Search

Background As of May 2016, pictorial health warnings (PHWs) showing the harms of smoking were implemented in the European Union. After one year they had to be fully implemented. We studied changes in awareness of the health risks of smoking after implementation of PHWs among smokers from the Netherlands, whether the trend before the implementation changed after the implementation, and whether there were differences between subgroups. Methods We used survey data from six yearly waves of the International Tobacco Control (ITC) Netherlands Survey from 2012 to 2017. The number of participating smokers ranged between 1236 and 1604 per wave. Data were analyzed using Generalized Estimating Equations (GEE) analyses. Results Indicators of awareness of the health risks of smoking that did not change between 2015 and 2017 were perceived susceptibility (β = 0.043, p = 0.059) and perceived severity (β = − 0.006, p = 0.679) regarding lung problems. Perceived susceptibility, however, was more pronounced between 2015 and 2017 than between 2012 and 2015(p value of interaction: p = 0.044). Noticing information about the dangers of smoking (β = 0.119, p p values of interactions: p = 0.002 and p Conclusions Introducing PHWs coincided with an increase in smokers’ knowledge about the health risks of smoking. Dutch tobacco control policy and campaigns should focus on improving Dutch smokers’ awareness of the health risks of smoking even more, especially among low educated smokers.

In 2016, the Netherlands was required to introduce new European Union (EU)&rsquo, s (pictorial) tobacco health warnings. Our objective was to describe the pathways through which the new EU tobacco health warnings may influence quit attempts and smoking cessation among Dutch smokers. Longitudinal data from 2016 and 2017 from the International Tobacco Control (ITC) Netherlands Survey were used. Smokers who participated in both surveys were included (N = 1017). Structural equation modeling was applied to examine the hypothesized pathways. Health warning salience was positively associated with more health worries (&beta, = 0.301, p &lt, 0.001) and a more positive attitude towards quitting (&beta, = 0.180, p &lt, 0.001), which, in turn, were associated with a stronger quit intention (health worries: &beta, = 0.304, p &lt, 0.001, attitude: &beta, = 0.340, p &lt, 0.001). Quit intention was a strong predictor of quit attempts (&beta, = 0.336, p = 0.001). Health warning salience was also associated with stronger perceived social norms towards quitting (&beta, = 0.166, p &lt, 0.001), which directly predicted quit attempts (&beta, = 0.141, p = 0.048). Quit attempts were positively associated with smoking cessation (&beta, = 0.453, p = 0.043). Based on these findings, we posit that the effect of the EU&rsquo, s tobacco health warnings on quit attempts and smoking cessation is mediated by increased health worries and a more positive attitude and perceived social norms towards quitting. Making tobacco health warnings more salient (e.g., by using plain packaging) may increase their potential to stimulate quitting among smokers.

Background: Our study evaluated the short-term impact of introducing European Union's tobacco pictorial health warnings (PHWs).Methods: Longitudinal data were collected at two time-points from adult smokers, participating in the International Tobacco Control (ITC) surveys, conducted in the Netherlands, Australia, Canada, the United Kingdom and the United States. In the Netherlands, textual health warnings (THWs) were replaced by PHWs between both time-points. Health warning policies did not change in the other countries. Data from continuing smokers were used (N = 3,487) and analyzed using Generalized Estimating Equations.Results: Between both time-points, only Dutch smokers showed increases in noticing health warnings (beta = 0.712, p Conclusions: Results suggest that introducing the European PHWs was effective in provoking changes closely related to health warnings, but there was no direct impact on variables more closely related to smoking cessation.

This study examined to what extent e-cigarette users noticed the European Union’s new legislation regarding e-cigarettes, and whether this may have influenced perceptions regarding addictiveness and toxicity. Data were obtained from yearly surveys (2015−2017) of the International Tobacco Control (ITC) Netherlands Survey. Descriptive statistics and Generalized Estimating Equations were applied. About a third of the e-cigarette users noticed the text warning (28%) and the leaflet (32%). When compared to tobacco-only smokers, e-cigarette users showed greater increases in perceptions regarding addictiveness (β = 0.457, p = 0.045 vs. β = 0.135, p < 0.001) and toxicity (β = 0.246, p = 0.055 vs. β = 0.071, p = 0.010). In conclusion, the new legislation’s noticeability should be increased.

Background The Netherlands implemented smokefree legislation in July 2008. However, this legislation was reversed and reimplemented for small bars without employees several times. Since October 2014, the smokefree legislation applies to all bars again, but not all of them comply and designated smoking rooms are still allowed. Methods A nationally representative sample of adult smokers from the Netherlands was interviewed each year between 2008 and 2016 as part of the International Tobacco Control (ITC) Survey (n=1246-1773 per year). Trends in perceptions of rules about smoking in bars they visited, seeing people smoke in bars during the last visit, support for smokefree bars, and social acceptance of smoking in bars were examined with GEE analyses. Results There was a significant increase in smokers reporting that bars they visited had a total smoking ban (9% in 2008 to 45% in 2016), which was more often reported by older and high income smokers. Between 10 and 18% of smokers reported that they did not know the rules about smoking in bars; this was more often reported by older smokers. Reports of having seen people smoking in bars during the last visit decreased from 93% to 19%. Support for smokefree bars doubled (20% to 43%) and was higher among older and high educated smokers. Social acceptance of smoking in bars decreased (75% to 41%) and was higher among younger and low income smokers. Conclusions Eight years after the implementation of smokefree legislation in bars, smoking in bars has decreased but is far from eliminated in the Netherlands. Educational campaigns targeted at younger and lower socioeconomic status smokers are needed to inform these groups about the (need for) rules about smoking in bars. Now that only a minority of smokers think it is still acceptable to smoke in bars, the Dutch government should consider banning designated smoking rooms too.

Background: Displaying tobacco products at point-of-sale (PoS) has become an important marketing strategy for the tobacco industry. This study was designed to (1) examine how support for a PoS cigarette display ban changed among Dutch smokers between 2010 and 2015 and (2) identify the variables that predict support among smokers for a PoS cigarette display ban. Methods: Longitudinal data from six annual survey waves (2010-2015) from the International Tobacco Control (ITC) Netherlands Survey were analyzed. The sample consisted of between 1279 and 1800 smokers per year. Smokers were asked whether they supported a complete ban on displays of cigarettes inside shops and stores. Results: Support for a PoS cigarette display ban increased from 28.9% in 2010 to 42.5% in 2015 (OR = 1.40, p < 0.001). A multiple logistic regression analysis revealed that support for a PoS display ban of cigarettes was more likely among smokers who had more knowledge about the health risks of smoking (OR = 3.97, p < 0.001), believed smoking-related health risks to be severe (OR = 1.39, p < 0.001), had a more positive attitude towards quitting smoking (OR = 1.44, p = 0. 006), reported stronger social norms to quit smoking (OR = 1.29, p = 0.035), had a higher self-efficacy for quitting smoking (OR = 1.31, p = 0.001), and had stronger intentions to quit smoking (OR = 1.23, p = 0.006). Conclusions: This paper showed that support for a PoS display ban of cigarettes increased among smokers in the Netherlands over the years. To further increase support, educational campaigns about the dangers of smoking, and campaigns that encourage quitting may be needed.