Social norms towards smoking and electronic cigarettes among adult smokers in seven European Countries: Findings from the EUREST-PLUS ITC Europe Surveys

Katherine East, Sara Christine Brenda Hitchman, Mairtin Seosamh McDermott, Ann Denise McNeill, Aleksandra Herbec, Yannis Tountas, Nicolas Bécuwe, Tibor Demjén, Marcela Fu, Esteve Fernández, Ute Mons, Antigona Trofor, Witold A Zatonski, Geoffrey T Fong, Constantine Vardavas

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Abstract

Introduction: This study explores whether current smokers’ social norms towards smoking and electronic cigarettes (e-cigarettes) vary across seven European countries alongside smoking and e-cigarette prevalence rates. At the time of surveying, England had the lowest current smoking prevalence; Greece the highest. Hungary, Romania and Spain had the lowest prevalence of any e-cigarette use; England the highest.

Methods: Respondents were adult (18+) current smokers from the 2016 EUREST-PLUS ITC (Romania, Spain, Hungary, Poland, Greece, Germany) and ITC 4CV England Surveys (N=7,779). Using logistic regression, associations between country and (a) smoking norms and (b) e-cigarette norms were assessed, adjusting for age, sex, income, education, smoking status, heaviness of smoking, and e-cigarette status.

Results: Compared with England, smoking norms were higher in all countries: reporting at least three of five closest friends smoke (19% vs. 65%-84% [AOR=6.9-24.0; Hungary-Greece]), perceiving people important to you approve of smoking (8% vs. 14%-57% [1.9-51.1; Spain-Hungary]), perceiving the public approves of smoking (5% vs. 6%-37% [1.7-15.8; Spain-Hungary]), disagreeing that smokers are marginalised (9% vs. 16%-50% [2.3-12.3; Poland-Greece]) except Hungary. Compared with England: reporting at least one of five closest friends use e-cigarettes was higher in Poland (28% vs. 36% [2.7]) but lower in Spain and Romania (28% vs. 6%-14% [0.3-0.6]), perceiving the public approves of e-cigarettes was higher in Poland, Hungary and Greece (32% vs. 36%-40% [1.5-1.6]) but lower in Spain and Romania in unadjusted analyses only (32% vs. 24-26%), reporting seeing e-cigarette use in public at least some days was lower in all countries (81% vs. 12%-55% [0.1-0.4]; Spain-Greece).

Conclusions: Smokers from England had the least pro-smoking norms. Smokers from Spain had the least pro-e-cigarette norms. Friend smoking and disagreeing that smokers are marginalised broadly aligned with country-level current smoking rates. Seeing e-cigarette use in public broadly aligned with country-level any e-cigarette use. Generally, no other norms aligned with product prevalence.
Original languageEnglish
Article numberA15
JournalTobacco Induced Diseases
Volume16
DOIs
Publication statusPublished - 22 Mar 2019

Keywords

  • Electronic cigarettes
  • Europe
  • Smoking
  • Social norms
  • Survey

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