Within most European populations, smoking prevalence rates differ substantially according to people’s level of education, income or occupation. In European countries, smoking inequalities are generally high, and smoking is the largest single contributor to socio-economic inequalities in mortality. Significant inequalities in smoking are now emerging in all European countries, especially amongst young people. Tobacco products and secondhand smoke (SHS) kill, as documented in over 20 reports (eg: IARC, US Surgeon General). Exposure to SHS causes around 79.000 deaths every year in the EU, including:- Deaths from lung cancer, coronary heart disease, stroke and chronic non-neoplastic respiratory disease; - Deaths in childhood - Significant morbidity, both acute and chronicSpecial Eurobarometer 429/2015 indicates that almost one third of European citizens currently smoke, including cigarettes, cigars and pipes. As smoking is responsible for half the difference in deaths across socio-economic groups, tobacco control has a major role to play in reducing health and social inequalities in Europe.With an increased capacity within its Secretariat, ENSP has the challenging task in 2016 to locally support its network members in the implementation of the TPD 2014/40/EU after its transposition into national laws by the month of May 2016. With activities based on scientific evidence and academic research, including a scientific committee, a new peer reviewed journal and a network of universities involved in tobacco control, ENSP has all the necessary competences and expertise to create a real impact in the de-normalisation of tobacco use in Europe. Remaining the only structured network specifically dedicated to tobacco control at European level, its work highly contributes to the comprehensive coordination of national and international tobacco control initiatives. ENSP 2016 work programme contributes to its wider 3-year strategy.

The tobacco pandemic causes the death of 700.000 European citizens every year. Compared to the rest of the world, the WHO European Region has one of the highest proportions of deaths attributable to tobacco. According to the Special Eurobarometer 429/2015 almost one third of European citizens currently smoke tobacco products, including cigarettes, cigars and pipes. As smoking is responsible for half the difference in deaths across socio-economic groups, tobacco control has a major role to play in reducing health and social inequalities in Europe.

With an increased capacity within its Secretariat, ENSP has had the challenging task in 2016 to locally support its network members in the implementation of the TPD 2014/40/EU after its transposition into national laws by the month of May 2016. With activities based on scientific evidence and academic research, including a scientific committee, a new peer reviewed journal and a network of universities involved in tobacco control, ENSP has all the necessary competences and expertise to create a real impact in the de-normalisation of tobacco use in Europe. Remaining the main structured network specifically dedicated to tobacco control at European level, its work highly contributes to the comprehensive coordination of national and international tobacco control initiatives.

The ENSP work programmes are structured on the basis its priority activities, as well as taking into consideration the results, experience and learning of previous years. Overall objectives for 2016 included:

• Working with local, regional and national actors to support the implementation of the FCTC and the transposition of the TPD into national laws in Europe;
• Strengthening the Network, by increasing the number of national coalitions, their pro-activeness, as well as promoting links between members, especially in countries not represented;
• Getting involved in European-wide projects;
• Strengthening internal and external communication, and effectively sharing information as well as building the capacity of all members and stakeholders working in tobacco control in Europe;
• Building the capacity and capability of the Association, by building the Secretariat team, increasing the number of members and reach out to new sectors.

As a bridge and information platform between EU institutions and national members, ENSP uses a mix of tools to disseminate and keep the network up-to-date with the most recent development in tobacco control issues. These are manifested in communication resources, presentations, information dissemination, meetings, events as well as write-ups.

Activity in 2016 has followed the foundation work from 2015, when ENSP worked with members to prepare for the TPD transposition and supported them with the implementation of the FCTC at national level, but with major improvements in a number of the communication means.

ENSP has organised three major events, launched its updated website, a new and more streamlined brand identity, updated the monthly newsletter format and increased regular publication, strengthened the position of the ENSP official scientific journal: Tobacco Prevention and Cessation and had high Social Media activity.

Through the new ENSP communication strategy, ENSP has in 2016 focused on high visibility and has produced a series of resources to enable increased recognition and awareness of the organisation from members but also wider stakeholders. Based on the new visual identity, materials designed and disseminated include: presentation leaflet, promotional leaflet for the scientific journal, roll-up banners for events, abstract booklets for conference and capacity building events.

One of ENSP’s main activities is to support national and international partners by contributing to events, conferences, workshops and meetings to present on specific topics related to tobacco control or to inform stakeholders on ENSP, its work and its projects.

In 2016, ENSP successfully achieved all the objectives agreed at the General Assembly and included in the 2016 Action Plan and Agreement with the European Commission. Some activities are still on going and will be completed during 2017 and some extra activities had been added to the work plan, as further needs and opportunities emerged as the work progressed.

Overall Progress:

In 2016, ENSP was in a fairly protected financial position, which allowed the Secretariat to concentrate all efforts in building the visibility and the strong links between members, partners but also other stakeholders. In March, ENSP recruited Andrea Glahn, as a Project Assistant to join the Secretariat based in Brussels.
In additional to the Operating Grant with the EU Consumers, Health and Food Executive Agency (CHAFEA), the organisation is partner in three EU research projects (EQUIPT, SILNE-R and TackSHS) and the coordinator of another (EUREST PLUS). It is also one of the partners for TOB-g, a EU Public Health project. In addition, it received the grants from Global Bridges for a the second face of the EPACTT project, which aims at producing tobacco dependence treatment guidelines in 15 European languages.

In 2016 ENSP has significantly improved:

- Through the many activities and the strategy of high visibility, ENSP attracted many new members. While most of the referrals were made by word of mouth and through networking, further activities to convince ex-members to come back to the Network were also initiated. This is however a long and winding process, taking into accounts personal sensitivities as well as high level diplomacy. Alongside with three individual members, ENSP welcomed five new full member organisations and now has a network of 37 Full member organisations, 9 Associated member organisations and 12 Individual members across 30 European countries (22 Member States and 8 non-EU countries).

- An increased capacity within the Secretariat, allowing better communication, closer exchange with members and stakeholders, stronger involvement at national level, greater level of support, more meetings and events attended etc. This highly contributed to the overall reputation and service quality of the organisation.

- Better and higher collaboration with partner NGOs, in a number of diverse joint initiatives with ERS, CTFK, SFP, EFA, ECPC and Global Bridges through advocacy campaigns, events, meetings, support visits etc.

- Overall higher engagement with members at national level, with increased number of calls for support, level of information sharing, attendance at meeting and events, and positive feedback and recognition from peers as to the useful role of ENSP as a facilitator and capacity builder. Examples include Romania and Slovenia, where ENSP engaged in intense tailored support of the local key players, have recorded considerable progress in tobacco control and should be showcased as examples of highly effective partnership as well as ENSP’s impact at national level.

To reach the operational objectives of 2016, a number of activities were carried out within the ENSP Secretariat in 2016.

WORK PACKAGE 1: POLICY

• Responded to over 50 support requests from members and stakeholders, which helped members to advocate for strong tobacco control measures;
• Plain packaging campaign, involving a high level event at the EU Parliament, position paper and evidence-based resources, which was followed by many countries expressing serious interest in adopting the measure;
• Survey to ENSP members to report on the implementation of TPD and FCTC, which received 22 responses providing in addition to in-depth desk research, a comprehensive snapshot at the current situation in Europe.
• Organisation of two network meetings, with in average 30 members, allowing the network to make decisions and discuss issues related to the organisation.


WORK PACKAGE 2: INCREASED CAPACITY FOR ALLIANCES AND COLLABORATION FOR SMOKING PREVENTION AND TOBACCO CONTROL IN EUROPE

• Contacts are on going and visits have been organised to engage with countries with priority countries. Engagement with Spain, Poland and Italy were successful in order to generate synergy. Other countries are still in discussion as a lack of financial funds combined with political support, if any, was an explanation to limited leadership and low activity.


WORK PACKAGE 3: JOINT PROJECTS

• Final EQUIPT project conference organised and attracted 85 stakeholders from across EU countries.
• Kick-off meeting for EUREST PLUS EU joint research project, which ENSP is coordinating.
• Kick-Off meeting for EPACTT PLUS Global Bridges project, which aims at producing an updated edition of the ENSP tobacco dependence treatment guidelines in 15 countries.


WORK PACKAGE 4: INFORMATION AND COMMUNICATION

• New updated website, which is hoped to become a reference for reliable evidence-based information for the tobacco control community;
• Production of 15 newsletters, which were quoted as very useful and reported to be translated for different networks;
• The increased activity and number of visit of the Tobacco Prevention and Cessation scientific journal, which received 109 submissions; 45 publications and 8.470 downloads;
• Active presence on social media, which generates interaction with fans and stakeholders (Facebook and Twitter);
• Organisation of three major events to disseminate and share information, research date and good practice to a total of 385 policy makers, advocates, NGOs etc.
• Implementation of a communication strategy, which resulted in a high visibility and recognition of the organisation, as well as improving awareness of tobacco control.
• Participation to around 15 high-level international or national meetings to present on various tobacco control issues and also ENSP, its work and projects


WORK PACKAGE 5: NETWORK OPERATION AND DEVELOPMENT

• All activities and the higher visibility, in addition to the discussions taking place in 2015, succeeded in attracting 5 new full members, three of which were young people organisations;
• Increased capacity of the Secretariat, which enabled the team to further support the network, its members and get involved in new topics;

ACHIEVED OUTCOMES


• The development and coordination of a strong network of EU national coalitions on tobacco control, with representatives in 30 European countries, 22 of which are EU Member States;
• Progress made at EU level towards the transposition of the Tobacco Products Directive;
• Effective dissemination of success stories and all relevant tobacco-related updates internationally through conferences and capacity building events, ENSP website, newsletters, online scientific journal and social media, also including e-mail alerts and calls to action;
• Strong cooperation with other academic and research partners within EU joint projects, including EUREST PLUS, TOB-g, EQUIPT, EPACTT/EPACTT PLUS, Tack-SHS and SILNE-R projects;
• Support to the transposition of the EU Tobacco Products Directive in cooperation with all the other Brussels based EU networks working on the issue, such as the the European Respiratory Society (ERS), Smokefree Partnership (SFP), European Public Health Alliances (EPHA), European Federation of Allergy and Airways Diseases Patients Associations (EFA), Zealand Denmark Regional Office and Fonds des Affections Respiratoires (FARES);
• Mobilization and coordination of EU national coalitions and other EU partners to promote effective FCTC implementation, aiming at the overall progress across Europe;
• Promotion and organization of 2 ENSP network meetings, one in April in Brussels and one in October in Ljubljana, in order to generate synergy and coordinated actions.

WORK IN PROGRESS

The challenges identified include:
• A need to close further the gap in tobacco control between western and eastern, as well as Northern and Southern EU members;
• Keeping EU countries more advanced on tobacco control engaged with the network
• The transposition of the Tobacco Products Directive in the Member States, especially in those with low political support or leadership
• Full implementation of the WHO FCTC in the wider WHO European region
• Supporting countries with a tobacco endgame strategy in Europe
• Securing on-going financial sustainability beyond the 3-year funds from the European Commission Operating Grants, which ends in 2017

An External Evaluation of the European Network for Smoking and Tobacco Prevention (ENSP) was conducted over a 8-week period starting in January 2017.
Methodology
The External Evaluation involved a qualitative research, background review of key documents, assessment of the indicators based on 2016 work programme. It involved three phases:
(1) qualitative research (analysis of ENSP’s documents and materials, survey and face-to-face and/or virtual interviews by phone, Skype, etc.) with its members and stakeholders,
(2) analysis of ENSP’s impact, evolution, and modus operandi, including operational management, within the 2016 work programme implementation,
(3) meetings and reports.

Phase 1: Qualitative Research
An evaluation team was established and included three board members (President, Treasurer, Administrator), ENSP staff (Secretary General and Communication officer) and the external evaluator.
Desk research was developed analysing ENSP’s documents and materials, such as the 2016 work programme, Statutes and Internal Rules, the Grant Agreement 709605 “Evaluation Strategy”, available reports on the status of the EU Tobacco Products Directive and implementation of the WHO FCTC in the European Region, new staff job descriptions, specific project reports, and 2016 budget.
A set of indicators (process indicators and output indicators) and measures was used based on those included in the Grant Agreement 709605.
A Focus group was organized in Ljubljana in October 2016
A survey was developed and administered by the evaluator among ENSP’s membership and relevant stakeholders. The list of people and organisations involved in the survey was provided by the staff and agreed with the evaluation team.
Phase 2: Analysis
An analysis of the content, implementation, and impact of ENSP’s work in 2016 was developed. The evaluation investigated the evolution of ENSP in the European tobacco control landscape; clarified what members are willing/able to offer the partnership; and described the modus operandi and operational management of ENSP and analyzed its effectiveness and efficiency.
Phase 3: Meetings and reports
Several calls were organized with ENSP staff and the evaluation team whenever necessary. Based on a review of background documents as well as survey and interview findings, an assessment of ENSP’s performance and effectiveness was conducted. The assessment focused on the objectives and activities as in the 2016 work plan as well as the modalities that ENSP uses to answer ongoing requests of support from members or due to urgent developments within the Tobacco Control environment and not included in the work plan.


Findings
Demonstrated success
Based on the 2016 work programme and the set of indicators identified, ENSP has successfully achieved all the objectives agreed at the General Assembly and included in the 2016 Action Plan and Agreement with the European Commission. Some activities are still ongoing and will be completed during 2017 and some activities had been added to the workplan, as they were fulfilling emerged needs and opportunities.
ENSP creates a real and strong European added value to the national tobacco control movements. It constitutes a true network of experts and Tobacco Control advocates which can be quickly mobilized to support each other with information and letter campaigns. In general terms, the Evaluation found that ENSP has successfully contributed to achieving its mission as in Articles 3 and 4 of its Statute.
Strategic achievements include:
• ENSP as one stop shop for Tobacco Control, as its own online scientific journal “Tobacco Prevention and Cessation” was established and in 2016, over 109 articles were submitted of which 93 on line manuscript. 34 articles and 45 abstracts were published on the site with a total number of downloads of 8470.
• Strategic Partnerships, as after several years of investing effort to develop a positive and constructive relationship with other