Open Access Research article

The relationship between smokers' motivation to quit and intensity of tobacco control at the population level: a comparison of five European countries

Jochen René Thyrian1*, Demosthenes B Panagiotakos2, Evangelos Polychronopoulos2, Robert West3, Witold Zatonski4 and Ulrich John1

Author Affiliations

1 Institute of Epidemiology and Social Medicine, Ernst-Moritz-Arndt University of Greifswald, Walther-Rathenau-Str. 48, 17489 Greifswald, Germany

2 Department Of Nutrition And Dietetics, Harokopio University, E Venizelou 70, 17571 Athens, Greece

3 Department of Epidemiology and Public Health, University of London, Brook House 2-16 Torrington Place, London WC1E 6B, UK

4 Cancer Epidemiological and Prevention Division, Cancer Center – Institute of Oncology, ul Roentgena 5, 02-781 Warsaw, Poland

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BMC Public Health 2008, 8:2  doi:10.1186/1471-2458-8-2

Published: 3 January 2008



Smoking prevalence differs significantly across Europe. In addition, there are considerable differences in tobacco control activities across European countries. The relationship between prevalence and policy is under-researched. The present analysis examines the motivation to change smoking behaviour across 5 different European countries that differ considerably in their tobacco control activities.


A population-based, representative survey of 1750 smokers, aged 16–59, from 5 different European countries (Germany, Greece, Poland, Sweden, UK) was used. Demographic variables, smoking status and the motivation to stop smoking were assessed. Motivation was assessed as, first, intending to quit (using the stages of change plus a modified stage for Precontemplation), and second, the desire to quit.


The majority of smokers want to stop smoking (73.5%), while only 35.0% want to stop definitely. Across countries, 10.2% definitely do not want to stop.

Most of the smokers can be categorised in the Precontemplation stage (between 62.6% and 77.7% depending on the country), one of the stages of change categories. The relationship between the stages of change and the country under examination is statistically significant (chi-square = 43.466, p < 0.001). In countries with a high level of tobacco control, the proportion of people in Precontemplation is lower than in countries with low tobacco control activity.


There are differences in the stages of change between the countries under examination. However, the categorisation of the countries into low, medium and high tobacco control activity used in this analysis does not explain these differences. Most smokers want to stop smoking, but a high proportion cannot indicate a time-frame when this is going to happen. Tobacco control efforts or other kinds of support might encourage these smokers to actually try to stop. Longitudinal studies at the population level are needed to assess, relate or monitor tobacco control activities and the intention to stop.