Methods 2021

The Tobacco Control Scale 2021 in Europe

The survey was conducted in 2004, 2005 (1), 2007 (3), 2010 (4), 2013 (5), 2016 (6), 2019 (7), and 2021. In 2004, the survey involved 28 countries: 25 European Union (EU) countries plus Switzerland, Iceland and Norway. In 2005 and 2007, the survey was repeated in 30 European countries (27 EU countries plus Switzerland, Iceland and Norway) (3), and in 2010 in 31 European countries (the 2007 sample plus Turkey). The 2016 survey was conducted in 35 European countries: the 2010 sample plus Croatia, Serbia, Ukraine and the Russian Federation. In 2019, Israel was added to the list of countries. In 2021, we have scored 37 countries with the inclusion of Bosnia & Herzegovina. The correspondents who provided the information in 2021 are shown in Table 1.

The data used for the 2021 survey refers to legislation in force on 1 January 2022, to 2020 cigarette price data, and to the tobacco control budget in 2020. Any legislation, price increase, or funding introduced or enforced after those dates are not included.

A questionnaire was used to collect information about countries’ tobacco control budgets and tobacco dependence treatment provisions from the contributors consulted (Table 1). The following other data sources were used:

PRICE

The weighted average price of a pack of 20 cigarettes in 2020 was based on the 2021 European Commission report “Excise duty tables. Part III Manufactured Tobacco.
The retail price of a pack of cigarettes (premium brand) for the non-EU countries: WHO Report on the Global Tobacco Epidemic, 2021. Geneva, World Health Organization, 2021 Table 9.20 Retail price of a pack of cigarettes: premium brand and cheapest brand.

ADVERTISING

An update of the legislation on advertising from the contributors or from health officials.

SMOKE FREE LEGISLATION

Smoke Free Partnership, 2022 Smoke Free Map.
European Commission. Eurobarometer 506, Attitudes of Europeans towards Tobacco and Electronic Cigarettes. Brussels: European Commission; 2021.

LABELLING

Canadian Cancer Society. Cigarette package health warnings. International status report. Ottawa: Canadian Cancer Society, 2021

DATABASES

WHO Report on the Global Tobacco Epidemic 2021. Geneva: World Health Organization, 2021.
Campaign for Tobacco Free Kids, Tobacco Control Laws. Washington DC: Campaign For Tobacco Free Kids; 2021.

TOBACCO CONTROL AND CESSATION BUDGET

Information was collected in 2022 from the contributors or from health officials.

TOBACCO INDUSTRY INTERFERENCE

STOP, Global Tobacco Industry Interference Index 2021.
Information was collected in 2022 from the contributors or from health officials.

ILLICIT TOBACCO TRADE

Ratification of the Protocol to Eliminate the Illicit Trade in Tobacco Products: United Nations Treaty Collection.
Framework Convention Alliance, Why the EU Tracking and Tracing system works only for the EU, Policy Briefing, 2018.

Countries that ratified the WHO FCTC Protocol to Eliminate the Illicit Trade in Tobacco Products (FCTC Protocol) received 1 point. A track and trace system for tobacco products, fully WHO FCTC Protocol compliant, is 2 points and a track and trace system for tobacco products, but not fully WHO FCTC Protocol compliant, is 1 point. A whole range of measures, well enforced, monitored and sanctioned, to restrict tobacco industry interference is 2 points. Some measures, well enforced, to restrict tobacco industry interference is 1 point. A single measure to limit the tobacco industry interaction at the Ministry of Health level (and not the whole government) is not enough to obtain 1 point. Examples of policies could include the recording and disclosure of meetings with the tobacco industry, the limitation of interactions with the tobacco industry to those only strictly necessary, or a code of conduct for public officials with which they should comply in their dealings with the tobacco industry.