Pathways of change explaining the effect of smoke-free legislation on smoking cessation in the Netherlands.

An application of the ITC Conceptual Model.

Gera Nagelhout, Hein de Vries, Geoffrey Fong, Math Candel, James Thrasher, Bas van den Putte, Mary Thompson, Michael Cummings, & Marc C. Willemsen

Presentation at WCToH pre-conference workshop ‘Effectiveimplementation of FCTC policies’, Singapore, March 2012

Smoke-free legislation and cessation

“Legislative bans reduced exposure to secondhand smoke. (…) There are fewer data measuring smoking prevalence and smoking behaviour with either no change or a downward trend reported” (Cochrane review Callinan, Clarke, Doherty, & Kelleher, 2010)

Smoke-free legislation and cessation

“The introduction of comprehensive smoke-free legislation has increased the rate at which smoking prevalence was declining in some locations, but in the majority of jurisdictions had no measurable impact on existing trends in smoking prevalence” (Bajoga, Lewis, McNeill, & Szatkowski, 2011)

Smoke-free legislation and cessation

ITC studies

Effect• Fong, Hyland et al., 2006• Nagelhout, de Vries et al., 2012

No effect• Hyland, Hassan et al., 2009• Cooper, Borland et al., 2010

Smoke-free legislation and cessation

Smoke-free Smoking

legislation cessation

Smoke-free legislation and cessation

Smoke-free Smoking

legislation cessation

Smoke-free legislation and cessation

Smoke-free Smoking

legislation cessation

ITC Conceptual Model

ITC Conceptual Model

ITC Conceptual Model

Methods

Four waves of ITC Netherlands Survey

One pre-ban, three post-ban waves

Smokers aged 15 or older

56% participating in 4th wave (n=1,012)

Structural Equation Modelling

Results

Results

Results

Conclusion

• Policies influence smoking cessation through policy-specific variables and psychosocial mediators.• Support for smoke-free legislation and attitudes about quitting are crucial in increasing intention to quit.• Subjective norms about quitting can be changed by creating awareness of the harm of (second-hand) smoking.

Future research

• Behavioural mediators (e.g. voluntary smoking bans, compliance with smoke-free legislation).• Implementation characteristics(e.g. comprehensive vs. partial, media attention).• Other countries and other policies.

Policy implications

Aim to increase support forsmoke-free legislation and attitudes favourable to quitting

(e.g. with media campaigns andmedia advocacy)

Thank you for your attention!

More information:

Gera.Nagelhout@MaastrichtUniversity.nl

www.itcproject.org