Public attitudes towards healthcare policies promoting tobacco cessation in Germany: results from the representative German study on tobacco use (DEBRA study)

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Abstract

Objective

The aim of this study was to assess public acceptance of four possible healthcare policies supporting tobacco dependence treatment in line with the Framework Convention for Tobacco Control, Article 14 recommendations in Germany.

Design

Cross-sectional household survey.

Setting

Data were drawn from the German population and collected through computer-assisted, face-to-face interviews.

Participants

Representative random sample of 2087 people ( >14 years) from the German population.

Outcome measures

Public acceptance was measured regarding (1) treatment cost reimbursement, (2) standard training for health professionals on offering cessation treatment, and making cessation treatment a standard part of care for smokers with (3) physical or (4) mental disorders. Association characteristics with smoking status and socio-economic status (SES) were assessed.

Results

Support for all policies was high (50%–68%), even among smokers (48%–66%). Ex-smokers and never-smokers were more likely to support standard training on cessation for health professionals than current smokers (OR 1.43, 95% CI 1.07 to 1.92; OR 1.43; 95% CI 1.14 to 1.79, respectively). Ex-smokers were also more likely than current smokers to support cessation treatment for smokers with mental disorders (OR 1.39, 95% CI 1.11 to 1.73). Men were less likely than women to support cessation treatment for smokers with physical diseases (OR 0.74, 95% CI 0.60 to 0.91) and free provision of treatment (OR 0.80, 95% CI 0.66 to 0.97). Offering cessation treatment to smokers with physical disorders was generally more accepted than to those with mental health issues.

Conclusions

The majority of the German population supports healthcare policies to improve the availability and affordability of tobacco dependence treatment. Non-smokers were more supportive than current smokers of two of the four policies, but odds of support were only about 40% higher. SES characteristics were not consistently associated with public acceptance.

Trial registration number

DRKS00011322.

Related collections

Most cited references 33

Record: found
Abstract: found
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Socioeconomic Inequalities in Health in 22 European Countries

Johan P Mackenbach, Irina Stirbu, Albert-Jan R Roskam … (2008)

Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes. In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern. We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care. Copyright 2008 Massachusetts Medical Society.

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Shape of the relapse curve and long-term abstinence among untreated smokers.

G. Hughes, Patricia J. Keely, Shelly Naud (2003)

To describe the relapse curve and rate of long-term prolonged abstinence among smokers who try to quit without treatment. Systematic literature review. Cochrane Reviews, Dissertation Abstracts, Excerpt Medica, Medline, Psych Abstracts and US Center for Disease Control databases plus bibliographies of articles and requests of scientists. Prospective studies of self-quitters or studies that included a no-treatment control group. Two reviewers independently extracted data in a non-blind manner. The number of studies was too small and the data too heterogeneous for meta-analysis or other statistical techniques. There is a paucity of studies reporting relapse curves of self-quitters. The existing eight relapse curves from two studies of self-quitters and five no-treatment control groups indicate most relapse occurs in the first 8 days. These relapse curves were heterogeneous even when the final outcome was made similar. In terms of prolonged abstinence rates, a prior summary of 10 self-quitting studies, two other studies of self-quitters and three no-treatment control groups indicate 3-5% of self-quitters achieve prolonged abstinence for 6-12 month after a given quit attempt. More reports of relapse curves of self-quitters are needed. Smoking cessation interventions should focus on the first week of abstinence. Interventions that produce abstinence rates of 5-10% may be effective. Cessation studies should report relapse curves.

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Mode of questionnaire administration can have serious effects on data quality.

Ann Bowling (2005)

One of the main primary data collection instruments in social, health and epidemiological research is the survey questionnaire. Modes of data collection by questionnaire differ in several ways, including the method of contacting respondents, the medium of delivering the questionnaire to respondents, and the administration of the questions. These are likely to have different effects on the quality of the data collected. This paper is based on a narrative review of systematic and non-systematic searches of the literature on the effects of mode of questionnaire administration on data quality. Within different modes of questionnaire administration, there were many documented potential, biasing influences on the responses obtained. These were greatest between different types of mode (e.g. self-administered versus interview modes), rather than within modes. It can be difficult to separate out the effects of the different influences, at different levels. The biasing effects of mode of questionnaire administration has important implications for research methodology, the validity of the results of research, and for the soundness of public policy developed from evidence using questionnaire-based research. All users of questionnaires need to be aware of these potential effects on their data.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2019

Publication date (Electronic): 27 August 2019

Volume: 9

Issue: 8

Electronic Location Identifier: e026245

Affiliations

[1 ] departmentInstitute of General Practice, Addiction Research and Clinical Epidemiology Unit , Heinrich-Heine-University, Düsseldorf , Düsseldorf, Germany

[2 ] departmentDepartment of Behavioural Science and Health , University College London , London, UK

[3 ] departmentDepartment of Environment and Health, School of Public Health , Bielefeld University , Bielefeld, Germany

Author notes

[Correspondence to ] Dr Sabrina Kastaun; sabrina.kastaun@ 123456med.uni-duesseldorf.de

Author information

Sabrina Kastaun http://orcid.org/0000-0002-5590-1135

Melanie Boeckmann http://orcid.org/0000-0001-5909-5508

Article

Publisher ID: bmjopen-2018-026245

DOI: 10.1136/bmjopen-2018-026245

PMC ID: 6720139

PubMed ID: 31462463

SO-VID: 727f3f59-032c-4002-8c63-43297660fe85

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 27 August 2018

Date revision received : 23 April 2019

Date accepted : 01 August 2019

Funding

Funded by: Ministry for Culture and Science of the German Federal State of North Rhine-Westphalia;

Award ID: N.A.

Custom metadata

special-feature unlocked

ScienceOpen disciplines: Medicine

Keywords: healthcare policy,public opinion,smoking cessation,household survey

Data availability:

ScienceOpen disciplines: Medicine

Keywords: healthcare policy, public opinion, smoking cessation, household survey

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Cited by 1

Mental Health Symptoms and Associations with Tobacco Smoking, Dependence, Motivation, and Attempts to Quit: Findings from a Population Survey in Germany (DEBRA Study)
Authors: Sabrina Kastaun, Leonie S. Brose, Esther Scholz …

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Public attitudes towards healthcare policies promoting tobacco cessation in Germany: results from the representative German study on tobacco use (DEBRA study)

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Abstract

Objective

Design

Setting

Participants

Outcome measures

Results

Conclusions

Trial registration number

Related collections

UCL: UN SDG 03 Good Health and Well-Being

Most cited references 33

Socioeconomic Inequalities in Health in 22 European Countries

Shape of the relapse curve and long-term abstinence among untreated smokers.

Mode of questionnaire administration can have serious effects on data quality.

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Funding

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Custom metadata

Comments

Comment on this article

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Cited by 1

Most referenced authors 500