Correlates of the support for smoke-free policies among smokers: A cross-sectional study in six European countries of the EUREST-PLUS ITC EUROPE SURVEYS
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Catalan Institute of Oncology (ICO), Barcelona, Spain
Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
University of Barcelona (UB), Barcelona, Spain
Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
University of Waterloo (UW), Waterloo, Canada
European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
University of Crete (UoC), Heraklion, Greece
Ontario Institute for Cancer Research (OICR), Toronto, Canada
University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi (UMF Iasi), Iasi, Romania
Aer Pur Romania (APR), Bucharest, Romania
Health Promotion Foundation (HPF), Warsaw, Poland
Maria Skłodowska-Curie Institute ‒ Oncology Center (MSCI), Warsaw, Poland
European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences (PSWZ), Kalisz, Poland
Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
National and Kapodistrian University of Athens (UoA), Athens, Greece
Marcela Fu   

Tobacco Control Unit, Catalan Institute of Oncology, Av. Granvia de L’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
Publish date: 2019-03-27
Tob. Induc. Dis. 2018;16(Suppl 2):A17

*Contributed equally

**EUREST-PLUS consortium members: European Network on Smoking and Tobacco Prevention (ENSP), Belgium: Constantine I. Vardavas, Andrea Glahn, Christina N. Kyriakos, Dominick Nguyen, Katerina Nikitara, Cornel Radu-Loghin, Polina Starchenko University of Crete (UoC), Greece: Aristidis Tsatsakis, Charis Girvalaki, Chryssi Igoumenaki, Sophia Papadakis, Aikaterini Papathanasaki, Manolis Tzatzarakis, Alexander I. Vardavas Kantar Public (TNS), Belgium: Nicolas Bécuwe, Lavinia Deaconu, Sophie Goudet, Christopher Hanley, Oscar Rivière Smoking or Health Hungarian Foundation (SHHF), Hungary: Tibor Demjén, Judit Kiss, Piroska A. Kovács Catalan Institut of Oncology (ICO); Bellvitge Biomedical Research Institute (IDIBELL), Spain: Esteve Fernández, Yolanda Castellano, Marcela Fu, Sarah O. Nogueira, Olena Tigova Kings College London (KCL), United Kingdom: Ann McNeill, Katherine East, Sara C. Hitchman Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Germany: Ute Mons, Sarah Kahnert National and Kapodistrian University of Athens (UoA), Greece: Yannis Tountas, Panagiotis Behrakis, Filippos T. Filippidis, Christina Gratziou, Paraskevi Katsaounou, Theodosia Peleki, Ioanna Petroulia, Chara Tzavara Aer Pur Romania, Romania: Antigona C. Trofor, Marius Eremia, Lucia Lotrean, Florin Mihaltan European Respiratory Society (ERS), Switzerland; Goethe University Frankfurt, Germany: Gernot Rohde, Tamaki Asano, Claudia Cichon, Amy Far, Céline Genton, Melanie Jessner, Linnea Hedman, Christer Janson, Ann Lindberg, Beth Maguire, Sofia Ravara, Valérie Vaccaro, Brian Ward Maastricht University, the Netherlands: Marc Willemsen, Hein de Vries, Karin Hummel, Gera E. Nagelhout Health Promotion Foundation (HPF), Poland: Witold A. Zatoński, Aleksandra Herbeć, Kinga Janik-Koncewicz, Krzysztof Przewoźniak, Mateusz Zatoński University of Waterloo (UW); Ontario Institute for Cancer Research, Canada: Geoffrey T. Fong, Thomas K. Agar, Pete Driezen, Shannon Gravely, Anne C. K. Quah, Mary E. Thompson
This report describes the support for smoke-free policies in different settings among smokers in six European countries and the relationship between their opinions about the places where smoking should be banned and their beliefs about the harms of secondhand smoke to non-smokers.

A cross-sectional survey (the ITC 6 European Country Survey, part of the EUREST-PLUS Project) was conducted using nationally representative samples of adult smokers in Germany, Greece, Hungary, Poland, Romania and Spain (n=6011). We describe the prevalence of agreement and support for smoke-free policies in different settings according to sociodemographics, smoking characteristics and beliefs about the danger of secondhand smoke to non-smokers.

There was high agreement with smoking regulations in cars with preschool children and in schoolyards of primary/secondary schools (>90% overall) and low agreement with banning smoking in outdoor terraces of bars/pubs (8.6%; 95%CI: 7.5%-9.8%) and restaurants (10.1%; 95%CI: 8.9%-11.4%). The highest support for complete smoking bans inside public places came from smokers in Poland, among women, people aged ≥25 years, who had low nicotine dependence, and who tried to quit smoking in the last 12 months. About 78% of participants agreed that tobacco smoke is dangerous to non-smokers, ranging from 63.1% in Hungary to 88.3% in Romania; the highest agreement was noted among women, the 25-54 age groups, those with higher education, low cigarette dependence, and those who tried to quit in the last 12 months. The support for complete smoking bans in public places was consistently higher among smokers who agreed that secondhand smoke is dangerous to non-smokers.

Smokers in six European countries declared strong support for smoke-free policies in indoor settings and in settings with minors but low support in outdoor settings, particularly leisure facilities. More education is needed to increase the awareness about the potential exposure to secondhand smoke in specific outdoor areas.

We thank the ITC Project Team at the University of Waterloo, and in particular P Driezen, for support in ITC dataset management and preliminary data analysis.
The authors declare that they have no competing interests, financial or otherwise, related to the current work. K Przewoźniak reports grants and personal fees from Polska Liga Walki Z Rakiem (Polish League Against Cancer) outside the submitted work. CI Vardavas reports that he is the Strategic Development Editor of TID and that there are no conflicts of interest with this current work. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.
The ITC 6 European Country Survey, a component of the EUREST-PLUS programme, is a Horizon 2020 project conducted by researchers from the six participating countries and the following institutional partners: the European Network on Smoking Prevention (Belgium), King’s College London (United Kingdom), German Cancer Research Centre (Germany), Maastricht University (The Netherlands), National and Kapodistrian University of Athens (Greece), Aer Pur Romania (Romania), European Respiratory Society (Switzerland), University of Waterloo (Canada), Catalan Institute of Oncology (Catalonia, Spain), Smoking or Health Hungarian Foundation (Hungary), Health Promotion Foundation (Poland), University of Crete (Greece), and Kantar Public Brussels (Belgium). The EUREST-PLUS project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 681109 (CIV) and the University of Waterloo (GTF). Additional support was provided to the University of Waterloo by a foundation grant from the Canadian Institutes of Health Research (FDN-148477). GTF was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research. Authors EF, MF, OT and YC are supported by the Ministry of Universities and Research, Government of Catalonia (2017SGR319). EF was supported by the Instituto de Salud Carlos III, Government of Spain (INT16/00211 and INT17/00103), cofunded by the European Regional Development Fund (FEDER).
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