Is Lithuania a success Is Lithuania a success story?story?

Aurelijus Veryga, MD, PhDLithuanian National Tobacco and Alcohol Control Coalition

Kaunas University of Medicine

Bratislava, 16/04/2007

Lithuania has banned smoking in bars, restaurants, café’s, clubs since January 1st 2007

Bratislava, 16/04/2007

Law of Tobacco controlLaw of Tobacco control

Article 19. Restrictions on the Consumption of Tobacco Products 1. It shall be prohibited to smoke (consume tobacco products) in the Republic of Lithuania: 1) in all educational establishments, health care facilities, Internet cafes (Internet clubs, etc.), and also in premises

where sport competitions and other events take place; 2) at indoor workplaces.  Special premises (places) may be set aside in undertakings, institutions and

organisations where smoking shall be permitted. The requirements for fitting out and operating smoking premises (places) shall be set forth by the Government of the Republic of Lithuania or an institution authorised by it.

3) in common-use residential and other public premises where non-smokers may be forced to breathe tobacco smoke-polluted air;

4) in all types of public transport, except for long-distance trains where individual cars must be designated for smokers and non-smokers and also on aircraft where separate places shall be designated for non-smokers and smokers;

5) in restaurants, coffee shops, bars and other mass caterers, clubs, and discotheques, except for cigar or pipe clubs specially fitted out for this purpose. The procedure and conditions of establishing cigar and pipe clubs shall be set forth by the Government of the Republic of Lithuania or an institution authorised by it.

2. In restaurants, cafes, bars and other premises designated to provide services for people, where smoking is not prohibited, separate premises (places) must be set aside for smokers.  Premises where smoking is not prohibited must be fitted out to protect clients (visitors) and staff members from tobacco smoke. The requirements for fitting out and operating such premises (places) shall be set forth by the Government of the Republic of Lithuania or an institution authorised by it.

Paragraph 2 of Article 19 has been repealed. 6) Municipal councils shall have the right to prohibit smoking in public places (parks, squares, etc.) and other

public places falling within the scope of their competence. 7) The administrative bodies of a legal person must ensure that its personnel, clients and visitors are not forced to

breathe tobacco smoke-polluted air; they must also ensure that non-smoking warnings or signs are displayed in visible locations and special premises (places) be set aside and fitted out for smoking with notices or signs indicating their location.

Background

Total ban of tobacco advertisement (2000) Ratification of FCTC (2004) Joining EU – new excise taxation policy (2004) Change of tobacco products labeling (2004) Smoking ban in bars, restaurants, cafe’s, clubs

(January 2007) Inclusion of tobacco and alcohol control issues

into National Drug prevention program (2005) National vide public awareness campaigns (“I

am born a non smoker”) competitions (“Quit and win”, “Smoke-free class” competition)

Bratislava, 16/04/2007

Smoking prevalence (adults)(regular smokers aged 20 – 64 years)

* p<0.05 comparing with year 1994

FINBALT study

%

43,3

47,3

48,5* 51,2

43,7

39,4

43,4

6,39,4

12,5*15,8*

12,8 14,2 14,5

0

20

40

60

Man Woman

1994

1996

1998

2000

2002

2004

2006

Bratislava, 16/04/2007

School children smoking prevalence year 1993-1994 (HBSC)

1

2

5

3

6

4

7

18

19

20

21

22

23

24

25

11

12

13

14

15

16

17

8

9

10

Mergaitės Berniukai

13.6 Denmark

18.8 France

14.2 Norway

24.8 Austria

Wales 18.5

0 020 20 3010

%%

12.7 Scotland

10.4 Sweden

13.6 Wales

7.1 Israel

17.1 Czech Republic

18.0 Canada

15.2 Germany

France 19.8

Israel 5.5

Lithuania 3.5

Sweden 12.3

Denmark 16.7

Austria 17.0

Germany 19.8

Russia 9.4

Estonia 4.2

Canada 21.1

Norway 13.8

Slovakia 5.5

Hungary 16.0

Scotland 16.1

Czech Republic 10.1

HBSC AVERAGE 13.8

Poland 8.0

30

Greenland 26.0

Spain 16.3

Latvia 11.9

Belgium-Fren 13.4

Belgium-Flem 13.3

N.Ireland 17.9

Finland 16.2

10

22.7 Latvia

11.3 Lithuania

19.7 Hungary

14.6 Estonia

16.7 Poland

16.7 Russia

19.8 Belgium-Flem

16.3 HBSC AVERAGE

15.4 Slovakia

13.8 Belgium-Fren

13.1 Spain

19.4 Finland

16.8 N.Ireland

24.5 Greenland

4040

Girls Boys

Bratislava, 16/04/2007

School children smoking prevalence year 2001-2002 (HBSC)

12

5

3

6

4

7

1819202122232425262728

11121314151617

8910

Mergaitės Berniukai

13.3 Denmark

16.5 France

15.2 Norway14.8 USA

19.8 Austria

Wales 18.8

0 020 20 3010

%%

9.8 Scotland10.5 Sweden

12.2 Wales

16.0 Italy15.9 England

16.7 Israel

14.1 Netherlands

16.2 Switzerland

20.5 Czech Republic

12.1 Canada

22.0 Germany

France 16.5

Israel 9.3

Lithuania 14.6

Portugal 18.2

England 20.6

Netherlands 15.7

Sweden 13.7

USA 10.6

Denmark 13.9

Austria 22.9Germany 22.9

Russia 13.8

Estonia 14.5

Canada 12.2

Norway 18.7

Slovenia 15.2

Italy 17.0

Macedonia 6.5

Hungary 19.2

Switzerland 15.2

Scotland 14.9

Czech Republic 18.5

HBSC AVERAGE 16.3

Poland 14.1

31

3332

3435

30

2930

Croatia 13.7

Greenland 42,0

Spain 18.5

Latvia 13.9

Belgium-Fren 11.5

Belgium-Flem 16.5

Ireland 13.8

Malta 17.1

Finland 22.2

Ukraine 15.1

10

28.0 Ukraine

22.0 Latvia

23.6 Lithuania22.3 Hungary

21.5 Estonia

20.3 Poland

17.5 Portugal

13.2 Croatia

20.0 Russia

16.0 Belgium-Flem

16.8 HBSC AVERAGE

8.2 Macedonia

11.1 Belgium-Fren

16.5 Spain

18.2 Finland

16.4 Slovenia

13.6 Ireland

16.2 Malta

29.5 Greenland36

8.9 GreeceGreece 8.0

4040

#

Girls Boys

Bratislava, 16/04/2007

School children smoking prevalence year 1994-2006 (HBSC)

Berniukai Mergaitės

% 4 5 2 3 2 35 1 8 1 35 8 23 27 30 47 17 7 2 19 7 18 12 16 8

1994 1994 19941998 1998 199820062002 2002 2002 2006200611 metų 13 metų 15 metų

GirlsBoys

years years years

Bratislava, 16/04/2007

Positive external factorsPositive external factors

Smoke – free policies in other European countries (Ireland, Italy, Malta etc.)

Evidence from other countries that ban does not damages business

FCTC

Positive internal factorsPositive internal factors

Active position of minister of health (professor of public health)

Strong NGO movement (Lithuanian National Tobacco and Alcohol Control Coalition - member of ENSP)

European Commission project “HELP – for a life without tobacco” in place

Existing ban of tobacco advertisement Already high public awareness about smoking

harm

Lessons we have learnedLessons we have learned

First voting in Parliament (ban introduced by one parliamentarian) was unsuccessful

Main reasons: No strategy Strong opposition from industry coming from

industry supported NGO’s

Second proposal from the Ministry of Second proposal from the Ministry of HealthHealth

Common strategy of MoH and NGO’s was developed Minister meetings with all Parliament comities (evidence

based information and facts for lobbying prepared by tobacco control advocates)

NGO coalition meetings with other NGO’s and petitions writing campaign development

Public opinion survey Youth manifesto (EC “HELP” campaign) Large public relation campaign

Public opinion surveyPublic opinion survey (age 18-74)(should smoking be banned in bars, restaurants and other hospitality places?)

1,8%

23,5%

74,7%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Has no meaning

Smoking shouldnot be banned

Smoking should bebanned

RAIT, 2006Bratislava, 16/04/2007

1,8%

12,3%

85,9%

1,8%

47,3%

50,9%

0% 20% 40% 60% 80% 100%

Has no meaning

Smoking shouldnot be banned

Smoking shouldbe banned

Smokers

Nonsmokers

Public opinion surveyPublic opinion survey (age 18-74)(should smoking be banned in bars, restaurants and other hospitality places?)

RAIT, 2006Bratislava, 16/04/2007

Very strong message: people want to Very strong message: people want to have smoking ban in placehave smoking ban in place

Public relation campaignPublic relation campaign

Main messages generated: Constitutional right of

workers to safe and health working place

Protection of customers from passive smoking

Positive influence to children (making smoking socially unacceptable)

Intensive use of evidence Ventilation does not

work Smoking ban does not

damage business Smoking ban can

improve hospitality workers and customers health

Main elements of public relation Main elements of public relation campaigncampaign

Special section in MoH websiteArticles in newspapers Participation in TV and radio debatesPress conferences

Youth manifesto (presenting opinion of hundreds NGO’s, presented to Parliament Youth manifesto (presenting opinion of hundreds NGO’s, presented to Parliament speaker, asking to ban smoking in bars, restaurants etc.speaker, asking to ban smoking in bars, restaurants etc.

Tobacco industry oppositionTobacco industry opposition

Mainly done by industry supported NGO’s

Main arguments used: Already made big investments to ventilation systems Smoking ban will cause financial problems for

hospitality industry Rights of smokers should be respected and there

should be separate rooms for smokers

Partially successful work (inclusion of exception to law for pipes and cigars clubs)

Changes afterChanges after

Some initiatives to discredit smoking ban

Increased public awareness (especially about smoking in common-use residential and other public premises)

Smoking ban is respected and implemented without problems

Thank you!Thank you!

WNTD celebrationWNTD celebration““I am born a non smoker”I am born a non smoker”