Einstellungen zur Raucherpolitik in Abhängigkeit vom Raucherstatus

High prevalence rates of cigarette smoking in Germany indicate that, in addiction to targeting individuals for smoking cessation interventions, there is a need to influence tobacco consumption by means of smoking policy regulations. Until today little is known in Germany about the population's attitudes toward smoking policy. Goals of this study were a) to evaluate the attitudes toward smoking policy with a German version (SPI-D) of the ‘Smoking Policy Index’, and b) to interpret these attitudes on the background of the subjects' sociodemographic characteristics, smoking status and behavior, and readiness to quit smoking. Additionally, the results were compared to international results which are based on a comparable smoking policy instrument (Laforge et al., 1998). The questionnaire contained 17 items relating to demographics, smoking history, smoking status, state of health and wellbeing. Addiction was measured by the Fagerstroem test for nicotine dependence (Heatherton et al., 1991). Smoking status and readiness for change were assessed through previously validated measures. Attitudes toward smoking policy were measured by the 30-item version of Smoking Policy Index (SPI-D). The SPI-D is an adaptation of the previously published Smoking Policy Inventory (Velicer et al., 1994, Laforge et al., 1998), a five-dimensional scale measuring attitudes and opinions about tobacco control and smoking policies. The newer SPI-D covers six dimensions: Attitudes toward (a) advertising and promotion, (b) public education, (c) penalties, (d) taxes and fees, (e) environmental restrictions on smoking and (f) sanctions for tobacco sale to minors. Each of the six SPI-D scales consists of five items which are scored from 1 to 5 on a Likert scale. In order to compare them with results of international studies, scores for the SPI-D were standardized. A convenience sample of n=394 subjects completed the questionnaires. The mean age was 34 years (SD=14), 57% were women. With 45% never-smokers, 18% ex-smokers and 37% current smokers, the smoking status was almost representative for the German population. Overall, the results confirmed the expected reliability and validity of the SPI-D. Younger subjects and subjects with higher levels of education showed slightly less agreement with smoking policy strategies. The attitude toward smoking policy was largely determined by the subjects’ actual smoking status: Smokers showed the lowest, non-smokers the highest and ex-smokers an intermediate agreement. In the subgroup of current smokers, agreement was positively correlated with readiness to quit and the number of 24-hours-abstinence attempts, but negatively correlated with addiction to nicotine. When comparing the results to those of international studies, German subjects showed a low agreement with public education on the hazards of smoking and with raising tobacco taxes. On the other hand, individuals were very supportive of limiting access to tobacco products for minors and of restricting tobacco advertising. The study confirms the SPI-D as an appropriate and broadly applicable tool for assessing support for tobacco control policies. The results indicate that a further restriction of tobacco advertising and promotion would find considerable support in the German population. Additionally, there was a high agreement about the importance of protecting minors – even in the subgroup of current smokers. While never- and ex-smokers showed the strongest support for tobacco regulation policies, current smokers also showed considerable agreement, especially to those restrictions which do not affect them directly (protection of minors, advertising etc.) However, the results should be interpreted carefully because of a possible bias in sample selection.