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Effect of nation-wide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries
  1. Maartje M. Schaap1,
  2. Anton E. Kunst1,
  3. Mall Leinsalu2,
  4. Enrique Regidor3,
  5. Ola Ekholm4,
  6. Dagmar Dzurova5,
  7. Uwe Helmert6,
  8. Jurate Klumbiene7,
  9. Paula Santana8,
  10. Johan P. Mackenbach1
  1. 1 Erasmus Medical Centre, Netherlands;
  2. 2 Södertörn University College, Netherlands;
  3. 3 Universidad Complutense de Madrid, Sweden;
  4. 4 University of Southern Denmark, Spain;
  5. 5 Charles University Prague, Denmark;
  6. 6 University of Bremen, Czech Republic;
  7. 7 Kaunas University of Medicine, Germany;
  8. 8 University of Coimbra, Lithuania
  1. E-mail: 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 cumulative 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.

Results: Quit ratios were especially high (>45%) in Sweden, England, 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 educated. 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 nation-wide tobacco control policies.

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