{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T15:08:48Z","timestamp":1765724928161,"version":"3.48.0"},"reference-count":35,"publisher":"BMJ","issue":"8","funder":[{"name":"Ministry for Culture and Science of the German Federal State of North Rhine-Westphalia","award":["N.A."],"award-info":[{"award-number":["N.A."]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,8,1]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"\n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Cross-sectional household survey.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Data were drawn from the German population and collected through computer-assisted, face-to-face interviews.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n \n Representative random sample of 2087 people (\n ><\/jats:underline>\n 14 years) from the German population.\n <\/jats:p>\n <\/jats:sec>\n \n Outcome measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Support for all policies was high (50%\u201368%), even among smokers (48%\u201366%). Ex-smokers and never-smokers were more likely to support standard training on cessation for health professionals than current smokers (OR 1.43, 95%\u2009CI 1.07 to 1.92; OR 1.43; 95%\u2009CI 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%\u2009CI 1.11 to 1.73). Men were less likely than women to support cessation treatment for smokers with physical diseases (OR 0.74, 95%\u2009CI 0.60 to 0.91) and free provision of treatment (OR 0.80, 95%\u2009CI 0.66 to 0.97). Offering cessation treatment to smokers with physical disorders was generally more accepted than to those with mental health issues.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n DRKS00011322.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026245","type":"journal-article","created":{"date-parts":[[2019,8,28]],"date-time":"2019-08-28T07:07:50Z","timestamp":1566976070000},"page":"e026245","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Public attitudes towards healthcare policies promoting tobacco cessation in Germany: results from the representative German study on tobacco use (DEBRA study)"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5590-1135","authenticated-orcid":false,"given":"Sabrina","family":"Kastaun","sequence":"first","affiliation":[{"name":"Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, D\u00fcsseldorf, D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Kotz","sequence":"additional","affiliation":[{"name":"Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, D\u00fcsseldorf, D\u00fcsseldorf, Germany"},{"name":"Department of Behavioural Science and Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Behavioural Science and Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lion","family":"Shahab","sequence":"additional","affiliation":[{"name":"Department of Behavioural Science and Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5909-5508","authenticated-orcid":false,"given":"Melanie","family":"Boeckmann","sequence":"additional","affiliation":[{"name":"Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, D\u00fcsseldorf, D\u00fcsseldorf, Germany"},{"name":"Department of Environment and Health, School of Public Health, Bielefeld University, Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,27]]},"reference":[{"key":"2025121407045395000_9.8.e026245.1","unstructured":"WHO . WHO report on the global tobacco epidemic. Warning about the dangers of tobacco 2011. Available: http:\/\/www.who.int\/tobacco\/global_report\/2011\/en\/ [Accessed 25 Jun 2018]."},{"key":"2025121407045395000_9.8.e026245.2","unstructured":"European Commission . Special Eurobarometer 458. Attitudes of Europeans towards tobacco and electronic cigarettes, 2017. Available: https:\/\/data.europa.eu\/euodp\/en\/data\/dataset\/S2146_87_1_458_ENG [Accessed 15 Apr 2019]."},{"key":"2025121407045395000_9.8.e026245.3","first-page":"235","article-title":"The use of tobacco, e-cigarettes, and methods to quit smoking in Germany. A representative study using 6 waves of data over 12 months (the DEBRA study)","volume":"115","author":"Kotz","year":"2018","journal-title":"Dtsch Arztebl Int"},{"key":"2025121407045395000_9.8.e026245.4","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1055\/s-0042-109372","article-title":"Social inequalities, Smoking and Health [Soziale Ungleichheit, Rauchen und Gesundheit]","volume":"17","author":"Kuntz","year":"2016","journal-title":"Suchttherapie"},{"key":"2025121407045395000_9.8.e026245.5","unstructured":"Royal College of Physicians, Royal College of Psychiatrists . Smoking and mental health. Royal College of psychiatrists Council report CR178, 2013. Available: https:\/\/www.rcplondon.ac.uk\/projects\/outputs\/smoking-and-mental-health [Accessed 14 Apr 2019]."},{"key":"2025121407045395000_9.8.e026245.6","unstructured":"WHO . Framework convention on tobacco control (FCTC) article 14 guidelines, 2010. Available: http:\/\/www.who.int\/fctc\/guidelines\/adopted\/article_14\/en\/ [Accessed 25 Mar 2019]."},{"key":"2025121407045395000_9.8.e026245.7","unstructured":"The Tobacco Control Scale 2016 in Europe . A report of the association of the European cancer Leagues, 2016. Available: https:\/\/www.tobaccocontrolscale.org\/ [Accessed 15 Apr 2019]."},{"key":"2025121407045395000_9.8.e026245.8","unstructured":"AWMF . Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) S3 Guideline \u201cScreening, Diagnostics, and Treatment of Harmful and Addictive Tobacco Use\u201d [S3-Leitlinie \u201cScreening, Diagnostik und Behandlung des sch\u00e4dlichen und abh\u00e4ngigen Tabakkonsums\u201d]. AWMF-Register Nr. 076-006, 2015. Available: http:\/\/www.awmf.org\/leitlinien\/detail\/ll\/076-006.html [Accessed 15 Apr 2019]."},{"key":"2025121407045395000_9.8.e026245.9","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1365052"},{"key":"2025121407045395000_9.8.e026245.10","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cki123"},{"key":"2025121407045395000_9.8.e026245.11","unstructured":"Kastaun S , Kotz D . Brief physician advice for smoking cssation: Results of the DEBRA study [\u00c4rztliche Kurzberatung zur Tabakentw\u00f6hnung \u2013 Ergebnisse der DEBRA Studie], 2019. Available: https:\/\/econtent.hogrefe.com\/doi\/abs\/10.1024\/0939-5911\/a000574"},{"key":"2025121407045395000_9.8.e026245.12","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X683149"},{"key":"2025121407045395000_9.8.e026245.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2004.00540.x"},{"key":"2025121407045395000_9.8.e026245.14","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckl048"},{"key":"2025121407045395000_9.8.e026245.15","first-page":"177","article-title":"Attitudes towards smoking policy and smoking status [Einstellungen zur Raucherpolitik in Abh\u00e4ngigkeit vom aktuellen Raucherstatus]","volume":"11","author":"Keller","year":"2002","journal-title":"Z Med Psychol"},{"key":"2025121407045395000_9.8.e026245.16","unstructured":"Schaller K , Braun S , P\u00f6tschke-Langer M . Success story protection from second-hand smoke exposure in Germany: Increased public support for legislative measures [Erfolgsgeschichte Nichtraucherschutz in Deutschland: Steigende Unterst\u00fctzung in der Bev\u00f6lkerung f\u00fcr gesetzliche Ma\u00dfnahmen]. Gesundheitsmonitor Newsl 2014:1\u20139."},{"key":"2025121407045395000_9.8.e026245.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-017-4328-2","article-title":"Study protocol of the German study on tobacco use (DEBRA): a national household survey of smoking behaviour and cessation","volume":"17","author":"Kastaun","year":"2017","journal-title":"BMC Public Health"},{"key":"2025121407045395000_9.8.e026245.18","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph15040696","article-title":"German public support for tobacco control policy measures: results from the German study on tobacco use (DEBRA), a representative national survey","volume":"15","author":"Boeckmann","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"2025121407045395000_9.8.e026245.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.07.012"},{"key":"2025121407045395000_9.8.e026245.20","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-11-479","article-title":"'The smoking toolkit study': a national study of smoking and smoking cessation in England","volume":"11","author":"Fidler","year":"2011","journal-title":"BMC Public Health"},{"key":"2025121407045395000_9.8.e026245.21","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdi031"},{"key":"2025121407045395000_9.8.e026245.22","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2015-052426"},{"key":"2025121407045395000_9.8.e026245.23","doi-asserted-by":"crossref","first-page":"i40","DOI":"10.1136\/tc.2009.029850","article-title":"Support for smoke-free policies among smokers and non-smokers in six cities in China: ITC China survey","volume":"19 Suppl 2","author":"Li","year":"2010","journal-title":"Tob Control"},{"key":"2025121407045395000_9.8.e026245.24","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1093\/ntr\/ntx087","article-title":"Trends in absolute and relative educational inequalities in adult smoking since the early 2000s: the case of Germany","volume":"20","author":"Hoebel","year":"2018","journal-title":"Nicotine Tob Res"},{"key":"2025121407045395000_9.8.e026245.25","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1007\/s00103-013-1698-1","article-title":"Prevalence of smoking in the adult population of Germany [Verbreitung des Rauchens in der Erwachsenenbev\u00f6lkerung in Deutschland]","volume":"56","author":"Lampert","year":"2013","journal-title":"Bundesgesundhbl Gesundheitsforsch Gesundheitsschutz"},{"key":"2025121407045395000_9.8.e026245.26","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00127-012-0536-3","article-title":"Social inequalities in mental health: results from the EU contribution to the world mental health surveys initiative","volume":"48","author":"Pinto-Meza","year":"2013","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"2025121407045395000_9.8.e026245.27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0707519"},{"key":"2025121407045395000_9.8.e026245.28","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-017-0644-5","article-title":"Social inequalities in the utilization of outpatient psychotherapy: analyses of registry data from German statutory health insurance","volume":"16","author":"Epping","year":"2017","journal-title":"Int J Equity Health"},{"key":"2025121407045395000_9.8.e026245.29","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1111\/add.13387","article-title":"A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses","volume":"111","author":"Sheals","year":"2016","journal-title":"Addiction"},{"key":"2025121407045395000_9.8.e026245.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g1151","article-title":"Change in mental health after smoking cessation: systematic review and meta-analysis","volume":"348","author":"Taylor","year":"2014","journal-title":"BMJ"},{"key":"2025121407045395000_9.8.e026245.31","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2017.01850","article-title":"Free will and the brain disease model of addiction: the not so Seductive Allure of neuroscience and its modest impact on the Attribution of free will to people with an addiction","volume":"8","author":"Racine","year":"2017","journal-title":"Front Psychol"},{"key":"2025121407045395000_9.8.e026245.32","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/nts158"},{"key":"2025121407045395000_9.8.e026245.33","first-page":"439","article-title":"Valuation of tobacco control policies by the public in North Carolina: comparing perceived benefit with projected cost of implementation","volume":"73","author":"Sanders","year":"2012","journal-title":"N C Med J"},{"key":"2025121407045395000_9.8.e026245.34","doi-asserted-by":"crossref","unstructured":"Piontek D , Kraus L , EGd M . Epidemiological Survey of Substance Abuse 2015 [Der Epidemiologische Suchtsurvey 2015] SUCHT; 2016: 259\u201369.","DOI":"10.1024\/0939-5911\/a000444"},{"key":"2025121407045395000_9.8.e026245.35","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp15X688117"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-026245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T15:05:03Z","timestamp":1765724703000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-026245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8,27]]},"published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1136\/bmjopen-2018-026245"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-026245","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}