Background:
Cancer is a major public health problem. Tobacco is linked to 80% of lung cancer deaths and associated with 16 other cancers, all of which could be prevented. The European Code Against Cancer (ECAC, 4thed.) is a health education tool aimed at raising awareness about evidence-based actions to prevent cancer. It reports 12 recommendations to reduce individuals’ cancer risk, including “not smoking or using any form of tobacco” and “making your home smoke-free and supporting smoke-free policies”.

Objectives:
To explore perceived barriers towards the adoption of tobacco-related cancer prevention actions recommended by the ECAC in 7 European countries.

Methods:
The COM-B model of behaviour change was used as a framework for the design and analysis of the study since it identifies factors (capability, opportunity, motivation) that need to be present for any behaviour to occur. We designed an exploratory research qualitative study by means of in-depth semi-structured interviews among adults with no previous cancer diagnose. Participants were selected using a quota sampling strategy according to sex, age and education level (N=18/country). Interviews were conducted in their native language by trained researchers. We conducted a thematic content analysis to identify common topics.

Results:
Participants who smoked reported that their main barrier to quit smoking was not being capable to overcome their nicotine addiction. Other reported barriers were not knowing where to find professional help, peer pressure, living with someone who also smokes, and lack of a support network. As a main barrier for second-hand smoke (SHS), participants declared not having control among others’ behaviours, however, they recognized smoke-free laws importance.

Conclusions:
Understanding how the ECAC recommendations are perceived by EU citizens and the barriers they encounter to take action to reduce their cancer risk from tobacco and SHS is key to promote adoption of the recommendations and improve supportive societal structures to overcome these barriers.