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. 2019 Feb 13:16:A10.
doi: 10.18332/tid/99542. eCollection 2018.

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

Antigona C Trofor  1   2 , Sophia Papadakis  3   4 , Lucia M Lotrean  2   5 , Cornel Radu-Loghin  6 , Marius Eremia  2 , Florin Mihaltan  2   7 , Pete Driezen  8 , Christina N Kyriakos  3   6 , Ute Mons  9 , Tibor Demjén  10 , Sarah O Nogueira  11   12 , Esteve Fernández  11   12 , Yannis Tountas  13 , Krzysztof Przewoźniak  14   15 , Ann McNeill  16   17 , Geoffrey T Fong  8   18   19 , Constantine I Vardavas  3   6 ; EUREST-PLUS consortium
Affiliations

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

Antigona C Trofor et al. Tob Induc Dis. .

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.

Keywords: Europe; ITC; health effects; health warnings; tobacco use knowledge.

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Conflict of interest statement

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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