{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T19:21:20Z","timestamp":1794597680327,"version":"4.9.1"},"reference-count":45,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"unspecified","delay-in-days":36,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"CERCA Programme\/ Generalitat de Catalunya","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}],"id":[{"id":"https:\/\/ror.org\/01bg62x04","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Ministry of Universities and Research from the Government of Catalonia","award":["2021SGR00906"],"award-info":[{"award-number":["2021SGR00906"]}],"id":[{"id":"https:\/\/ror.org\/0341vw408","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,6,5]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tobacco control efforts have succeeded in reducing smoking prevalence and increasing smoking cessation rates in the European Union Member States (EU27). However, the impact of these policies has been unequal across different income groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ecological study with the country as unit of analysis. We used the Tobacco Control Scale (TCS) in EU27 in 2010 and the prevalence of smoking and quit ratios from the Eurobarometer surveys (2009, n=27 788; and 2020, n=28\u2009288). We analysed the relationship between the TCS scores (2010) and smoking indicators and their relative changes (between 2009 and 2020) using scatter plots and multiple linear regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      In the EU27, high inequalities exist among different income groups. High-income residents had lower smoking prevalence (19 vs 40%) and higher quit ratios (55 vs 32%) compared with the low-income group. Positive changes in smoking indicators from 2009 to 2020 were stronger in the high-income group. There was a stronger negative correlation between TCS scores and smoking prevalence in high-income groups (r\n                      <jats:sub>sp<\/jats:sub>\n                      =\u22120.615, p&lt;0.01; r\n                      <jats:sub>sp<\/jats:sub>\n                      =\u22120.498; p=0.01) and between its relative changes but only in the high-income group (r\n                      <jats:sub>sp<\/jats:sub>\n                      =\u22120.478; p=0.01). A positive correlation was observed between TCS scores and quit ratios (r\n                      <jats:sub>sp<\/jats:sub>\n                      =0.580, r\n                      <jats:sub>sp<\/jats:sub>\n                      =0.548, both p&lt;0.01) in high- and moderate-income populations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Declines in smoking prevalence and increases in quit ratios were considerably lower in moderate- and low-income groups. Tailoring tobacco control policies to address financial, social and structural barriers, such as ensuring free access to cessation services, implementing targeted outreach programmes, adopting culturally and linguistically appropriate interventions, among others, is essential for making these measures more equitable, which is key for the EU27 to achieve its tobacco-free goal by 2040.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-002418","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T07:40:37Z","timestamp":1754552437000},"page":"e002418","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Impact of tobacco control policies on socioeconomic inequalities in smoking prevalence and quit ratios: an ecological study in the European Union (2009\u20132020)"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0033-9026","authenticated-orcid":false,"given":"Ariadna","family":"Feliu","sequence":"first","affiliation":[{"name":"Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK"},{"name":"Center for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteve","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Center for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Madrid, Spain"},{"name":"Tobacco Control Unit, Cancer Prevention and Control Program, Institut Catal\u00e0 d\u2019 Oncologia, L\u2019Hospitalet de Llobregat, Spain"},{"name":"Tobacco Control Research Group, Institut d\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge-IDIBELL, L\u2019Hospitalet del Llobregat, Spain"},{"name":"School of Medicine and Health Sciences, Universitat de Barcelona, L\u2019Hospitalet del Llobregat, Spain"},{"name":"Secretariat for Public Health, Department of Health, Government of Catalonia, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1404-8641","authenticated-orcid":false,"given":"Irene","family":"Tam\u00ed-Maury","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0108-3288","authenticated-orcid":false,"given":"Cristina","family":"Martinez","sequence":"additional","affiliation":[{"name":"Center for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Madrid, Spain"},{"name":"Tobacco Control Unit, Cancer Prevention and Control Program, Institut Catal\u00e0 d\u2019 Oncologia, L\u2019Hospitalet de Llobregat, Spain"},{"name":"Tobacco Control Research Group, Institut d\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge-IDIBELL, L\u2019Hospitalet del Llobregat, Spain"},{"name":"Faculty of Nursing, Universitat de Barcelona, L\u2019Hospitalet del Llobregat, Spain"},{"name":"Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"2026010703055352000_3.2.e002418.1","unstructured":"WHO . WHO Framework Convention on Tobacco Control. Geneva: WHO, 2003."},{"key":"2026010703055352000_3.2.e002418.2","unstructured":"WHO . MPOWER. Geneva: WHO, 2008."},{"key":"2026010703055352000_3.2.e002418.3","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(17)30045-2"},{"key":"2026010703055352000_3.2.e002418.4","doi-asserted-by":"publisher","DOI":"10.1002\/1878-0261.12918"},{"key":"2026010703055352000_3.2.e002418.5","unstructured":"Joossens L , Feliu A , Fern\u00e1ndez E . The Tobacco control scale 2019 in europe. Brussels, 2019."},{"key":"2026010703055352000_3.2.e002418.6","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2021-056857"},{"key":"2026010703055352000_3.2.e002418.7","unstructured":"WHO . WHO Report on the Global Tobacco Epidemic 2017: Monitoring Tobacco Use and Prevention Policies. Geneva: WHO, 2017."},{"key":"2026010703055352000_3.2.e002418.8","doi-asserted-by":"publisher","DOI":"10.1136\/tc-2022-057670"},{"key":"2026010703055352000_3.2.e002418.9","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2020-055874"},{"key":"2026010703055352000_3.2.e002418.10","doi-asserted-by":"publisher","DOI":"10.18332\/tid\/152138"},{"key":"2026010703055352000_3.2.e002418.11","doi-asserted-by":"publisher","DOI":"10.1136\/tc.2007.024265"},{"key":"2026010703055352000_3.2.e002418.12","doi-asserted-by":"crossref","unstructured":"Feliu A , Filippidis FT , Joossens L , et al . Impact of tobacco control policies on smoking prevalence and quit ratios in 27 European Union countries from 2006 to 2014. Tob Control 2017. doi:10.1136\/tobaccocontrol-2017-054119","DOI":"10.1136\/tobaccocontrol-2017-054119"},{"key":"2026010703055352000_3.2.e002418.13","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2013-051110"},{"key":"2026010703055352000_3.2.e002418.14","doi-asserted-by":"publisher","DOI":"10.1136\/tc.2005.015347"},{"key":"2026010703055352000_3.2.e002418.15","unstructured":"Rationale . Tobacco control scale. Available: http:\/\/www.tobaccocontrolscale.org\/rationale\/ [Accessed 27 Apr 2017]."},{"key":"2026010703055352000_3.2.e002418.16","unstructured":"GESIS-suche: eurobarometer 72.2. Available: https:\/\/search.gesis.org\/research_data\/ZA4976 [Accessed 2 Feb 2024]."},{"key":"2026010703055352000_3.2.e002418.17","unstructured":"GESIS-suche: eurobarometer 93.2. 2020. Available: https:\/\/search.gesis.org\/research_data\/ZA7739 [Accessed 2 Feb 2024]."},{"key":"2026010703055352000_3.2.e002418.18","doi-asserted-by":"crossref","DOI":"10.1136\/tc.2010.036103","article-title":"Smoking prevalence in the European Union: a comparison of national and transnational prevalence survey methods and results","volume":"20","author":"Bogdanovica","year":"2011","journal-title":"Tob Control"},{"key":"2026010703055352000_3.2.e002418.19","unstructured":"Joossens L , Raw M . The Tobacco Control Scale 2010 in Europe. Brussels, 2011."},{"key":"2026010703055352000_3.2.e002418.20","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2020-056395"},{"key":"2026010703055352000_3.2.e002418.21","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.21.2.31"},{"key":"2026010703055352000_3.2.e002418.22","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00596-2019"},{"key":"2026010703055352000_3.2.e002418.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.05.020"},{"key":"2026010703055352000_3.2.e002418.24","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2013-051436"},{"key":"2026010703055352000_3.2.e002418.25","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1093\/ntr\/ntac023","article-title":"Gender, Tobacco Control Policies, and Persistent Smoking Among Older Adults: A Longitudinal Analysis of 11 European Countries","volume":"24","author":"Gao","year":"2022","journal-title":"Nicotine Tob Res"},{"key":"2026010703055352000_3.2.e002418.26","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1111\/add.14577","article-title":"Tobacco control policies and smoking among older adults: a longitudinal analysis of 10 European countries","volume":"114","author":"Serrano\u2010Alarc\u00f3n","year":"2019","journal-title":"Addiction"},{"key":"2026010703055352000_3.2.e002418.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2009.05.001"},{"key":"2026010703055352000_3.2.e002418.28","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-042623","article-title":"Gender differences within the barriers to smoking cessation and the preferences for interventions in primary care a qualitative study using focus groups in The Hague, The Netherlands","volume":"11","author":"Dieleman","year":"2021","journal-title":"BMJ Open"},{"key":"2026010703055352000_3.2.e002418.29","unstructured":"WHO Regional Office for Europe . Through a Gender Lens: Women and Tobacco in the WHO European Region . Copenhagen, 2021. Available: https:\/\/www.who.int\/europe\/publications\/i\/item\/WHO-EURO-2021-1847-41598-56811"},{"key":"2026010703055352000_3.2.e002418.30","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2017-053986"},{"key":"2026010703055352000_3.2.e002418.31","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0153966","article-title":"Socioeconomic Inequalities in Smoking and Smoking Cessation Due to a Smoking Ban: General Population-Based Cross-Sectional Study in Luxembourg","volume":"11","author":"Tchicaya","year":"2016","journal-title":"PLoS ONE"},{"key":"2026010703055352000_3.2.e002418.32","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2013-051430"},{"key":"2026010703055352000_3.2.e002418.33","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2011-050417"},{"key":"2026010703055352000_3.2.e002418.34","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-006552","article-title":"Opposite trends in the consumption of manufactured and roll-your-own cigarettes in Spain (1991\u20132020)","volume":"4","author":"Fu","year":"2014","journal-title":"BMJ Open"},{"key":"2026010703055352000_3.2.e002418.35","doi-asserted-by":"publisher","DOI":"10.5694\/mja11.10074"},{"key":"2026010703055352000_3.2.e002418.36","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2012-050644"},{"key":"2026010703055352000_3.2.e002418.37","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdp008"},{"key":"2026010703055352000_3.2.e002418.38","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-016-0298-2","article-title":"Woman focused smoking cessation programming: a qualitative study","volume":"16","author":"Minian","year":"2016","journal-title":"BMC Womens Health"},{"key":"2026010703055352000_3.2.e002418.39","doi-asserted-by":"crossref","unstructured":"Notley C , Gentry S , Livingstone-Banks J , et al . Incentives for smoking cessation. Cochrane Database Syst Rev 2025;2025. doi:10.1002\/14651858.CD004307.pub7","DOI":"10.1002\/14651858.CD004307.pub7"},{"key":"2026010703055352000_3.2.e002418.40","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1093\/ntr\/ntu266","article-title":"Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities","volume":"17","author":"Garrett","year":"2015","journal-title":"NICTOB"},{"key":"2026010703055352000_3.2.e002418.41","unstructured":"European Parliament and the Council . Europe\u2019s beating cancer plan. 2021."},{"key":"2026010703055352000_3.2.e002418.42","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2011-050294"},{"key":"2026010703055352000_3.2.e002418.43","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/ntn010"},{"key":"2026010703055352000_3.2.e002418.44","unstructured":"European Comission . Special eurobarometer 506 report attitudes of Europeans towards tobacco and electronic cigarettes. 2021."},{"key":"2026010703055352000_3.2.e002418.45","unstructured":"European Commission: European Education and Culture Executive Agency . The structure of the European education systems 2023\/2024 - schematic diagrams. 2023."}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2024-002418","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:06:37Z","timestamp":1767783997000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2024-002418"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":45,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,8,6]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bmjph-2024-002418"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2024-002418","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}