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Public attitudes towards healthcare policies promoting tobacco cessation in Germany: results from the representative German study on tobacco use (DEBRA study)
  1. Sabrina Kastaun1,
  2. Daniel Kotz1,2,
  3. Jamie Brown2,
  4. Lion Shahab2,
  5. Melanie Boeckmann1,3
  1. 1Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
  2. 2Department of Behavioural Science and Health, University College London, London, UK
  3. 3Department of Environment and Health, School of Public Health, Bielefeld University, Bielefeld, Germany
  1. Correspondence to Dr Sabrina Kastaun; sabrina.kastaun{at}


Objective 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.

Design Cross-sectional household survey.

Setting Data were drawn from the German population and collected through computer-assisted, face-to-face interviews.

Participants Representative random sample of 2087 people (>14 years) from the German population.

Outcome measures 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.

Results Support for all policies was high (50%–68%), even among smokers (48%–66%). Ex-smokers and never-smokers were more likely to support standard training on cessation for health professionals than current smokers (OR 1.43, 95% CI 1.07 to 1.92; OR 1.43; 95% CI 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% CI 1.11 to 1.73). Men were less likely than women to support cessation treatment for smokers with physical diseases (OR 0.74, 95% CI 0.60 to 0.91) and free provision of treatment (OR 0.80, 95% CI 0.66 to 0.97). Offering cessation treatment to smokers with physical disorders was generally more accepted than to those with mental health issues.

Conclusions 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.

Trial registration number DRKS00011322.

  • healthcare policy
  • public opinion
  • smoking cessation
  • household survey

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  • Contributors SK coordinates the DEBRA study, drafted the manuscript and analysed and interpreted the data. MB co-wrote the manuscript and interpreted the data. DK conceived the DEBRA study, contributed to the study design for the policy question analysis and contributed to the writing of the manuscript. LS and JB work for the English Smoking Toolkit Study with which DEBRA is closely aligned, and contributed to the study design as well as to the writing of the manuscript. All named authors contributed substantially to the manuscript and agreed on its final version.

  • Funding This work was supported by the Ministry for Culture and Science of the German Federal State of North Rhine-Westphalia ("NRW-Rückkehrprogramm"). It had no involvement in the design of the study, the collection, analysis, interpretation of data or in the writing of the manuscript.

  • Competing interests SK and MB have no conflict of interest to declare. JB has received unrestricted research funding from Pfizer who manufacture smoking cessation medications. LS has received honoraria for talks, an unrestricted research grant and travel expenses to attend meetings and workshops from Pfizer, and has acted as a paid reviewer for grant-awarding bodies and as a paid consultant for healthcare companies. DK received an unrestricted grant from Pfizer in 2009 for an investigator-initiated trial on the effectiveness of practice nurse counselling and varenicline for smoking cessation in primary care (Dutch Trial Register NTR3067). All authors declare no financial links with tobacco companies or e-cigarette manufacturers or their representatives.

  • Patient consent for publication Not required.

  • Ethics approval This study has been approved by the Ethics Committee of the Medical Faculty of the Heinrich-Heine-University Dusseldorf (ID 5386/R).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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