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Health Educ Res. 2014 Feb;29(1):72-82. doi: 10.1093/her/cyt073. Epub 2013 Jul 16.

Associations between tobacco control policy awareness, social acceptability of smoking and smoking cessation. Findings from the International Tobacco Control (ITC) Europe Surveys.

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Department of Health Promotion, Maastricht University, Alumni, Department of Health Promotion, Maastricht University (CAPHRI), 6200 MD Maastricht, STIVORO Dutch Expert Centre on Tobacco Control, 2500 BB the Hague, Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany, French Institute for Health Promotion and Health Education (INPES), Saint-Denis, Cermes3 - Cesames Team (Research Centre Medicine, Sciences, Health, Mental Health, Health Policy), CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS, Paris, France, Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, SC, USA and Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico.


This study examined whether awareness of tobacco control policies was associated with social unacceptability of smoking and whether social unacceptability had an effect on smoking cessation in three European countries. Representative samples (n = 3865) of adult smokers in France, the Netherlands and Germany were used from two survey waves of the longitudinal International Tobacco Control Europe Surveys. Associations were examined of aspects of social unacceptability of smoking (i.e. feeling uncomfortable, important people disapproval and societal disapproval) with tobacco policy awareness (i.e. awareness of warning labels, anti-tobacco information and smoking restrictions at work) and smoking cessation. Only the positive association of awareness of anti-tobacco information with feeling uncomfortable about smoking was significant in each of the three countries. Important people disapproval predicted whether smokers attempted to quit, although this did not reach significance in the French and German samples in multivariate analyses. Our findings suggest that anti-tobacco information campaigns about the dangers of second-hand smoke in France and about smoking cessation in the Netherlands and Germany might have reduced the social acceptability of smoking in these countries. However, campaigns that influence the perceived disapproval of smoking by important people may be needed to ultimately increase attempts to quit smoking.

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