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Impact of tobacco control policies on smoking prevalence and quit ratios in 27 European Union countries from 2006 to 2014
  1. Ariadna Feliu1,2,3,
  2. Filippos T Filippidis4,
  3. Luk Joossens5,
  4. Geoffrey T Fong6,7,
  5. Constantine I Vardavas8,9,
  6. Antoni Baena1,3,
  7. Yolanda Castellano1,3,
  8. Cristina Martínez1,3,10,
  9. Esteve Fernández1,2,3
  1. 1 Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d’Oncologia- ICO, L’Hospitalet de Llobregat, Barcelona, Spain
  2. 2 Departament of Clinical Sciences, School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L’Hospitalet del Llobregat, Barcelona, Spain
  3. 3 Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
  4. 4 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  5. 5 Association of European Cancer Leagues (ECL), Brussels, Belgium
  6. 6 Department of Psychology, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  7. 7 Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  8. 8 Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
  9. 9 Institute of Public Health, American College of Greece, Athens, Greece
  10. 10 Medicine and Health Scienc School, Universitat Internacional de Catalunya, Barcelona, Spain
  1. Correspondence to Dr Esteve Fernández, Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d’Oncologia- ICO, 08908, L’Hospitalet de Llobregat, Barcelona, Spain; efernandez{at}


Background Tobacco use is still highly prevalent in Europe, despite the tobacco control efforts made by the governments. The development of tobacco control policies varies substantially across countries. The Tobacco Control Scale (TCS) was introduced to quantify the implementation of tobacco control policies across European countries

Objective To assess the midterm association of tobacco control policies on smoking prevalence and quit ratios among 27 European Union (EU) Member States (EU27).

Methods Ecological study. We used the TCS in EU27 in 2007 and the prevalence of tobacco and quit ratios data from the Eurobarometer survey (2006 (n=27 585) and 2014 (n=26 793)). We analysed the relationship between the TCS scores and smoking prevalence and quit ratios and their relative changes (between 2006 and 2014) by means of scatter plots and multiple linear regression models.

Results In EU27, countries with higher scores in the TCS, which indicates higher tobacco control efforts, have lower prevalence of smokers, higher quit ratios and higher relative decreases in their prevalence rates of smokers over the last decade. The correlation between TCS scores and smoking prevalence (rsp=–0.444; P=0.02) and between the relative changes in smoking prevalence (rsp=–0.415; P=0.03) was negative. A positive correlation was observed between TCS scores and quit ratios (rsp=0.373; P=0.06). The percentage of smoking prevalence explained by all TCS components was 28.9%.

Conclusion EU27 should continue implementing comprehensive tobacco control policies as they are key for reducing the prevalence of smoking and an increase tobacco cessation rates in their population.

  • public policy
  • surveillance and monitoring
  • advertising and promotion
  • packaging and labelling
  • price

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  • Contributors Study design: AF and EF. Collected data and prepared database for analysis: AF, LJ and FTF. Contributed to strategy of analysis: AF, EF and GTF. Analysed data: AF and YC. Interpreted data results: AF, EF, FTF, AB, CM, LJ and YC. Drafted manuscript: AF. Critically revised manuscript: all authors. Approved final manuscript version: all authors. Guarantor: EF.

  • Funding This research forms part of the EUREST-PLUS Project. This Project has received funding from the European Union’s Horizon2020 Research and Innovation Programme under agreement No. 681109. AF, AB, YC, CM and EF were also supported by the Department of Universities and Research, Government of Catalonia (grants 2014SGR999 and 2017SGR319).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets of the Eurobarometer supporting the conclusions of this article are freely available online in doi:10.4232/1.10981, doi:10.4232/1.12265 and doi:10.4232/1.12264.

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