Ensp Framework Project 2002/2003

EUROPEAN NETWORK FOR SMOKING PREVENTION

RESEAU EUROPEEN POUR LA PREVENTION DU TABAGISME aisbl

ENSP FRAMEWORK PROJECT 2002/2003

FINAL REPORT - Technical

Operation of the European Network for Smoking Prevention (ENSP) Agreement Number SPC.2002411

Reporting Period: 15 Sept 2002 – 30 Nov 2003

[01/03/2004]

144 Chaussée d’Ixelles 1050 Bruxelles – Belgium Tel : + 32 2 230 65 15 Fax : + 32 2 230 75 07 e-mail: [email protected] internet: http://www.ensp.org 1

TABLE OF CONTENTS

- EXECUTIVE SUMMARY

- PROJECT OBJECTIVES

- BACKGROUND

- INTRODUCTION

- IMPLEMENTATION

- RESULTS

- DISCUSSION

- CONCLUSIONS / WAY FORWARD

- EVALUATION

- LIST OF PROJECT PARTNERS

EXECUTIVE SUMMARY

The operation of the European Network for Smoking Prevention (ENSP) was started on time and has followed the general work plan outlined in the grant agreement, though the first payment of funds (30%) only arrived more than 5 months after the start of the project. Additionally, an extension of 2.5 months was requested by ENSP from the Commission to ensure the quality of project results and to compensate for the late start of the next annual projects, due to late signature of contract and late payment by the European Commission. This means that the projects for 2002-2003 ran from 15 September 2002 until 30 November 2003. Activities that took place during this extra 2.5 month period are included in this final report.

ENSP bid farewell to its first Secretary General, Sibylle Fleitmann in March 2003. Sibylle had been the Secretary General of ENSP since its creation in 1997. This was a great loss to the Secretariat and it also marked the beginning of a period of adjustment. In the second half of 2003, ENSP grew to include two new members of staff: a part time Project Coordinator took on the technical management of the ENSP Framework projects and project applications from March 2003 and a new Information Officer from October 2003, allowed ENSP to expand its information gathering and dissemination capabilities. The acquisition of these new members of staff not only increased capacity, but their new skills and experience also energised the activities of ENSP and resulted in the increased output and productivity.

During this project period, ENSP increased its network membership from 383 member organizations in September 2002, to 511 member organizations by November 2003. Members of ENSP include organisations, health professionals and individuals active in tobacco control in Europe. This surge in membership can be attributed in part to ENSP’s gaining new contacts in the EU accession countries and welcoming two national coalitions from Poland and from Slovakia, as new members of ENSP.

In view of the enlargement of the European Union, ENSP put much emphasis on building capacity and contacts in the accession countries, finding out about the tobacco control situation and promoting not only awareness of problems, but also of new tobacco control experience to Eastern activists and ENSP Members. In order to confirm and encourage this, the next ENSP Network Meeting and General Assembly is planned to take place in Krakow in Poland in May 2004. ENSP has therefore set May 2004, which is also the month that the 10 new accession countries will be entering the European Union, as a target deadline for encouraging as many accession countries as possible to form national coalitions and apply for membership of ENSP. During this project period ENSP had already begun to identify representatives from each of these countries who had formed or were capable of triggering the formation of a coalition, to attend. ENSP already includes 3 of the 10 countries (CZ, PL and SK) amongst its members and many strong ties were built with the other countries as a direct result of ENSP activities this year.

Information dissemination plays an important role in ENSP’s networking activities and this year saw the publication and dissemination of 41 copies of the ENSP’s electronic European News Bulletin (see later) which, in tandem with ENSP’s regularly updated website (www.ensp.org) is managed in a flexible and reactive way in order to continue to be relevant and also to deserve the praise that it often attracts from readers. We know that from January to November 2003 (inclusive) the website received almost 900,000 hits from about 30,000 visitors.

ENSP was extremely active and visible during this project period through its contributions to conferences and through its information stands at two major conferences. These activities helped to grow ENSP’s contacts and raise awareness, as well as providing the opportunity for disseminating information and project results. Conferences to which ENSP contributed during the project period included: ‘Effective Advocacy and Health in Europe’ organised by the OSI foundation (Riga, Latvia); The European Society of Cardiology Congress (Vienna, Austria); The European Respiratory Society Congress (Vienna, Austria); The WHO Counterparts Meeting (Helsinki, Finland); and the 12th World Conference on Tobacco and Health (WCTOH) (Helsinki, Finland).

The highlight of ENSP’s activities during the project period, was The 12th World Conference on Tobacco or Health in August 2003. This conference provided us with the opportunity for wide visibility in the tobacco control and health community, presenting results, promoting awareness, organising events, gaining knowledge and new insight into tobacco control experience at European and global level, acquiring new contacts and solidifying older ones. During the 6 days of the conference, ENSP’s activities included: manning an ‘ENSP’ stand, chairing sessions; making presentations; taking part in various workshops, including one organised by the European Commission; running a main session on EU Policy, at which a member of the European Commission gave a presentation; launching recommendations on smoke-free workplaces (see Annex); and organising a workshop focusing on NGOs in accession countries.

Another highlight of 2004 for ENSP and for tobacco control globally, from a policy point of view was the adoption of the Framework Convention on Tobacco Control (FCTC) and ENSP was pleased to follow this every step of the way. ENSP attending the last sessions of Intergovernmental Meetings (INB5 and INB6), working closely in collaboration with the FCA and other colleagues working on tobacco control at European level, and also attending the historic 56th World Health Assembly, which saw the historic unanimous adoption of the FCTC, after 4 years of hard work and negotiations. This was a fantastic opportunity for ENSP to show its worth as a disseminator of relevant up-to-the-minute information to its members, build capacity, promote coordinate activities and interact with governmental, non- governmental and intergovernmental organisations, as well as the European press, on a treaty which we hope will have a positive and lasting effect on tobacco control and tobacco related deaths throughout the world, for future generations.

Specifically in European policy, ENSP was particularly active during this project period in coordinating action to support a firm legal base in the draft Constitution Treaty, during meetings of the EU Convention and on continuing to promote smoke free workplace legislation through meetings with the European Commission, through discussions with intergovernmental officials, with governmental representatives and advocates at national level, and through letter writing and promoting awareness of the firm evidence base for EU level legislation through project results and our smoke-free workplace recommendations (see previous Annex). It is interesting to note that these recommendations were of particular interest to sources from the European Commission and Parliament who were working towards implementing their own internal smoke free rules.

Whilst national tobacco control legislation, EU level policy and even a global treaty adopted before and during this project period have been huge achievements on paper, the stark truth is that this is only ‘the end of the beginning’ and that implementation and monitoring is vital for policy to have any effect. To this end, ENSP has worked hard at promoting awareness of tobacco control legislation and the contents of Directives and of the FCTC by giving presentations, by attending and reporting back from expert meetings and workshops. Through this we have also gained further insight into the various issues encountered by governments and at European level that can stall positive changes in tobacco control. We have worked on strategies and developed ideas to provide support to our members and to the EU tobacco control struggle as a whole. One of the ways that we have done this has been through promoting coordination and collaboration in tobacco control activities in the EU and encouraging participation from other European countries too. We have used our information dissemination and conferences to do this, as well as our widening mailing list and network, its contacts with WHO Europe and with the FCA. ENSP strives to provide relevant information, contacts and guidance for coalitions or tobacco control advocates seeking working at national or at EU level both at conferences and events or personally, on a case-by-case basis. Moving forward it is vital that we are able to maintain this momentum and continue to provide the support and guidance, in terms of information communication, networking and project administration, that we have seen is so greatly needed, particularly in accession countries.

ENSP produced two reports during this project period: - A status report on Oral Tobacco, investigating the possible implications of lifting the ban on oral tobacco outlined in the EU Tobacco Products Directive. This was produced in collaboration with Stivoro (NL) and the Public Health Institute in Sweden (S). Due to the controversy of the subject matter, this report was astringently peer reviewed and electronic copies were available for ENSP Members and to policy makers from 20 November 2003, before printing. - A summarized version of the final reports of the ENSP Framework Projects 2001-2002 was produced and widely disseminated in paper and CD format to members, policy makers and interested persons by mail, through the ENSP website and at conferences. Additionally individual project results were disseminated by both the project leaders and by ENSP Secretariat to relevant audiences: ENSP, in collaboration with one of the project

leaders, FARES, organized a press conference in the European Parliament with Elizabeth Lynne MEP to disseminate the results of the 2001-2002 project investigating the effect of no smoking legislation in bars and restaurants in a sample of European cities. Research findings on cigarette package labelling and on the exposure to nicotine through environmental tobacco smoke both linking with the Tobacco Products Directive were disseminated to the relevant policymakers and to other tobacco control advocates working on the issue. The European Network of Quitlines best practice guidelines were shared with national coalitions interested in implementing their own national quitlines. The Smoke Free Hospitals Network project results and CD rom was distributed to visitors of the ENSP stand at the European Respiratory Society Congress in September 2003, and it was received with great interest and congratulations.

The project period saw the ENSP and its staff, grow and develop rapidly and much of this can be attributed to the exciting political climate brought on by the enlargement of the European Union. We hope that this report reflects that despite internal adjustments, extended project activity and some delays in funding, that ENSP was able to not only be able to fulfil the objectives and targets that it had set itself, but also, in some cases, was successful in surpassing them.

PROJECT OBJECTIVES

Objective I: Promote the exchange of information and experience and consensus building on a European Level. 1. Operation of a permanent secretariat in Brussels. 2. Organisation of 5 Executive Board meetings and 2 ENSP network conferences (Copenhagen Autumn 2002 and Utrecht Spring 2003) to provide the latest scientific information and promote consensus building within European tobacco control. 3. 7 visits to national coalitions and specialized networks to provide personalized advice and promote co-ordination between national and European level activities. 4a. Management and update of ENSP internet site (www.ensp.org) and an interactive mail conference by a full time Information Officer. 4b. Dissemination of timely and up to date information on national, European and international tobacco control issues. 5. Publication of 2 information bulletins, 1 ENSP leaflet and 1 scientific report in collaboration with a scientific adviser. 6. Attendance of 5 conferences and/or fairs to acquire scientific input and communicate on ENSP activities to tobacco control community. 7. Organisation of a satellite seminar for NGOs of the 13 accession countries on the occasion of the 12th World Conference on Tobacco or Health in Helsinki in August 2003.

Expected Results: ¾ Increase network membership in the European Region with special emphasis on health professional organizations (cardiovascular, asthma, allergy, dentists, COPD…) ¾ Improved analysis, compilation and dissemination of up-to-date and timely information through the ENSP interactive conference site – as a consequence increase from 500 to 600 active email participants. ¾ Targeted scientific evidence to underpin policy developments through project effective building procedures especially with regard to the tobacco regulation directive, the advertising ban and the Framework Convention on Tobacco Control (FCTC). ¾ EU wide policy change in favour of smoke free workplaces. ¾ NGO support for a strong FCTC. ¾ Collaboration and active participation of NGOs in the 13 accession countries.

Objective II:

Evaluation: An interim evaluation is due to be conducted at the end of the project period, based on previous evaluation studies.

BACKGROUND

ENSP was created in 1997 as an international non-profit association under Belgian law – registration Nº16377/97 with the aim of developing a coordinated approach to tobacco control activities on a European level. The ENSP General Assembly consists of 45 full voting members, consisting of representatives of national coalitions of the 15 Member States of the European Union plus Iceland, Norway, Switzerland and 3 of the 10 European Union acceding countries (Poland, Slovakia and the Czech Republic) as well as 5 European networks.

Between 15 September 2002 and 30 November 2003, ENSP operated under the responsibility of an Executive Board, regularly elected by the General Assembly and in accordance with its statutes. The Executive Board delegated the coordination of the network and the daily management to a Secretary General, Sibylle Fleitmann, until March 2003 and then to the Finance & Administration Manager/Director, Operations, Francis Grogna, and a Information Officer/Director, Strategy & Communications, Sophie Kazan from April 2003 onwards.

Members of the Executive Board between 15 September 2002 and 30 November 2003:

PRESIDENT Ms. Doreen McIntyre (United Kingdom) [until Trudy Prins (Netherlands) September 2003] STIVORO No Smoking Day Unit 203 Office building Haagsche Hof 16 Baldwin Gardens Parkstraat 83 UK – London EC1N 7RJ 2514 JG The Hague United Kingdom Tel (44) 207 916 8070 Netherlands Fax (44) 207 916 7556 Tel (31) 70 312 0400 [email protected] Fax (31) 70 312 0493 [email protected] Dr. Elizabeth Tamang (Italy) Centro Regionale di Riferimento per la Prevenzione (CRP) VICE PRESIDENT Azienda ULSS 12 Veneziana Dr Thorsteinn Njálsson (Iceland) Rio Tre Ponti, Dorsoduro 3494/A Tobacco Control Task Force of Iceland I – 30123 Venezia Italy Drangagata 1 Tel (39) 041 279 1661/0 220 Hafnarfjordur Fax (39) 041 279 1667 Iceland [email protected] Tel (354) 565 5448 Prof. Bertrand Dautzenberg (France) Fax (354) 562 1417 Office Français de Prévention du Tabagisme [email protected] (OFT) 66 Bd Saint Michel TREASURER F – 75006 Paris Mr. Michel Pettiaux (Belgium) France Tel (33) 1 42 17 67 70 F.A.R.E.S. Fax (33) 1 44 23 92 55 Rue de la Concorde, 56 Mobile (33) 6 13 43 70 48 B – 1050 Brussels [email protected] Belgium Tel (32) 2 514 66 53 Fax (32) 2 512 32 73 [email protected]

INTRODUCTION

The ENSP framework project 2002-2003 consisted of the operation of the European NGO Network for Smoking Prevention (ENSP) and 10 independent but interlinked subprojects (see table below). ENSP acts as the administrative and financial coordinator. The present report covers the ENSP network activities. (Annex: Separate final reports of ENSP Framework Projects.)

The aim of the ENSP project is the continued development of networking on a pan European scale among non-profit organization, in order to increase cost effectiveness and efficiency of smoking prevention activities on a non-governmental level. This action is complementary to governmental tobacco control policy development at EU and at national level. The aim is to pool creative energy to benefit not only policy, but also mutual learning, the sharing of resources and experience, as well as to build consensus around tobacco control issues.

The project’s two major objectives were:

Objective I: to intensify the exchange of up-to-date information and best practice; to promote support for the development of effective legislation at national and European level; to create interaction and synergy between non-governmental and governmental agencies on national and international level; to actively support the work of organizations in the EU accession countries and facilitate the transfer of technology.

Objective II: to initiate and coordinate large scale, innovate, priority driven and cost-effective European smoking prevention projects in support of policy development in order to raise expertise and capacity to act to the highest level possible.

1. OPERATION OF THE EUROPEAN NETWORK FOR SMOKING PREVENTION (ENSP) 2. 12TH WORLD CONFERENCE ON TOBACCO OR HEALTH (WCTOH 2003) 3. EUROPEAN ACTION ON SMOKING CESSATION IN PREGNANCY – EUROSCIP II 4. GLOBALINK – TELECOMMUNICATIONS FOR EUROPEAN SMOKING PREVENTION. 5. PROTECTING WORKERS FROM PASSIVE SMOKING. 6. DEVELOPMENT OF A MEASUREMENT TOOL FOR TOBACCO CONTROL ACTIVITIES IN EUROPEAN COUNTRIES. 7. TACKLING SOCIOECONOMIC INEQUALITIES IN SMOKING IN THE EUROPEAN UNION. 8. EUROPEAN NETWORK OF QUITLINES. 9. EUROPEAN SMOKE-FREE HOSPITALS NETWORK 2002-2003. 10. 3RD CONFERENCE ON SMOKELESS TOBACCO. 11. IDENTIFICATION OF GAPS IN THE TRAINING DENTISTS IN TREATMENT OF TOBACCO DEPENDENCE.

Initially, the expected results of this project were that ENSP should: Increase network membership in the European Region (with special emphasis on health professional

organizations); Provide improved analysis, compilation and dissemination of up-to-date and timely information (through the ENSP interactive conference site - The target being to increase from 500 to 600 active email participants); Promote targeted scientific evidence to underpin policy developments through project effective building procedures (especially with regard to the tobacco regulation directive, the advertising ban and the FCTC); Promote EU wide policy change in favour of smoke free workplaces; Encourage NGOs to support a strong FCTC; Collaborate and encourage the participation of NGOs from the 13 accession countries in tobacco control activities.

IMPLEMENTATION

Objective I Exchange of information/experience and consensus building on a European level.

1. Operation of a permanent secretariat in Brussels.

The permanent ENSP Secretariat is located at 144 Chaussée d’Ixelles, 1050 Brussels, Belgium. During the project period, the network employed: - A full time Secretary General (Sibylle Fleitmann – D/B) until March 2003 - A full time Financial Coordinator/Director, Operations (Francis Grogna – B) - A full time Information Officer/Director, Strategy & Communications (Sophie Kazan – UK) - A part time Administrative Assistant/Events & Administrative Officer (Sophie Van Damme – B). - A full time Project Coordinator (Paloma Martin – E) from March 2003, who became part time in June 2003. - A full time Information Officer (Edward Riley – UK) from October 2003. - A full time stagaire (David King – USA) from June to August 2003.

Sibylle Fleitmann resigned from the position of Secretary General as of 21 March 2003 and her responsibilities were delegated by the Board to Francis Grogna and Sophie Kazan in interim until August 2003, when it was decided that these responsibilities would become permanent and that the Secretary General position as such would not be refilled. Francis Grogna takes on the financial responsibility and proxy signature responsibility, previously held by the Secretary General.

In April/May 2003, it was decided that with the changes in management should come assessments of qualitative and quantitative research on the roles and productivity of staff in the Secretariat. This was done not only to clarify staff roles/priorities and reflect new responsibilities, but also to ensure maximum efficiency, effectiveness and performance. The presentation of documents was revised, fact sheets on ENSP and on ‘Criteria for ENSP Membership’ were produced (see Annex) in order to ensure clarity and best practice. Additionally, workloads were reviewed and efforts were made to ensure that goals were realistic and that staff skills and strengths were employed as far as possible. This investigation showed a need for a new member of staff, the Information Officer, who was recruited in October 2003, as well as staff training and increased participation in activities. It also allowed us to set realistic goals, prioritise tasks and manage time effectively so as to provide the best possible service to our members and the highest possible quality documents for information, presentations etc. Briefly taking stock of ENSP achievements to date, our capabilities and capacities as well as our weak points for improvement, has affected ENSP production in a positive way, during

this project period and we look forward to continue this assessment periodically, in order to ensure that momentum is maintained.

All ENSP staff contracts are established in compliance with Belgian law and ENSP Secretariat fulfils its administrative obligations towards the Belgian State and the administrative follow-up of the EU contract obligations.

Changes in Belgian Law concerning non-profit organisations necessitate some amendments of the ENSP statutes before the end of 2004. Additionally, new rules apply to book keeping and these have already been implemented since the beginning of the ENSP operation.

In November 2003, ENSP membership consisted of 511 member organizations – compared to 383 in September 2002. ENSP membership now includes 21 national coalitions, with 2 new national coalitions joining ENSP in 2003, as well as 4 theme-based European networks. Through the work of the ENSP Secretariat and as of November 2003: A national coalition was founded in Cyprus in September 2003 and its founders have already applied for membership of ENSP; national tobacco control coalitions are planned in the near future in Lithuania and in Latvia; there already exists a coalition for tobacco control in Slovenia and ENSP is due to visit in 2004, in order to present the situation of tobacco control in the EU and to introduce ENSP.

2. Organisation of 8 Executive Board meetings and 2 ENSP network conferences (Copenhagen Autumn 2002 and Utrecht Spring 2003) to provide the latest scientific information and promote consensus building within European tobacco control.

Board Meetings: During the project period, 8 Board meetings were organised. In order to keep a steady flow of information on a short-term basis, weekly activity reports have been sent out to the Board members in addition to the Board meetings. - ENSP Board meeting in Helsingor – 11 October 2002. - ENSP Board meeting in Brussels – 16 December 2002. - ENSP Board meeting in Brussels – 10 February 2003. - ENSP Board meeting in Brussels – 24 March 2003. - ENSP Board meeting in Brussels – 29 April 2003. - ENSP Board meeting in Utrecht – 23 May 2003. - ENSP Board meeting in Helsinki – 6 August 2003. - ENSP Board meeting in Brussels – 17 October 2003.

ENSP Network Meetings and General Assemblies: During the project period, 2 Network Meetings and General Assemblies took place, in conformity with the ENSP Statutes and with the budgets foreseen. The Danish Coalition Against Smoking hosted the first meeting in October 2002, and the second was hosted by the Dutch coalition in May 2003.

- Helsingor – Denmark, 11-12 October 2002

Held in Denmark, during the Danish presidency of the European Union this meeting drew together 49 participants from 22 countries. This conference saw three new participants from accession countries, who plan to set up a national coalition: Romania, Slovakia and Slovenia.

Speakers included: Carin Hakansta from the International Labour Office (ILO) in Geneva, a representative of the Danish Presidency and Dr Haik Nikogosian from WHO Europe headquarters. In view of promoting future ‘cross-cutting’ collaboration with other health related networks, Dr Juha Lavikainen was invited to present the European Network on Mental Health.

The meeting consisted of plenary presentations and interactive workshops followed by the ENSP General Assembly on 12 October. The plenaries and workshops covered the issues of: environmental tobacco smoke and the new ILO ‘Safe Work’ report; the future of tobacco control prevention in Germany - this being of particular interest in view of the upcoming INB5 negotiations of the FCTC; updates on EU policy - the Tobacco Products Directive, the Sales Promotion Regulation and on the Tobacco Advertising Directive; and a training workshop on impact assessment. Additionally, special sessions were devoted to progress achieved by national coalitions (DK, I, CH, CZ and SI) and networks (INWAT).

In view of an expected call for proposals by the new EU public health programme, the ENSP Secretariat presented the main points of the new Public Health Programme, as far as known to date and reported on progress made during the ENSP project building meeting on 10-11 September 2003, for the development of a consolidated framework grant application. A preliminary list of projects was presented: The Tobacco Control Research Centre (TCRC) – promotion of media advocacy for medical associations; Quit lines – development of best practice tools; Health Professionals – adoption/implementation of cessation guidelines; Development of non-smoking policy recommendations for educational institutions working with adolescents; European Status Report on Passive Smoking; ENSP network activities including support for Globalink and coordination of the whole the framework project.

General conclusions of the conference and General Assembly: o Policy: Delegates agreed that the new Tobacco Advertising Directive would be weak or even counter productive without a specific provision to allow Member States to go further that the restrictions outlined, particularly since indirect advertising is not covered. It was decided to increase and focus NGO advocacy efforts on this issue. o Economical ideas were suggested in view of a potential reduction in the budget of the ENSP core grant and of the increased participation of advocates from accession countries. These included: Ceasing to provide simultaneous translation in French at ENSP meetings; and asking participants to pay their own travel expenses. Additionally, participants agreed to reduce the ENSP network meeting to meeting only once a year and that this should either be longer, or that there should be an additional technical conference, which could take place in Brussels.

o Concerning the activities of ENSP: It was decided that a European status report monitoring the implementation of legislation and perceived obstacles covering EU and accession countries, would be an important and useful undertaking for the next project period. o Regarding cross-cutting with other organisations, such as the European Network on Mental Health: It was generally felt that there was a lack of common interest and that synergy of action would be difficult to establish for the time being, but that this would remain an important concern. o The ENSP General Assembly approved officially, the European Union of Non Smokers and the Czech Coalition Against Tobacco, as full voting members of ENSP. Annex: ENSP meeting report Helsingor 2003.

- Utrecht – Netherlands, 23-24 May 2003 Originally scheduled in Dublin, Ireland, the Irish Coalition under re-organisation could not organise the meeting. The Icelandic coalition had then proposed to host the meeting, but for budgetary reasons, the Board finally decided to hold the meeting in Utrecht, the Netherlands. This conference drew together 53 participants from 23 countries, and saw participation from delegates from 3 accession countries (Poland, Malta and Hungary).

Speakers included two international speakers: Simon Chapman (Australia) to speak about the rebirth of the tobacco industry and Joe Cherner (US) who campaigned for a smoke- free New York; as well as Mr Aginus Kalis, Director of the Public Health Department of the Dutch Ministry of Health, Welfare and Sports; Mr John O’Toole, Health Counsellor, Permanent Representation of Ireland to the EU; and Gavin Coopey (UK) Director of the National Corporate Partnerships Cancer Research.

The meeting consisted of plenary presentations and interactive workshops, followed by the ENSP General Assembly on 24 May 2003. The plenaries covered the issues of: The state of EU legislation on tobacco products and advertising; The EU Convention negotiations and the implications of a change in the Treaty of the European Union; The rebirth of the tobacco industry; How to win smoke-free workplace legislation; Fundraising and the experience of Cancer Research UK’s campaigns and corporate partnerships. Workshops were largely focused on the ENSP Framework Project results 2001-2002, and were led by participants/project leaders of some of the projects, which looked at: Research on the labelling of Tobacco Products in Europe; Results and Policy implications of a new EU collaborative study on Economics and Tobacco consumption in Europe; and Recommendation on regulation of smoking in bars and restaurants.

Additionally a special session was held on the preparation of the ENSP Status Report on Oral Tobacco, presented by the consultancy responsible for coordinating Research for Policy (NL), with updates from the authors of each chapter: Witold Zatonski (PL) Tore Sanner (NO) Susan Anderson (UK) . Paul Nordgren (S) from the Swedish Public Health Institute and Esteve Fernandez (E) from the Catalan Institution of Oncology, did not attend the meeting but will be contributing to the report.

A professional group photograph of delegates took place during a break. This will be made into a poster and exhibited at the ENSP stand at the 12th World Conference in Helsinki in August 2003.

ENSP Network Meeting Utrecht (NL) May 2003

o A poster session was held to which 8 EU countries contributed with presentations of their best achievements in 2001-2002. (D-GR-AU-FR-UK-SW-DK-ESP) and there was a short presentation of the Tobacco Control Research Centre’s new service, The Tobacco Fact File, which is newly online (www.tobaccofactfile.org).

General conclusions of the conference and General Assembly: o The presentation by Simon Chapman and particularly Joe Cherner had inspired participants to adopt and positive and pro-active attitude when tackling smoke-free legislation. Email exchanges with Joe Cherner and some of the participants followed the meeting. o Regarding the ENSP Status Report on Oral Tobacco: There were many comments after this session as to the scope and contents of the report and whether now was a good time for ENSP to take on such a controversial issue. It was emphasised that the report is a status report and will/should not make any recommendations. Nevertheless, it was agreed that a stringent peer review of the report should be included to emphasise its scientific backbone. o The recommendations on regulation of smoking in bars and restaurants, that had come about as a result of a survey led in five countries on Non-smokers protection in restaurants and bars in Europe (ENSP Framework Project 2001-2002) were hotly debated, due to a reference to ventilation that had come out of the survey as a recommendation that could be made in countries with poor tobacco control. The

general recommendation emanating from this workshop overall was to: ‘Promote occupational health and safety regulations aimed at eliminating ETS exposure of employees in restaurants and bars’. The consensus was that there is a firm evidence base to show that any amount of ventilation cannot get rid of the carcinogenic danger of environmental tobacco smoke and that ventilation is a solution promoted by the tobacco industry. It was also decided to focus advocacy efforts on smoke free workplaces moving forward and particularly through addressing hospitality industry workers in the first instance. o Members received a pre-publication printed copy of the Recommendations on Smoke free Workplaces (by John Griffiths for ENSP) and they were ask to consider endorsing the document on behalf of: “people gathered in Utrecht for the General Assembly of ENSP on 23-24 May endorse this document” or on behalf of separate organisations. It was agreed that the ENSP Secretariat would be in touch with each ENSP Member in the following weeks to obtain the decision of whether they would endorse the recommendations or not. The recommendations were to be launched at the 12th World Conference on Tobacco or Health, in August 2003 in Helsinki, Finland. o The ENSP working priorities for 2003 were approved. Annex: Draft ENSP meeting report Utrecht 2003 and approved ENSP working priorities for 2002.

3. 7 visits to national coalitions and specialized networks to provide personalized advice and promote co-ordination between national and European level activities.

By November 2003, the membership of ENSP had grown to 21 coalitions (with the addition of the Polish and Slovakian coalitions) and increased from 383 to at least 511 member organizations. Membership differs per country, depending on the cultural specificity and organization of the coalitions:

Coaltions Italy 15 UK 46 Austria 10 GD Lux. 2 Belgium 14 Netherlands 5 Networks Czech Repub. 34 Norway +2 (no figures as ENYPAT 14 Denmark 16 yet) ENSFH 14 Finland 46 Poland 9 EUNS 2 France 24 Portugal 23 INWAT 11 Germany 97 Slovakia 32 TCRC (no figures as yet) Greece 11 Spain 30 Ireland 18 Sweden 13 Iceland 3 Switzerland 70 Contacts with national coalitions, potential national coalitions and theme-based networks:

General contact with ALL coalitions during the project period

Since ENSP was extremely active in coordinated activities such as the FCTC, the 12th WCTOH etc., we were in general contact with a large number of coalition representatives, potential coalition representatives and networks on several occasions and therefore there was little need to plan specific visit to coalitions during the project period. Visits are needed to accession countries, in order to present EU legislation on health and on tobacco control as well as to introduce ENSP and these are planned during 2004.

ENSP activities that provided the opportunity for ENSP to have general contact with coalitions and networks this year were: Coordinating action to encourage negotiations and agreement for a strong Framework Convention on Tobacco Control (FCTC) around the INB5 in October 2002; at the INB6 in February 2003; the 56th World Health Assembly in May 2003, when the FCTC was finally unanimously adopted; Pan- European Union action in support of a firm legal base for health and for tobacco control legislation in the draft EU Treaty (during the EU Convention negotiations in November and December 2002 during the Intergovernmental Conference (IGC) in September 2003); At both ENSP Network meetings; In personal contact and through email exchanges of information and advice for future activities etc. Various other issues of ENSP, such as the amendment of the ENSP statutes and the General Assemblies brought coalition members and the ENSP Secretariat into close contact and communication, which led to extended exchanges of ideas and collaboration.

Belgium 15-18 September 2002: During the first francophone conference on tobacco or health in Montreal (CIFCOT) links were developed with Belgian partners in tobacco control, Belgian parliamentarians and representatives of the Belgian Health Ministry.

7 November 2002: Sibylle Fleitmann (Secretary General of ENSP) participated in the Belgian Coalition meeting to motivate participation in the tobacco advertising ban campaign.

16 November 2002: At the request of FARES (Belgian coalition member) Sibylle Fleitmann gave a lecture on European and Belgian tobacco control legislation in the framework of a ‘Smoking cessation training course for health professionals’ in Brussels.

18 October 2003: At the request of FARES, Sophie Kazan (Director, Strategy and Communications) gave a lecture on European tobacco control legislation in the framework of a ‘Tobacco control training course for health professionals’ in Brussels.

ENYPAT ENSP has shared information regarding funding opportunities with ENYPAT during 2003 and coordinated with ENYPAT, in order for them to be able to nominate members for European Commission bursaries to travel to and attend the 12th World Conference on Tobacco or Health in Helsinki in August 2003. Additionally, in March 2003, Sibylle Fleitmann took part in the ENYPAT Spring School.

Finland November 2003: ENSP has been asked to become involved with the activities of KTL (Finnish Institute of Health, from which ENYPAT comes) in a working group to do with capacity building with candidate countries. Meetings have already been held in Helsinki and ENSP will be invited to share experience, present

17 on EU health policy and to network with accession countries at the next meeting of the working group, planned in Tallinn, Estonia in 2004.

Germany ENSP has been in close contact not only with the German coalition, but also with the German Medical Association representative in Brussels, particularly around the time of the FCTC negotiations in October 2002, February 2003 and the World Health Assembly in May 2003.

Israel Elana Mayshar, Deputy Legal Advisor in the Isreali Health Ministry was contacted to participate in the work of ENSP. They are interested in collaboration with ENSP in the framework of their national tobacco control forum with members from government ministries and NGOs, in the future.

Malta Maria Elul from the Maltese Health Promotion Dept. was contacted to participate in the work of ENSP and her successor, Elaine Caruana was invited to attend the ENSP Network Meeting in Utrecht and to keep ENSP closely up to date with the possible formation of a tobacco control coalition. Currently, the Maltese Health Promotion Dept. is the key institution working in tobacco control nationally. A meeting is planned in Malta for 2004.

Norway ENSP has been in contact with Rita Lindbak of the Norwegian Health Ministry in particular this year (August 2003) for information on Norway’s impressive early ratification of the FCTC. Additionally, we have been in contact with Tore Sanner regarding the latter’s participation in the ENSP Status Report on Oral Tobacco.

Poland 16 March 2003: During the ‘kick off’ meeting for the ENSP Status Report on Oral Tobacco, Sophie Kazan made contact with Professor Witold Zatonski and discussed the possibility of Poland becoming involved with ENSP Framework Projects 2003-2004 and of the possibility of the Polish coalition joining ENSP. The Polish coalition presented its application to join ENSP the following month and it was approved by the ENSP General Assembly in Utrecht in May 2003.

Contacts were made with the Polish coalition regarding its hosting of the ENSP Network Meeting in May 2004 and Witold Zatonski’s participation in the ENSP Status Report on Oral Tobacco.

In November 2003, Sophie Kazan was invited to speak about EU legislation at the Polish World Conference on Tobacco or Health to be held in Warsaw on 4-5 December 2003.

Slovakia ENSP has been in contact with the Slovakian coalition to do with possible participation in a number of ENSP activities, including the suggestion of an expert on environmental tobacco smoke and children, Dagmar Kopcanova, to join the project building workshop that ENSP coordinated in Brussels on 12 March 2003.

Spain

ENSP nominated the Spanish coalition to receive a NGO award from WHO on the occasion of World No Tobacco Day 2003, which they received for their efforts at getting tobacco control on the national political agenda and for mobilizing governmental support for a tobacco advertising ban.

UK ENSP assisted ASH UK in November 2003 in updating the EU legislation section of its website with up-to- date information and the correct URLs.

Accession Countries (general) 3-4 April 2003: Sophie Kazan attended and gave a presentation at the OSI/EPHA conference on ‘Effective Advocacy for Health in Europe’ in Riga, Latvia. Contacts were made with a variety of health advocates (governmental and non-governmental) at this meeting. Sophie Kazan gave a presentation on capacity building and the importance of civil society/NGO action and coordination.

2 August 2003: Contact was made with a variety of accession, CES and Balkan country tobacco control advocates and government or health institute representatives, on the occasion of Sophie Kazan making a presentation about the work of ENSP at the WHO National counterparts meeting in Helsinki, Finland. The importance of exporting best practice in tobacco control to European countries outside the Union was expressed by both the European Commission and WHO. WHO offered to subsidize the attendance of around 10 tobacco control advocates from accession countries and from outside the European Union, to attend the ENSP Network Meeting in May 2004.

4-8 August 2003: Much contact and assistance was given to tobacco control advocates from all 10 accession countries, including the 7 that have not yet joined ENSP: Slovenia, Cyprus, Malta, Estonia, Lithuania, Latvia, Hungary) before and during the 12th World Conference on Tobacco or Health in Helsinki. This occurred due to: The offering of ENSP bursaries (travel and per diem) – which were eventually increased further through collaboration between ENSP and DG Sanco; and through contact at the conference itself, through individual communication at the ENSP stand, through personal meetings, the ENSP plenary session on ‘EU Policy’ and workshop session on ‘Networking between EU and Accession country NGOs’. Some results were invitations for ENSP to visit and help to capacity build in Slovenia and also Romania and Bulgaria (due to accede to the European Union at a later date) and also in the formation of the Cypriot Coalition Against Smoking and its application to join ENSP in October 2003.

ENSP has been in contact with accession country representatives this year in order to ensure the participation of adolescents to the European Commission’s conference on ‘Tobacco Control and Youth Campaigns’ that took place in November in Rome. In the end, it was decided internally by the European Commission that young non-smokers or ex-smokers were not needed.

4a. Management and update of ENSP internet site (www.ensp.org) and an interactive mail conference by a full time Information Officer.

ENSP website/electronic mailing list

The ENSP website was finalized and publicized on Globalink and via the ENSP list server at the end of September/October 2003. Passwords were attributed to the full members of ENSP and to other ‘safe’ tobacco control advocates for the restricted ‘members only’ section.

The electronic mailing list is used to disseminate timely and up-to-date information to the European and international tobacco control community. The number of people wishing to be part of the mailing list has been steadily increasing: September 2000: 361 addresses September 2001: 469 addresses September 2002: 550 addresses November 2003: 677 addresses

Additionally, ENSP has begun to set about translating the website into French – the software used to make changes allows for information to be uploaded onto the site in English and French simultaneously. ENSP has acquired the site: www.rept.org this year, to cater to our French browsers, and we hope that this site will be up and running in 2004.

European News Bulletins (Nº10 – 59) To disseminate timely and up-to-date information on national, European and international tobacco control issues, 49 weekly electronic European News Bulletins in total were sent, during the project period, to the ENSP mailing list (see number of addresses above) and published on the ENSP website homepage and on Globalink. European News Bulletins are compiled, with input from Emmanuelle Beguinot (CNCT) and sent to Dr Sinéad Jones at the British Medical Association’s Tobacco Control Research Centre for scientific/medical editing, and then sent out. During the project period, the communication concept was strengthened by the introduction of clearer subheadings, specific EU/WHO news and updates, as well as special ‘features’ on specific issues as they arose.

Issue Date of issue 10 14 sep 2002 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_10_14_september02. doc 11 24 sep 2002 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_11_24_september02. doc 12 1 oct 2002 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_12_1october2002.do c 13 9 oct 2002 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_13_8_October_2002 .doc 14 29 oct 2002 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_14_29_October_200 2.doc 15 3 nov 2002 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_15_4_November_20 02.doc 16 13 nov 2002 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_16_12_November_2 002.doc 17 26 nov 2002 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_17_26_November_2 002.doc 18 3 dec 02 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_18_3_December_20

02.doc 19 10 dec 02 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_19_10_December_2 002.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_20_17_December_2 20 18 dec 03 002.doc 21 7 jan 2003 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_21_7_Jan_2003.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_22_14_Jan_2003.do 22 14 jan 2003 c http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_23_21_Jan_2003.do 23 21 jan 2003 c http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_24_28_Jan_2003.do 24 28 jan 2003 c 25 5 feb 03 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_25_5_Feb_2003.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_26_20_Feb_2003.do 26 20 feb 03 c http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_27_4_March_2003.d 27 4 mar 2003 oc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_28_12_March_2003. 28 12 mar 2003 doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_29_19_March_2003. 29 19 mar 2003 doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_30__26_March_200 30 27 mar 2003 3.doc 31 2 mar 03 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_31_2April_2003.doc 32 9 apr 03 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_32_9April_2003.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_33_16April_2003.do 33 16 apr 03 c http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_34_30April_2003.do 34 30 apr 03 c http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_35__7_May_2003.d 35 7 may 03 oc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_36__15_May_2003. 36 15 may 03 doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_37__27_May_2003. 37 27 may 03 doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_38__3_June_2003ed 38 3 jun 03 .doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_39__11_June_2003e 39 12 jun 03 d.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_40_26_June_2003.d 40 26 jun 03 oc 41 3 jul 03 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_41_3_July_2003.doc 42 9 jul 03 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_42_9_July_2003.doc 43 18 jul 03 http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_43_17_July_2003.do

c http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_44_22_July_2003.do 44 24 jul 03 c http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_45_28_July_2003.do 45 31 jul 03 c http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_46_21_August_2003 46 21 aug 03 .doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_47_3_September_20 47 3 sep 2003 03.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_48_12_September_2 48 12 sep 2003 003.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_49_19_September_2 49 19 sep 2003 003.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_50_27_September_2 50 27 sep 2003 003.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_51_3_October_2003 51 3 oct 2003 _ed.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_52_10_October_200 52 10 oct 2003 3_ed.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_53_17_October_200 53 17 oct 2003 3_ed.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_54_24_October_200 54 24 oct 2003 3_ed.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_55_31_October_200 55 31 oct 2003 3_ed.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_56_07_November_2 56 7 nov 2003 003_ed.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_57_14_November_2 57 14 nov 2003 003_ed.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_58_21_November_2 58 21 nov 2003 003_ed.doc http://www.ensp.org/files/EUROPEAN_NEWS_BULLETIN_59_28_November_2 59 28 nov 2003 003_ed.doc

During the project period, 49 European News Bulletins were published, which can be downloaded from the ENSP’s online archive: http://www.ensp.org/news.cfm

We learnt this year that the European News Bulletin is used as a basis for several organizations’ updates to their members, including: for a development tobacco control journal published informally by David Simpson (also one of the Editors of Tobacco Control) for African countries.

4b. Dissemination of timely and up to date information on national, European and international tobacco control issues.

A priority of the ENSP Secretariat is to follow policy development on national, European and international level and to give the NGO community the opportunity to participate in the political dialogue. Collection, analysis and dissemination of information is an essential part of networking and consensus building in support of a comprehensive tobacco control policy in the European Union.

Special emphasis was put upon support for the EU Tobacco Advertising Directive, advocacy for a firm legal base for health (particularly tobacco control) legislation and the inclusion of health as a shared competence in the forthcoming EU Constitution during the EU Convention discussions and in the following Intergovernmental Conference (IGC). Follow-up services were also provided on the implementation of the EU Tobacco Products Directive (particularly concerning labelling and the proposal for a draft ‘Commission Decision on the use of colour photographs’) the adoption of the Council Recommendation on the prevention of smoking, as well as the signature of the FCTC by the European Community and Member States and steps made towards its eventual ratification and implementation.

EU wide policy change in favour of smoke-free workplaces was set as a permanent priority, particularly following Commissioner Byrne’s endorsement of smoke free places, some suggestions of commitment for smoke-free workplaces by Employment & Social Affairs Commissiner Diamantopoulou, as well as the publication of the European Commission’s ‘Environment & Health Strategy’. ENSP mobilised members, met with Commission representatives and conducted media work in Brussels in support of smoke-free workplaces.

ENSP was also active in facilitating communication between the European Commission and NGOs at national level with regard to the European Commission Media Campaign and in attending expert and focal point meetings.

Information on policy issues concerning possible action by network members are sent out through specific information releases. (See list of information releases at the end of this chapter.)

EU Tobacco Advertising Directive During November 2002, our energy was put into the organisation of an advocacy campaign in support of the advertising directive in the European Parliament, in collaboration with other Brussels based health networks, interested in tobacco control.

Realising the danger that the Legal Affairs Committee amendments posed on the European Commission’s proposal for a Directive on Tobacco Advertising, ENSP developed a strategy for coordinated action on 5-6 November 2002, aimed at: - Mobilising and informing national coalitions to successfully help strengthen the Directive by influencing national politicians. - Providing support and empowering the coalitions’ national advocacy efforts through information, model letters, press releases, visits to MEPs in Brussels if necessary, regular reports etc.

The strategy was approved by the ENSP Board on 6 November 2002 and was promptly sent to national coalitions. ENSP found national coalitions to be responsive and happy to be involved in this international tobacco control effort. Many felt empowered to be in meaningful and relevant contact with high-level officials in their country and it was a pleasure to be able to provide tools with which to communicate on EU

23 level issues. In many cases, ENSP offered to send the names and email addresses of MEPs per country and even sometimes relayed translated letters to busy national coalitions (e.g. French letter went to Belgium, Luxembourg and Switzerland). ENSP attended the parliamentary vote in Strasbourg and swiftly relayed the results to members.

As a result of ENSP’s actions, contact with EU officials and personalised collaboration with tobacco control and health advocates resulted in ENSP learning about other organisations, increasing visibility of the ENSP and capacity building in view of possible future collaboration. As a result of in-depth information on a current issue, collaboration with other organisations with the same, worthwhile aim and contacts with high level officials at national level, ENSP coalitions gave extremely positive feedback on the campaign and many felt empowered and encouraged by their ability to have an effect on policy. Annex: ENSP strategy in support of the Tobacco Advertising Directive. Annex: See article: ‘Life-saving tobacco advertising directive in danger’, in the EU Reporter Strasbourg edition, the week of the vote in the European Parliament for the Tobacco Advertising Directive. 18 November 2003.

EU Constitution Participation in the conference on governance and the future of the European Union on 2 October 2002, gave insight into the discussions on the European Convention and the difficulties of imposing social/health views compared to the influence of industry and commerce.

ENSP played a leading role in coordinating action and building alliances and capacity with other NGOs, particularly European health networks in developing a strategy to promote an EU Convention that would provide a more firm legal basis for tobacco control and a higher health competence. In practical terms this could be achieved by: - Including health as one of the Values and Objectives of the Treaty. - Making public health a ‘shared competence’ of the European Community and Member States. - Establishing a strong legal base for EU tobacco legislation.

After approval by the ENSP Board and in coordination with other organisations active in tobacco control at European level, a letter was drafted by ENSP in support of the strong health competence to the president of the EU Convention, Mr Valerie Giscard d’Estaing by post and via the official online site, to the Chairman and all members of the Working Group on Social Europe, responsible for drafting and discussing sections of the draft text containing ENSP’s main points of concern (see above) by email and to all members of the Convention.

Before the start of the Intergovernmental Conference (IGC) on 4 October 2003, ENSP conceived a strategy to help support tobacco control and health further in the Treaty discussions and underlining the same points as above by drafting a model letter, which was translated by national coalitions and sent to their Health Ministries to pass on to those colleagues in the Foreign Ministry who would be attending the IGC. The ENSP Board approved this strategy previously. Additionally, ENSP sent the letter to the 15 national permanent representatives to the EU, responsible for health.

As a result of these actions, we received several letters directly from MEPs with questions or outlining their positions. The opinion of the Working Group on Social Europe did include health as an objective of the

European Union, however this part of the report that the working group produced was unfortunately not taken up by the EU Convention drafts. ENSP managed to actually put a briefing paper outlining the importance of health in the draft treaty directly into the hand of Mr Giscard d’Estaing and of Mr Prodi, however economic concerns and the organisation of the EU institutions after the enlargement seem to have taken priority during the final Convention negotiations and the start of the IGC negotiations. The latter continue and ENSP continues to promote the same three key points (see above) whenever relevant and possible.

EU Tobacco Products Directive and Draft Commission Decision on the use of colour photographs On 14 November 2002, ENSP attended a stakeholders meeting in Luxembourg concerning the development of a Commission decision on the use of colour photographs (follow up to Directive 2001/37/EC). Called at very short notice, only 4 NGO representatives were present – whereas that morning, 25 representatives from the tobacco industry had met with the Commission. Nonetheless, ENSP drafted a meeting report and it was sent, with the agreement of the Commission, exclusively to member of the ENSP General Assembly, along with the draft proposal for a ‘Commission’s Decision on the use of colour photographs’ and a request for comments. The wider NGO community was informed of the meeting’s taking place, via an information release, and later of the call for tender that ensued for a library of colour photographs (see: Information release – 2 September 2003.)

EU Tobacco Products Directive and challenge to the EU ban on Oral Tobacco The European Commission services had pointed out to NGOs the threat to Article 8 of the Tobacco Products Directive, which bans oral tobacco in the European Union, with the exemption of Sweden, posed by a legal challenge to the Directive by Swedish Match. This challenge is seen by many members of the tobacco control community as an opportunity to lift the ban on oral tobacco in the EU, it may lead to regulations on all forms of tobacco and thereby lead the way to ‘alternative’ tobacco products being endorsed as ‘reducing harm’ rather than solving the problem of tobacco related deaths. As a result of controversial discussions on this issue and in order to make sure that there was a basic amount of sound evidence available to those wishing to enter into debates pertaining to oral tobacco, the ENSP Board commissioned an ENSP Status Report outlining the possible consequences of lifting the ban on oral tobacco in the European Union. This report was aimed to give particular attention to: - The possible issues of accession countries, regarding oral tobacco. - Epidemiological evidence of oral tobacco use. - Marketing strategies developed by oral tobacco producers. - Socio-economic aspects of freely available oral tobacco. - Strategic, legal and political consequences of lifting the ban.

A ‘kick-off’ meeting was held at STIVORO premises in the Hague on 26 March 2003, for authors of the report, ENSP, STIVORO and a consultancy who will be involved in coordinating the report for STIVORO. The aim was to create a draft of the report to present at the ENSP General Assembly in May 2003. A request has been put forward to the Commission to authorise the budget switch within the ENSP budget to finance the report upto 10,000 Euros. The report was co- financed and co-ordinated by STIVORO (15,000 - 20,000 Euros), contributions were also be made by the Swedish Public Health Institute (5,000 + the time of the author Paul Nordgren). ENSP was in charge of proofing, printing and the ENSP Board was the final editors. (see ENSP Statuts Report on Oral Tobacco: http://www.ensp.org/files/Oral_Tobacco_Report_(final).pdf) Signature of the FCTC by the European Community and Member States

This project period saw the historic adoption of the FCTC by the 56th World Health Assembly (WHA) and its signature by, amongst others, the European Community. This was the result of 4 years of negotiations by governments and 4 years of campaigning by tobacco control advocates. ENSP was extremely active in disseminating information and key facts about the FCTC, building collaboration and promoting action amongst NGOs in Europe and gaining as much information ourselves as to what was going on and what actions would be effective in the long term to make sure that the FCTC was adopted, signed and on its way to being ratified and implemented in the European Union and around the world.

During this project period, in summary, ENSP activities included: - ENSP was present at a high level round table session to discuss tobacco and development and also the FCTC in early February 2003. Delegates were invited from around the world, particularly, members of the Framework Convention Alliance (FCA) NGO alliance, and ENSP coordinated with the WHO and the European Commission in order to organise a meeting between NGOs and the Chairman of the FCTC’s INB negotiations, Mr Seixas Correa, in order for tobacco control advocates to express their concerns and receive the information. - Attending the final intergovernmental session of the FCTC (INB6). These ended on 1 March 2003 with a final text but still no consensus. - ENSP was busy between 1 March and 21 May 2003, in mobilising national coalitions, promoting awareness through the press etc. and supporting and gaining information from our German Coalition as to the German government’s possible vote at the WHA, where the text was due to be presented for vote, since Germany was the principle country in Europe that had not supported the final FCTC text. - ENSP networked with other organisations related to tobacco control such as the Standing Committee of Doctors and the Standing Committee of Nurses as well as the IUHPE and other organisations who were concerned with this issue, in order to send out common message and exchange information. - On 18 April 2003, ENSP urged members to sign an online petition urging the German government to stop blocking the FCTC. This was delivered personally to the German Chancellor Schroeder’s offices in mid-May. - On 2 May 2003, ENSP mobilised members to promote awareness of the importance of the adoption of the FCTC in their countries’ press and to their countries’ health ministries preceding an emergency meeting of EU Health Ministers on 6 May 2003 to discuss the FCTC and the SARS epidemic – ‘Two dangerous threats to health, the first being the most dangerous’. - On 21 May 2003, ENSP attended the World Health Assembly meeting in Geneva and witness the FCTC being unanimously adopted. This marked a historic occasion and a press release was put together within minutes together with other European organisations working in tobacco control and sent to the press and to ENSP members to translate and send to their national news desks, outlining the victory and emphasising the pressing need now to ratify and implement this historic new health treaty. (see final text: http://www.who.int/tobacco/fctc/text/final/en/) - Once the FCTC had been adopted and signed by the European Community and some Member States in June 2003, ENSP began to promote the importance of ratification and implementation of the FCTC, which is the only way that this historic treaty will have any effect.

In conclusion: ENSP not only rallied strong NGO support for the FCTC, through its network of tobacco control coalitions, networks and contacts with medical and professional organisations, we also continued to disseminate up-to-the-minute information throughout this period, keeping organisations clearly informed and took every opportunity possible to gain information, promote collaboration with non-governmental and governmental organisations for tobacco control.

Smoke-Free Workplaces In August 2003, ENSP published ‘Policy Recommendations on Smoke-Free Workplaces - Optimising Organisational and Employee Performance,’ put together by John Griffiths of Work 2 Health, at the 12th World Conference on Tobacco or Health in Helsinki. Additionally, paper and CD rom copies of the recommendations were sent out to policy makers and made available on the ENSP website (see: http://www.ensp.org/files/rapport_complet_A5.pdf)

On 27 May 2003, ENSP coordinated with UK MEP Elizabeth Lynne, who is herself an asthma sufferer, to organise a briefing for the press any other interested groups at the European Parliament, not only as a way of promoting smoke-free workplaces and the imminent World No Tobacco Day on 31 May 2003, but also as a means of disseminating the ENSP Framework Project 2001-2002 project results ‘Non-Smokers Protection in Restaurants and Bars in Europe, a survey in five European countries’. Speakers included the project participants from the Belgian Fondation contre les Affections Respiratoires et pour l’Education à la Santé (FARES), representatives from CERES and from the Belgian Coalition. The briefing resulted in coverage in the Brussels European Voice, in the Brussels ‘Metro’ newspaper (front page) and in various other publications via press agencies and wires.

Reports in the press and interviews from Commissioner Byrne showed that legislation for smoke-free places in Europe could be attainable but that much rested on the support of DG Employment & Social Affairs and Commissioner Anna Diamantopoulou. For this reason, ENSP, in coordination with other organisations active in tobacco control at European level, drafted and disseminated a press release in response to press reports on the subject, outlining how important a ban on smoking in the workplaces would be at EU level to smokers and non-smokers alike. Additionally, a meeting was requested with Head of Unit for Health & Safety at Work at DG Employment, Mr Biosca.

Additionally, in July 2004 it was announced that the European Commission would ban smoking from all its premises from 1 May 2004 and ENSP was glad to have been of help in providing information and pre- publication copies of the workplace recommendations to the working group responsible.

Environment and Health Strategy and the European Health Policy Forum ENSP is a member of the European Health Policy Forum, put in place by the European Commission to discuss with stakeholders future public health policy developments.

On 22 November 2002, the Health Policy Forum recommendation for enlargement was agreed and a letter from the Forum to the President of the European Convention was agreed in order to push health higher on the Convention agenda. The Commission expressed the concern that NGOs were not active enough in this area.

ENSP gave active input to an informal meeting of the European Health Policy Forum, in preparation for the official meeting on 6 June 2003. A first draft of the EHPF recommendations on ‘health and social policy’ was discussed. ENSP pointed out the necessity to highlight positive relations between health and social policy i.e. smoking prevention and reduced cost for enterprises, as well as increased healthy workforce. A particular reference was made to healthy ageing in relation to the European social agenda.

At the Health Policy Forum meeting of 6 June 2003, the Environment and Health Strategy was outlined by Prudencio Pereira and a stakeholders ‘Information and Consultation’ meeting was announced for 11 July 2003 . During this meeting, the focus of the Environment and Health Strategy was explained (‘SCALE’: Science; Children; Awareness; Legislation; and Evaluation) as well as its coordination by 3 Directorate Generals: DG Sanco, DG Environment and DG Research (see: http://europa.eu.int/comm/environment/health/stakeholder_en.htm). The working plan was also described and stakeholders (particularly health NGOs) were invited to apply to be part of technical working groups and the Consultative Group, which will help to coordinate the reports of each of the group and follow data emerging (see: http://europa.eu.int/comm/environment/health/index_en.htm#4). The final reports will act as a base for the Commission’s contribution to the WHO Inter-ministerial Conference on Environment and Health in Budapest in June 2004 and into the Commission’s own ‘Environment & Health Action Plan’ 2004-2010. ENSP therefore relayed the information, application details and deadline to members in order to encourage tobacco control advocates to become involved in this new initiative that brought together concerns for the environmental harm and the damage to health (particularly that of children) caused by tobacco products. ENSP applied to be on the Consultative Group, onto which it was accepted in October 2003, in order to be able to continue to relay information to the network and in order to be able to promote and support tobacco control policy within this context.

European Commission Media Campaign ENSP was instrumental in proposing European experts to constitute the expert panel to assist the Commission in monitoring the development of the campaign concept 2002-2003. On 9 December 2002, ENSP attended a meeting on the EU Media campaign strategy for 2003, where it was agreed that ENSP (in collaboration with ENYPAT) would identify national focal points in each of the EU Member States to facilitate implementation of the campaign at national level. This list of focal points was approved by the European Commission.

The role of focal points was agreed as follows: - Media Consulta, the contractor in charge of the campaign, will inform national focal points on behalf of the European Commission of activities/events that are scheduled to take place in order to allow focal points to inform interested parties in their country. The contact person at Media Consulta was identified as: Ms Ute Gunsenheimer – [email protected] - In return, the focal points will advise the European Commission, through Media Consulta on planned national activities related to tobacco control and/or youth taking place, in order to avoid clashing interests on either side, in order to avoid confusion and in order to create synergy between national activities/events. - Planned publications material and media material to be used will first be fed through the focal points, well in advance, in order to allow screening for incoherencies which may occur due to misunderstanding the cultural specificities/overlapping with ongoing projects and allow for proposals to be put forward constructively, with a view to improving effectiveness.

The network of focal points is considered to be a privileged communication channel for EU wide information related activities, which are implemented at national level. A final list of national focal points was submitted to the Commission services on 14 February 2003.

Following meetings of the focal points were held on 7 April 2003 and 3 September 2003. ENSP was be represented at meetings by Elizabeth Tamang and/or by Sophie Kazan. Annex: List of national focal points – EU Media Campaign

EU ECO Label. Criteria for the development of an ‘ECO label’ for tourist accommodation services were developed by DG Environment. The provisions for smoke-free areas has been watered down from the initial proposal ‘all accommodation structure, all common rooms and 80% of private rooms shall be non-smoking’ to a simple obligation to have smoke-free areas and an option to have 50% of rooms smoke-free. http://europa.eu.int/comm/environment/ecolabel/producers/pg_tourism.htm

ENSP had inquired with DG Sanco and DG Environment on the possibilities to influence the criteria, however the consultation process took place without leaving room for NGO input. The Commission Decision was published in April/May 2003, on the DG Environment website. A possibility to revise the criteria is not expected for another 2-3 years. Unfortunately, this seems like a lost opportunity for governmental and non governmental health advocates and NGOs to support and enforce smoke-free areas in the hospitality industry in the frame of a recognised EU ‘ECO Label’.

Other issues followed on which information was disseminated: - Proposal for a Directive on Sales Promotion in the Internal Market – March 2003. - The revision of ‘TV Without Frontiers’ Directive – April 2003. - Proposal for a Directive on Unfair Business to Consumer Commercial Practices – June 2003.

Information releases The following information releases were disseminated to ENSP Members and to the ENSP list server/mailing list during the project period (15 September 2002 – 30 November 2003.)

Date sent Subject 18 September 2002 12th World Conference on Tobacco or Health in Helsinki. 26 September 2002 The European Health Report and Closure of the 52nd Session of the WHO Regional Committee for Europe 1 October 2002 NGO Consultation organised by the European Commission (FCTC). 3 October 2002 Urgent Call to Action (Tobacco Advertising Directive). 9 October 2002 IMPORTANT - Media Advocacy for the Framework Convention 10 October 2002 Legal Committee position on the proposal for a Tobacco Advertising Directive.

15 October 2002 Letter to German Ambassador – future action of European Parliamentarians to influence the Tobacco Advertising Directive. 8 November 2002 EU Media Campaign ‘Feel Free to Say No’ (information and list of expert panel.) 14 November 2002 Proposed amendments to the Proposal for a Tobacco Advertising Directive (reports on press conference of Heidi Hautala MEP and notice of Strasbourg plenary session.) 20 November 2002 Tobacco Advertising Directive Vote in the European Parliament. 20 November 2002 Report on vote/adoption of the Tobacco Advertising Directive in the European parliament. 3 December 2002 Report on important decisions at the meeting of the European Health Ministers (Health Council) in Brussels on 2 December 2002. (Adoption of Tobacco Advertising Directive by political agreement/qualified majority vote; adoption of Council Recommendation on the Prevention of Smoking.) 8 January 2003 EU Media Campaign: list of focal points and information update. 15 January 2003 New Chair’s Text (FCTC.) 7 February 2003 EU Convention – keeping you up-to-date. 6 March 2003 Good News and Call to Action on Sales Promotion. 13 March 2003 Call for Proposals for New Public Health Programme 20 March 2003 About Tobacco Fact File – a valuable resource. 10 April 2003 Call to make nominations for Luther Terry Award for Exemplary Leadership in Tobacco Control. 18 April 2003 Important petition urging Germany to stop blocking FCTC. 2 May 2003 URGENT call to action before emergency meeting of EU Health Ministers (FCTC) 4 July 2003 ENSP Activities at the 12th World Conference on Tobacco or Health in Helsinki. 18 July 2003 Call for participation: Consultative and Technical Groups of the European Environment and Health Strategy. 1 September 2003 Smoke Free Workplaces – Optimising Organisational and Employee Performance. 2 September 2003 Call for Tender for colour warnings deadlines on 22 September. 5 September 2003 Latest results of ENSP tobacco control framework projects

15 September 2003 Important Information on the EU Convention and Intergovernmental Conference (IGC). 23 September 2003 Urgent: Letter to send to EU Health Ministers before 4 October 2003. 9 October 2003 European Commission Recommendation on occupational diseases 9 October 2003 New ENSP Information Officer (introduction of Edward Riley). 20 October 2003 Environment and Health Consultative Group. 20 October 2003 WHO Call for Proposals: "Channel the Outrage!" 24 October 2003 ENSP website update: Tobacco Legislation Overview 28 October 2003 Petition congratulating the Irish Minister for Health and Children for putting in place legislation to ban smoking in all workplaces as and from 26th january 2004 12 November 2003 EU Call for Research: 6th Framework Programme 19 November 2003 Final Recommendations from Media and Smoking Prevention Rome Conference 20 November 2003 Preview: ENSP Status Report on Oral Tobacco

European Public Health Alliance (EPHA) Additionally, ENSP benefited from its membership of the EPHA to disseminate information on projects and activities and to enlist the support of organisations such as professional patients, doctors and nurses associations, for example, in tobacco and also health related issues – such as the EU convention. Meetings were held on the following dates, in Brussels (see: www.epha.org for minutes)

EPHA coordination meetings: 16 July 2003; 29 October 2003 EPHA General Assembly: 12-13 June 2003 EPHA Environment Network: 25 March 2003

Additionally, Sophie Kazan was elected onto the Executive Board of EPHA in August 2003 and she attended a meeting of the Board on 24 September 2003 in Brussels.

5. Publication of 2 information bulletins, 1 ENSP leaflet and 1 scientific report in collaboration with a scientific adviser.

During this project period, ENSP published: - ENSP policy recommendations for smoke-free workplaces (A5 booklet) - Summarised final reports of ENSP Framework Projects 2001-2002 (A4 publication) [Grant Agreement Siz: 324433] - ENSP Status Report on Oral Tobacco

All these publications are available on the ENSP website and in Annex.

In addition, a CD-Rom was created on ‘Smoke-Free Workplaces’, containing the ENSP policy recommendations on smoke-free workplaces, together with the ENSP Status Report on Smoke Free Workplaces, produced under the 2000-2001 grant agreement. [Grant Agreement Siz: 324433]

A second CD-Rom was created for ‘ENSP Framework Projects’, containing the Summarised final reports of ENSP Framework Projects 2001-2002, together with the Summarised final reports of the ENSP Framework Projects 2000-2001, that had been published last year in the previous grant agreement.

This burning of CD roms, marks not only ENSP’s transfer into the digital age, its consciousness of the environment (less paper copies were produced than usual) and costs (CD roms are lighter to send by post), the grouping of past and previous reports in such a relevant way also shows the consistency and continued high quality and significance of ENSP’s work.

ENSP disseminated the CD roms widely at the 12th World Conference on Tobacco or Health in Helsinki, and at the European Respiratory Society Congress in August 2003, they were also disseminated by post on request and were received with great interest.

6. Attendance of 5 conferences and/or fairs to acquire scientific input and communicate on ENSP activities to tobacco control community.

15-18 September 2002 ‘Première Conférence internationale francophone sur le contrôle du Tabagisme’ in Montréal, Canada. The European Commission DG Sanco exceptionally allowed ENSP to attend this meeting (outside the European Union) at which its work was presented as a best practice example of network building and trans- national project development, in a francophone environment. The conclusions/future steps of the conference have been put on the ENSP website and sent out to the ENSP mailing list. The main conference conclusion was that the constitution of a francophone network on tobacco control with provisional offices in African and Québec is vital. ENSP will stay in contact with the francophone network’s activities to create coordination and synergy of activities.

September – October 2002 Several EU meetings, in Brussels. 30 September 2002 ‘EU parliament: discussion of Advertising Directive’

30 September/1 October 2002 ‘EU conference on data protection’ 1 October 2002 ‘EU conference on the EU Convention’ 2 December 2002 EPHA General Assembly and seminar on the future of the European Constitution, in Brussels. ENSP attended this meeting, participated in discussions and gained insight on the issue. A follow up working group was planned on 4 December 2002, for the purpose of coordinating a campaign and mobilising all European Health networks with the aim of promoting health on the agenda of the EU Convention’s ‘Social Europe’ Working Group.

3-4 February 2003 ‘High level round table on tobacco control and development policy’, in Brussels. The aim was to analyse the tobacco control situation in Europe and to look at its effect in developing countries. Speakers included Commissioner Byrne (Health & Consumer Protection) and Commission Nielsen (Development). The aim was to analyse and discuss best practices and financial needs for tobacco control in developing countries, with particular emphasis on the FCTC. The meeting was attended by many NGOs involved in tobacco control from all over the world and many members of the FCA. ENSP followed up with this meeting by organising a meeting with the member of the cabinet of Development Commissioner Nielsen responsible for health and NGO issues, on 17 March 2003. This was to ascertain the breadth of DG Development’s commitment to tobacco control issues and to investigate whether any special aid was being offered for the FCTC implementation that ENSP could disseminate. Though this was an interesting meeting, we found that this was not directly the case.

17-21 March 2003 ‘ENYPAT Spring School’ Helsinki, Finland. As an outcome, the participants requested ENYPAT have more information on policy issues linked to the research segment of youth smoking prevention and cessation. Annex: ENSP Mission Report on the ‘ENYPAT Spring School’.

21 March 2003 Information Day on New Public Health Programme Following the European Commission’s Call for Proposals for New Public Health Programme at the beginning of March, ENSP attended this information day at the European Commission in Luxembourg, in order to benefit from presentations by the Commission and additional information as well as meeting other organisations interested in receiving funding for projects under the New Public Health Programme for the period 2003-2006.

2 April 2003 Review of ‘TV Without Frontiers’ Directive, Brussels, Belgium. ENSP attended the review of the ‘TV Without Frontiers’ Directive 89/52/EEC, which took place at the European Commission and was attended by many members of the European Broadcasting associations in case the ban on tobacco advertising on television was brought up and challenged. This was happily not the case.

3-5 April 2003 ‘Effective Advocacy for Health in Europe’, Riga, Latvia. ENSP attended this conference, organised by the Open Society Foundation (OSI) and EPHA in order to gain further knowledge of the health situation in general and the tobacco control situation if possible, in particular, in accession countries. ENSP made a presentation on why building capacity and forming

33 coalitions and alliances is important and introduced ENSP to NGO and government representatives from some of the EU Member States and a large number from accession countries 24 June 2003 Social Inclusion and Health Across the EU, European Parliament, Brussels. ENSP attended a seminar organised by EuroHealthNet which focused on the results of a project on social inclusion and health, coordinated by the Dutch Institute for Health Promotion and Disease Prevention. Catherine Stihler, the UK MEP spoke briefly about the importance of fighting social exclusion. An NGO perspective on this issue was also given by representatives from the European Anti-Poverty Network and from Mental Health Europe. ENSP will keep in touch with Josée van Remoortel of Mental Health Europe will keep in contact regarding the issue of high smoking rates amongst the mentally ill in Europe.

8 July 2003 Launch of Men’s Health Forum and its "Report on the state of men's health across 17 European countries", Brussels. ENSP attended and arrangement to meet with the executive of the newly founded Men’s Health Forum in the future, in an attempt to work towards a more coordinated and crosscutting approach to tobacco control in Europe.

8 July 2003 Launch of the European Commission-support project on Mental Health, in the European Parliament, Brussels. ENSP was invited by EuroHealthnet to attend the launch of a report on mental health and on its European Recommendations to Cope with Depression, Anxiety and Stress. Tobacco is seen as a major threat to the mentally ill and tragically smoking is used to ‘calm down’ the mentally ill. ENSP made interesting contacts with the consortium responsible for the project that included: Mental Health Europe; the European Network for Workplace Health Promotion; the National Research and Development Centre for Welfare and Health; and University of Deusto. It studied three age groups- under 25, 25 to 60, and older than 60- led to recommendations for improving mental health that included teaching skills to cope with stressful life transitions and, for older people, ensuring social inclusion. Horst Kloppenburg of the Health and Consumer Protection Directorate-General delivered remarks on behalf of Commissioner David Byrne, who was unable to attend. These remarks expressed the Commission's wish to cast light on and reduce the stigma of mental illness vis-à-vis the public, in part by urging Member States to implement the project's recommendations after the Commission receives the final report. The conference "Mental Health in Europe- New Challenges, New Opportunities" took place from 9 to 11 November 2003 in Bilbao, Spain.

11 July 2003 ‘Stakeholders Information and Consultation Meeting on the European Environment and Health Strategy’, Brussels. The conference was chaired by Prudencio Perera (DG Environment) and attended by NGOs, members of the European Commission and international organisations such as the World Health Organisation and European Environment Agency, as well as industries (e.g. chemical and tobacco?). Commissioner for the Environment, Margot Wallström described the Environment and Health strategy, underlined the importance of stakeholder participation and finished by saying: “What is harmful to our children is bad for everybody. But what is good for our children is good for us all and for the future of our society as a whole.” Representatives from DG Research, the Joint Research Centre and DG Sanco then spoke of their contributions to the strategy. A represenative from WHO and from the European Environment Agency also spoke and ENSP gained much

34 information to disseminate to members as well as a deadline for applications to be on the strategy’s technical working groups and consultative group. Annex: Report on the ‘Stakeholders Information and Consultation Meeting on the ‘European Environment and Health Strategy’.

1-2 August 2003 WHO Counterparts Meeting for Tobacco Control, Helsinki, Finland. ENSP was invited to this meeting by WHO to make a presentation on the importance of NGOs and coalitions in the EU wide tobacco control effort and in ENSP’s work in particular. The meeting also saw the launch of the WHO European Country Profiles 2003 and ENSP was able to meet a wide variety of WHO counterparts from NGOs and governmental organisations in many of the European Union candidate countries and in the greater European region. Through discussions it was agreed that WHO Europe would fund 10 people from central and eastern Europe to attend the next ENSP Network meeting in Krakow in May 2004. The European Commission publicly approved of this idea during a presentation, because it would make ENSP a ‘European Network in the truest sense’ and allow countries to become involved in tobacco control activities at European level, benefit from best practice, the tools and experience of members as well as an already running information dissemination system.

2-8 August 2003 ‘12th World Conference on Tobacco or Health’, Helsinki, Finland. ENSP participated greatly in this conference, with three members of the ENSP staff attending to organise and participate in: - The ENSP Exhibition Stand, which was reserved in a central and strategic location within the conference exhibition area. This was manned by ENSP staff and Board Members according to a rota system and material (reports, CD roms and leaflets about ENSP) were widely and rapidly disseminated. Additionally, a demonstration of the ENSP website was available to introduce people to the website and its functions. - Launch of ‘Recommendations for Smoke-Free Workplaces’ 6 August 2003 John Griffiths introduced the recommendations during a workshop on 'Measuring ETS exposure' and they were distributed at the end of the presentation. - Main Session on ‘European Policy’ 7 August 2003 ENSP organised a session that included an outline by a European Commission representative of the mandate of the European Union as regards health and tobacco control in particular, speakers from Ireland, Slovenia, Turkey and Russia gave an overview of tobacco control in their countries, from the point of view of a Member State and a candidate country with advanced legislation (Ireland and Slovenia) and from the point of view of a non-EU country and of a CES country (Turkey and Russia). The session was extremely informative not only to the audience but the speakers were also extremely glad to be presenting the issues of concern regarding tobacco control. - Workshop session ‘Networking with Accession Country NGOs’ 7 August 2003 The President of ENSP, Trudy Prins as well as Sophie Kazan and Francis Grogna made presentations on ENSP, its information dissemination and project coordinating roles. National coalition representatives from Denmark and Spain gave a brief overview of the work done in their countries, concerning strategic planning and national tobacco control projects. There followed a discussion, aimed specifically at accession countries that was chaired by Aurelijus Veryga, a tobacco control NGO from Lithuania. Participants in the discussion included representatives from Romania, Poland, Bulgaria, Czech Republic, Slovakia, Hungary, Malta and others. This was an extremely successful exercise since many of the participants noted that this was the opportunity to participate and speak out informally to their peers, during the conference.

- European Commission Workshop on ‘Changing the Face of EU Tobacco Control’ 7 August 2003. Additionally, ENSP attended and made a presentation on the role of ENSP in the Commission Workshop on ‘Changing the Face of EU Tobacco Control’ on 7 August 2003 and also moderated a session on ‘New Science and Tobacco Control’.

In his address at the opening of the Conference, Commissioner Byrne spoke about global tobacco control and of the efforts and activities in the European Union. In this context he commended the work of the European Network for Smoking Prevention. We were able to thank the Commissioner, on meeting him the next day, at the European Commission exhibition stand. A poster describing ENSP and its aims/mission was exhibited on the stand of the European Commission. Annex: ENSP Mission report on the ‘12th World Conference on Tobacco or Health’.

28-30 August 2003 ‘Tackling inequalities in smoking in Europe’ workshop, Edinburgh, Scotland. Organised by the Interventions Network for social inequality, this workshop was organised to disseminate, share and build on the results of the work of University of Rotterdam for the ENSP 2002-2003 Framework Project on ‘Tackling Socio-Economic Inequalities in Smoking Prevention in the European Union’. ENSP made a presentation on current EU policy regarding tobacco control, possibilities for future action, with emphasis on which legislation related to the effective measures to promote cessation amongst socio- economically challenged areas, as defined in the project (Education/Awareness, Smoke-Free Policies, Cessation and Taxation.)

1 September 2003 ‘European Society of Cardiology Congress’, Vienna, Austria. ENSP was invited by the European Heart Network to make a presentation at the European Society of Cardiology Congress on the work of ENSP (particularly information dissemination and project coordination) and on the importance of the involvement of medical professionals in tobacco control in setting an example to patients and particularly in mobilising to make demands on governments (for policy) and on places of work/hospitals (for smoke-free workplaces). This was a new context for ENSP and new insight was gained on the importance and influence of groups from the medical profession. ENSP was asked particularly about the ‘Smoke Free Hospitals’ ENSP Framework Project and on projects to do with health professionals and General Practitioners, nurses etc.

10 September 2003 ‘Governance and Leadership Course for Hospital Directors & Managers’, Brussels. ENSP was invited by Eurohealthnet to speak at a course organised by the King’s Fund in London for hospital directors, managers and medical professionals on how policy ‘happens’ in Brussels. ENSP presented on the work of ENSP, the way tobacco control NGOs and networks work, the importance of coalitions and on ENSP activities and plans for the future. Interesting contacts were made both with the participants and other speakers and we were able to provide further information to interested parties by email, following the conference.

11 September 2003 Briefing meeting with the European Commission DG Sanco, Luxembourg. On this occasion, Matti Rajala and Kari Paaso met with ENSP, and other organisation active in tobacco control at European level: The European Cancer Leagues, European Respiratory Society and the European

Heart Network to discuss issues of concern. These included the Commission’s call for tender for a report on tobacco control in Europe, in which ENSP is participating as part of a Consortium with the ‘afore mentioned organisations, the implementation of the Tobacco Products Directive and the way forward towards ratification of the FCTC by Member States.

27 September – 1 October 2003 European Respiratory Society Annual Congress 2003, Vienna, Austria. ENSP were offered a free stand by the European Respiratory Society for their Annual Congress 2003. This was a great privilege and also an extremely rewarding means of disseminating information on ENSP projects to interested groups. Participants mainly included health professionals and academics. ENSP distributed reports and CD roms and gained many new contacts.

30-31 October 2003 Tobacco Ingredients Conference, Bilthoven, the Netherlands. ENSP attended this meeting, which included an international programme of speakers examining the issue of tobacco ingredients and regulation. This gave ENSP insight into ways of interpreting and implementing the Tobacco Products Directive, using experience and expert suggestions from the USA and Canada, amongst other. Annex: ENSP Mission report of Tobacco Ingredients Conference, Bilhoven.

13-15 November 2003 “Tobacco, Youth Prevention and Communication Conference”, Rome, Italy. ENSP attended this meeting hosted in Rome by the European Commission and the Italian Presidency of the European Council in order to learn more and discuss tobacco youth prevention. This meeting was extremely interactive with plenaries followed by working group sessions that proved extremely productive, particularly since participants were a mix between tobacco control activists and media professionals. This double expertise/experience ensured that the recommendations that emerged were as realistic and as ‘true to life’ as possible, but also possessed scientific grounding and a firm evidence-base. Annex: Recommendations and ENSP Mission report of the ‘Tobacco, Youth Prevention and Communication Conference’.

November 2003 Meetings in Brussels 25 November 2003 ‘Launch of European Respiratory Society (ERS) White Book on Lung Disease’. 27 November 2003 Conference on the legal base for health in the new Treaty Text, organised by ERS and EPHA. Annex: ENSP Mission reports on these events.

7. Organisation of a satellite seminar for NGOs of the 13 accession countries on the occasion of the 12th World Conference on Tobacco or Health in Helsinki in August 2003.

This was organised as a workshop on ‘Networking with Accession Country NGOs’ that took place on 7 August 2003 at the 12th World Conference on Tobacco or Health in Helsinki.

Participants Participants included representatives from each of the accession countries, some of whom had received bursaries to attend, which were organised by ENSP and eventually subsidised by the European Commission. These bursaries included travel, daily allowances for 6 days of the conference (to include hotel accommodation etc.) and registration to the conference. The conditions of the bursaries were that beneficiaries should attend the ENSP main session on ‘European Policy’ and this workshop, as well as a workshop organised by the European Commission on tobacco control in the European Union. Additionally, participants were asked to send a report on the tobacco control situation in their country to ENSP for information and possible future publication. Annex: List of countries who were contacted for bursaries by ENSP and who attended the sessions.

Programme ***** ENSP workshop at the 12th World Conference Tobacco or Health Helsinki (Finland) 7 August 2003

‘Networking between EU and accession country NGOs’

The objective of the workshop was to promote the work of non-governmental organisations active in tobacco control in EU accession countries, with a view to integrate into the ENSP networking effort.

Chair: Trudy Prins (ENSP)

PRESENTATIONS (Total time: 25 mins) • Overview of EU tobacco control and the role of ENSP – Trudy Prins, ENSP • Networking, disseminating information and the importance of coalitions – Sophie Kazan, ENSP • ENSP framework projects – Francis Grogna (ENSP)

Best practice examples of coalition activities (Total time: 25 mins) • Hans Storm/Jorgen Falk, Denmark – From regional to cross border project development • Dr Javier Toledo, Spain – Strategic planning for efficient tobacco control advocacy

DISCUSSION GROUP (Total time: 25 mins) Facilitator: Aurelius Veryga (Lithuania) assisted by Sophie Kazan (ENSP).

Aim: To identify common strengths, weaknesses, opportunities and threats to the development of a comprehensive tobacco control policy in the enlarged European Union on national/regional level, with regard to: EU Legislation; Trans-border collaboration and an ENSP network of Accession countries.

Common conclusions: It emerged from discussions that much work needs to be done in accession countries and Central and Eastern European countries, to encourage tobacco control advocacy and support the work of NGOs/civil society, financially and through shared experience and tools. ENSP does much and plans to do much in this way to support not only the tobacco control effort in accession countries and beyond, but is also

38 committed to integrating as many accession countries as possible into the ENSP network and promoting awareness of their individual needs and concerns regarding tobacco control. Annex: ENSP information fliers for the 12th WCTOH and photos of the ENSP stand.

Expected Results:

¾ Increase network membership in the European Region with special emphasis on health professional organizations.

In November 2003, the ENSP membership increased by 128 members from 383 to 511 member organisations. Specific collaborations have been developed with the Standing Committee of Doctors, the Standing Committee of Nurses of the EU, the European Society of Cardiology, the European Respiratory Society, EuroHealthNet (Health Promotion) and the European Federation of Allergies and Asthma Associations.

ENSP has consciously sought to closen links with other European networks working in tobacco control, in view of collaboration for specific activities (e.g. EU Convention) but also to explore cross cutting issues of tobacco control, as outlined in the Commissions Public Health Strategy. ENSP was able to do this through: - Attendance at the Health Policy Forum and other Commission events for stakeholders. - Involvement with the activities of the Framework Convention Alliance (FCA) and in meetings to do with the FCTC. - Attendance of launches and meetings organised by other groups related to tobacco control, for example the Men’s Health Forum and the launches of reports on Mental Health and on Social Inclusion, by EuroHealthNet. - Membership of an informal working group of organisations active in tobacco control at European level (European Respiratory Society, European Cancer Leagues, European Heart Network, Hungarian Filter Online and ENSP). - Attendance and involvement with the activities of the European Public Health Alliance (EPHA) and its members and the co-signature of a letter entitled ‘A Health Constitution for Europe’ which was signed by EPHA members and sent to member of the EU Convention, asking for a firm legal base for health and for health to be included in the Values and Objectives of the Union. ENSP joined members of EPHA in handing these out to delegates of the Convention. Additionally, Sophie Kazan became a member of the Executive Board of EPHA on behalf of ENSP in August 2003. Through this activity, and through attending EPHA’s regular members’ policy sessions, ENSP gained closer contact with Mental Health Europe, Eurohealthnet (Health Promotion), the Pharmacist representation to the EU, the Standing Committee of Doctors, the Standing Committee of Nurses, the European Council for Classical Homeopathy and the European Child Safety Alliance.

The increase in membership and contacts with other health networks and with health professional organisations in particular has helped to forward the visibility of ENSP as an EU initiative in tobacco control and has also widened the participation of organisations in the European region in ENSP’s advocacy effort concerning: - The adoption of the draft Tobacco Advertising Directive, by the European Parliament, with an additional safeguard clause for stronger national legislation and a statement that indirect advertising is Member States’ responsibility.

- The negotiation and signature of a strong Framework Convention on Tobacco Control (FCTC) as well as plans for national ratifications. - The inclusion of public health as a shared competence in the discussions on the values and objectives of the draft EU Treaty by the European Convention, its working group and in the Intergovernmental Conference (IGC) that followed.

Additionally, ENSP contributed an article to the European Heart Network’s magazine, ‘Heart Matters’ on NGO activities in tobacco control for the July 2003 issue. ENSP also contributed a long article on ENSP, to the magazine ‘Cancer Futures’’ July/August 2003 edition, in which the importance of the FCTC was outlined as was the importance of coordinated activities and capacity building. Annex: See articles

Currently ENSP’s statutes only allow for European networks and not networks active in tobacco control in Europe that may not be European. Political factors such as the FCTC and technological factors such as internet and the Globalink network mean that more and more international tobacco control organisations are aware of and are taking an interest in the tobacco control situation in Europe. Since ENSP would ideally like to be inclusive rather than exclusive, this issue will be addressed in early 2004, through a working group discussion of ENSP Members. It may result in a change of statutes at the ENSP General Assembly in May 2004.

¾ Improved analysis, compilation and dissemination of up-to-date and timely information through the ENSP interactive conference site – as a consequence increase from 500 to 600 active email participants. The ENSP list server participants increased from 469 email addresses in September 2001, to 677 in November 2003. The analysis of a constant information flow from national, European and international sources, resulted in the compilation and dissemination of 45 electronic weekly European News Bulletins and publications on the ENSP website. Over the project period, more than 37 information releases on subjects providing up-to-the-minute information or requiring immediate action/attention on behalf of ENSP member organisations were disseminated by the Secretariat and published on the restricted access area (members only) of the ENSP website.

Constant updating and assessment of the website and its fulfilment of members’ needs has become best practice in ENSP and the organisation, quantity and quality of information, its analysis, compilation and dissemination form and style are constantly being improved. From statistics gathered between January to November 2003 (inclusive) the website received almost 900,000 hits from about 30,000 visitors, and we believe that these were largely due to the high quality information provided and presented to ENSP members, provided through links to the ENSP website.

The ENSP European News Bulletins are highly appreciated by the tobacco control community. Commissioner Byrne and Members of the Health Group of the Council of Ministers have personally requested to be on the mailing list. David Simpson (co-editor of Tobacco Control, an international scientific magazine published by the British Medical Journal Group) uses the European News Bulletin to compile information for developing countries.

In January 2002, ENSP received a letter from Commission Byrne, expressing his “appreciation for the outstanding work which all those in the ENSP undertake to defend the health of our citizens from the scourge of tobacco.”

¾ EU wide policy change in favour of smoke free workplaces.

ENSP Policy Recommendations on Smoke-Free Workplaces ENSP Policy Recommendations on Smoke-Free Workplaces were finalised during this project period. It was decided to launch the recommendations at the 12th World Conference on Tobacco or Health, in Helsinki, Finland in August 2003, in order to receive the most impact and attention. (see: http://www.ensp.org/files/rapport_complet_A5.pdf )

The recommendations were disseminated to the ENSP networks for individual endorsements and these were received from: - Ash Ireland - The Austrian Coalition against Tobacco - The Danish Cancer Society - The Danish Heart Foundation - The Danish Diabetes Foundation - The Dutch Coalition against Tobacco - The Greek Coalition against Tobacco - The Finnish Coalition against Tobacco - The Spanish Coalition against Tobacco - The Swiss Association for Tobacco Prevention - The Swedish Coalition against Tobacco

The recommendations were published in a booklet and distributed at the 12th World Conference, were posted to key policy makers and were uploaded onto the ENSP website and emailed to members and to the press. Additionally, a poster was made to publicise the launch of the recommendations and CD roms were burnt containing the recommendations and the ENSP Status Report on Smoke Free Workplaces, produced under the 2000-2001 Framework Programme (see: http://www.ensp.org/reports.cfm#ensp )

These recommendations became all the more relevant due to two principle factors: - In September 2003, when Commissioner Byrne announced the importance of smoke-free legislation. - Article 8 of the FCTC relates to the ‘Protection from exposure to tobacco smoke’ and the adoption and signature of the Treaty by a large number of the EU Member States and investigations by national governments and tobacco control NGOs into the possibilities of implementing this treaty necessitate the consideration of recommendations in the field.

ENSP chose to have these recommendations and the ENSP Status Report 2001 on Smoke-Free Workplaces burnt onto a CD-ROM in order to provide not only recommendations but also evidence base. These CD- ROMs were widely disseminated by ENSP at conferences and events, to policy makers and through the ENSP network.

ENSP received inquiries during the project period from individuals working in the European Commission and in the European Parliament in Luxembourg who were concerned about creating or implementing smoke- free workplaces within their own working environment. ENSP was able to offer them these recommendations – together with ENSP’s previous status report and other material from ILO etc. We hope that this helped bring about the decision to make the European Commission buildings smoke free from May 2004.

The way forward to implement smoke free workplace regulations in the EU Health and Safety legislative framework. Another report was commissioned by ENSP from Karola Grodzki, to plan the implementation of smoke free workplaces in the regularions of the EU Health and Safety legislative framework. This report will be published on the ENSP network as a baseline for advocacy development. Annex: Report (pre-publication copy) commissioned from K. Grotzki on: “The way forward to implement smoke free workplace regulations in the EU Health and Safety legislative framework.”

Smoke free workplaces advocacy As well as publishing literature, ENSP was active in a practical sense, advocating and supporting advocates of smoke free workplaces. This included: - Respond to inquiries and provide information to inquiries from task forces from the European Parliament and from the European Commission, who are in the process of negotiating and implementing their own smoke free laws. ENSP provided information on the benefits of a smoke free workplaces, examples of cost effectiveness, of the dangers of environmental tobacco smoke as well as support etc. formally and informally. - Organising a meeting with the Head of Unit for Health and Safety at Work, DG Employment and Social Affairs. This will hopefully take place in December 2003. - ENSP drafted press releases and actively advocated in support of Commissioner Byrne’s announcements and interviews in August – October 2003, regarding the importance of smoke free places to health, by promoting awareness of the dangers of tobacco smoke in the workplace to the European press together with other organisations active in tobacco control at European level and by sending a model press release to members. Annex: Press release in support of smoke-free workplaces: ‘Support for EU Health and Employment Commissioners’ efforts to protect Europeans against work related cancer and heart disease.’

¾ NGO support for a strong Framework Convention on Tobacco Control (FCTC). Intergovernmental Conference (INB) 5 14-25 October 2002 Prior to the INB 5 meeting in Geneva on 14-25 October, ENSP was involved with advocacy efforts of international NGOs through the email exchanges of the ‘Lobbying’ and ‘Media’ Committees. ENSP drafted a press release, backgrounders and media work guides for the FCTC NGO media pack, which was released on 1 October 2002. ENSP forwarded this guide to all contacts and the ENSP mailing list in order to promote awareness of the negotiations and to brief members on what action could be undertaken/supported and of the main facts supported by health NGOs in support of the FCTC. Additionally, ENSP called on members to nominate an ‘FCTC Correspondent’ who would pay particular attention to updates sent by ENSP during the negotiations and who would identify contacts with the press/promote awareness in a reactive way. This was achieved (see below).

Annex: FCA Media Advocacy Guide, FCA Media Kit for the FCTC negotiations at INB5.

Sophie Kazan attended an NGO briefing on the FCTC negotiations organised by the European Commission in Luxembourg on 7 October 2002. The Commission informed on plans to coordinated action with DG Development and of its plans to organise a Round Table on Tobacco Control and Development policy in early 2003. The Greek Presidency and DG Internal Market representatives attended the meeting, the latter also encouraging action to have the sales promotion amended so that it would include tobacco control.

At the ENSP Network Meeting in Helsingor on 11-12 October 2002, a workshop was held on the main issues covered in the FCTC and it was agreed that national coalitions from each European country would send a letter to the German Ambassador of their country, denouncing the German position against a total ban on tobacco advertising in the FCTC and pointing out the isolation in to which Germany had manoeuvred itself by taking this position. A letter was drafted, checked by German delegates and sent out to the ENSP General Assembly for action. ENSP has also written an article, ‘Working with the FCTC’ for the ENYPAT magazine Interaction. Annex: Copy of the article written by ENSP in Interaction.

Sophie Kazan attended the FCTC from 14-25 October 2002, collaborating with the media group of the FCA, providing regular information on the negotiations to ENSP members and particularly ‘FCTC Correspondents’ directly by email.

Following the meeting, ENSP received the request form the FCA to take a more active role in developing the advocacy effort around the FCTC in the European Region: - Coordinating joint advocacy efforts. - Raising funds to bring Eastern European NGOs to the INBs. - Getting more regional NGOs from Europe to attend the negotiations and promoting awareness. - Analysing the situation and developing responses to get the desired changes implemented. Annex: ENSP report on INB5

Intergovernmental Conference (INB) 6 18-28 February 2003 Leading up to INB6, several initiatives were taken.

17 January 2003 Derek Yach (TFI – WHO Headquarters) invited ENSP to participate in a restraint FCTC briefing for NGOs by the INBs chairman, Mr Seixas Correa in Geneva.

23 January 2003 ENSP attended an FCTC briefing from the European Commission. The meeting turned out to be a constructive dialogue with the Commission agreeing that the new text was weak compromise but dictated by reality. The Commission agreed to propose stronger language for advertising based on the acquis (ban on radio, TV, internet, written press and sponsorship of cross border events). Signature and ratification of the Treaty is required from both the European Community and by each Member State.

A special information release was published to support the FCTC, relaying the call to action of German tobacco control advocates and the ENSP German coalition. This consisted of signing a petition to the German government and members could also contact the German ambassadors in their countries to promote

43 awareness of the importance of the FCTC. Information was put on the home page of the ENSP website. Sweden and Ireland scheduled meetings with their ambassadors and Austria and the Netherlands contributed with a letter.

NGOs and the Health Group of the European Council were informed by ENSP on the NGO position paper, drafted by the FCA. National coalitions were asked to contact their government representatives attending the INB6, with the recommendations.

ENSP drafted a model press release for INB6, which was also distributed to members to translate and send to their national press.

ENSP staff attended INB6 and reported regularly to ENSP members directly by email through the website and mailing list. The interactive ENSP website allowed us to upload documents within seconds and proved extremely useful. Annex: ENSP report on INB6 and Press release.

20-21 May 2003 Adoption of the FCTC at the 56th World Health Assembly. ENSP attended the 56th World Health Assembly in Geneva and reported back on the adoption of the draft FCTC text in a focussed working group on 20 May 2003 and its final unanimous adoption by all nations present at the 56th World Health Assembly on 21 May 2003. This was a historic event – the first ever global treaty on health - and it was made all the more emotional because it had taken four tough years of negotiation to achieve and it was accompanied by individual speeches of thanks and declarations of commitment to tobacco control by many of the country representatives attending, following the vote.

Previous to the meeting: ENSP actively encouraged European organisations to attend the meeting and become involved in activities. ENSP coordinated with members of the Health Group of the European Council to find out the latest situation of agreement of Member States, in order to try to anticipate whether the FCTC would be blocked by a European country and relayed this information back to members, in order for them to be briefed as quickly as possible. Additionally, ENSP organised a briefing for a representative of the Australian mission to the EU with an expert on tobacco control (Luk Joossens) in the ENSP office, for an advisory report that the former was drafting for his country on how to vote on the FCTC at the 56th World Health Assembly.

During the event: ENSP was active, together with other European organisations in reporting back what was happening and in drafting a press release that was sent to the international press and to ENSP members to be translated and sent to the press in their country. Annex: Press release marking the adoption of the FCTC by the 56th World Health Assembly.

ENSP believes that some of its efforts in informing and mobilising national coalitions may have had a positive effect promotion of the FCTC nationally and at EU level. As a direct result of ENSP activities surrounding the FCTC, ENSP built capacity and strengthened alliances with members and other organisations, as well as attending and forging contacts with national and EU level officials. ENSP was able to rally press interest on the issue of the FCTC and promote awareness and positive

44 support for the historic Treaty. We realise that this is only ‘the end of the beginning’ and that the ratification and implementation of the Treaty are vital if it is to have any effect. Therefore ENSP has already begun to follow the process of ratification at national and EU level, understand the legal framework and highlight when other countries around the world ratify the Treaty, as positive encouragement to EU governments.

¾ Collaboration and active participation of NGOs in the 13 accession countries.

During INB6 and due to reduced access for NGOs in the negotiations, efforts were also concentrated on meeting NGOs and government representatives from accession countries as well as from Central and Eastern Europe with a view to organising the main session and workshop on ‘Networking for NGOs’ at the 12th World Conference on Tobacco or Health in Helsinki, Finland in August 2003. Special connections were made with Lithuania, Slovenia, Slovakia, Hungary, Malta, Russia, Ukraine and Turkey.

12th World Conference on Tobacco or Health in Helsinki, Finland. 2-8 August 2003 The participation of ENSP in the 12th World Conference on Tobacco or Health in Helsinki, Finland (Objective I, Point 9) was extremely important in identifying, supporting, learning about and planning future collaboration/contact between NGOs and the accession countries to the European Union. Additionally, organising for accession country participants to receive grants to attend the 12th World Conference, allowed ENSP to meet and interact with delegates capable of triggering the formation of a tobacco control coalition in their country.

As a direct result of learning about ENSP at the conference, after attending ENSP events and after speaking to staff and Board members: - The Cypriot Cancer Society decided to form a coalition and join ENSP. The Cypriot Coalition Against Smoking, submitted its application for membership to ENSP in October 2003 and it will be formally presented for vote at the next ENSP General Assembly in May 2004. - Croatian tobacco control advocates, though they cannot currently join ENSP, requested to receive information and be involved as much as possible in activities. Tobacco control activists and coalitions from other Balkan countries were also interested in the work of ENSP. - Bulgarian tobacco control advocates expressed their wish to form a coalition and join ENSP in the near future, as did representatives from Romania and Slovenia. - Representatives from Lithuania assured ENSP that the formation of a coalition was imminent. - ENSP identified tobacco control advocates from Estonia and Latvia.

Other key factors that helped bring ENSP into closer collaboration with NGOs from accession countries were: - Information dissemination on tobacco policy issues and calls to action. - Information dissemination by ENSP of grants and other information on funding directly relevant to NGOs from accession countries. This included the WHO Europe Call for Proposals for ‘Channelling the Outrage’ grants. - Projects: While they could not receive funding, members from accession countries, namely Romania and Slovakia, took part in project building workshops during the project period and are now participants in ENSP Framework Projects 2003-2004.

Additionally, ENSP submitted a short article on the formation of the Coalition for Smoke Free Eastern Europe and Central Asia, which occurred at INB6 of the FCTC in Geneva, to the EPHA ‘Updates’ magazine. Annex: See article, which appeared in the March/April 2003 edition.

Evaluation:

An interim evaluation was planned to be conducted at the end of the project period, based on previous evaluation studies.

RESULTS

DISCUSSION

CONCLUSIONS / WAY FORWARD

EVALUATION

DISSEMINATION

LIST OF PROJECT PARTNERS

[list of partner organizations]

49 Objective II

Initiate and co-ordinate large scale, innovate, priority driven and cost-effective European smoking prevention projects.

1. Final reports of ENSP framework project 2001 including site visits to project partners and final reports.

2. Management of the present ENSP framework project grant application 2002 (10 subprojects + ENSP core grant), including site visits to project partners, interim and final reports). In order to deliver the final report of the present grant application, the ENSP central secretariat applies for 12 months + 3 months operating cost.

3. Preparation of European scale pilot projects in support of evidence based policy building for 2003. ENSP call for proposals January 2003, project building workshop May 2003, finalisation of projects Sept. 2003.

Expected results:

1. Acquisition of targeted scientific evidence to underpin policy development through effective project building procedures especially with regard to the tobacco regulation directive, the advertising ban and the framework convention on tobacco control .

2. Results of the framework project with specific reference to the 10 research projects (see attached list in Annex) will be announced in a press conference and to European policy makers. The results will be published on the ENSP web site (www.ensp.org) and be proposed for publication in peer reviewed international journals.

Interim Evaluation

Conduct an interim evaluation at the end of the project period based on previous evaluation studies.

Please Note: The interim evaluation will take place this year (2004) and thus it will be an integral part of the 2003/2004 ENSP Final Report.

• Objective II

Initiate and co-ordinate large scale, innovative, priority driven and cost effective European projects

Introduction

One of the main objectives of the ENSP is to initiate and coordinate joint framework grant applications to the European Commission in the field of tobacco control. The aim being to promote high quality, European projects with a wide geographical coverage, and by doing so adding value to single stand –alone projects. From past experience (before the creation of the ENSP) there was a clear need for a change in the application procedure. Overlapping between projects was frequent and projects generally showed very little European added value. In response to this, ENSP was created and proposed to the European Commission that it changed its procedure from passive project collection to pro-active, co-ordinated project building. Instead on introducing a multitude of small applications, ENSP suggested that interested parties should be invited to submit project proposals o ENSP several months before the submission deadline of the Commission. Each year ENSP develops action priorities to promote a coordinated approach to European tobacco control policy. Based on these priorities combined with the funding conditions on the European Commission, a call for expression of interest to the tobacco control community is launched several months in advance of the official Commission call for proposals. Those project proposals that can be developed into large scale European grant applications are grouped according to priority sectors. The project building procedure starts with a workshop in Brussels where EU funding conditions are explained and project partners have the opportunity to meet, share views and start developing the coordinated project grant application. Once individual project grant applications have been developed, they are regrouped into an ENSP framework grant application. Following a call for expression of interest to the tobacco control a framework grant application was introduced for funding to the European Commission. A grant agreement was signed with the European Commission the 21st November 2002 covering 12 sub projects for a 12 month period. An addendum to the original contract gave the opportunity for the project coordinators to continue their activities for an extra 2.5 months. The Secretary General of the ENSP left on March 2003, since then there have been some changes on the way the projects have been managed at the ENSP. The financial part of the projects has been completely taken over by the Finance Manager of the ENSP, who has been delivering for the past three years a flawless work on finance project management. The technical part of the projects has been managed by a project coordinator since march 2003, who has been able to do a very close follow up of all project activities, ensuring that the projects have complying with the initial objectives, that all deliverables were produced on a timely fashion and to the maximum quality standards and that the new grant application runs in parallel with the New Public Health Programme from the Commission.

Reporting period 15/09/2002-30/11/2003

Time Frame of ENSP Project Management

Drafting of the summary of final reports 2001-2002

Management of the ongoing FW Projects 2002-2003

Launch EOI 2003-2004

Creation of the Framework Application 2003-2004/6

Re worked of the Framework Application 2003-2006 on a yearly base : 2003-2004

1. Final reports of ENSP framework project 2001 including site visits to project partners

The final reports 2001-2002 (scientific and financial) were submitted to the European Commission on 14 December 2002. Comments and requests for additional documents were received from the EC and transmitted to the concerned coordinators.

Summaries the project results 2001-2002 were drafted, compiled and published in July 2003 (see annex), well before the initially planed date of release (September 2003). The aim of the early publication of the summary reports was because it was intended an official launch of the report in the World Conference of tobacco or health in Helsinki (3/08/2003) .100 paper copies + 200 CD ROM copies where published and exposed at the stand of the ENSP in Helsinki. Within the first two days, all copies had been distributed. Additional requests for the publication were satisfied via email with the publication being sent on Pdf.

As far as ENSP framework project results for 2001-2002 are concerned, research findings have been finalised on cigarette package labelling with special reference to the tobacco regulation directive and the advertising ban. Further research is being published on the effect of non-smoking legislation in bars and restaurants through a press conference in the European Parliament . Results of a study on the exposure to nicotine through environmental tobacco smoke and a study on the economics of tobacco control have attracted the attention of national press. Please notice that the national/international dissemination plan past and ongoing, for the projects results 2001/2002 can be found on the final reports/ summary of final reports 2001/2002.

A strategic dissemination plan had been agreed with all project co-ordinators to streamline dissemination to health professionals, the media and policy makers.

• The media: no specific press conference will be organised per project (unless requested by the project leader) – but media will be invited to scientific conferences where the subject is presented/discussed

• To policy/decision makers: Develop a fact sheet from the executive summary and/or use selected information of the research/project results to be sent to selected persons without using tables/arguments that will be reproduced in the scientific publication

• To the general public on the Internet: Publish only the executive summary, make a note « Not for citation – in the process of publication - for further information please contact the project leader »

2. Management of the present ENSP framework project grant application 2002 (10 subprojects + ENSP core grant), including site visits to project partners, interim and final reports) .

The ENSP grant agreement was signed on 21 November 2002. Copies were sent to each Project coordinator. Only end of February 2003 , the 30% advance payment arrived on the ENSP bank account. Until that time, most ENSP payments to suppliers were delayed in order be able to avoid a bank overdraft and the built cost .

5 ENSP has followed the development of the projects and supported project co-ordinators with continued administrative and financial advice. Technical and financial interim reports were collected and collated into a consolidated framework interim report for the European Commission on the 05 June 2003 including: (Please note that the full table including the name and contact address of the Coordinator can be found on the Annex)

• ENSP Core Grant • 12th WORLD CONFERENCE ON TOBACCO OR HEALTH (WCTOH 2003) • IDENTIFICATION OF GAPS IN TRAINING DENTISTS IN TREATMENT OF TOBACCO DEPENDENCE • EUROPEAN ACTION ON SMOKING CESSATION IN PREGNANCY - EUROscip II • GLOBALink – TELECOMMUNICATIONS FOR EUROPEAN SMOKING PREVENTION • PROTECTING WORKERS FROM PASSIVE SMOKING • DEVELOPMENT OF A MEASUREMENT TOOL FOR TOBACCO CONTROL ACTIVITIES IN EUROPEAN COUNTRIES • TACKLING SOCIOECONOMIC INEQUALITIES IN SMOKING IN THE EUROPEAN UNION • EUROPEAN NETWORK OF QUITLIINES • EUROPEAN SMOKE-FREE HOSPITALS NETWORK 2002-2003 • 3rd CONFERENCE ON SMOKELESS TOBACCO

A second interim financial report was and sent to the EC on 26/06/03. This report showed that 30% of the budget has been spent and therefore allowed the second payment to be made.

Unfortunately due to the late arrival of payment and administrative difficulties, the project “Identification of Gaps in Training Dentist in Treatment of Tobacco Dependence” could not start as early as initially planned by the project coordinator. In July 2003 they requested from the ENSP an official overrun of the project, which the ENSP could not assure at the time, and so they decided to terminate the project. The official letter or resignation came to the ENSP on 15 of July 2003. To our utmost regret the Commission accepted the addendum to the contract for an extra 3.5 months a bit later on that the coordinator of the project had decided to terminate the project irreversibly.

Different visits to project meetings (i.e. socio-economic inequalities) , made realized the ENSP that it would be important to follow up from the beginning all the different projects including the attendance of the Project coordinator to kick off meetings of the individual projects. The project coordinator would then contribute positively, if necessary, with the information provided by previously successfully conducted ENSP projects.

3. Preparation of European scale pilot projects in support of evidence based policy building for 2003-2006.

6 As far as the projects building procedure for the 2003-2006 EU grant application is concerned, priority was given to the development of horizontal collaboration and advice/guidelines for policy makers. Taking into account the scarce information available concerning the new public health programme and the working priorities to come, co-ordinated field work was carried out successfully to identify essential tobacco control policy tools which would guarantee continued improvement of action. The ENSP called for a Expression of Interest on the 12/08/2002 with the following priorities:

• ENSP Framework project priorities 2003

A/ Activities related to the monitoring and rapid reaction systems

Develop socio-economic indicators to reduce tobacco consumption in different settings and with special risk groups (workplace, schools, public places, government premises , health care institutions, women, young people, socially disadvantaged, minorities.)

B/ Activities on health determinants

Report on the economic advantage of integrating smoking prevention activities in traditional health care, its positive effect on the public health budget. This report would stretch across all the major health determinants and include tobacco, alcohol, nutrition, physical exercise. Develop policy recommendations/guidelines for implementation .

Develop best practice guidelines for effective media campaigning on health determinants with specific focus on changing the social environment.

C/ Activities related to legislation

4. ENSP co-ordinated report to the general public/the media, on the implementation of EU legislative measures /Council recommendations, referring to tobacco control/smoking prevention, and perceived obstacles for effective implementation, with specific reference to tobacco industry activities. Develop country profiles and benchmarking indicators to compare legislation/regulation between EU member states, associated and candidate countries. The report aims to promote the citizen's right to claim high level health protection in the field of tobacco control.

5. Report on the production, marketing and sale of "harm reduction nicotine products" to develop evidence for integration of these products in the tobacco regulation directive 2001/37/EC while taking into account policy development in other areas.

6. Report on the use of < Roll your own tobacco > with the aim of integrating the production, marketing and sale of hand rolled tobacco into the tobacco regulation directive 2001/37/EC. The report should also develop a rationale for increasing taxation of < Roll your own tobacco >to same level as cigarettes taking into account policy development in DG Taxation ;

7. ENSP status report on Environmental Tobacco Smoke/Passive Smoking and international consultation conference to develop evidence based recommendations for legislative measures to protect non smokers - taking into account policy development in DG Environment.

8. Health impact assessment of Community legislation: Report on the positive and negative effects of measures taken in other policy areas on tobacco control at EU level (Agriculture, Taxation, Industry, Internal Market, Employment and social affairs, Consumer protection, Environment, Education.)

D/ Activities related to consultation, knowledge and information

9. Develop measures for the implementation of best practice guidelines to promote the effectiveness of prevention and cessation activities among health professionals working in health care settings as telephone counsellors, nurses, dentists, GPs, Gynaecologists , Pediatricians, midwives etc. Here also, action can be developed on several health determinants simultaneously to create a horizontal approach to disease prevention. 17 EOI’s where received and evaluated following the pre-agreed evaluation method included on annex. Six themes were identified during a project building meeting on 10-11 September 2002 for the development of a consolidated ENSP framework grant application.

The lack of involvement of doctors in the advocacy effort was addressed, best practice tools for Quitlines was further developed featuring among others an EU quality label for “Quitlines” . Large- scale involvement of all categories of health professionals (doctors, nurses, gynaecologists, midwives etc.) was promoted through promotion of a common understanding of smoking cessation practice and implementation of European guidelines on national level.

Development of non-smoking policy recommendations for educational institutions working with adolescents was another priority task as well as a European Status Report on Passive Smoking which will be the follow-up to the previous work done in the frame of ENSP projects. And last but not least, Globalink – the European dimension of the international electronic tobacco control network was be further extended. After the project building workshop, it was decided by the ENSP team that an extra project should be included on the application based on the fact that for the past three years, the particular project had been part of the Framework Application. The Réseau Européen des Höpitaux sans Tabac, was then included to the above list and presented to the Commission.

Please find the summary of the constructed projects on the above meeting on the table below:

( The full table including the name and contact address of the Coordinator can be found on the Annex)

• TCRC – promotion of media advocacy of medical associations • Quit lines : development of best practice tools • Health Professionals adoption / implementation of cessation guidelines • Development of non-smoking policy recommendations for educational institutions working with adolescents • European Status Report on Passive Smoking • Globalink – the international electronic tobacco control network • Réseau Européen des Hôpitaux sans Tabac

These project themes had to be developed into grant applications, once the official call for proposals from the European Commission was launched on the 15 Mars 2003. Intensive preparatory work, was started by ENSP and its partners well ahead of time to develop effective and meaningful applications.

8 • Special attention was given to the development of the following projects which included personal assistance and organization of co-ordination meetings in Brussels

1/ Development of non-smoking policy recommendations for educational institutions working with adolescents.

On 27 September 2002, ENSP organised a meeting to develop smoking policy recommendations for educational institutions with the Danish Cancer Society and the School of Public Health of the Free University of Brussels .A concept for a new project outline was agreed covering three phases: 1st year: developing a report on youth smoking using the material of the “HSBC” study “CAS“ and merge it with a communication/advocacy message. For some countries cannabis smoking will also be reported. 2 nd year: organising a conference to develop recommendations on cessation and school anti smoking policy implementation . In addition to the conference organise a “supermarket” where people can shop for existing intervention material, 3rd year: develop European policy recommendations for legislators to involve DG Education, translate, publish and disseminate the produced material. Partners: European Network of Health Promoting Schools, European Network of Health Promoting Agencies, European Network of Teachers and Trade Unions of Teachers, Cancer, heart associations, Tobacco group of ERS . Danielle Piette of the School of Public Health would be project leader and prepare the project proposal.

2/ ETS project building meeting on March 12, 2003 in Brussels

During the meeting, and according to the suggestions of the ENSP assembly held in Denmark, it was agreed that the project would have two main elements, addressing both the epidemiological assessment of exposure and the “policy shaping”. The empirical element would consist of two parts: a) a population telephone survey designed to assess the extent of exposure at passive smoking among the general (adult) population, and b) a direct measure of ETS presence in a sample of public places and workplaces, building upon the results and conclusions of the previous pilot project. Regarding responsibilities and duties, Dr. Friedrich Wiebel kindly offered himself to lead the policy branch, and Mr. Maurice Mulcahy offered to work in collaboration with Dr Wiebel. For the survey, Esteve Fernandez offered to lead this part following his previous experience with both ENSP projects and a national project where he had been developing a (telephone) questionnaire to assess passive smoking. Marco Albertini also offered his expertise in surveys to collaborate in this phase. Finally, regarding the measurement of nicotine in the air, some of the participants in this meeting (including Manel Nebot, Hans Moshammer, Maria Pilali) had already participated in the previous study, which may facilitate the field work. It was also proposed and agreed that the Agency of Public Health of Barcelona would carry on the general coordination of the project. After the meeting, some contacts have been made with other participants in the previous project. As a result, it might be that in Italy Marco Albertini would carry on the survey part while Giuseppe Gorini could run the nicotine measurement. To accomplish the project objectives, it was agreed that during the first two years most of the budget would be devoted to the “empirical” phase (nicotine measurement and telephone questionnaire), while the third year a large proportion would be spent in the policy development. Roughly, it had been estimated that for every country except Germany (assuming the costs of the policy element) and Spain-Agency of Public Health, a yearly sum will be necessary for each of the years one and two, to cover the costs of nicotine study (year one) and survey (year two). For the year 3, a similar amount can be assigned to every country to support and spread the policy-oriented dimensions of the project at the national level, besides the amount to be managed centrally for this purpose (20.000 year 1, 30.000 year 2 and 50.000 year 3).

3/ ENSP Core Grant application

The Core Grant was developed taking into account the previous core grant applications, specially last years applications and from the « guidelines » that Sybille Fletman (Secretary General of the ENSP) left before leaving. Considerable effort was put into the drafting and the systematic checking of legal documents to ensure that a great deal of the Commission priorities would be considered (and visible) in our application. The result was a complete application which counted with the introduction of new elements. This new elements would not only contribute to the ENSP aims and objectives but would reinforce ENSP position at Community level. One major output outcome of the 2003-2004 year grant application in preparation, was the plan to publish an annual media advocacy report on implementation of legislation and obstacles to the implementation in the EU, accession and associated countries. In order to identify a suitable methodology for the report, special interest was taken in following up on the project 2002-2003 “Development of a measurement tool for tobacco control activities in European countries” co-ordinated by the Greifswald University in Germany. ENSP contacted Prof. Ulrich John to find out if the methodology of this project could be used for the media advocacy report. A meeting took place with Luk Joossens on 28 February to discuss the way forward and to give input into the development of the methodology structure. The result is that the ENSP is currently working on an important tobacco control report that we hope will not only provide valuable comparative information, but also an analysis of the tobacco control situation throughout the growing European Union. A large part of this report would involve ranking the tobacco control situation in each of the 29 European countries that we have chosen to focus on: the 15 EU countries, 10 accession countries as well as the 4 EFTA countries (Switzerland, Norway, Iceland and Liechtenstein.) Method: A questionnaire has been devised by our Expert Researcher for this project, Mr Luk Joossens, together with a working group of experts. These experts will also develop a grading system, based on the World Bank criteria for cost- effective tobacco control interventions against which national tobacco control situations will be compared.

• Higher taxes on cigarettes and other tobacco products • Bans/restrictions on smoking in public and work places • Comprehensive bans on advertising and promotion of all tobacco products, logos and brand names • Better consumer information: counter advertising, media coverage, research findings • Large, direct warning labels on cigarette boxes and other tobacco products • Help for smokers who wish to quit, including increased access to nicotine replacement (NRT) and other cessation therapies

A national tobacco control expert per country will be contacted. This role, which will be financially remunerated, will consist of: Completing this detailed questionnaire regarding national tobacco control measures.. Read and check through the analysis that is made of the situation of the country/region/ Europe. Possibly attend a meeting or take part by email in final discussions and analyses. The report as a whole is expected to take no longer than 4-6 months in total and results will be disseminated widely to the press at European level and, at national level. We anticipate that it will attract a lot of media attention.

• Launch of the new public health programme

10 ENSP staff attended the reception to launch the New Public Health Programme at the European Parliament on 18 March 2003 and a special information day on the New Public Health Programme on 21 March 2003 in Luxembourg.

On 18 March the project building partners were informed by email on the Commission’s call for proposal, the deadline for proposals (16 May 2003) and the expected deadline for budgetary engagement ( 15th December 2003)

- Providing all info on the call for proposals - Proposing time schedule for coordination with ENSP - Asking for info on the current development of each project - Asking for a first draft ASAP - Asking for nomination of one coordinator per project

• Introduction of the application on the original THREE YEAR form.

The initial call for proposals (March 2003) asked for large scale three year proposals, the ENSP had put considerable effort on creating projects which will be conducted on a three year base, with a fixed budget and technical objectives. The application this way, was introduced to the Commission the 16/05/2003 with the following objectives:

(…) The ENSP Core Grant involves a strategic approach to encourage the creation of national tobacco control coalitions in each of the Accession and Central and Eastern European countries and quickly integrating them fully coherent way into the ENSP network, taking into consideration their specific problems. This will result in up to 10 new national coalitions in the ENSP General Assembly and many new contacts in the ENSP network database and dissemination list. Measurable results will be, that coalitions become better informed and more involved on EU issues, familiar with the implications of EU policy on national legislation, able to compare with the situation in other countries and consult with others easily and regularly. ENSP will facilitate and support them with ‘tools’ in the form of published reports (Media Advocacy Report) , up-to-date information releases, transfer of technology, best practices, regularly update website with further information etc. Particular attention and value will be given to the maintenance of communication channels with governmental organisations, to fully inform support and advance policy developments.

The Globalink project serves as a forum of exchange of reliable information by linking intergovernmental, non-governmental and national organisations, as well as individuals, through a secure information system, this is an ongoing project. It enhances the capability of smoking prevention associations, organisations, networks and bodies by facilitating and supporting their communication infrastructure to ensure effective cooperation and providing them with instant access to an interactive computer information service through an expanding multimedia database of reference and resource materials, electronic conferences, regular news bulletins and ‘action alerts’.

Globalink will improve planning and coordination of smoking prevention and public health initiatives leading to increased efficiency, timely awareness of the relevant issues, better access to the relevant information throughout Europe resulting in a quicker and more effective response. It will provide with targeted, well-argued and sustained pro-health initiatives in Europe, from a broader, better informed and more united healthcare network. The quantifiable results of the project will be reviewed on a yearly basis: Membership growth , number of list served by GLOBALink, number of messages exchanged via GLOBALink and Email survey of GLOBALink members

The Quit project aims to build upon the Network’s success of the first three years and extend the development and promotion of quality standards throughout the European Network of Quitlines and to evaluate the effectiveness of the quitlines operating throughout Europe, to assess which factors influence success, and to find out what kind of assistance is sought (and received) by what kind of

11 smokers. The project will result in concrete recommendations on how quitlines should be organised and run to have optimum impact on smoking behaviour and establish the evidence base for the clinical effectiveness and cost effectiveness of quitlines as an essential component of a comprehensive tobacco control programme. Ultimately they will develop, publish and disseminate an authoritative ‘European Network of Quitlines Code of Practice’ – Promoting best practice, quality standards and effectiveness.

The European Network of Quitlines will ensure provision of more effective, scientifically sound, best quality standard and cost effective smoking cessation programmes. The Project will produce a cost effective, evidence based sustainable quitline model, accessible to countries without large budgets, for example, the new accession countries, thus contributing to the strengthening of solidarity and cohesion between the EU and applicant countries.The results of the ENQ will be seen through publication of a Code of Practice and dissemination of the guide on Globalink and other European online publications. One of the Networks major verifiable and specific results will be in the form of ENQ Quality Standard Accreditation, which will lead to the achievement of high quality standards across Europe.The ENQ/stivoro research will result in clear indicators to show the success and cost effectiveness of the quitlines, and demonstrate which factors most influence success.

The project developed by the European Medical Associations Explains that the coordination of action and responses to policy and scientific initiatives at European level can bring synergies, resulting in greater impact and visibility. They seek to build on their experience of working with medical associations across Europe so as to better engage and coordinate medical associations in supporting and articulating evidence-based public health policies and practices on tobacco. The project aims to develop networks, expert information and dissemination tools to better communicate the need for and nature of evidence-based public health policies on tobacco to the medical profession and the specialist medical journals, and to the general media, as well as to opinion-leaders and policy makers.

The main outcome of the project developed by the European Medical Associations The main outcome of the project developed by the European Medical Associations will be the provision of accurate and concise information to health professionals to enable them to fulfil their potential in tackling tobacco. European doctors and their professional bodies will be better informed and motivated regarding their roles and responsibilities. A range of high-quality, evidence-based information and resources will facilitate active engagement. They will be more closely involved in exchange of expertise and best practice, and better informed and organised to support national and international initiatives. Public awareness of expert opinion will be enhanced. Other outcomes include capacity building for medical networks and improved press and public affairs relations. Health Professionals and Smoking Cessation in a Larger Europe aims at developing a horizontal European smoking cessation programme through the identification, assessment and development of best practice strategies, policies and guidelines on smoking cessation for health care providers (including general practitioners, gynaecologists, paediatricians, dentists, nurses, midwives, lung physicians, cardiologists, and pharmacists), thus contributing to the exchange of information on quality standards in all Member States and applicant countries and at European levels, and taking into account gender differences and socio-economic inequalities; a long-term goal of the project is to reduce the burden of disease caused by tobacco.

Health Professionals and Smoking Cessation in a Larger Europe will provide a European evidence based assessment tool to assess the quality of the strategies, policies and guidelines on smoking cessation at the country level. Using the assessment tool, a registry and inventory of existing services for smoking cessation in all Member States and applicant countries, with an assessment of current services and identification of needs for improvement, will be completed. Country based partnerships and networks will be created in all countries . The partnerships will complete the assessment tool and it will make recommendations for the improvement of smoking cessation services. A European expert network on smoking cessation will be created which will prepare a Europe wide best practice report on the implementation of strategies, policies, programmes and

12 guidelines for health care providers for smoking cessation, with endorsement by all country based and European partners.

The project developed to create a tobacco-free environment for adolescents, best practice guidelines for teachers and other adults involved in adolescents education aims at promoting local tobacco policies including smoking prevention and cessation policies among teachers and adults working with adolescents. The ultimate aim is to reduce avoidable morbidity and mortality among adolescents. This will be achieved by providing a tobacco-free environment (TFE) for adolescents not only to preserve them from passive smoking but also to de-normalise smoking. The health impact of national laws related to TFE is diminished when it is not reinforced by local consensual rules. Other analyses showed social class and gender inequalities in smoking among adolescents. These data are underused, partly as these studies were not conducted in all European countries. However, their implications for policies are relevant to other countries.

The project developed to create a tobacco-free environment for adolescents, best practice guidelines for teachers and other adults involved in adolescents education will provide with quality deliverables, the development of TFE local policy in partner countries and the development of TFE local policy in an enlarged number of partners.

Evidence-based policy development and enforcement for the prevention of exposure to passive smoking in European and accession countries (EB-ETSPV) project aims at quantifying levels of environmental tobacco smoke (ETS) in workplaces and public places of a sample of European and accession countries, through objective markers (nicotine) and asses the extent and the characteristics of exposure to environmental tobacco smoke among the general (adult) population of these European and accession countries. An additional aim is to disseminate results to raise awareness of the ETS exposure problem to enforce existing smoking control policies and to support the development of new policies and the establishment of best practice for the approach to comprehensive national and EU and accession countries legislation on smoke-free workplaces with the view of providing a quality assessment of such legislation in countries where it is in force. The project will help to establish an EU wide common standard with the purpose of achieving a high human level of protection against the health risks of passive smoking by using a two pronged, mutually supporting approach: 1) to advance or reinforce non-smokers protection against ETS- exposure by creating awareness of the issue and advance policy development on the national level and 2) to support and advance, and when necessary initiate, the establishment of EU legislative measures, such as an EU-directive on non-smokers protection at the workplace.

The project dealing with the Evidence-based policy development and enforcement for the prevention of exposure to passive smoking in European and accession countries (EB-ETSPV) is clearly divided into two parts each of them producing a different set of results. The first part will provide an objective assessment of the situation regarding smoking in workplaces and public places, quantifying concentrations of vapour phase nicotine (ETS marker). These concentrations of nicotine are an objective measurement of the level of ETS exposure in public places and workplaces in the different countries. The second part: Policy Development will result in the establishment and preparation of best practice guidelines on national and EU-wide legislation. These documents will cover three subjects: 1) Analysis of approaches made for establishing comprehensive legislation on smoke-free workplaces in EU-member states and accession countries. Benchmarking of legislation to identify best practice in the EU as well as accession and EFTA countries. 2) Analysis of comprehensive national legislative measures to determine their strengths and weaknesses. Definition of a ‘gold standard’ for comprehensive legislation on smoke-free workplaces at the national level. 3) Assessment of the best way forward to establish EU wide legislation, for example by amending a directive or making a new directive, on smoke-free workplaces.

13 Finally the aim of the European Network, smoke free Maternity and Hospitals is to continue the development of the ongoing project “Smoke Free Hospitals” and to enlarged it to applicant countries. In addition a new network " European network of smoke free Maternity” will be created and an emphasis will be put on developing the important role and the enormous credibility of the Health professionals in order to influence the female population in age of procreation.

The European Network, smoke free Maternity and Hospitals will create three distinctive types of results which have been divided into actions. Action I- will be to create the basis for the organisation and structure to reach efficiently the female population. To integrate on the network strategy the maternity of each individual country and to increase by 10 % per year the number of employees working on them. Action II will be the creation of a validated national and European indicator of pregnant woman addiction to smoke and of health professionals for the evaluation, comparison, follow up and set up of correctives measures. Finally Action III will be the development of validated and consensual recommendations on the European level in order to set up basic training programs in health imparting schools. (…)

• The EU asks the re-working the technical and budgetary application for funding on a yearly base.

After introduction of the three year application, the European Commission sent a letter dated 23 October 2003 indicating a reduction on the amount of Community co-financing and the fact that the technical objectives, initially conceived for a three year period, had to be divided on a yearly base. This caused, of course, much disruption to coordinators, that had input a lot of energy to create a large scale project. Some of the coordinator, given the administrative burden and the reduction of budget, were hesitating whether to leave the Framework application. Fortunately after several discussions with the ENSP, their decision took a positive turn. The revision of the projects as requested by the Commission was immediately started.. The new application was finally introduced the 21/ 11/2003, a month later we received the letter indicated that the Commission services had decided to accept our request for co-financing. The initial objectives of the projects had to be adapted and re worked. The new application will aim at complying with the following objectives.

(…) Through its network structure, the ENSP is committed to promote and improve health and reduce avoidable morbidity by tackling tobacco as a health determinant. The aim of the ENSP is to ensure continuity with the existing networking on a pan European scale among stakeholder organisations, to address in a coordinated and coherent way the concerns of the civil society and to be able to increase cost effectiveness and efficiency of smoking prevention activities. One of the main tasks of the ENSP since 1998 has been to initiate/co-ordinate large scale, innovate, priority driven and cost-effective European smoking prevention projects in support of policy development in order to rise the know-how and scientifically sound information. These projects will stand as an example of effective practice and they complement each other to create the 2003-2004 ENSP Framework application. The individual objectives for each project are indicated generally bellow and described in detail in the point 1 of the Annexes 2,3,4,5,6,7 and 8 which provide a detailed description of the individual projects.

The Globalink project will serve as a forum of exchange of reliable information by linking intergovernmental, non-governmental and national organisations, as well as individuals, through a secure information system, this is an ongoing project. It enhances the capability of smoking prevention associations, organisations, networks and bodies by facilitating and supporting their communication

14 infrastructure to ensure effective cooperation and providing them with instant access to an interactive computer information service through an expanding multimedia database of reference and resource materials, electronic conferences, regular news bulletins and ‘action alerts’.

The European Network of Quitlines has as an overriding aim to contribute to and promote the improvement of health, to reduce avoidable morbidity and premature mortality by the development of Code of Practice tools and policy recommendations, in order to bring together both experienced and newer Quitlines. The Network will ensure continuity and build on the successes that it had achieved over the first year and will extend the development and promotion of quality standards, while incorporating all accession and EFTA countries.

Health Professionals and Smoking Cessation in a Larger Europe aims at developing a horizontal European smoking cessation programme through the identification, assessment and development of best practice strategies, policies and guidelines on smoking cessation for health care providers in all Member States and applicant countries and at European levels, with a long term goal of reducing the burden of disease caused by tobacco.

Evidence-based policy development and enforcement for the prevention of exposure to passive smoking in European and accession countries (EB-ETSPV) project will provide sound scientific expertise in order to quantify levels of environmental tobacco smoke (ETS) in workplaces and public places of a sample of cities located in seven European countries and two accession countries (The Slovak Republic and Poland) This will provide both a description of the situation, that will be used to raise awareness and prompt interventions in those places with the highest exposure levels, and to be used as “bottom line” to monitor trends and progress in the situation, including the assessment of the impact of smoking control policies.

Finally the aim of the European Network, smoke free Maternity and Hospitals is to continue the development of the ongoing project “Smoke Free Hospitals” and to enlarged it to applicant countries. In addition a new network " European network of smoke free Maternity” will be created and an emphasis will be put on developing the important role and the enormous credibility of the Health professionals in order to influence the female population in age of procreation.

Results project activities objective II

6. Acquisition of targeted scientific evidence to underpin policy development especially with regard to the tobacco regulation directive, the advertising ban and the framework convention on tobacco control .

The ENSP expects to develop, facilitate and support a fully dynamic and interactive network of tobacco control advocates working in collaboration with other informed stakeholder organisations towards progressive tobacco control policies. Each different project application (2001/2002) (2002/2003) (2003/2004) defined their specific and realistic objectives aiming at produce lasting and sustainable results.

Under the previous grant application (2001-2002) research has been conducted among others into cigarette package labelling with special reference to the tobacco regulation directive and the advertising ban. Further research has been done on the effect of non smoking legislation in bars and restaurants, exposure to nicotine through environmental tobacco smoke and the economic influence on smoking rates. These results will be published individually by the project co-ordinators, through the ENSP website and through a publication of project results which will be disseminated to policy makers.

The new round of projects 2002/2003 have produced outstanding results which have contributed positively into the acquisition of targeted scientific evidence for the Tobacco control community. Please find below a summary of the main findings and the preliminary dissemination of the results:

12th World Conference on Tobacco or Health (WCTOH) Helsinki, August 3-8 2003

The Finnish Centre For Health Promotion also contributed an expert evaluation on the conference, in which the organisers and key personnel of the committees evaluated the event. The expert evaluation was carried out by an e-mail interview after the conference, and some conclusions can be made based on these interviews.

Overall the Conference succeeded as expected. Sessions were generally of high quality and themes supported each other. The distributed material was relevant and correct. Material distributed in the media centre helped to concentrate on the hot topics.

The biggest challenge for the organisers was the insecurity of the finances. As the conference was a world scale event, resources for communications, in particular, should have been more stable. Communications is one of the key factors of success in an event like this, and therefore the importance of the communications should have been recognised already in the beginning of the preparations.

From the point of view of the organising committees, the arrangement of the Conference worked well. There were enough committees and the committees did their work well despite of the lack of the recourses.

Programme and Topics

Overall, the topics and the programme were multidisciplinary, as intended. As always, some of the matters were covered more than others. The topic covered the best were smoking cessation, addiction and the Framework Convention.

Nowadays it seems that research on addiction receives much attention, while for example the point of view of the social sciences is not properly represented. This trend was seen also in the conference, where abstracts on social science were almost non-existent.

The biggest challenge now and at future conferences is the Framework Convention on Tobacco Control. The Framework Convention was well covered, but, for example, the Asian point of view on it could have been broader. In addition, discussion about harm reduction could have been more prominent.

Gender equality was one of the goals of the conference. This goal was strongly emphasised, but it could have been realised better.

From the point of view of achieving professional knowledge and skills, the conference succeeded well. Plenaries, main sessions, workshops and paper sessions were of high quality and the themes supported each other. On the other hand, it would have been possible to devote even more to them.

Unfortunately, those in charge of the conference did not have enough time to participate in many sessions, and therefore their opinion is mainly based on the experience of dealing with the abstracts in the arrangement of the conference.

Organising and Committees

From the point of view of the organisers, it can be said that everything went well as everybody cooperated and took care of their responsibilities. There were enough organising committees and these committees were established already early in the preparation phase. The personnel responsible of the organising committees felt they succeeded in their tasks. Some obstacles were faced during the preparations, but these problems were handled quickly and efficiently. Also the conference office was helpful and offered a variety of services.

The biggest problem for the organising committees was the uncertainty and lack of financial resources.

Communications and media activities were an essential part of the conference. This event was seen as a unique opportunity to distribute key information about tobacco control in the international and national media as well as in the international media.

The conference website served both the needs of the conference participants and the media. The daily press conferences gathered internationally known experts to present their views and concerns on tobacco. These press conferences attracted Finnish and international media, and especially because of active participation of leading international newspapers the main messages of the conference gained preferred coverage.

Information material on the conference was provided for the media and for the participants before and during the conference. These materials were distributed on the conference website, by mail, at the international events, in the Fair Centre and via e-mail. The main information materials were:

17 • Conference brochures • Conference newsletter • Background materials • Press releases • Conference newspaper • Photos • Other marketing materials: ready-to-print ads, etc. • Other publications

Each day of the Conference press briefings took place in the Media centre. The aim of the press conferences was to cover as many significant topics as possible, and make them interesting for different kinds of media.

Media coverage

The aim of the communications team was to reach as many media as possible. To do this, media alerts were sent three times before the Conference for domestic and international media. Also networks of the health organisations helped to gain the attention of the media. Accreditation to the Conference started in May 2003. Eventually the conference gathered 120 media representatives, of whom 45 were international and 75 domestic journalists.

Overall the media coverage of the conference was good, especially considering geographic location of Finland. The Conference featured daily in the domestic media. The topics covered were mostly the same as in the press briefings.

International Media

International media coverage was based on the activity of the international news wires, such as Reuters, AP and AFP. This was because only very few international media have correspondents in Finland. Topics that went through the international news wires were mainly the research revealing increased smoking among teenage girls, new graphic warnings on the cigarette packs and the problems in developing countries.

Coverage in the other international media was based on e-mail press releases during the conference and arranged telephone interviews. Telephone interviews were an essential tool for getting the message of the conference through internationally. During the conference the Media Centre organised numerous telephone interviews and sent material to the international media . Usually journalists wanted to interview a particular speaker or expert on a certain topic. Sometimes journalists wanted to find persons to interview based on knowledge of a certain language. Among the media that covered the conference outside Helsinki were the BBC, The Times, El Pais and Financial Times. The Conference Media Centre was also contacted from Brazil, Mexico, and France.

The Conference was closely followed by the Irish and Norwegian media, as the debate on tobacco policies was particularly active in these countries. The articles published concentrated on the follow up of the Conference discussions on their complete smoking bans. Also the tobacco industry and health effects of tobacco were covered.

In the North American media the most comprehensive topic seemed to be the research revealing increased smoking among teenage girls. This research was published in the press briefing organised by the CDC. Among the media covering the topic were The Boston Globe, The Sun Herald Mississippi, Buffalo News, Milwaukee Journal Sentinel, CBS, Miami Herald, and the Washington Post.

Nordic media were very interested in the Conference, and articles on it were published regularly during the week in papers such as Dagens Nyheter (Sweden), Svenska Dagbladet (Sweden) and

18 Aftonposten (Norway). Icelandic newspaper Morgunbladid followed the conference intensively and started a wide public debate about smoking in Iceland.

Some registered journalists supported communication activities by translating press releases into their own language and sending them to their domestic media and health associations (Norway and Japan).

Latin American countries received reports from a correspondent, who worked for CNN Spanish, Caracol Radio and for radio stations in Peru and Bolivia.

Other conference topics that drew special attention in the international media were the problems of the developing countries, new warning signs on tobacco packs and smuggling. Also the opening of the conference received widespread media attention.

Domestic Media

The Conference was intensively followed by the domestic media. The conference was covered during the week by the main newspapers, TV channels and radio stations. Also professional, medical and health publications wrote articles of the topics of the Conference.

Media attention started already the previous week before the Conference started, when a pre-press briefing was held in the Ministry of Social Affairs and Health on 31 July. This press briefing on the nicotine replacement treatment and public health insurance received much attention, and was publicised in several news programmes and by all the main newspapers and radio stations. The same press briefing also informed the media about the tax cuts on tobacco products, which would be less than expected. This was also widely published in the media. The third point that was stressed in the briefing was the plan to allow tobacco sales only for the licensed retail sale.

The launch of the Conference attracted media attention. The presence of the Director-General of the World Health Organisation Dr. Lee Jong-Wook and of EU Commissioner Mr. David Byrne also received coverage. Both speakers stressed the importance of the Framework Convention on Tobacco Control and of decreasing smoking among young people.

Other newsworthy topics were snus and health, Finnish people smoking the least in Europe, the general decrease in the smoking habits of young people and cigarette smuggling.

European Actions on smoking cessation in pregnancy (Euroscip III)

Produced a set of Recommendations that have been compiled in the following table:

12. Summary and recommendations

• In general, more men in the participating countries are smokers than women (except in Sweden) • In most participating countries, the prevalence of smoking is still increasing in women, especially in young women. • Data on smoking in pregnant women is not easily accessible, national data are often missing. • For comparisons it is important to watch the point in time during pregnancy measuring smoking prevalence (at the time a woman finds out to be pregnant or at the time of delivery) • The Swedish example of a registry recording the prevalence of smoking in pregnant women should be followed by other countries. The registry serves as an efficient tool to measure intervention effects and time trends. • Data on smoking cessation should be validated, numerators and denominators are not always clear for calculating quit rates (who is considered to be a smoker, how successful cessation is defined) • European tobacco legislation has led to a more uniform pattern in terms of access to tobacco, labelling of tobacco packages with warning signs, restriction of smoking in public buildings, restaurants, and at the worksite, and advertising. However, there remain still large discrepancies to be handled in the future. • Prevention campaigns on the European and on the national level should find more support. Motivational Interviewing as a counselling method seems to be especially promising and should be spread further. EuroSCIP II has made a special contribution by providing teaching material (MI-manual) • The EuroSCIP-Survey has been a successful pilot Survey and should be repeated on a larger scale with larger samples allowing statically stable inferences. • Future steps should put more emphasis on Motivational Interviewing as a counselling method, the effects on smoking prevalence could be measured in a randomised trial. The method should be spread by other media than just print media: The video tape from Sweden should be adapted to other European languages and settings.

The dissemination of the results have been taking place mainly by the already existing website that has been updated and where all materials are accessible to the public, such as:

1. Newsletters 2. National Status Reports, including the Survey reports 3. Cover sheets of all Manuals for training in Motivational Interviewing

20 Links were produced and updated for international references on smoking prevention and national links by country.

Globalink: Telecommunications for European Smoking Prevention

The GLOBALink public and membership websites were re-engineered in 2002 in order to cope with the growing demand by the public and by its membership for synthetic tools. With the wealth of information available, it was essential to provide tools/short-cut to access the relevant information to each target group. Website navigation and user-interface were improved in 2003, based on new requests and experiences.

GLOBALink was selected by tobacco control leaders to be the recipient of the prestigious 2003 Luther L. Terry Award in the category of Outstanding Organisation.

GLOBALink has been providing tobacco control information via its improved public website (http://www.globalink.org) which has become a key “tobacco control entry-point” on the Internet. One of the reasons for this success was our ability to interconnect successfully GLOBALink information with major documents and websites such as TobaccoPedia, The Online Tobacco Encyclopedia. Indeed, most information published on GLOBALink is categorised on TobaccoPedia, which, again makes it easy to retrieve.

Tobacco News

GLOBALink has become one of the largest –if not the largest- collection of tobacco related news- bulletins and services, including the EU funded Eureopean News Bulleting edited by GLOBALink’s partner, the European Network for Smoking Prevention (ENSP). GLOBALink News are very popular on the internet. This is why they are ranked #1 on Google (www.google.com) for terms such as: - tobacco news Europe - tobacco news united kingdom - tobacco news France (please see Annex 1 for Google screen-shots)

GLOBALink provide timely information and support to its membership: the 300+ list-servers have been integrated into a database which now allows greater flexibility: instead of “getting-all/none” messages for a particular list, a new tool has been designed to enable members to select delivery mechanisms for each list among the four following options:

• Receive the messages of this list as soon as they are posted • Receive once a day the messages posted to this list • Receive once a day the titles of the messages posted to this list • Do not receive by email the messages of this list

GLOBALink acted as a small yet fast clearinghouse. While it is are able to guide members to potential sources of information and to relay requests to the most adequate recipients, due to the lack of human resources, some questions –requiring intensive labour- cannot always be addressed.

21 Internet Services GLOBALink offered Internet and hosting services for health related events. GLOBALink served as the backbone for communication from the World Conference on Tobacco or Health (Helsinki, August 2003) which used GLOBALink as its main communication vehicle.

GLOBALink European Partners helped by making significant contributions: this resulted in an improved user interface (website) as well as the delivery of email messages in plain text as well as in HTML format.

Conclusions: GLOBALink remains a key strategic tool for European and global tobacco control. It is described by several members as “the glue holding the entire tobacco control movement” and as such, it is a very useful means to help those active in the prevention of smoking. Thanks to recent technical developments, GLOBALink has been able to show its rapid adaptation to the ever fast evolving needs of tobacco control professional organisations and agencies. GLOBALink is now more than a tobacco control network – it is recognized by all as the community of tobacco-control professionals and as such, can expand into new areas of tobacco control, can organize workshops, symposia, training courses. GLOBALink is a partner for all its members who can easily benefit from the wide range of services offered.

Protecting Workers from Passive Smoking

The main aim of the project was to collect, develop and disseminate information across Europe to help workers negotiate smoking policies at work. The project was particularly focussed on those people who work in the leisure industry – pubs, nightclubs and restaurants. These workers are most at risk from the effects of passive smoking.

Specifically the project aimed to develop a set of training materials for union representatives to use which would help them to learn more about passive smoking and help them to tackle the issue in the workplace. The materials would also form a key part of a website which would be set up with further information on passive smoking, copies of collective agreements and case studies of best practice. Finally, during the project a European Network of union representatives was established which will continue to monitor developments in this area and update each other on events in their own countries such as laws or best practice.

They set up a steering group of union representatives from the UK, Ireland, Denmark, Portugal, Sweden and Romania. It met in March, April and October.

The steering group members collected information on smoking on work and smoking policies and provided guidance on how the website could be designed to ensure that worker representatives found it accessible. They also provided guidance on the translation of the text.

In April the steering group members participated in a conference on passive smoking in London which was jointly sponsored by this project. Our representative from Ireland gave a presentation on good practice in Irish companies.

The first edition of the website was ready in May 2003 in four languages – French, English, Romanian and Portuguese. During the year, updates were made to the site and it was completed by mid-October. It is now available in eight languages which includes those above plus Swedish, Spanish, German and Italian. The site is called www.smokeatwork.org

22 The website is designed around the following key areas:

What is the project about? Why is passive smoking a health and safety issue? Documents and Resources Training Materials What we need from you Frequently asked questions

All members of our steering group have set up a link from the smokeatwork website to their own union websites. There are also links to health sites in their countries such as the health and safety agencies. They regularly receive comments from users from all over Europe via the “feedback form” included in the site. These workers tell us of their experience of passive smoking. They refer any specific questions to the relevant unions in the steering group.

Between May 2003 until September 2003, they designed the training materials in consultation with our steering group. The materials are flexible and modular as the steering group believed that each country would like to use them differently – either as a stand alone course or as modules on a wider health and safety course. This reflects the fact that all the countries represented are at a different stage in dealing with workplace smoke. For example, Ireland has implemented a ban on smoking from 2004 while in Portugal there is little existing legal protection and new legislation is unlikely to be implemented in the near future.

The materials were piloted with union representatives in the UK and in Portugal during June and July 2003. All the feedback was excellent from both participants and tutors, and only minor changes were made to the initial content and style. The materials are divided into the following sections:

How to use the materials 15 Activities Tutor Notes 5 Fact Sheets

They can be downloaded from the website in PDF format for ease of use and to enable the presentation of the materials to look professional. They are available in all eight languages.

The website and training materials were formally launched at a conference held in London in October 2003. The conference, entitled “Passive Smoking in European Workplaces” was attended by around 50 participants from a range of European countries and there were representatives from trade unions, government bodies and companies. The conference was addressed by an MEP, the President of the ENSP and by trade union representatives from Ireland, Portugal and Norway.

At the end of the conference, the TUC formally launched a European Network of trade union representatives who will continue to share information with each other about passive smoking issues after the project is over. Those steering group members will form the network and an email address has been circulated amongst trade union representatives in the European Union to encourage further participation.

Conclusions

Two of our steering group members carried out a presentation at the conference in October and summed up how important this project has been to them. It has no doubt raised the awareness of passive smoking in their own unions and given them valuable resources – a website and training materials – to use to help them to persuade others of the health and safety risks. These resources are

23 valuable to them in their own jobs but are also being used by others – union representatives, employers and government agencies.

All of the steering group members are using or planning to use the training materials in their own countries. This will allow union representatives to build up knowledge and confidence to enable them to negotiate smoking policies where they don’t currently exist.

In Portugal, the UGT has helped to establish the National Confederation on Prevention of Tobacco Use which is meeting for the first time at the end of 2003. The training materials are being introduced into all the union’s health and safety courses and all negotiators will receive the training. The union continues to press the Government and the NGOs to take passive smoking seriously. Also, several NGOs in Portugal have shown an interest in using the training materials themselves. There has been a lot of national press interest in the website in Portugal which has led to newspaper articles and radio interviews.

The Danish representative from the Restaurant workers union has said “there is no doubt that the website will be used as a significant instrument in our struggle to prevent our members from the risks through exposure to passive smoking”.

Similarly, the representative from the Irish Congress of Trade Unions has said that his organisation “found this project particularly helpful in identifying the issues which a total ban on smoking at work gives rise to. The issues include the scientific evidence, possible job losses, disciplinary issue relating to non-compliance, prosecution for non-compliance and help and support for tobacco addicts”.

Tackling socio-economic inequalities in smoking in the European Union

There is a wide variety of tobacco control activities across Europe. A measure is needed which provides valid and reliable information about the qualitative as well as the quantitative aspects of single tobacco control activities as well as the tobacco control in sum in each European country and region.

The objectives of this project were (a) to develop a tool for the quantitative measurement of tobacco control activities, (b) to deliver a detailed description of the tobacco control activities in selected European countries and (c) to compare the European countries according to their tobacco control activities.

Methods: A comprehensive item pool was developed and revised by literature research, research of cooperating partners and scientific exchange on an international expert workshop. Two questionnaires were developed (a) one regarding tobacco control legislation/ regulation and (b) one assessing experts evaluation of tobacco control activities implemented in their respective country

.Data assessment: For (a) we gathered data from 10 EU-member states and 7 accession countries. For (b) we gathered data from 142 different experts from 14 different EU member states during the course of the World Conference on Tobacco or Health in Helsinki.

Results: A comprehensive report about tobacco control legislation and regulations was written and the questionnaires proved to deliver the information wanted. A comparison of European countries indicating their rank in different fields of tobacco control and in total is provided. Therefore experts in Finland rate their country as the most active in tobacco control, followed by Sweden, Ireland, the UK and the Netherlands. The least active countries in tobacco control are Greece and Germany, behind Austria, Spain, Belgium and Portugal. Italy, France and Denmark constitute the middle field. There is a difference between expert ratings about tobacco control in their respective country and the actual amount of tobacco control in that country.

24 Discussion: The objectives of the study have been met. Yet, quality of data is limited by several factors including the source of the data, differences in political systems across Europe, the short duration of the project, delayed payment of funding etc. The discrepancy between experts rating and experts knowledge needs to be investigated further.

Recommendation: Correcting and updating data needs to be done, longitudinal data assessment should be conducted. Further population based research on evaluation of tobacco control activities is the next logical step for research.

Smoking is more common in lower socio-economic groups in nearly all EU member states. An important challenge for comprehensive tobacco control policies, both at the national an international levels, is to reach lower socio-economic groups in particular. Some tobacco control measures have the potential to be more effective in lower socio-economic groups. However, it is uncertain (a) to what extent these measures have already been applied in different European countries and (b) whether their application may have had demonstrable effects on trends in smoking among lower socio-economic groups. This project aimed at producing part of this missing information, and thus to contribute to the development of equity-oriented tobacco control policies.

Background to empirical studies

Part A. Many (> 30) studies have investigated time trends in social inequalities in smoking in individual countries. However, there are no international comparative overviews of these trends, except for a Monica based study on trends during the 1980s, and a systematic literature review of trends up to the late 1980s. Therefore, there is a need to prepare an overview of time trends in inequalities in smoking during the last 10 to 15 years of the 20th century, including an assessment of the pattern of inequalities by the year 2000.

Part B. There are several international overviews and comparisons of tobacco control policies. However, no overview has addressed the question to which extent policies in different countries have seized the possibilities to tackle smoking in lower groups in particular. A recent review showed that some demand-side tobacco control measures have the potential to be more effective in lower socio- economic groups. This raises the question to what extent these policies have been implemented over the last 10 to 15 years in different European countries.

Part C. Several studies have aimed to assess whether tobacco control policies have influenced trends in smoking in individual countries. However, relatively few studies have aimed to determine whether the effects of tobacco control measures differed according to socio-economic group. Several authors have suggested that health education campaigns have influenced upper socio-economic groups more than lower groups, thus contributing to a widening of inequalities in smoking. Supporting empirical evidence is however rare. There are more empirical studies with regards to the effect of tobacco price policies, but the evidence from these studies is yet mixed.

Part A: Time trends in inequalities in smoking

Objectives

The main objective of this part was to give an overview of time trends in inequalities in smoking during the 1980’s and 1990’s. A secondary objective was to produce an international overview of patterns of inequalities in smoking in recent years. This Part would in addition results in an international data bank on socio-economic inequalities in smoking, to be used for possible additional international overviews.

Methods

We obtained data from national health interview and similar surveys from eight European countries. Many of these surveys had large samples, which were nationally representative, and with detailed information on both smoking and socio-economic status. We obtained detailed data from Finland, Sweden, Norway, Denmark, the United Kingdom, the Netherlands, Germany, Italy and Spain. For each country, data were obtained from 4 surveys held between the years 1985 and 2000.

We in addition used more data that could be used for in-depth studies. We acquired data from the European Community Household Panel, with data on smoking by educational level and income level in about 12 member states of the European Union. In addition, data from one country, Italy, were analysed in more detail in order to determine and to explain trends in smoking inequalities between 1980 and 2000.

Results

Among men, socio-economic inequalities in smoking were substantial in all countries. These inequalities were larger in relationship to educational level than in relationship to income level. These inequalities were observed in all member states of the European Union (as of the year 2000), with small variations in the precise magnitude. During the 1990s, these inequalities were stable in most countries, with increases in a few countries, but no decreases elsewhere.

Among women, socio-economic inequalities in smoking were observed in the north of Europe, while no or even inverse social gradients exist in the south. The inequalities were widening in most northern countries, and emerging in southern countries, due to more favourable trends in smoking among highly educated women. Among the youngest female generations, inequalities in smoking were observed in nearly all countries, except the very south.

Conclusion

Trends in inequalities in smoking in the European Union follow the predictions based of the four-stage smoking epidemic model. This epidemic follows a common path in most countries, with a north-south difference in the timing of its phases. The parallel trends stress that, despite major regional and national variations, inequalities in smoking constitute a problem whose roots are common to all European countries.

Part B: Inventory of smoking policies

Objectives

The principle objective of this part was to assess the extent to which smoking interventions and policies in different European countries contain elements that may be effective especially in lower socio-economic groups. The specific objectives were (a) to identify tobacco control measures that may be potentially effective especially among lower socio-economic groups and (b) to prepare of an overview of trends in the implementation of these measures in about six European countries.

Methods

The identification of potentially relevant tobacco control measures was based on a review of Platt et al that was prepared at about 2000. This review was updated by including more recent publications,

26 including new Cochrane reviews on specific tobacco control measures. The overview did not only rely on evidence from experimental studies, but also looked at (both quantitative and qualitative) evidence with tobacco control in real-world situations.

The international overview started with a collection of data from international studies and data banks, such as those on the price of tobacco products. However, most of these sources of information lacked information of time trends, which was the central focus of our study. Therefore, additional information was obtained from six individual countries. Detailed questionnaires were prepared on the implementation of five types of tobacco control measures in 1985, 1990, 1995 and 2000 respectively. National representatives completed and returned the questionnaires.

Results

Five tobacco control measures were found to have a considerable potential to reduce inequalities in smoking between socio-economic groups by having the greatest effects among lower groups. These include banning of advertisement, rising tobacco prices, work place interventions, free supply of NRT and similar cessation aids, and telephone help lines. Some other specific measures (e.g. health publicity campaigns) should also be considered as part of comprehensive tobacco control strategies, but are generally be less effective in reducing inequalities in smoking.

Potentially relevant tobacco control measures were not fully implemented in European countries during the past decades. Banning of tobacco advertisement was not complete in most countries, and indirect forms of promotion persisted is most countries. Tobacco taxation rates greatly vary between countries, with much room for large price increases in many European countries by the year 2000. Bans on smoking in working place are voluntary in many countries, with greater rates of implementation in professional and white collar settings than in the manufacturing industry and other blue collar places. By the year 2002, NRT were made available free of cost on a national level only in the UK and France. Finally, many countries lack national quit lines that are proactive and free of charge.

Discussion

There is much potential to develop tobacco control strategies that are maximally effective among lower socio-economic groups. However, no European country has yet fully seized this potential. Even though most countries implemented at least some potentially relevant tobacco control measures, these measures were often implemented partially and not fully to the benefit of lower socio-economic groups.

27 Part C: Assessment of the effect of smoking policies

Objectives

The general objective of this part was to determine the extent to which trends in smoking behaviour in lower socio-economic groups may actually have been affected by tobacco control measures in the past. Differential effects of past tobacco control policies were studied in additional analyses of our international data bank on smoking trends. In addition, national case studies reviewed the experience of tobacco control policies in specific settings.

Methods

In the international study, data on smoking trends between about 1985 and 2000 were obtained in part A of this study, while data on the implementation of tobacco control policies in the same period were obtained in part B. Given the current scientific controversy on this issue, we decided to concentrate this international analysis on the differential effects of increases in tobacco price.

National case studies were selected in such a way as to capture the experience from different countries (both in north and south of Europe) with different tobacco control measures (with emphasis on smoking cessation aids). The studies selected came from Sweden, United Kingdom and Spain. We also included a comprehensive study of trends in New Zealand.

Results

The tobacco control policies that have been carried out in European countries thus far seems to have had more effect on trends in smoking among upper socio-economic groups than on trends among lower groups. For example, even though maternity-related and other smoking policies have achieved a substantial reduction in tobacco consumption among pregnant women in Sweden during the last 20 years, socio-economic inequalities in smoking prevalence and cessation persisted, and even widened in relative terms.

The supply of NRT and other smoking cessation services is likely to have increased rates of successful cessation among upper socio-economic groups more than among lower social groups. For example, the likelihood of successful quit attempts among clients of a smoking cessation clinic in Barcelona was considerably larger among smokers with a higher educational level or higher occupational class. The greater success of upper socio-economic groups was achieved despite (or perhaps due to) the fact that the same services were provided to all smokers.

In the past years, high tobacco taxation rates were probably the most effective single measure to reduce levels of tobacco consumption among lower socio-economic groups. Overall, however, the evidence on a differential impact on different socio-economic groups is mixed. Our international study found that in England and Wales, prices elasticities were higher among lower educational groups. However, no such differential effect was observed in most other countries. Thus, even though tobacco taxation may have strongly influenced tobacco consumption among lower socio-economic groups, higher groups in many countries may have responded in similar ways, and inequalities in smoking may have remained unchanged, albeit at lower overall levels of consumption.

Discussion

Tobacco control policies seem to have had generally larger effects on trends in smoking among upper socio-economic groups than among lower groups. This is not an exclusively European phenomenon. A paper from New Zealand discussed in detail how (the absence of) tobacco control policies during the 1980s and 1990s contributed to a widening of inequalities in smoking in relation to income and ethnicity.

Part D: Recommandations

Objectives

The last part of the project aimed to develop recommendations for comprehensive national and European tobacco control policies to reduce smoking behaviour in lower socio-economic groups. These recommendations were presented in the form of a small brochure aimed at policy makers who are involved in tobacco control at local, national or international levels.

Methods

The general outline of the brochure was developed during a two-day workshop held at the end of the project. When writing the brochure, we drew upon a wide range of studies published in the international literature. Special attention was given to the evidence that was accumulated in parts A, B and C of this proposal, and that was evaluated during the two-day workshop at the end of the project.

Results

In each European country, there is still a considerable scope for developing comprehensive strategies aimed at tackling socio-economic inequalities in smoking. There are several ways to increase the effectiveness of specific tobacco control measures among lower socio-economic groups, including (a) strict enforcement of laws and agreements, (b) removal of financial and other barriers, (c) geographic or social targeting of services and (d) tailoring of communication approaches. Comprehensive strategies should give weight to tobacco control measures that have most potential to reach lower socio-economic groups, such as price policies. Equity concerns should also guide the policy process, including target setting, advocacy and mobilisation, and the recruitment of workers for tobacco control.

There is a large potential to increase effects of traditional tobacco control policies by linking up with social and economic policies that can improve the living conditions and personal resources of disadvantaged people. At local levels, tobacco control can be integrated into community-based actions such as local support groups and actions for a safe and healthy living environment. At national and international levels, socio-economic policies such as income support for the poor can be integrated with tobacco control measures such a rising tobacco taxes.

Conclusion

As smoking is increasingly more concentrated among lower socio-economic groups, reaching these groups is essential to achieve main reductions in tobacco consumption across Europe. To meet this challenge, comprehensive tobacco control policies should fully implement a series of measures, and tailor these measures according to the needs of lower socio-economic groups. These measures should be backup up by broader policies, at local, national and international levels, aimed at creating supportive environments for lower socio-economic groups.

Dissemination of the Results

The core result of this project is a brochure that summarises the main findings and recommendations for policy makers and health care professionals throughout Europe. This brochure, called “Socio- economic inequalities in smoking in the European Union: applying an equity lens to tobacco control policies”, is yet in a draft form. The final version will be given wide distribution across Europe, e.g.

29 through the website of the ENSP. A plan for dissemination of this brochure will be set up, in cooperation with the ENSP and other organisations, before completing the final version of this report.

The scientifically most interesting results of this project will be disseminated by means of publications in peer-reviewed international journal. At this moment, the following papers are submitted to an international journal, or will be submitted within half a year. Each paper is supported with funds from the present project.

1. K. Giskes et al. Trends in smoking inequalities in eight European countries, 1985-2000. 2. K. Giskes et al. Effects of price on trends in smoking among different educational groups in eight European countries. 3. M. Huisman et al. Educational differences in smoking among men and women in 12 member states of the European Union. 4. M. Huisman et al. Education compared to income as predictors of smoking in 12 member states of the European Union. 5. B. Federico et al. Trends between 1980 and 2000 in educational differences in smoking in the macro regions of Italy. 6. B. Federico et al. Inequalities in initiation and cessation of smoking in three different generations in Italy. 7. A. Kunst et al. Review of policies that are potentially effective to tackle inequalities in health, and their implementation in five European countries. 8. S. Platt et al. inequalities in smoking in Scotland: the role of individual-level versus area-level determinants. 9. K. Moussa et al. Trends in inequalities in smoking among pregnant women in Sweden. 10. E. Fernandez et al. Inequalities in smoking cessation among patients of a smoking clinic in Barcelona.

Some of these papers have been presented orally at international conferences, including the annual meeting of the European Union of Public Health Associations (Rome, 2003), and the 12th World Conference on Tobacco or Health (Helsinki, 2003). More presentations at both national and international occasions are envisaged.

European Network of Quitlines

The achievements of the European Network of Quitlines (Year III) can be summarised as follows:

• The launching of the first draft of the European Network of Quitlines Guide to Best Practices • Successful results 6 months after the first year since establishing the Portuguese Quitline, with the help of mentoring from the European Network of Quitlines • Presenting on the European Network of Quitlines at the WCToH in Helsinki. • Inclusion of three new Accession countries and more wishing to join in 2004-01-15 • Steve Crone presenting on the European Network of Quitlines at the North American Quitlines conference • Producing a cost effective, evidence based sustainable quitline model, accessible to countries without large budgets

Réseau Européen des Hôpitaux sans tabac

Achèvements e Recommandations :

¾ Création du nouveau Réseau Hôpital sans Tabac, en Grèce. (nouveau partenaire au projet). Mise en place progressive d’un Réseau Grec Hôpital sans Tabac avec une progressive augmentation des hôpitaux adhérents.

¾ Renforcement des contacts avec les Etats membres de l’Union européennes et surtout avec l’Allemagne dans la perspective d’une création d’un Réseau National Hôpitaux sans Tabac.

¾ Renforcement des liens avec le Réseau HPH et implication dans la stratégie des Hôpitaux Promoteurs de la Santé.

¾ Excellente collaboration avec le partenaire Italien. Audit de l’Hôpital Vitoria Venneto, à l’occasion de la Réunion de Venise ( juillet 2003) . Collaboration avec le partenaire Italien pour l’organisation de la présentation du projet sous forme d’atelier au congrès de la SNRT, à Padou.

¾ Excellente collaboration avec le partenaire Roumain : traduction du Code, du guide de formation et d’implémentation d’un hôpital sans tabac en roumain, participation à la présentation du Réseau au congrès d’Helsinki et contribution à la rédaction des newsletters.

¾ Excellente collaboration avec le partenaire Irlandais. Réflexion et proposition d’une modification du Code, des nouvelles standards européens d’un Hôpital sans Tabac et de l’outil d’évaluation (grille auto-audit), rédaction d’un rapport.

¾ Diffusion des résultats par la participation aux congrès, conférences scientifiques européennes et internationales. Grâce à l’implication des partenaires dans les conrès scientifiques, européens, des actions de communication et de formation, non prévues dans le projet initial, ont pu être réalisées. ( HPH- Florence, SNRT-Padou, Vienne, Lisbonne)

¾ Nouveau Code- Standards. Intégration de la notion du rôle promoteur de la santé de l’hôpital et de l’hôpital en tant que lieu de travail sain. L’hôpital étant un modèle de santé en général, il induit auprès de la population des comportements qui doivent être plus sains. L’hôpital sans tabac doit mener vers une vie sans tabac.

¾ Réflexion, proposition et validation par tous les pays membres du REHST du questionnaire sur le baromètre du tabagisme des soignants, qui constitue désormais un instrument consensuel de mesure du tabagisme à l’hôpital.

3rd International Conference on Smokeless Tobacco

Nicotine dependence is the most widespread addiction in the world. Addiction to nicotine affects about 20 percent of the adult population and the overwhelming majority of tobacco users inhale their nicotine. About 1,2 billion people on the planet are smokers. The number of smokeless tobacco (ST) users is probably 5 to 10 percent of that figure. ST is tobacco that is not burned when it is used. It may be used alone or in combination with other substances and used at any site that permits the absorption into the human body of nicotine and/or other constituents in tobacco or added to tobacco. In some countries, traditional ST products are highly carcinogenic and constitute major health problems. Most

31 studies that focus on ST or include a ST component have been investigator-initiated. While this process has advanced the science, it does not ensure the systematic investigation of important issues. Consequently, speakers at the 3rd ICST were asked, in addition to summarizing the state – of – the – science, to identify significant research questions. Their recommendations, and others subsequently identified, are organized into general subject areas.

1. A standard lexicon is needed. Terminology is confusing and incomplete. 2. Standard biomarkers and survey questions are needed. It is evident that information is lacking about smokeless tobacco use, effects, marketing, and so on in vast areas of the world. Monitoring systems and feedback loops are needed. 3. A global smokeless tobacco research agenda is needed. This is a critical issue, and the information presented in the conference provides an excellent basis for agenda development. 4. Research information should be easily available globally. In the press of time with too few people having responsibility and opportunity huge, handy access to the literature is needed. 5. A global ListServ is needed. This conference demonstrates that there is an excellent pool of knowledge and talent around the world. 6. A forum is needed for scientific exchange of information, define research and public health priorities, and for individuals active in smokeless tobacco issues in one way or another to meet one another as conference participants. 7. A global resource development system is needed. This is not simply a funding issue. Capacity building of every kind is needed so that distinguished workers of every talent needed are available in every culture and on every continent where smokeless tobacco is used. 8. A global science transfer system is needed. Researchers, public health workers, health care providers, educators, and those who guide the public through policy making, business enterprises and community leadership need to understand why there is concern and have sound scientific facts in their hands in a timely way.

Future results and future dissemination ( Projects 2003/2004)

The ENSP Framework application expects to develop, facilitate and support a fully dynamic and interactive network of tobacco control advocates working in collaboration with other informed stakeholder organisations towards progressive tobacco control policies.

This for example in the case of the ENSP Core Grant will involve a strategic approach to encourage the creation of national tobacco control coalitions in each of the Accession and Central and Eastern European countries and quickly integrating them fully coherent way into the ENSP network, taking into consideration their specific problems. This will result in up to 10 new national coalitions in the ENSP General Assembly and many new contacts in the ENSP network database and dissemination list. Measurable results will be, that coalitions become better informed and more involved on EU issues, familiar with the implications of EU policy on national legislation, able to compare with the situation in other countries and consult with others easily and regularly. ENSP will facilitate and support them with ‘tools’ in the form of published reports (Media Advocacy Report) , up-to-date information releases, transfer of technology, best practices, regularly update website with further information etc. Particular attention and value will be given to the maintenance of communication channels with governmental organisations, to fully inform support and advance policy developments.

32 The European Network of Quitlines will ensure provision of more effective, scientifically sound, best quality standard and cost effective smoking cessation programmes. The Project will produce a cost effective, evidence based sustainable quitline model, accessible to countries without large budgets, for example, the new accession countries, thus contributing to the strengthening of solidarity and cohesion between the EU and applicant countries.The results of the ENQ will be seen through publication of a Code of Practice and dissemination of the guide on Globalink and other European online publications. One of the Networks major verifiable and specific results will be in the form of ENQ Quality Standard Accreditation, which will lead to the achievement of high quality standards across Europe.The ENQ/DEFACTO research will result in clear indicators to show the success and cost effectiveness of the quitlines, and demonstrate which factors most influence success.

The European Medical Associations will produce as a result a: • Scientific report one expert scientific report on smoking and health in Europe, with associated briefing documents and press materials • Capacity building: Establish a core network of doctors trained in press and public affairs, and briefed on tobacco. Support with journal subscriptions, action alerts, briefings, and training • Medical editors’ resource pack: Open copyright tutorial materials on tobacco for translation and publication in selected European medical journals, drawing on materials published in BMJ group journals • Survey of medical journal coverage of tobacco: Research to analyse the coverage of tobacco in selected European medical journals. Research, analysis, collation for publication. • Medical editors’ conference on tobacco: A feasability study of proposal to hold a closed expert conference for medical editors on tobacco. Scoping, advisory board, assessment, action plan.

The project dealing with the Evidence-based policy development and enforcement for the prevention of exposure to passive smoking in European and accession countries (EB-ETSPV) The results of the project will provide a description about the ETS exposure situation in cities of seven different European countries (which) , especially in workplaces (i.e. hospitality sector). The environmental measurements will provide objective, sound scientific information about ETS levels in workplaces and public places. As a result, a report will be prepared and disseminated about “Environmental Tobacco Smoke in Europe. An updated assessment of the situation with special emphasis on workplace”. Also, a common questionnaire to be used to assess the perceived frequency and determinants of exposure to ETS among general population will be developed and pilot-tested during this first year of the project. The questionnaire will eventually be used in a second phase to update and complement estimates of exposure at the population level as well as to provide a global assessment of impact of ETS in Europe.

Finally the European Network, smoke free Maternity and Hospitals will create three distinctive types of results which have been divided into actions. Action I- will be to create the basis for the organisation and structure to reach efficiently the female population. To integrate on the network strategy the maternity of each individual country and to increase by 10 % per year the number of

33 employees working on them. Action II will be the creation of a validated national and European indicator of pregnant woman addiction to smoke and of health professionals for the evaluation, comparison, follow up and set up of correctives measures. Finally Action III will be the development of validated and consensual recommendations on the European level in order to set up basic training programs in health imparting schools. Further results can be consulted under this same heading in Annex 8.

All The results of the ENSP framework project application will be disseminated in order to gain visibility and also to make sure that this leads to increased awareness. All the ENSP framework projects will use suitable dissemination strategies and provide in detail their designed dissemination plan. For a detailed description, please refer to the Annexes under this same heading. The ENSP Core Grant proposes to divide the dissemination of the results in three successive phases including: Basic and immediate online dissemination, dissemination to target groups and target group activities. In order to limit the volume of information delivered to members, GLOBALink is segmented by interest areas – Members can choose the networks and lists (news/discussions) they subscribe to. Members can post information/questions to the appropriate community and trigger debate with other community members. The Communication strategy on this project will be comprehensive and strong both on the dissemination and marketing of our project outcomes. The support of the ENSP/EC will be prominently acknowledged on our website, e-publications, publications, media interviews and all PR activity, including TV, radio and press.

The ENQ project will mainly disseminate their results in the top medical journals across Europe, and will be publishing and distributing the Code of Practice on Globalink and other European online publications. The Network will use oral presentations at the European and World Conference on Tobacco or Health. The website for the European Network of Quitlines will provide e-copies of all publications in common formats, while again recognising the help of the ENSP/EC.

For the European Medical Associations, For the European Medical Associations, coordinated actions by NMAs (National Medical Associations) will bring the issue to the attention of decision- makers nationally and internationally, and will inform public policy and opinion. All efforts will be made to publicise the products of the project through the relevant networks, publications, websites, institutions, professional bodies, and scientific journals and newsletters. Advocacy, direct contact and correspondence with decision-makers will inform them of public policy measures needed. Press activities will ensure wider public awareness of the roles and positions of the medical profession with respect to tobacco.

Health Professionals and Smoking Cessation in a Larger Europe will disseminate the results by creating networks and partnerships in each Member State and applicant country and at the European level by preparing and implementing the outcomes of the project; a dissemination strategy is built in right from the beginning of the project. The partnership will be charged with the responsibility of implementing the recommendations throughout the duration of the project and after the end of the three year project. The country based networks and partnerships will have the responsibility of transferring and disseminating the information throughout the relevant country based professional organisations and health care systems and structures.

The results on ETS-exposure and the best practice policy guidelines on the establishment of smoke free workplace legislation at the national level will be presented and discussed at national conferences which are to take place in major cities of the Member States or accession countries participating in the project. The policy document which analyses the best way forward to establish smoke free workplace regulations in the EU health and safety legislative framework will be presented and discussed at an international conference. This conference is planned to take place in Brussels under the umbrella of ENSP with the participation, for example, of representatives of the EU commission as well as European organisations and national authorities concerned with health and safety at the workplace.

34 And Finally the the European Network, smoke free Maternity and Hospitals will disseminate the results and the future strategy ( expert recommendations and « white paper » ) via the website of the REHMST network and the support of the communication channels of national and international countries participating in the project and through the framework of the partenaria developed with other thematic networks ( HPH, HOPE, Nurses Network …). A communication strategy will be developed to disseminate the results at International congresses ( SRNT, Prague 2005…). All efforts will be made to publicise the products of the project through the relevant professional medical journals and liaison bulletins from the REHMST network.

Conclusion

Summaries the project results 2001-2002 were drafted, compiled and published in July 2003 well before the initially planed date of release (September 2003). The publication of the summary reports was compiled before deadline because it was intended to be officially launched at the World Conference of tobacco or health in Helsinki (3/08/2003) .100 paper copies + 200 CD ROM copies where published and exposed at the stand of the ENSP in Helsinki. Within the first two days, all copies had been distributed. Concerning the FWP 2002/2003, the fact that the first payment of funds (30%) and contract signature, only arrived 6 months after the start of the projects meant that there serious delays on the project activities and ENSP decided to ask for an amendment to the Agreement in order to complete the objectives indicated on the original application for funding. The amendment was approved by the European Commission and the projects have been completed successfully. Unfortunately this came too late for one of our project coordinators (Identification of gaps in training dentist in treatment of tobacco dependence) which felt that the completion of his objectives was jeopardized by the lack of time, and he decided to withdraw for the FPW 2002-2003. As initially foreseen all the other 9 projects which constituted the FWP 2002/2003 have complied with their aim of producing sets of recommendations and/ or facilitate and support a fully dynamic and interactive network of tobacco control advocates working towards progressive tobacco control policies .Once the final reports for the 2003/2003 FWP have been introduced to Commission services, the results and the set of recommendations will be announced in a press conference and to the European Policy makers. This results will be published on the ENSP web site and proposed for publication in peer reviewed international journals. A Summary of Final Reports will be compiled and published shortly and, as in previous applications, widely distributed. Following-up the publication of the new EU public health programme (15/03/03) and intensive intelligence gathering in collaboration with European Health organisations had enabled ENSP to develop a project grant application 2003-2006 on 7 major themes well in advance of the call for proposals. These project proposals already incorporated the final working priorities of the European Commission, project partners had met and organised their collaboration on a project building workshop . The departure of the Secretary General around that time, meant that a period of adaptation was necessary for the ENSP to cope with the new situation. A new Project Coordinator took over the technical part of the projects assuring a sound scientific content and a timely application for funding. The financial part has been managed separately by a finance director. This new management arrangements has been working perfectly well and the projects have been introduced successfully on a timely manner to the Commission.. Unfortunately the original application (2003/2006) initially conceived for a three year period (following Commission requirements) had to be reworked on a yearly base which was a laborious and complicated administrative task, many of the coordinators threatened of leaving the Framework (in fact at the time of reporting, one of the project coordinators have resigned of their assignments and withdraw the project proposal). Nowadays, after thorough rethinking and serious work, the projects developed are innovative, priority driven and cost effective and designed to improve tobacco control in all different levels, including the promotion of effective legislation and know-how and are/ will be an essential element for a coherent and coordinated approach to tobacco control in the European Union as well as serve as a tool for increasing the effectiveness in the future.

• Partners annex: list of partner organisations

36 This report was produced by a contractor for Health & Consumer Protection Directorate General and represents the views of the contractor or author. These views have not been adopted or in any way approved by the Commission and do not necessarily represent the view of the Commission or the Directorate General for Health and Consumer Protection. The European Commission does not guarantee the accuracy of the data included in this study, nor does it accept responsibility for any use made thereof.