title: Tobacco control policy development in the European Union: do political factors matter?
abstract: BACKGROUND
  There has been much variation between European countries in the development of tobacco control policy. Not much is known about the factors that shape this variation. This study aimed to assess the role of political factors in tobacco control policy development.
  
  
  METHODS
  We used data from 11 European countries from 1996 to 2010. Multilevel regression modelling was used to investigate associations between the Tobacco Control Scale (TCS) and indicators of left-wing government and government effectiveness (policy formulation, implementation and enforcement), with control for confounders.
  
  
  RESULTS
  An association was found between left-wing government and TCS over the period 1996-2003, but not over the whole period. The association between government effectiveness and TCS was significant and negative over the whole period, but positive between 2001 and 2005. Residual analysis showed that TCS scores from 2002 onwards were higher than expected based on the political factors. Associations varied among the five subscales of the TCS.
  
  
  CONCLUSIONS
  The results suggest that, on the whole, national political factors have had only a minor influence on the large variations in tobacco control policy development in Europe over the last 15 years. However, there are indications that left-wing governments were important for early adoption of tobacco control policy, and high government effectiveness was important in the phase of adopting innovative policies. However, since 2002, with the advent of international treaties, the influence of national politics has diminished.
authors.affiliation: 1 Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands j.bosdriesz@amc.uva.nl.
authors.forename: Jizzo R
authors.initials: JR
authors.lastname: Bosdriesz
authors.affiliation: 2 Alliance Smokefree Holland, The Hague, The Netherlands 3 Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Willemsen
authors.affiliation: 1 Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: 1 Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
mesh_terms: D005062:European Union; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D011050:Policy Making; D011057:Politics; D019460:Tobacco Industry / Q000331:legislation & jurisprudence; D064424:Tobacco Use / Q000331:legislation & jurisprudence* / Q000517:prevention & control