Background This study investigated the cross-national and longitudinal associations between national tobacco control policies and current smoking in 28 European Union (EU) member states between 2009 and 2017. It also examined the interaction between tobacco control policies and occupational status.
Methods We used data from four waves of Eurobarometer (2009, 2012, 2014 and 2017). The total sample size was 105 231 individuals aged ≥15 years. Tobacco Control Scale (TCS) scores (range 0 to 100) for years 2005, 2007, 2012 and 2014 measured the strength of country-level tobacco control policies. Logistic multilevel regression analyses with three levels (the individual, the country-year and the country) were performed with current smoker as the dependent variable.
Results Across the EU, average smoking prevalence fell from 29.4% (95% CI 28.5% to 30.2%) in 2009 to 26.3% (95% CI 25.4% to 27.1%) in 2017. We confirmed that cross-nationally, strong national tobacco control policies are significantly associated with a low probability of smoking. A one-point increase in TCS score was associated with lower odds of smoking (OR=0.990; 95% CI 0.983 to 0.998), but longitudinally (within-country) increases in TCS were not associated with current smoking (OR=0.999; 95% CI 0.994 to 1.005). Compared with those in manual occupations, the cross-national association was stronger in the upper occupational group (conditional OR for the interaction=0.985; 95% CI 0.978 to 0.992) and weaker in the economically inactive group (conditional OR for the interaction=1.009; 95% CI 1.005 to 1.013).
Conclusion Differences in tobacco control policies between countries were associated with the probability of smoking but the changes in TCS within countries over time were not. Differences between countries in tobacco control policies were found to be most strongly associated with the likelihood of smoking in the highest occupational groups and were found to have only a weak association with smoking among the economically inactive in this sample.
- public health
- multilevel modelling
- tobacco control
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Contributors VHTS, CB, DC and SH were involved in the conception and design of the work. VHTS conducted the data analysis and wrote the first draft of the manuscript. VHTS, CB, DC and SH undertook the revision of the manuscript. All the authors contributed to the data interpretation and the manuscript preparation.
Funding This study was supported by the Cancer Research UK (C60724/A23876).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository.
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