Variation across Romania in the health impact of increasing tobacco taxation.

Background: Tobacco is the leading preventable cause of death globally and tobacco taxation is a cost-effective method of reducing tobacco use in countries and increasing revenue. However, without adequate enforcement some argue the risk of increasing illicit trade in cheap tobacco makes taxation ineffective. We explore this by testing sub-national variations in the impact of tobacco tax increases from 2009 to 2011, on seven smoking-related diseases in adults in Romania, to see if regions that are prone to cigarette smuggling due to bordering other countries see less benefit. Method: We use a pragmatic natural experiment study approach to analyse the study period 2009-15. Findings from hospital episodes data relating to smoking-attributable diseases are analysed for six regional subgroups which are compared according to border characteristics with other countries. Results: At a national level smoking-attributable diseases reduced over the study period especially around the tax increase years, with asthma showing the most significant decline. Sub-nationally there was no statistically significant correlation in variations between central regions and those bordering other countries. Conclusion: There is a reassuring decline in hospitalizations for smoking-related diseases associated with the tax increases, and no sub-national association with smuggling risk measured by variation in the size of this effect and regions that border other countries. More comprehensive and progressive tobacco control in Romania should be implemented in line with the WHO Framework Convention for Tobacco Control.

[The new directive on tobacco products: "(a Battle) ended, (Battle) is just beginning"!]. / Noua directiva privind produsele din tutun: "(Batalia) s-a terminat; (Batalia) de-abia începe"!

As tobacco products are sold in all the 28 member states of the European Union, they are subject of regulation of the internal common market. Thus, the Directive 2001/37/EC lays down rules at Union level concerning the manufacture, presentation and sale of tobacco products. In order to reflect scientific, market and international developments, substantial changes have to be made and the Directive was replaced by a new Directive. The process has begun in 2009 and was finished in December 2013, with a political agreement regarding the new provisions. The final vote in the European Parliament (expected for February 2014) will mark the end of a long and difficult legislative process. The article presents the main changes of the regulation of tobacco products from the point of view of health professionals, closer to their expectations and understandings. The complete text in Romanian and English language of the new directive will be available on: www.stopfumat.eu.

[Information group--a solution to increase the efficacy of specialized intervention for smoking cessation]. / Grupul de informare--o solutie de crestere a eficacitatii consultatiei specializate pentru renuntarea la fumat.

Since 2007, in Romania, the Ministry of Health implements the national programme for tobacco control which contains also a sub-programme for sustaining smoking cessation through free treatment and counselling. Because the specialised intervention lasts too long (often more than 60 minutes) and the requests for support increased with a high rate, we had to identify methods to increase the efficacity of the intervention and, thus, the efficiency. According to this new situation, since January 2008, all the smokers asking for support to the Center for Smoking Cessation from the National Institute of Pneumology "Marius Nasta" had to participate to an "information group" prior to visit to the doctor or/and psychologist for specialized help. The aim of this group is to offer the common information needed by all smokers and does not have any elements of group therapy. During 1st January 2008 - 31st December 2009, 829 smokers asked for help in Bucharest centers, from which 585 addressed to the physicians and 288 to the psychologists, a percentage being referred to both specialists. The smokers who are going directly to the specialist tend to choose only one specialist (67,8% doctor and 24% psychologist); only 8,1% are going to both specialists. In the meantime, those smokers who are participating to the information group, are using the services of both counsellors: 30,8% comparing with 28,2% only to doctor and 9,4% only to psychologist. Comparing with the smokers who went directly to the doctor, the smokers who underwent the group of information had an increased succes rate at 3 months after quiting with 27,8%. Also, the percentage of "lost" persons decreased with 51%. Participation to the information group increases the likelihood of attendance to both specialists by 2,8 times. The common approach of the smoker increased the abstinence rate independently of the participation to the information group: 44% increase for smokers who participated to the information group, and 67,3% for persons that directly addressed to the physician. In conclusion, organising an information group will increase the double approach of the smoker (by physician and psychologist) which, in turn, will increase the success rate and the efficiency of the medical act.