Prevalence and patterns of tobacco use in Serbia
Biljana Kilibarda
Institute of Public Health of Serbia
Background
• Three laws under different ministries
• Gap in smoke free law and low compliance
• TPD not transposed into legislation
• High exposure to tobacco smoke and prevalence of smoking since years
• Emerging tobacco products on the market
• Changing patterns of nicotine/tobacco products use
Youth
Adults
Available surveys/researches
ESPAD
GYTS
HBSC
Health surveys (15+)
Annual surveys among adults (18+)
Survey among hospitality sector vistors
Vulnebrable populationBio-bihevioural surveys
Lack of data
Tobacco/nicotine use among youth
Пушење цигарета
3,1
8,0
24,8
2,1
6,1
31,8
2,6
7,1
28,3
14,5
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
V grade ES VII grade ES I grade HS
Boys Girls Total Serbia total (among students V, VII gradae ES and I grade HS)
Lifetime cigarette smoking, students by grade
IPHS. HBSC Serbia 2018
2,0%3,5%
17,9%
1,0%2,2%
22,0%
1,5%2,9%
20,0%
9,5%
0,0%
5,0%
10,0%
15,0%
20,0%
25,0%
V grade ES VII grade ES I grade HS
Boys Girls Total Serbia total all grades
Current cigarette smoking, students by grade
IPHS. HBSC Serbia 2018
Lifetime and current WTS, students I grade HS
IPHS. HBSC Serbia 2018
27,1
31,529,3
17,216,0 16,6
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
Boys Girls Total
Lifetime WTS Current WTS
Current cigarette smoking, students 13-15 by year (%) – GYTS *
IPHS. GYTS Serbia 2018
12,2
13,1 12,8
9,38,9
9,3
12,713,3 13,0
10,9 11,2 11,0
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
Boys Girls Total
2003 2008 2013 2017
10,9
7,6
9,2
11,2
4,8
8,7
11,0
6,2
9,0
0,0
2,0
4,0
6,0
8,0
10,0
12,0
Cigarette E cigarette Waterpipe
Boys Girls Total
Current cigarette, e-cigarette and waterpipe smoking, students 13-15 (%) – GYTS 2017 *
Eight different categories of students according to tobacco/nicotine use status:- non users- cigarette only- waterpipe only- e-cigarette only- dual e-cigarette and waterpipe- dual e-cigarette and cigarette- dual waterpipe and cigarette - poly tobacco/nicotine users
52,839,3 45,7
12,2
21,9
15,9
11,0
22,227,5
12,822,9
15,8
Cigarette Ecigarette Wateripe
Excusive cigarette Exclusive e-cigarette
Exclusive wateripe Dual ecig and cig
Current cigarette, e-cigarette and waterpipe smoking, students 13-15 (%)– GYTS *
IPHS. GYTS Serbia 2018
2,5
7,5
2,2
5,3
6,5
4,5
11,7
9,0
10,7
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
Exclusive cigarette smoking EC/WP Cig and other products
7th grade 8th grade 1st grade sec. school
Among student in the youngest group of students e-cigarette and/or waterpipe tobacco smoking threefold higher than exclusive cigarette use
Curent tobacco/nicotine products use by school grade(%), students 13-15, Serba, 2017
Exposure to tobacco smoke
72
40
58
64
56
73
66
74
45
3532 31
22
34
39 38
51
59
54 54
47
5350
54
50 4947 47
42
5249
47
0
10
20
30
40
50
60
70
80
2010. 2011. 2012. 2014. 2015. 2016. 2017. 2018
Exposure-hospitality sector
Exposure -workplace
*where applicable
Exposure to tobacco smoke* at work and in hospitality sector, Serbia, 2010-2018
Survey on attitudes towards SF law, adults, Serbia
Is smoking allowed in your household?Serbia(%), 2018
40
35
13 12
0
5
10
15
20
25
30
35
40
45
Yes, everywhere Yes, but only in somerooms
Only terrace, yars No, nowhere
Survey on attitudes towards SF law, adults, Serbia
Exposure to secondhand smoke in hospitality sector in the past 12 months (%)
73
88
0 10 20 30 40 50 60 70 80 90 100
Restaurant
Café
IPHS. Smoking among adult vistors of hospitality sector, 2018
Answers to Q „How often are you exposed to secondhand smoke in no-smoking part of the hospitality sector?“ (%)
28
18
17
17
0 5 10 15 20 25 30
Always/very often
Often
Rarely
Very rarley/never
IPHS. Smoking among adult vistors of hospitality sector, 2018
Percantage of visitors stating that exposure to secondhand smoke in the hospitality sector bothers them
59
52
48 50 52 54 56 58 60
Restaurant
Café
IPHS. Smoking among adult vistors of hospitality sector, 2018
4
78
18
5
78
17
0
10
20
30
40
50
60
70
80
90
Yes No NA/DK/don’t rempember
Café Restourant
In the last 12 months, have you ever asked someone not to smoke as it bothered you?
51
22
27
64
18 17
38
26
36
0
10
20
30
40
50
60
70
Agree Neutral Disagree
Total Smokers Non smokers
Level of agreement/disagreement with the statement“Smoke free law violates smokers” right
The highest perecantage of smokers is among age group 45-54
42,4
34,7
49,646,9
42,537,7
40,244,7
20,4
27,1
45,1
12,115,5
32,9
0
10
20
30
40
50
60
2000.god 2006 2013
20 - 34 35 - 44 45 - 54 55 - 64 65 +
Smoking prevalence (%) among Serbian adults, Health Survey 2000-2013
Adults
Smoking among vulnerable/stigmatized and general populations (%) in 2013 in Serbia, by gender
Vulnerable groups
Lifetime prevalence of cigarette, waterpipe, HTPs and electronic cigarette use among Serbian adults
59,0
58,0
58,0 58,052,0
51,0
55,051,0
50,0
55,0
3,17,8
5,98,911,2
7,2
10,613,0
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
XI 2010 III 2011 V 2011 XI 2011 2012 2014 2015 2016 2017 2018
Smoking LTP HTPS LTP WTS LTP EC
Surveys on attitudes towards SF law, adults, Serbia
42,0 42,0
37,0
39,0
37,0
1,6
0,6
0,8
0,2
1,2
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
34,0
35,0
36,0
37,0
38,0
39,0
40,0
41,0
42,0
43,0
XI 2010 III 2011 V 2011 XI 2011 XII 2012 XII 2014 2015 2016 2017 2018
Smoking Current e-cigarette use Current HTP
Current use of cigarette, waterpipe; HTPs and electronic cigarette use among Serbian adults (%)
Surveys on attitudes towards SF law, adults, Serbia
What is the dominant factor that influence choice of cigarettes?
41
31
13
10
2
3
0 5 10 15 20 25 30 35 40 45
Price
Taste
TNCO info
Specific brand
Flavours/additives
Design
Survey on attitudes towards SF law, adults, 2018 Serbia
Weaknesses/gaps/challanges
M
P
O
Lack of advanced monitoring of exposure to tobacco smoke
• Exemption for hospitality sector• Insufficient compliance
• Low demand and low coverage with interventions • No national Quit line• Low motivation to provide smoking cessation services and high
smoking prevalence among health professionals
Weaknesses/gaps/challanges
W
E
R
• Insufficient funds• No recent campaigns• No pictorial warnings• Textual warnings -at least 30% of the front and 40% of back
side of the packs
• Exemption for point of sale• Limited bans on indirect advertising, promotion and
sponsorship
• Affordable tobacco products
THANK YOU FOR YOUR ATTENTION