from research to policy, especially in countries with weak tobacco-control infrastructures.
We thank Anca Toma Friedlaender (Smoke-Free Partnership) for comments on the manuscript.
Authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
There was no source of funding for this research.
Not commissioned; externally peer reviewed.
Joossens L, Raw M. The tobacco control scale 2016 in Europe. Brussels, Belgium: Association of European Cancer Leagues; 2017. https://www.cancer.be/sites/de.... Accessed February 8, 2019.
Hipple Walters B, Petrea I, Lando H. Tobacco Control in Low-and Middle-Income Countries: Changing the Present to Help the Future. J Smok Cessat. 2018;13(4):187-188. doi:10.1017/jsc.2018.4
Andersson TM, Engholm G, Brink AL, et al. Tackling the tobacco epidemic in the Nordic countries and lower cancer incidence by 1/5 in a 30-year period -The effect of envisaged scenarios changing smoking prevalence. Eur J Cancer. 2018;103:288-298. doi:10.1016/j.ejca.2018.02.031
Starchenko P. Tobacco-Free Europe: Meeting New Challenges, Driving to Tobacco Endgame. 2017. http://ensp.org/2017/05/31/ath.... Accessed February 8, 2019.
Ministerie van VWS, Nationaal Preventieakkoord. Naar een gezonder Nederland. Hague: Ministry of Public Health, Welfare and Sport; 2018.
Ministry of Social Affairs and Health. Roadmap to a Tobacco-free Finland: Action Plan on Tobacco Control. Helsinki, Finland: Ministry of Social Affairs and Health; 2014. http://julkaisut.valtioneuvost.... Accessed February 8, 2019.
Department of Health. Tobacco free Ireland: Report of the Tobacco Policy Review Group. Dubin, Ireland: Department of Health; 2013. https://health.gov.ie/wp-conte.... Accessed February 8, 2019.
Scottish Government. Creating a tobacco-free generation: A Tobacco Control Strategy for Scotland. Edinburgh, Scotland: Scottish Government; 2013. https://www2.gov.scot/resource.... Accessed February 8, 2019.
French Ministry of Solidarity and Health. Priorité prevention: Rester en bonne santé tout au long de sa vie. Paris, France: Ministère des Solidarités et de la Santé, Ministre de l’Action et des Comptes publics; 2018. https://solidarites-sante.gouv.... Accessed February 8, 2019.
Willemsen MC, Kiselinova M, Nagelhout GE, Joossens L, Knibbe RA. Concern about passive smoking and tobacco control policies in European countries: an ecological study. BMC Public Health. 2012;12(1):876. doi:10.1186/1471-2458-12-876
Martínez-Sánchez JM, Fernández E, Fu M, et al. Smoking behaviour, involuntary smoking, attitudes towards smoke-free legislations, and tobacco control activities in the European Union. PLoS ONE. 2010;5(11):e13881. doi:10.1371/journal.pone.0013881
Chung-Hall J, Craig L, Gravely S, et al. Impact of the WHO FCTC over the first decade: a global evidence review prepared for the Impact Assessment Expert Group. Tob Control. 2019;28:s119-s128. https://tobaccocontrol.bmj.com.... Accessed February 8, 2019.
World Health Organization. Building blocks for tobacco control: A handbook. Geneva, Switzerland: World Health Organization; 2014. https://www.who.int/tobacco/re.... Accessed February 8, 2019.
Méndez D, Alshanqeety O, Warner KE. The potential impact of smoking control policies on future global smoking trends. Tob Control. 2013;22(1):46-51. doi:10.1136/tobaccocontrol-2011-050147
Van der Eijk Y. Development of an integrated tobacco endgame strategy. Tob Control. 2015;24(4):336-340. doi:10.1136/tobaccocontrol-2013-051211
World Health Organization. Parties to the WHO Framework Convention on Tobacco Control. http://www.who.int/fctc/signat.... Accessed November 28, 2018.
World Health Organization. Guidelines and policy options and recommendations for implementation of the WHO FCTC. http://www.who.int/fctc/treaty.... Accessed November 28, 2018.
Willemsen MC. Tobacco Control Policy in the Netherlands: Between Economy, Public Health, and Ideology. New York, NY: Palgrave Macmillan; 2018. https://www.palgrave.com/gp/bo.... Accessed February 8, 2019.
Giovino GA, Kulak JA, Kalsbeek WD, Leischow SJ. Research Priorities for FCTC Articles 20, 21, and 22: Surveillance/Evaluation and Information Exchange. Nicotine Tob Res. 2013;15(4):847-861. doi:10.1093/ntr/nts336
Warner KE, Tam J. The impact of tobacco control research and policy: 20 years of progress. Tob Control. 2012;21(2):103-109. doi:10.1136/tobaccocontrol-2011-050396
Hatchard JL, Fooks GJ, Evans-Reeves KA, Ulucanlar S, Gilmore AB. A critical evaluation of the volume, relevance and quality of evidence submitted by the tobacco industry to oppose standardised packaging of tobacco products. BMJ Open. 2014;4(2):e003757. doi:10.1136/bmjopen-2013-003757
Lie JLY, Fooks G, de Vries NK, Heijndijk SM, Willemsen MC. Can’t see the woods for the trees: exploring the range and connection of tobacco industry argumentation in the 2012 UK standardised packaging consultation. Tob Control. 2018;27:448-454. doi:10.1136/tobaccocontrol-2017-053707
Cairney P, Studlar D, Mamudu H. Global tobacco control: Power, policy, governance and transfer. Governance. 2012;27(4):735-737. doi:10.1111/gove.12113
Weishaar H. Tobacco research in the European Union: Call for action and lessons learned. Brussels: Smoke Free Partnership; 2017. file:///C:/Users/Chatzopoulou/Downloads/SFP-Article20-report_20jun2017.pdf. Accessed February 8, 2019.
ASPECT Consortium. Tobacco or health in the European Union: Past, present and future. Luxembourg: Office for Official Publications of the European Communities; 2004. http://ec.europa.eu/health/arc.... Accessed February 8, 2019.
UKTAS. UK Centre for Tobacco & Alcohol Studies. https://www.ukctas.net/. Accessed November 28, 2018.
NNvT. Nederlands Netwerk voor Tabaksonderzoek (NNVT). www.nnvt.org. Accessed February 8, 2019.
Willemsen MC, Nagelhout GE. Country differences and changes in focus of scientific tobacco control publications between 2000 and 2012 in Europe. Eur Addict Res. 2016;22(1):52-58. doi:10.1159/000381674
Man JP, Weinkauf JG, Tsang M, Sin JHD. Why do some countries publish more than others? An international comparison of research funding, English proficiency and publication output in highly ranked general medical journals. Eur J Epidemiol. 2004;19(8):811-817. doi:10.1023/b:ejep.0000036571.00320.b8
Daube M, Moodie R, McKee M. Towards a smoke-free world? Philip Morris International's new Foundation is not credible. Lancet. 2017;390(10104):1722-1724. doi:10.1016/s0140-6736(17)32561-8
Studlar DT. Tobacco control policy instruments in a shrinking world: How much policy learning? International Journal of Public Administration. 2006;29(4-6):367-396. doi:10.1080/01900690500437006
Geneau R, Stuckler D, Stachenko S, et al. Raising the priority of preventing chronic diseases: a political process. Lancet. 2010;376(9753):1689-1698. doi:10.1016/s0140-6736(10)61414-6
Wipfli H, Stillman F, Tamplin S, da Costa SVL, Yach D, Samet J. Achieving the Framework Convention on Tobacco Control’s potential by investing in national capacity. Tob Control. 2004;13(4):433-437. doi:10.1136/tc.2003.006106
Stillman FA, David AM, Kibria N, Phan HT. Building capacity for implementation of the framework convention for tobacco control in Vietnam: lessons for developing countries. Health Promot Int. 2014. 29(3):442-453. doi:10.1093/heapro/dat005
Lasker RD, Weiss ES, Miller R. Partnership Synergy: A Practical Framework for Studying and Strengthening the Collaborative Advantage. Milbank Q. 2001;79(2):179-205. doi:10.1111/1468-0009.00203
Nielson P. Tobacco Control and Development Policy. Brussels: European Comission, World Health Organization, World Bank; 2003. https://ec.europa.eu/health/to.... Accessed February 8, 2019.
UK Centre for Tobacco and Alcohol Studies. Tobacco Control Capacity Programme. https://ukctas.net/GCRF-TCCP.h.... Accessed December 13, 2018.
Ikeda T, Cobiac L, Wilson N, Carter K, Blakely T. What will it take to get to under 5% smoking prevalence by 2025? Modelling in a country with a smoke free goal. Tob Control. 2015;24(2):139-145. doi:10.1136/tobaccocontrol-2013-051196
Levy DT, Blackman K, Currie LM, Levy J, Clancy L. SimSmokeFinn: how far can tobacco control policies move Finland toward tobacco-free 2040 goals? Scand J Public Health. 2012;40(6):544-552. doi:10.1177/1403494812456635