Article Text

Download PDFPDF
Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries
  1. M M Schaap1,
  2. A E Kunst1,
  3. M Leinsalu2,
  4. E Regidor3,
  5. O Ekholm4,
  6. D Dzurova5,
  7. U Helmert6,
  8. J Klumbiene7,
  9. P Santana8,
  10. J P Mackenbach1
  1. 1
    Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
  2. 2
    Stockholm Centre on Health of Societies in Transition, Södertörn University College, Stockholm, Sweden; Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
  3. 3
    Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Spain
  4. 4
    National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  5. 5
    Faculty of Sciences, Charles University Prague, Czech Republic
  6. 6
    Centre for Social Policy Research, University of Bremen, Bremen, Germany
  7. 7
    Institute for Biomedical Research of Kaunas University of Medicine, Lithuania
  8. 8
    Centre of Geographical Studies, University of Coimbra, Portugal
  1. M M Schaap, PO Box 2040, 3000 CA Rotterdam, The Netherlands; m.m.schaap{at}


Background: Recently a scale was introduced to quantify the implementation of tobacco control policies at country level. Our study used this scale to examine the potential impact of these policies on quit ratios in European countries. Special attention was given to smoking cessation among lower educational groups.

Methods: Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25–39 and 40–59 years) and educational level. Age-standardised quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale (TCS).

Results: Quit ratios were especially high (>45%) in Sweden, England, The Netherlands, Belgium and France and relatively low (<30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low education. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban.

Conclusion: Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nationwide tobacco control policies.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: None.