How the New European Union’s (Pictorial) Tobacco Health Warnings Influence Quit Attempts and Smoking Cessation: Findings from the 2016–2017 International Tobacco Control (ITC) Netherlands Surveys
Department of Health Promotion, Maastricht University (CAPHRI), 6229 HA Maastricht, Limburg, The Netherlands
Department of Methodology and Statistics, Maastricht University (CAPHRI), 6229 HA Maastricht, Limburg, The Netherlands
Department of Family Medicine, Maastricht University (CAPHRI), 6229 HA Maastricht, Limburg, The Netherlands
IVO Research Institute, 2595 AA The Hague, Zuid Holland, The Netherlands
Netherlands Expertise Center for Tobacco Control (NET), Trimbos Institute, 3521 VS Utrecht, The Netherlands
School of Psychology, Deakin University, Geelong 3220, Australia
Department of Communication, University of Amsterdam (ASCoR), 1001 NG Amsterdam, Noord Holland, The Netherlands
Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(21), 4260; https://doi.org/10.3390/ijerph16214260
Received: 12 September 2019 / Revised: 17 October 2019 / Accepted: 25 October 2019 / Published: 2 November 2019
(This article belongs to the Special Issue Smoking Prevention and Tobacco Control)
In 2016, the Netherlands was required to introduce new European Union (EU)’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 (β = 0.301, p < 0.001) and a more positive attitude towards quitting (β = 0.180, p < 0.001), which, in turn, were associated with a stronger quit intention (health worries: β = 0.304, p < 0.001; attitude: β = 0.340, p < 0.001). Quit intention was a strong predictor of quit attempts (β = 0.336, p = 0.001). Health warning salience was also associated with stronger perceived social norms towards quitting (β = 0.166, p < 0.001), which directly predicted quit attempts (β = 0.141, p = 0.048). Quit attempts were positively associated with smoking cessation (β = 0.453, p = 0.043). Based on these findings, we posit that the effect of the EU’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.