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This study aimed to characterize the current state and evolution of tobacco epidemic in Portuguese school-aged adolescents and to compare it with other European countries&#44; by sex&#44; based on data from the Health Behaviour in School-Aged Children &#40;HBSC&#41; reports from 1997&#47;1998<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> &#40;the date on which Portugal became integrated into this report&#41; to 2013&#47;2014&#44; the latest study&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These reports are based on data collected by self-report questionnaires applied to adolescents aged 11&#44; 13 and 15 years old&#44; from 19 European countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a> For this study&#44; daily and weekly smoking was grouped as regular smoking &#40;including those who smoke &#8220;at least one cigarette per week&#8221;&#41;&#46; According to the most recent HBSC report&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> the prevalence of regular smokers aged 15 years old in Portugal is 12&#37; among boys and 10&#37; among girls&#44; which is similar to the European mean prevalence &#40;12&#37; among boys and 11&#37; among girls&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding the evolution of tobacco consumption in Portugal&#44; between 1997&#47;1998 and 2013&#47;2014&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a> the prevalence of regular smoking among adolescents aged 15 years old has decreased from 19&#37; to 12&#37; in boys and from 14&#37; to 10&#37; in girls&#59; at 13 years old&#44; the smoking prevalence has decreased from 5&#37; in boys and 4&#37; in girls to 3&#37; for both sexes&#59; at 11 years old a decrease was also observed from 2&#37; in boys and girls to 1&#37; in boys and 0&#37; in girls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Concerning the evolution of regular smoking prevalence in the 19 European Union countries from 1997&#47;1998 to 2013&#47;2014&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a> oscillations occurred over time in both males &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#41; and females &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#41;&#46; Among male adolescents&#44; a decrease in the prevalence of regular smokers was observed in the majority of the European countries between the 1997&#47;1998 and 2009&#47;2010 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#41;&#46; Between 2009&#47;2010 and 2013&#47;2014&#44; a decrease in the smoking prevalence was registered in all countries with the exception of Portugal&#44; which registered an increase of 1 percentage point in relation to the previous four years&#46; According to data from the HBSC reports between 1997&#47;1998 and 2013&#47;2014&#44; the prevalence of female smoking adolescents &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#41; in Europe has been decreasing in a general and accentuated way&#44; especially in the last four years&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In the majority of the countries that participated in the HBSC study&#44; gender differences in prevalence were found&#59; for example Hungary&#44; France&#44; Slovakia&#44; Czech Republic&#44; Germany&#44; Denmark and Sweden present higher prevalence among girls&#46; The rise in consumption among girls&#44; particularly in Central and Eastern Europe&#44; is a cause for concern and specific aspects related to female smoking should be reflected in preventive measures&#44; such as the risk of thromboembolic complications when consumption occurs simultaneously with hormonal contraceptives&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Like Portugal&#44; the majority of the European countries have opted for partial smoking bans in public places&#44; however some countries have gone further&#44; opting for complete bans in enclosed public places&#44; public transport and workplaces&#44; and these factors can help to explain the differences in prevalence registered among the countries in the HBSC study&#46; Those countries with a lower prevalence of regular smoking among adolescents &#40;Norway and Sweden&#41; have developed preventive measures such as smoking prevention programmes at schools&#44; besides legislative policies banning smoking in public places and all outdoor areas of kindergartens&#44; primary and secondary schools&#44; and areas close to the entrances of health institutions and public companies&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The combined effect of public awareness interventions and strategies and bans to control smoking &#40;e&#46;g&#46;&#44; restrictions on tobacco vending and purchase age&#41; with strict policies implemented in many countries and regions &#40;including the increase in prices and tobacco taxes&#44; bans on smoking in public places and restrictions in advertising&#41;&#44; along with the implementation of school-based programmes with parental and community involvement seems to be associated with a reduction of tobacco consumption in adolescence&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">At a moment in which the smoking epidemics seem to be stabilized&#44; the investment in preventive measures at school&#44; through health promotion and education&#44; is essential&#46; In Portugal&#44; the &#8220;SmokeOut&#8221; curriculum-based programme constitutes a validated and available resource for implementation in school context&#44; presenting promising results in improving student attitudes and knowledge about smoking and in preventing tobacco consumption&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Afterwards&#44; longitudinal evaluation of these interventions is essential to produce evidence-based knowledge on smoking prevention&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This study was co-funded by national funding from the Foundation for Science and Technology &#40;FCT&#41; and by the Programa Operacional Capital Humano &#40;POCH&#41;&#44; co-participated by the European Social Fund and by national funds of MCTES&#44; under the PhD scholarship SFRH&#47;BD&#47;125425&#47;2016 &#40;to Isabel Sousa&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Correspondence
Current state and evolution of the tobacco epidemic in Portuguese and European school-aged adolescents by sex, between the years 1998 and 2014
I. Sousaa,
Corresponding author
isabelsousa@ie.uminho.pt

Corresponding author.
, C. Samorinhab, J. Preciosoa
a Instituto de Educação, Universidade do Minho, Campus de Gualtar, 4700-057 Braga, Portugal
b EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n.° 135, 4050-600 Porto, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">To prevent tobacco consumption among adolescents&#44; Portugal and other countries have implemented policies such as the development of curriculum-based programmes&#44; environmental changes &#40;e&#46;g&#46;&#44; smoke-free schools&#59; bans on smoking in public places&#41;&#59; parental involvement and restrictive strategies for tobacco access &#40;e&#46;g&#46;&#44; restriction of tobacco purchase age&#44; creation of specific places for selling&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; despite the global progress in tobacco control&#44; more than one third of the world&#39;s population is still unprotected from the level recommended by the MPOWER approach adopted by WHO&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Monitoring the tobacco epidemic is necessary to evaluate the effectiveness of the preventive measures developed to control tobacco consumption by adolescents and adults&#46; This study aimed to characterize the current state and evolution of tobacco epidemic in Portuguese school-aged adolescents and to compare it with other European countries&#44; by sex&#44; based on data from the Health Behaviour in School-Aged Children &#40;HBSC&#41; reports from 1997&#47;1998<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> &#40;the date on which Portugal became integrated into this report&#41; to 2013&#47;2014&#44; the latest study&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These reports are based on data collected by self-report questionnaires applied to adolescents aged 11&#44; 13 and 15 years old&#44; from 19 European countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a> For this study&#44; daily and weekly smoking was grouped as regular smoking &#40;including those who smoke &#8220;at least one cigarette per week&#8221;&#41;&#46; According to the most recent HBSC report&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> the prevalence of regular smokers aged 15 years old in Portugal is 12&#37; among boys and 10&#37; among girls&#44; which is similar to the European mean prevalence &#40;12&#37; among boys and 11&#37; among girls&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding the evolution of tobacco consumption in Portugal&#44; between 1997&#47;1998 and 2013&#47;2014&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a> the prevalence of regular smoking among adolescents aged 15 years old has decreased from 19&#37; to 12&#37; in boys and from 14&#37; to 10&#37; in girls&#59; at 13 years old&#44; the smoking prevalence has decreased from 5&#37; in boys and 4&#37; in girls to 3&#37; for both sexes&#59; at 11 years old a decrease was also observed from 2&#37; in boys and girls to 1&#37; in boys and 0&#37; in girls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Concerning the evolution of regular smoking prevalence in the 19 European Union countries from 1997&#47;1998 to 2013&#47;2014&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a> oscillations occurred over time in both males &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#41; and females &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#41;&#46; Among male adolescents&#44; a decrease in the prevalence of regular smokers was observed in the majority of the European countries between the 1997&#47;1998 and 2009&#47;2010 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#41;&#46; Between 2009&#47;2010 and 2013&#47;2014&#44; a decrease in the smoking prevalence was registered in all countries with the exception of Portugal&#44; which registered an increase of 1 percentage point in relation to the previous four years&#46; According to data from the HBSC reports between 1997&#47;1998 and 2013&#47;2014&#44; the prevalence of female smoking adolescents &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#41; in Europe has been decreasing in a general and accentuated way&#44; especially in the last four years&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In the majority of the countries that participated in the HBSC study&#44; gender differences in prevalence were found&#59; for example Hungary&#44; France&#44; Slovakia&#44; Czech Republic&#44; Germany&#44; Denmark and Sweden present higher prevalence among girls&#46; The rise in consumption among girls&#44; particularly in Central and Eastern Europe&#44; is a cause for concern and specific aspects related to female smoking should be reflected in preventive measures&#44; such as the risk of thromboembolic complications when consumption occurs simultaneously with hormonal contraceptives&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Like Portugal&#44; the majority of the European countries have opted for partial smoking bans in public places&#44; however some countries have gone further&#44; opting for complete bans in enclosed public places&#44; public transport and workplaces&#44; and these factors can help to explain the differences in prevalence registered among the countries in the HBSC study&#46; Those countries with a lower prevalence of regular smoking among adolescents &#40;Norway and Sweden&#41; have developed preventive measures such as smoking prevention programmes at schools&#44; besides legislative policies banning smoking in public places and all outdoor areas of kindergartens&#44; primary and secondary schools&#44; and areas close to the entrances of health institutions and public companies&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The combined effect of public awareness interventions and strategies and bans to control smoking &#40;e&#46;g&#46;&#44; restrictions on tobacco vending and purchase age&#41; with strict policies implemented in many countries and regions &#40;including the increase in prices and tobacco taxes&#44; bans on smoking in public places and restrictions in advertising&#41;&#44; along with the implementation of school-based programmes with parental and community involvement seems to be associated with a reduction of tobacco consumption in adolescence&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">At a moment in which the smoking epidemics seem to be stabilized&#44; the investment in preventive measures at school&#44; through health promotion and education&#44; is essential&#46; In Portugal&#44; the &#8220;SmokeOut&#8221; curriculum-based programme constitutes a validated and available resource for implementation in school context&#44; presenting promising results in improving student attitudes and knowledge about smoking and in preventing tobacco consumption&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Afterwards&#44; longitudinal evaluation of these interventions is essential to produce evidence-based knowledge on smoking prevention&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This study was co-funded by national funding from the Foundation for Science and Technology &#40;FCT&#41; and by the Programa Operacional Capital Humano &#40;POCH&#41;&#44; co-participated by the European Social Fund and by national funds of MCTES&#44; under the PhD scholarship SFRH&#47;BD&#47;125425&#47;2016 &#40;to Isabel Sousa&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Article information
ISSN: 25310437
Original language: English
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