Silvano Gallus - Academia.edu (original) (raw)

Papers by Silvano Gallus

Research paper thumbnail of Evidence-informed recommendations to reduce dissemination bias in clinical research: conclusions from the OPEN (Overcome failure to Publish nEgative fiNdings) project based on an international consensus meeting

BMJ open, 2015

Dissemination bias in clinical research severely impedes informed decision-making not only for he... more Dissemination bias in clinical research severely impedes informed decision-making not only for healthcare professionals and patients, but also for funders, research ethics committees, regulatory bodies and other stakeholder groups that make health-related decisions. Decisions based on incomplete and biased evidence cannot only harm people, but may also have huge financial implications by wasting resources on ineffective or harmful diagnostic and therapeutic measures, and unnecessary research. Owing to involvement of multiple stakeholders, it remains easy for any single group to assign responsibility for resolving the problem to others. To develop evidence-informed general and targeted recommendations addressing the various stakeholders involved in knowledge generation and dissemination to help overcome the problem of dissemination bias on the basis of previously collated evidence. Based on findings from systematic reviews, document analyses and surveys, we developed general and targ...

Research paper thumbnail of Towards a greater understanding of the illicit tobacco trade in Europe: a review of the PMI funded 'Project Star' report

Tobacco control, 2014

Following a legal agreement with the European Union (EU), Philip Morris International (PMI) commi... more Following a legal agreement with the European Union (EU), Philip Morris International (PMI) commissions a yearly report ('Project Star', PS) on the European illicit cigarette trade from KPMG, the global accountancy firm. Review of PS 2010 report. Comparison with data from independent sources including a 2010 pan-European survey (N=18,056). Within PS, data covering all 27 EU countries are entered into a model. While the model itself seems appropriate, concerns are identified with the methodologies underlying the data inputs and thus their quality: there is little transparency over methodologies; interview data underestimate legal non-domestic product partly by failing to account for legal cross-border sales; illicit cigarette estimates rely on tobacco industry empty pack surveys which may overestimate illicit; and there is an over-reliance on data supplied by PMI with inadequate external validation. Thus, PMI sales data are validated using PMI smoking prevalence estimates, ye...

Research paper thumbnail of PPACTE policy recommendations and integrated report

Research paper thumbnail of Aspirin and Prostate Cancer Prevention

Recent Results in Cancer Research, 2014

Aspirin has been associated to a reduced risk of colorectal, and possibly of other cancers. Data ... more Aspirin has been associated to a reduced risk of colorectal, and possibly of other cancers. Data from at least 25 observational studies also suggest a modest reduced risk of prostate cancer in regular aspirin users, with a summary relative risk, RR, of 0.91 (95 % confidence interval, CI, 0.86-0.96) overall, 0.87 (95 % CI 0.74-1.02) from nine case-control studies, and 0.92 (95 % CI 0.87-0.97) from 16 cohort studies. However, risk estimates are heterogeneous and there is no relation with frequency, dose, or duration of aspirin use. Data from randomized controlled trials of aspirin for the prevention of vascular events showed a nonsignificant reduced risk of death from prostate cancer after a latent period of five or more years (RR 0.52, 95 % CI 0.20-1.24) based on 37 deaths from prostate cancer from seven trials. The RR was 0.81 (95 % CI 0.61-1.06) after 20 years of follow-up, based on 210 cases from three trials with long-term follow-up. Thus, data from observational studies and clinical trials are compatible with a modest favorable effect of aspirin on prostate cancer. Inference for causality and public health implications are, however, far from conclusive given the heterogeneity of results and the lack of dose and duration-risk relationships. Data on prostate cancer survival are still limited and inconsistent.

Research paper thumbnail of Relation between national-level tobacco control policies and individual-level voluntary home smoking bans in Europe

Tobacco control, Jan 21, 2014

Little is known about the relationship between national tobacco control policies and implementati... more Little is known about the relationship between national tobacco control policies and implementation of private home smoking bans. To determine the relationship between the Tobacco Control Scale (TCS), a score measuring national-level strength of tobacco control policies, and the prevalence of in-home smoking bans and beliefs on other tobacco control policies, among the Member States (MS) of the European Union (EU) that participated in the Pricing Policy And Control of Tobacco in Europe (PPACTE) project. A face-to-face representative survey, based on 18 056 individuals aged ≥15 years, from 18 European countries-including 16 EU MS-was conducted in 2010. Multilevel logistic regression models were fit to examine the relationship between the TCS score and in-home smoking ban prevalence and beliefs that other policy approaches are useful. In 2010, the TCS scores ranged from 32 in Austria and Greece to 77 in England. The TCS score correlated with the prevalence of in-home smoking bans (rsp...

Research paper thumbnail of Illicit cigarettes and hand-rolled tobacco in 18 European countries: a cross-sectional survey

Tobacco Control, 2012

Little evidence, other than that commissioned by the tobacco industry, exists on the size of the ... more Little evidence, other than that commissioned by the tobacco industry, exists on the size of the illicit tobacco trade. This study addresses this gap by examining the level and nature of illicit cigarettes and hand-rolled tobacco in 18 European countries. Face-to-face cross-sectional survey on smoking. 18 European countries. For each country, around 1000 subjects representative of the population aged 15 and over were enrolled. Current cigarette smokers were asked to show their latest purchased pack of cigarettes or hand-rolled tobacco. A comprehensive measure called an Identification of an Illicit Pack (IIP) was used to study the extent of illicit trade, defining a pack as illicit if it had at least one of the following tax evasion indicators: (1) it was bought from illicit sources, as reported by smokers, (2) it had an inappropriate tax stamp, (3) it had an inappropriate health warning or (4) its price was substantially below the known price in their market. Overall, the proportion of illicit packs was 6.5%. The highest prevalence of IIP was observed in Latvia (37.8%). Illicit packs were more frequent among less educated smokers and among those living in a country which shared a land or sea border with Ukraine, Russia, Moldova or Belarus. No significant association was found with price of cigarettes. This study indicates that IIP is less than 7% in Europe and suggests that the supply of illicit tobacco, rather than its price, is a key factor contributing to tax evasion.

Research paper thumbnail of Effects of the economic crisis on smoking prevalence and number of smokers in the USA

Tobacco Control, 2013

Scanty and controversial information is available on the impact of macroeconomic fluctuations on ... more Scanty and controversial information is available on the impact of macroeconomic fluctuations on smoking behaviour. No study has quantified the effects of fiscal crises on smoking prevalence. This study aimed to investigate the effects of the 2007-2008 economic crisis on smoking prevalence and number of smokers in the USA. Using data from the repeated Behavioural Risk Factor Surveillance System (BRFSS) surveys in pre-crisis (2005-2007) and post-crisis (2009-2010) periods on a total of 1,981,607 US adults, we separated the expected (after allowance for the demographic growth of the US population, secular smoking prevalence trends and changes in sociodemographic characteristics) from the unexpected (assumed attributable to the economic crisis) changes in the number of smokers across different employment statuses. Joinpoint regression analysis revealed no significant changes in smoking prevalence trends over the period 2005-2010. The crisis resulted in an increase in the number of smokers in the US by 0.6 million. This is largely due to an unexpected decrease of 1.7 million smokers among employed and an increase of 2.4 million smokers among unemployed individuals, whose smoking prevalence also remains extremely high in the post-crisis period (32.6%). The 2008 financial crisis had a weak effect on smoking prevalence. The pro-cyclical relationship (ie, the crisis results in a lower number of smokers) found among the employed is offset by the counter-cyclical relationship (ie, the crisis results in a higher number of smokers) found among unemployed individuals. Public health interventions should specifically target those in unemployment, particularly in hard times.

Research paper thumbnail of Attitudes towards the extension of smoking restrictions to selected outdoor areas in Italy

Tobacco Control, 2012

To estimate the attitudes of Italians on the extension of the smoking ban to selected public outd... more To estimate the attitudes of Italians on the extension of the smoking ban to selected public outdoor areas. The authors considered data from two Italian surveys on smoking conducted in 2009 and 2010 on a total sample of 6233 individuals, representative of the Italian population aged 15 years or over. 64.6% of Italians supported smoke-free policies in public parks, 68.5% in sports stadiums, 62.1% in beaches, 85.9% in school courtyards and 79.9% in outdoor areas surrounding hospitals. Among current smokers, the corresponding estimates were 32.9% for parks, 38.2% for stadiums, 31.2% for beaches, 67.6% for schools and 55.3% for hospitals. Extension of the smoking ban to selected outdoor areas is supported by the large majority of the Italian population. The overwhelming majority of support for smoke-free school grounds and outdoor areas surrounding hospitals indicates that legislative action is required.

Research paper thumbnail of Dietary iron intake and risk of non-fatal acute myocardial infarction

Public Health Nutrition, 2006

Objective: The relation between several measures of body iron and atherosclerotic disease, partic... more Objective: The relation between several measures of body iron and atherosclerotic disease, particularly acute myocardial infarction (AMI), is debated. This is of specific interest since iron is frequently included in supplementation and fortification of foods. We assessed the relation between dietary iron intake and the risk of non-fatal AMI. Design: Case-control study. The information was collected by interviewers using a food-frequency questionnaire tested for validity and reproducibility. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple unconditional logistic regression models, including terms for energy and alcohol intakea, as well as for sociodemographic factors, tobacco and other major recognised risk factors for AMI. Setting: Milan, Italy, between 1995 and 1999. Subjects: Cases were 507 patients, below age 79 years, with a first episode of non-fatal AMI, and controls were 478 patients admitted to hospital for a wide spectrum of acute conditions unrelated to known or potential AMI risk factors. Results: Compared with patients in the lowest tertile of total iron intake, the OR was 0.48 (95% CI 0.29 -0.82) for those in the highest tertile. The corresponding value for haem iron was 0.71 (95% CI 0.48-1.06), for non-haem, non-alcohol iron was 0.80 (95% CI 0.51 -1.24) and for iron derived from alcoholic beverages was 0.60 (95% CI 0.40-0.90). Sex-specific OR for total iron intake were not heterogeneous. Conclusions: In this Italian population dietary iron intake was inversely related to AMI risk. This inverse association may depend on other nutrients present in the major sources of iron in the Italian diet.

Research paper thumbnail of Socio-demographic variation in smoking habits: Italy, 2008

Preventive medicine, 2009

To provide updated information on smoking prevalence in Italy, with a focus on demographic and so... more To provide updated information on smoking prevalence in Italy, with a focus on demographic and socio-economic characteristics.

Research paper thumbnail of A population-based estimate of tobacco dependence

The European Journal of Public Health, 2004

Research paper thumbnail of Roll-your-own cigarettes in Europe

European Journal of Cancer Prevention, 2014

Excise duties on roll-your-own (RYO) tobacco, which are generally based on RYO cigarettes contain... more Excise duties on roll-your-own (RYO) tobacco, which are generally based on RYO cigarettes containing 1 g of tobacco, are lower than duties on factory-made (FM) cigarettes. This provides a price incentive for smokers to switch to RYO, the use of which is increasing across Europe. To effectively approximate duties on the two types of products, accurate data on the weight of RYO cigarettes are required. We provide updated information on RYO use and RYO cigarette weight across Europe. From a representative face-to-face survey conducted in 2010 in 18 European countries (Albania, Austria, Bulgaria, Czech Republic, Croatia, England, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Poland, Portugal, Romania, Spain and Sweden), we considered data from 5158 current smokers aged 15 years or above, with available information on daily consumption of FM and RYO cigarettes separately. In Europe, 10.4% of current smokers (12.9% of men and 7.5% of women) were 'predominant' RYO users (i.e. >50% of cigarettes smoked). This proportion was highest in England (27.3%), France (16.5%) and Finland (13.6%). The median weight of one RYO cigarette is 0.75 g (based on 192 smokers consuming exclusively RYO cigarettes). The proportion of RYO smokers is substantial in several European countries. Our finding on the weight of RYO cigarettes is consistent with the scientific literature and industry documents showing that the weight of RYO cigarettes is substantially lower than that of FM ones. Basing excise duties on RYO on an average cigarette weight of 0.75 g rather than 1 g would help increase the excise levels to those on FM cigarettes.

Research paper thumbnail of Pricing Policies And Control of Tobacco in Europe (PPACTE) project

European Journal of Cancer Prevention, 2014

Limited data on smoking prevalence allowing valid between-country comparison are available in Eur... more Limited data on smoking prevalence allowing valid between-country comparison are available in Europe. The aim of this study is to provide data on smoking prevalence and its determinants in 18 European countries. In 2010, within the Pricing Policies And Control of Tobacco in Europe (PPACTE) project, we conducted a face-to-face survey on smoking in 18 European countries (Albania, Austria, Bulgaria, Czech Republic, Croatia, England, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Poland, Portugal, Romania, Spain and Sweden) on a total of 18 056 participants, representative for each country of the population aged 15 years or older. Overall, 27.2% of the participants were current smokers (30.6% of men and 24.1% of women). Smoking prevalence was highest in Bulgaria (40.9%) and Greece (38.9%) and lowest in Italy (22.0%) and Sweden (16.3%). Smoking prevalence ranged between 15.7% (Sweden) and 44.3% (Bulgaria) for men and between 11.6% (Albania) and 38.1% (Ireland) for women. Multivariate analysis showed a significant inverse trend between smoking prevalence and the level of education in both sexes. Male-to-female smoking prevalence ratios ranged from 0.85 in Spain to 3.47 in Albania and current-to-ex prevalence ratios ranged from 0.68 in Sweden to 4.28 in Albania. There are considerable differences across Europe in smoking prevalence, and male-to-female and current-to-ex smoking prevalence ratios. Eastern European countries, lower income countries and those with less advanced tobacco control policies have less favourable smoking patterns and are at an earlier stage of the tobacco epidemic.

Research paper thumbnail of Pizza consumption and the risk of breast, ovarian and prostate cancer

European Journal of Cancer Prevention, 2006

Pizza has been favourably related to the risk of prostate cancer in North America. Scanty informa... more Pizza has been favourably related to the risk of prostate cancer in North America. Scanty information, however, is available on sex hormone-related cancer sites. We therefore studied the role of pizza consumption on the risk of breast, ovarian and prostate cancers using data from three hospital-based case-control studies conducted in Italy between 1991 and 2002. These included 2569 women with breast cancer, 1031 with ovarian cancer, 1294 men with prostate cancer, and a total of 4864 controls. Compared with non-pizza eaters, the multivariate odds ratios for eaters were 0.97 (95% confidence interval (CI) 0.86-1.10) for breast, 1.06 (95% CI 0.89-1.26) for ovarian and 1.04 (95% CI 0.88-1.23) for prostate cancer. Corresponding estimates for regular eaters (i.e. > or =1 portion per week) were 0.92 (95% CI 0.78-1.08), 1.00 (95% CI 0.80-1.25) and 1.12 (95% CI 0.88-1.43), respectively. Our results do not show a relevant role of pizza on the risk of sex hormone-related cancers. The difference with selected studies from North America suggests that dietary and lifestyle correlates of pizza eating vary between different populations and social groups.

Research paper thumbnail of Price and consumption of tobacco in Spain over the period 1965???2000

European Journal of Cancer Prevention, 2004

Changes in cigarette price have had an appreciable impact on smoking prevalence in several countr... more Changes in cigarette price have had an appreciable impact on smoking prevalence in several countries. We analysed the price elasticity of demand for cigarettes (effect of price of cigarettes on tobacco consumption) between 1965 and 2000 in Spain. For total consumption of cigarettes, a 1% increase in price is associated with a 0.19% decrease of consumption (price elasticity of -0.19; P<0.01). The real price of blond cigarettes was significantly and inversely associated with blond cigarette consumption: on average, smoking prevalence decreased 1.25% for a 1% increase in the real price of cigarettes (significant price elasticity of -1.25). For black cigarettes we found a lower but still high and significant elasticity of -0.61. There is an inverse relation between price and consumption of cigarettes in Spain, indicating that interventions at the economic level (such as real increases in prices) may have an important public health impact in tobacco control.

Research paper thumbnail of Italy SimSmoke: the effect of tobacco control policies on smoking prevalence and smoking attributable deaths in Italy

BMC public health, 2012

While Italy has implemented some tobacco control policies over the last few decades, which result... more While Italy has implemented some tobacco control policies over the last few decades, which resulted in a decreased smoking prevalence, there is still considerable scope to strengthen tobacco control policies consistent with the World Health Organization (WHO) policy guidelines. The present study aims to evaluate the effect of past and project the effect of future tobacco control policies on smoking prevalence and associated premature mortality in Italy. To assess, individually and in combination, the effect of seven types of policies, we used the SimSmoke simulation model of tobacco control policy. The model uses population, smoking rates and tobacco control policy data for Italy. Significant reductions of smoking prevalence and premature mortality can be achieved through tobacco price increases, high intensity media campaigns, comprehensive cessation treatment program, strong health warnings, stricter smoke-free air regulations and advertising bans, and youth access laws. With a co...

Research paper thumbnail of Estimating the probabilities of making a smoking quit attempt in Italy: stall in smoking cessation levels, 1986-2009

BMC Public Health, 2012

Background: No data on annual smoking cessation probability (i.e., the probability of successfull... more Background: No data on annual smoking cessation probability (i.e., the probability of successfully quit in a given year) are available for Italy at a population level. Mathematical models typically used to estimate smoking cessation probabilities do not account for smoking relapse. In this paper, we developed a mathematical model to estimate annual quitting probabilities, taking into account smoking relapse and time since cessation. Methods: We developed a dynamic model describing the evolution of current, former, and never smokers. We estimated probabilities of smoking cessation by fitting the model with observed smoking prevalence in Italy, 1986-2009.

Research paper thumbnail of Effects of new smoking regulations in Italy

Annals of Oncology, 2005

the Italian government banned smoking in all indoor public places.

Research paper thumbnail of Occupational and leisure time physical activity and the risk of nonfatal acute myocardial infarction in Italy

Annals of Epidemiology, 2004

PURPOSE: Physical activity has long been related to a reduced risk of coronary heart disease (CHD... more PURPOSE: Physical activity has long been related to a reduced risk of coronary heart disease (CHD), including acute myocardial infarction (AMI). However, the quantitative estimates of the possible protective role of physical activity appear to vary across studies ...

Research paper thumbnail of Evidence-informed recommendations to reduce dissemination bias in clinical research: conclusions from the OPEN (Overcome failure to Publish nEgative fiNdings) project based on an international consensus meeting

BMJ open, 2015

Dissemination bias in clinical research severely impedes informed decision-making not only for he... more Dissemination bias in clinical research severely impedes informed decision-making not only for healthcare professionals and patients, but also for funders, research ethics committees, regulatory bodies and other stakeholder groups that make health-related decisions. Decisions based on incomplete and biased evidence cannot only harm people, but may also have huge financial implications by wasting resources on ineffective or harmful diagnostic and therapeutic measures, and unnecessary research. Owing to involvement of multiple stakeholders, it remains easy for any single group to assign responsibility for resolving the problem to others. To develop evidence-informed general and targeted recommendations addressing the various stakeholders involved in knowledge generation and dissemination to help overcome the problem of dissemination bias on the basis of previously collated evidence. Based on findings from systematic reviews, document analyses and surveys, we developed general and targ...

Research paper thumbnail of Towards a greater understanding of the illicit tobacco trade in Europe: a review of the PMI funded 'Project Star' report

Tobacco control, 2014

Following a legal agreement with the European Union (EU), Philip Morris International (PMI) commi... more Following a legal agreement with the European Union (EU), Philip Morris International (PMI) commissions a yearly report ('Project Star', PS) on the European illicit cigarette trade from KPMG, the global accountancy firm. Review of PS 2010 report. Comparison with data from independent sources including a 2010 pan-European survey (N=18,056). Within PS, data covering all 27 EU countries are entered into a model. While the model itself seems appropriate, concerns are identified with the methodologies underlying the data inputs and thus their quality: there is little transparency over methodologies; interview data underestimate legal non-domestic product partly by failing to account for legal cross-border sales; illicit cigarette estimates rely on tobacco industry empty pack surveys which may overestimate illicit; and there is an over-reliance on data supplied by PMI with inadequate external validation. Thus, PMI sales data are validated using PMI smoking prevalence estimates, ye...

Research paper thumbnail of PPACTE policy recommendations and integrated report

Research paper thumbnail of Aspirin and Prostate Cancer Prevention

Recent Results in Cancer Research, 2014

Aspirin has been associated to a reduced risk of colorectal, and possibly of other cancers. Data ... more Aspirin has been associated to a reduced risk of colorectal, and possibly of other cancers. Data from at least 25 observational studies also suggest a modest reduced risk of prostate cancer in regular aspirin users, with a summary relative risk, RR, of 0.91 (95 % confidence interval, CI, 0.86-0.96) overall, 0.87 (95 % CI 0.74-1.02) from nine case-control studies, and 0.92 (95 % CI 0.87-0.97) from 16 cohort studies. However, risk estimates are heterogeneous and there is no relation with frequency, dose, or duration of aspirin use. Data from randomized controlled trials of aspirin for the prevention of vascular events showed a nonsignificant reduced risk of death from prostate cancer after a latent period of five or more years (RR 0.52, 95 % CI 0.20-1.24) based on 37 deaths from prostate cancer from seven trials. The RR was 0.81 (95 % CI 0.61-1.06) after 20 years of follow-up, based on 210 cases from three trials with long-term follow-up. Thus, data from observational studies and clinical trials are compatible with a modest favorable effect of aspirin on prostate cancer. Inference for causality and public health implications are, however, far from conclusive given the heterogeneity of results and the lack of dose and duration-risk relationships. Data on prostate cancer survival are still limited and inconsistent.

Research paper thumbnail of Relation between national-level tobacco control policies and individual-level voluntary home smoking bans in Europe

Tobacco control, Jan 21, 2014

Little is known about the relationship between national tobacco control policies and implementati... more Little is known about the relationship between national tobacco control policies and implementation of private home smoking bans. To determine the relationship between the Tobacco Control Scale (TCS), a score measuring national-level strength of tobacco control policies, and the prevalence of in-home smoking bans and beliefs on other tobacco control policies, among the Member States (MS) of the European Union (EU) that participated in the Pricing Policy And Control of Tobacco in Europe (PPACTE) project. A face-to-face representative survey, based on 18 056 individuals aged ≥15 years, from 18 European countries-including 16 EU MS-was conducted in 2010. Multilevel logistic regression models were fit to examine the relationship between the TCS score and in-home smoking ban prevalence and beliefs that other policy approaches are useful. In 2010, the TCS scores ranged from 32 in Austria and Greece to 77 in England. The TCS score correlated with the prevalence of in-home smoking bans (rsp...

Research paper thumbnail of Illicit cigarettes and hand-rolled tobacco in 18 European countries: a cross-sectional survey

Tobacco Control, 2012

Little evidence, other than that commissioned by the tobacco industry, exists on the size of the ... more Little evidence, other than that commissioned by the tobacco industry, exists on the size of the illicit tobacco trade. This study addresses this gap by examining the level and nature of illicit cigarettes and hand-rolled tobacco in 18 European countries. Face-to-face cross-sectional survey on smoking. 18 European countries. For each country, around 1000 subjects representative of the population aged 15 and over were enrolled. Current cigarette smokers were asked to show their latest purchased pack of cigarettes or hand-rolled tobacco. A comprehensive measure called an Identification of an Illicit Pack (IIP) was used to study the extent of illicit trade, defining a pack as illicit if it had at least one of the following tax evasion indicators: (1) it was bought from illicit sources, as reported by smokers, (2) it had an inappropriate tax stamp, (3) it had an inappropriate health warning or (4) its price was substantially below the known price in their market. Overall, the proportion of illicit packs was 6.5%. The highest prevalence of IIP was observed in Latvia (37.8%). Illicit packs were more frequent among less educated smokers and among those living in a country which shared a land or sea border with Ukraine, Russia, Moldova or Belarus. No significant association was found with price of cigarettes. This study indicates that IIP is less than 7% in Europe and suggests that the supply of illicit tobacco, rather than its price, is a key factor contributing to tax evasion.

Research paper thumbnail of Effects of the economic crisis on smoking prevalence and number of smokers in the USA

Tobacco Control, 2013

Scanty and controversial information is available on the impact of macroeconomic fluctuations on ... more Scanty and controversial information is available on the impact of macroeconomic fluctuations on smoking behaviour. No study has quantified the effects of fiscal crises on smoking prevalence. This study aimed to investigate the effects of the 2007-2008 economic crisis on smoking prevalence and number of smokers in the USA. Using data from the repeated Behavioural Risk Factor Surveillance System (BRFSS) surveys in pre-crisis (2005-2007) and post-crisis (2009-2010) periods on a total of 1,981,607 US adults, we separated the expected (after allowance for the demographic growth of the US population, secular smoking prevalence trends and changes in sociodemographic characteristics) from the unexpected (assumed attributable to the economic crisis) changes in the number of smokers across different employment statuses. Joinpoint regression analysis revealed no significant changes in smoking prevalence trends over the period 2005-2010. The crisis resulted in an increase in the number of smokers in the US by 0.6 million. This is largely due to an unexpected decrease of 1.7 million smokers among employed and an increase of 2.4 million smokers among unemployed individuals, whose smoking prevalence also remains extremely high in the post-crisis period (32.6%). The 2008 financial crisis had a weak effect on smoking prevalence. The pro-cyclical relationship (ie, the crisis results in a lower number of smokers) found among the employed is offset by the counter-cyclical relationship (ie, the crisis results in a higher number of smokers) found among unemployed individuals. Public health interventions should specifically target those in unemployment, particularly in hard times.

Research paper thumbnail of Attitudes towards the extension of smoking restrictions to selected outdoor areas in Italy

Tobacco Control, 2012

To estimate the attitudes of Italians on the extension of the smoking ban to selected public outd... more To estimate the attitudes of Italians on the extension of the smoking ban to selected public outdoor areas. The authors considered data from two Italian surveys on smoking conducted in 2009 and 2010 on a total sample of 6233 individuals, representative of the Italian population aged 15 years or over. 64.6% of Italians supported smoke-free policies in public parks, 68.5% in sports stadiums, 62.1% in beaches, 85.9% in school courtyards and 79.9% in outdoor areas surrounding hospitals. Among current smokers, the corresponding estimates were 32.9% for parks, 38.2% for stadiums, 31.2% for beaches, 67.6% for schools and 55.3% for hospitals. Extension of the smoking ban to selected outdoor areas is supported by the large majority of the Italian population. The overwhelming majority of support for smoke-free school grounds and outdoor areas surrounding hospitals indicates that legislative action is required.

Research paper thumbnail of Dietary iron intake and risk of non-fatal acute myocardial infarction

Public Health Nutrition, 2006

Objective: The relation between several measures of body iron and atherosclerotic disease, partic... more Objective: The relation between several measures of body iron and atherosclerotic disease, particularly acute myocardial infarction (AMI), is debated. This is of specific interest since iron is frequently included in supplementation and fortification of foods. We assessed the relation between dietary iron intake and the risk of non-fatal AMI. Design: Case-control study. The information was collected by interviewers using a food-frequency questionnaire tested for validity and reproducibility. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple unconditional logistic regression models, including terms for energy and alcohol intakea, as well as for sociodemographic factors, tobacco and other major recognised risk factors for AMI. Setting: Milan, Italy, between 1995 and 1999. Subjects: Cases were 507 patients, below age 79 years, with a first episode of non-fatal AMI, and controls were 478 patients admitted to hospital for a wide spectrum of acute conditions unrelated to known or potential AMI risk factors. Results: Compared with patients in the lowest tertile of total iron intake, the OR was 0.48 (95% CI 0.29 -0.82) for those in the highest tertile. The corresponding value for haem iron was 0.71 (95% CI 0.48-1.06), for non-haem, non-alcohol iron was 0.80 (95% CI 0.51 -1.24) and for iron derived from alcoholic beverages was 0.60 (95% CI 0.40-0.90). Sex-specific OR for total iron intake were not heterogeneous. Conclusions: In this Italian population dietary iron intake was inversely related to AMI risk. This inverse association may depend on other nutrients present in the major sources of iron in the Italian diet.

Research paper thumbnail of Socio-demographic variation in smoking habits: Italy, 2008

Preventive medicine, 2009

To provide updated information on smoking prevalence in Italy, with a focus on demographic and so... more To provide updated information on smoking prevalence in Italy, with a focus on demographic and socio-economic characteristics.

Research paper thumbnail of A population-based estimate of tobacco dependence

The European Journal of Public Health, 2004

Research paper thumbnail of Roll-your-own cigarettes in Europe

European Journal of Cancer Prevention, 2014

Excise duties on roll-your-own (RYO) tobacco, which are generally based on RYO cigarettes contain... more Excise duties on roll-your-own (RYO) tobacco, which are generally based on RYO cigarettes containing 1 g of tobacco, are lower than duties on factory-made (FM) cigarettes. This provides a price incentive for smokers to switch to RYO, the use of which is increasing across Europe. To effectively approximate duties on the two types of products, accurate data on the weight of RYO cigarettes are required. We provide updated information on RYO use and RYO cigarette weight across Europe. From a representative face-to-face survey conducted in 2010 in 18 European countries (Albania, Austria, Bulgaria, Czech Republic, Croatia, England, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Poland, Portugal, Romania, Spain and Sweden), we considered data from 5158 current smokers aged 15 years or above, with available information on daily consumption of FM and RYO cigarettes separately. In Europe, 10.4% of current smokers (12.9% of men and 7.5% of women) were 'predominant' RYO users (i.e. >50% of cigarettes smoked). This proportion was highest in England (27.3%), France (16.5%) and Finland (13.6%). The median weight of one RYO cigarette is 0.75 g (based on 192 smokers consuming exclusively RYO cigarettes). The proportion of RYO smokers is substantial in several European countries. Our finding on the weight of RYO cigarettes is consistent with the scientific literature and industry documents showing that the weight of RYO cigarettes is substantially lower than that of FM ones. Basing excise duties on RYO on an average cigarette weight of 0.75 g rather than 1 g would help increase the excise levels to those on FM cigarettes.

Research paper thumbnail of Pricing Policies And Control of Tobacco in Europe (PPACTE) project

European Journal of Cancer Prevention, 2014

Limited data on smoking prevalence allowing valid between-country comparison are available in Eur... more Limited data on smoking prevalence allowing valid between-country comparison are available in Europe. The aim of this study is to provide data on smoking prevalence and its determinants in 18 European countries. In 2010, within the Pricing Policies And Control of Tobacco in Europe (PPACTE) project, we conducted a face-to-face survey on smoking in 18 European countries (Albania, Austria, Bulgaria, Czech Republic, Croatia, England, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Poland, Portugal, Romania, Spain and Sweden) on a total of 18 056 participants, representative for each country of the population aged 15 years or older. Overall, 27.2% of the participants were current smokers (30.6% of men and 24.1% of women). Smoking prevalence was highest in Bulgaria (40.9%) and Greece (38.9%) and lowest in Italy (22.0%) and Sweden (16.3%). Smoking prevalence ranged between 15.7% (Sweden) and 44.3% (Bulgaria) for men and between 11.6% (Albania) and 38.1% (Ireland) for women. Multivariate analysis showed a significant inverse trend between smoking prevalence and the level of education in both sexes. Male-to-female smoking prevalence ratios ranged from 0.85 in Spain to 3.47 in Albania and current-to-ex prevalence ratios ranged from 0.68 in Sweden to 4.28 in Albania. There are considerable differences across Europe in smoking prevalence, and male-to-female and current-to-ex smoking prevalence ratios. Eastern European countries, lower income countries and those with less advanced tobacco control policies have less favourable smoking patterns and are at an earlier stage of the tobacco epidemic.

Research paper thumbnail of Pizza consumption and the risk of breast, ovarian and prostate cancer

European Journal of Cancer Prevention, 2006

Pizza has been favourably related to the risk of prostate cancer in North America. Scanty informa... more Pizza has been favourably related to the risk of prostate cancer in North America. Scanty information, however, is available on sex hormone-related cancer sites. We therefore studied the role of pizza consumption on the risk of breast, ovarian and prostate cancers using data from three hospital-based case-control studies conducted in Italy between 1991 and 2002. These included 2569 women with breast cancer, 1031 with ovarian cancer, 1294 men with prostate cancer, and a total of 4864 controls. Compared with non-pizza eaters, the multivariate odds ratios for eaters were 0.97 (95% confidence interval (CI) 0.86-1.10) for breast, 1.06 (95% CI 0.89-1.26) for ovarian and 1.04 (95% CI 0.88-1.23) for prostate cancer. Corresponding estimates for regular eaters (i.e. > or =1 portion per week) were 0.92 (95% CI 0.78-1.08), 1.00 (95% CI 0.80-1.25) and 1.12 (95% CI 0.88-1.43), respectively. Our results do not show a relevant role of pizza on the risk of sex hormone-related cancers. The difference with selected studies from North America suggests that dietary and lifestyle correlates of pizza eating vary between different populations and social groups.

Research paper thumbnail of Price and consumption of tobacco in Spain over the period 1965???2000

European Journal of Cancer Prevention, 2004

Changes in cigarette price have had an appreciable impact on smoking prevalence in several countr... more Changes in cigarette price have had an appreciable impact on smoking prevalence in several countries. We analysed the price elasticity of demand for cigarettes (effect of price of cigarettes on tobacco consumption) between 1965 and 2000 in Spain. For total consumption of cigarettes, a 1% increase in price is associated with a 0.19% decrease of consumption (price elasticity of -0.19; P<0.01). The real price of blond cigarettes was significantly and inversely associated with blond cigarette consumption: on average, smoking prevalence decreased 1.25% for a 1% increase in the real price of cigarettes (significant price elasticity of -1.25). For black cigarettes we found a lower but still high and significant elasticity of -0.61. There is an inverse relation between price and consumption of cigarettes in Spain, indicating that interventions at the economic level (such as real increases in prices) may have an important public health impact in tobacco control.

Research paper thumbnail of Italy SimSmoke: the effect of tobacco control policies on smoking prevalence and smoking attributable deaths in Italy

BMC public health, 2012

While Italy has implemented some tobacco control policies over the last few decades, which result... more While Italy has implemented some tobacco control policies over the last few decades, which resulted in a decreased smoking prevalence, there is still considerable scope to strengthen tobacco control policies consistent with the World Health Organization (WHO) policy guidelines. The present study aims to evaluate the effect of past and project the effect of future tobacco control policies on smoking prevalence and associated premature mortality in Italy. To assess, individually and in combination, the effect of seven types of policies, we used the SimSmoke simulation model of tobacco control policy. The model uses population, smoking rates and tobacco control policy data for Italy. Significant reductions of smoking prevalence and premature mortality can be achieved through tobacco price increases, high intensity media campaigns, comprehensive cessation treatment program, strong health warnings, stricter smoke-free air regulations and advertising bans, and youth access laws. With a co...

Research paper thumbnail of Estimating the probabilities of making a smoking quit attempt in Italy: stall in smoking cessation levels, 1986-2009

BMC Public Health, 2012

Background: No data on annual smoking cessation probability (i.e., the probability of successfull... more Background: No data on annual smoking cessation probability (i.e., the probability of successfully quit in a given year) are available for Italy at a population level. Mathematical models typically used to estimate smoking cessation probabilities do not account for smoking relapse. In this paper, we developed a mathematical model to estimate annual quitting probabilities, taking into account smoking relapse and time since cessation. Methods: We developed a dynamic model describing the evolution of current, former, and never smokers. We estimated probabilities of smoking cessation by fitting the model with observed smoking prevalence in Italy, 1986-2009.

Research paper thumbnail of Effects of new smoking regulations in Italy

Annals of Oncology, 2005

the Italian government banned smoking in all indoor public places.

Research paper thumbnail of Occupational and leisure time physical activity and the risk of nonfatal acute myocardial infarction in Italy

Annals of Epidemiology, 2004

PURPOSE: Physical activity has long been related to a reduced risk of coronary heart disease (CHD... more PURPOSE: Physical activity has long been related to a reduced risk of coronary heart disease (CHD), including acute myocardial infarction (AMI). However, the quantitative estimates of the possible protective role of physical activity appear to vary across studies ...