title: Pathways of change explaining the effect of smoke-free legislation on smoking cessation in The Netherlands. An application of the international tobacco control conceptual model.
abstract: BACKGROUND
  This study aims to test the pathways of change from individual exposure to smoke-free legislation on smoking cessation, as hypothesized in the International Tobacco Control (ITC) Conceptual Model.
  
  
  METHODS
  A nationally representative sample of Dutch smokers aged 15 years and older was surveyed during 4 consecutive annual surveys. Of the 1,820 baseline smokers, 1,012 participated in the fourth survey. Structural Equation Modeling was employed to test a model of the effects of individual exposure to smoke-free legislation through policy-specific variables (support for smoke-free legislation and awareness of the harm of [secondhand] smoking) and psychosocial mediators (attitudes, subjective norm, self-efficacy, and intention to quit) on quit attempts and quit success.
  
  
  RESULTS
  The effect of individual exposure to smoke-free legislation on smoking cessation was mediated by 1 pathway via support for smoke-free legislation, attitudes about quitting, and intention to quit smoking. Exposure to smoke-free legislation also influenced awareness of the harm of (secondhand) smoking, which in turn influenced the subjective norm about quitting. However, only attitudes about quitting were significantly associated with intention to quit smoking, whereas subjective norm and self-efficacy for quitting were not. Intention to quit predicted quit attempts and quit success, and self-efficacy for quitting predicted quit success.
  
  
  CONCLUSIONS
  Our findings support the ITC Conceptual Model, which hypothesized that policies influence smoking cessation through policy-specific variables and psychosocial mediators. Smoke-free legislation may increase smoking cessation, provided that it succeeds in influencing support for the legislation.
authors.affiliation: Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands. gnagelhout@stivoro.nl
authors.forename: Gera E
authors.initials: GE
authors.lastname: Nagelhout
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Fong
authors.forename: Math J J M
authors.initials: MJ
authors.lastname: Candel
authors.forename: James F
authors.initials: JF
authors.lastname: Thrasher
authors.forename: Bas
authors.initials: B
authors.lastname: van den Putte
authors.forename: Mary E
authors.initials: ME
authors.lastname: Thompson
authors.forename: K Michael
authors.initials: KM
authors.lastname: Cummings
authors.forename: Marc C
authors.initials: MC
authors.lastname: Willemsen
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009426:Netherlands; D011050:Policy Making; D011159:Population Surveillance; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000331:legislation & jurisprudence*; D016540:Smoking Cessation / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D012944:Social Support; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution