La democracia y el desarrollo

While in the beginning of the last century female smoking was socially not accepted, its prevalence increased constantly with each following birth cohort. In the 19501959 cohort, smoking prevalence among both sexes was nearly balanced (37% and 41% for females and males, respectively) (La Vecchia et al., 1988). Another trend of female smoking is the earlier age of starting smoking for younger ones, which in addition is characterized by heavier tobacco consumption. Furthermore, it has been stated, that older men are more likely to quit smoking compared to older women. Since the early 1970s cigarette sales increased steadily with a strong rise, which levelled o around 3 000 cigarettes per adult/year on average (La Vecchia et al., 1988). Gmel (2000) reported increasing trends in current smoking in 19931997 for both genders. Costanza et al. (2006) analysed gender- specic habits in tobacco use and concluded a stable smoking prevalence for males and females based on a surveillance study in Geneva during 19932003. In 2010, the smoking population was around 30% for males and 24% for females. Almost half of them (48%) intented to quit smoking, while this willingness is highest in the French-speaking part of the country (Keller et al., 2011).

1.2.1 Tobacco-related policies

Lack of knowledge regarding the harms of tobacco use has been observed among smokers as well as non-smokers. Many people are unaware of the range of risks implied and diseases caused by tobacco-smoking (WHO, 2008).

Light cigarettes are one example of a wrong perception, as they are seen to be less adverse compared to regular ones. Cigarettes labelled as light are often used as a pre-step before quitting. Studies showed that there is a positive association of switching to light cigarettes and the attempt to quit smoking. However, so far there is no evidence that changing to light-tar cigarettes increases the chance to stop smoking (Weinstein, 2001).

Dierent strategies exist to prevent and control the burden of tobacco use and related diseases. In Switzerland, the National Programme Tobacco 20082012 has been launched by the Federal Oce of Public Health (FOPH) with the long-term goal to reduce the number of tobacco-related morbidity and mortality. In 2012, it was extended till the end

1.2 Tobacco use in Switzerland 7

of 2016 and determines the national strategy regarding tobacco-prevention.

As the country is splitted into 26 cantons, each being independent and relying on a local government and decision making processes, no strict national agreement or law exists. In 2007, the majority (64%) of the Swiss population (aged 1465) favoured a smoking ban in restaurants, cafés and bars (Krebs et al., 2008). The acceptance was highest in the Italian-speaking region, followed by the French- (74%) and German-speaking (61%) part of the country. In 2010, the Federal law to protect against passive smoking was conducted. The smoking ban regulation aimed to achieve smoke-free interiors, covering public or working places as restaurants, bars, schools, hospitals etc. As a renement of this minimal protection, further details have been dened independently at cantonal level. While some cantons allowed service in rooms labelled as smoke-rooms, some prohibit any service in rooms where smoking is allowed. This regulation, not oering any service in smoke-rooms, protects the waiting sta, which is no longer exposed to the smoke of the guests and being therefore passive-smokers.

In 2012, the Swiss population had to vote regarding an initiative for stricter smoking ban regulations to protect against passive-smoking. This policy would have implied no service in smoke-rooms for the whole country. With a turnout of 42.3% the initiative failed. Around 34.0% voted for the new initiative, while the lowest number of proponents was observed in the German-speaking part (31.5%), followed by the French-speaking area (39.7%) and almost half of the population living in the Italian-speaking region (48.8%). Geneva was the only canton that voted for the initiative (51%).

Other federal smoking regulations include health warning labels on cigarette packs. Labels either show statements of the health consequences of smoking or illustrate them, as a metastatic lung.

In 2011, the FOPH launched a rather contrary campaign called SmokeFree, focusing on advantages from non-smoking instead of highlighting disadvantages and risks from smoking. The initiative attempts to emphasize on the coolness of non-smoking and the positive implications.

1.2.2 The tobacco lobby

Worldwide, the tobacco industry inuences tobacco-related interventions and public health eorts. In Switzerland, the tobacco market is mainly driven by two tobacco companies: Philip Morris and British American Tobacco, controlling the market of cigarette sales of 4550% each. It has been stated that Switzerland is a paradise for the tobacco industry, being inuenced by the tobacco lobby to a greater extent than anywhere else.

8 Chapter 1. Introduction

`We have now a clear view of the tobacco industry's strategies in Switzerland as a result of lawsuits in the United States which have made millions of pages of previously secret tobacco industry documents public. These documents reveal that [...] the tobacco industry made a large, and largely invisible, eort in Switzerland to prevent implementation of meaningful tobacco control legislation and policies in Switzerland.'(Lee and Glantz, 2001)

In addition, the lowest tobacco excise tax in Western Europe can be found in Switzerland. One essential component of an eective intervention strategy planning is to discuss in public and nally aim to eliminate the counter movement by the tobacco industry. In Switzerland, this factor has been identied as a major obstacle of tobacco prevention. However, interventions in the past have rather ignored this inuence (Lee and Glantz, 2001).