RESEARCH PAPER
Knowledge of the health risks of smoking and impact of cigarette warning labels among tobacco users in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys
 
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1
University of Medicine and Pharmacy, ‘Grigore T. Popa’ Iasi, Iasi, Romania
2
Aer Pur România, București, România
3
University of Crete (UoC), Heraklion, Greece
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Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
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Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
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University of Medicine and Pharmacy 'Carol Davilla', Bucharest, Romania
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Department of Psychology, University of Waterloo (UW), Waterloo, Canada
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Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
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Tobacco Control Unit, Catalan Institute of Oncology (ICO), Barcelona, Spain
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Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute, Barcelona, Spain
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National and Kapodistrian University of Athens (UoA), Athens, Greece
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Health Promotion Foundation (HPF), Warsaw, Poland
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Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland
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National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London (KCL), London, United Kingdom
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UK Centre for Tobacco and Alcohol Studies, London, United Kingdom
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School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
19
Ontario Institute for Cancer Research, Toronto, Canada
CORRESPONDING AUTHOR
Lucia M. Lotrean   

Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Publish date: 2019-02-13
 
Tob. Induc. Dis. 2018;16(Suppl 2):A10
KEYWORDS
TOPICS
*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. Kovacs 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
ABSTRACT
Introduction:
The aim of this study was to examine knowledge of health effects of smoking and the impact of cigarette package warnings among tobacco users from six European Union (EU) Member States (MS) immediately prior to the introduction of the EU Tobacco Products Directive (TPD) in 2016 and to explore the interrelationship between these two factors.

Methods:
Cross-sectional data were collected via face-to-face interviews with adult smokers (n=6011) from six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) between June–September 2016. Sociodemographic variables and knowledge of health risks of smoking (KHR) were assessed. Warning salience, thoughts of harm, thoughts of quitting and foregoing of cigarettes as a result of health warnings were assessed. The Label Impact Index (LII) was used as a composite measure of warning effects. Linear and logistic regression analyses were used to examine sociodemographic predictors of KHR and LII and the inter-relationship between knowledge and LII scores.

Results:
The KHR index was highest in Romania and Greece and lowest in Hungary and Germany. While the majority of smokers knew that smoking increases the risk for heart diseases, lung and throat cancer, there was lower awareness that tobacco use caused mouth cancer, pulmonary diseases, stroke, and there were very low levels of knowledge that it was also associated with impotence and blindness, in all six countries. Knowledge regarding the health risks of passive smoking was moderate in most countries. The LII was highest in Romania and Poland, followed by Spain and Greece, and lowest in Germany and Hungary. In almost all countries, there was a positive association between LII scores and higher KHR scores after controlling for sociodemographic variables. Several sociodemographic factors were associated with KHR and LII, with differences in these associations documented across countries.

Conclusions:
These data provide evidence to support the need for stronger educational efforts and policies that can enhance the effectiveness of health warnings in communicating health risks and promoting quit attempts. Data will serve as a baseline for examining the impact of the TPD.

CONFLICTS OF INTEREST
The authors declare that they have no competing interests, financial or otherwise, related to the current work. L. M. Lotrean reports grants from Aer Pur Romania, during the conduct of the study. K. Przewoźniak reports grants and personal fees from the Polish League Against Cancer, outside the submitted work. C. I. 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.
 
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