The association between tobacco use and perceptions of tobacco price strategies within primary care patients in rural Greece
More details
Hide details
Department of Social Medicine, Clinic of Social and Family Medicine, University of Crete, Greece
Primary Care Setting of Siatista, Greece
Submission date: 2015-11-25
Final revision date: 2016-02-28
Acceptance date: 2016-03-09
Publication date: 2016-04-21
Corresponding author
Emmanouil Symvoulakis   

Department of Social Medicine, Clinic of Social and Family Medicine, University of Crete, Greece, University of Crete, 71003 Heraklion, Greece, Greece
Tob. Prev. Cessation 2016;2(April):63
Editorial Note: A typesetting error was noted in the first version of the manuscript that was uploaded. Please accept our apologies for any inconvenience that may have been caused.
Tobacco use is a detrimental public health issue associated with a plethora of adverse health outcomes. The purpose of this report was to investigate the association between tobacco use and perceptions of tobacco price strategies to reduce consumption in a rural primary care setting in Northern Greece.

Material and Methods:
The study took place within a primary care setting, in Alonakia, in Northern Greece within a primary health care setting. Consecutive patients who were current smokers (n=121) with a routine appointment for any reason were invited to participate over a 6-week period, during the second semester of 2013.

The mean daily cigarette consumption was 20.2 ± 12.4 (range: 2-60) and their pack/year consumption was 31.8 ± 30.4 (range: 1-150 pack/years). Within the context of a regression analysis, the likelihood for patients who were smokers to positively respond that the cost of tobacco has an effect on their daily cigarette consumption was found to decrease by 3% for every cigarette smoked more per day and by 2% for every more pack/year. Furthermore, the likelihood for participants to report that they would quit smoking in case of a doubling in the price of tobacco products decreased by 5% for every cigarette smoked more per day.

The above findings imply that the reduction in tobacco use in rural Greece, is complex and a population’s sensitivity should be enhanced through primary care initiatives that are adjusted between health promotion and counseling in conditions of socioeconomic distress.

Azagba S, Sharaf M. Cigarette taxes and smoking participation: evidence from recent tax increases in Canada. Int J Environ Res Public Health. 2011 May;8(5):1583-600. doi: 10.3390/ijerph8051583
Tsalapati K, Vardavas CI, Athanasakis K, Thireos E, Vozikis A, Pavi E, Behrakis P, Kyriopoulos I. Going up in ashes? Smoking-attributable morbidity, hospital admissions and expenditure in Greece. Eur J Public Health. 2014 Mar 27. doi: 10.1093/eurpub/cku040.
He P, Yano E. Tobacco companies are booming despite an economic depression. Tob Induc Dis. 2009 Jun 15;5(1):9. doi: 10.1186/1617-9625-5-9.
Sussman S, Levy D, Lich KH, Cené CW, Kim MM, Rohrbach LA, Chaloupka FJ. Comparing effects of tobacco use prevention modalities: need for complex system models. Tob Induc Dis. 2013 Jan 22;11(1):2. doi: 10.1186/1617-9625-11-2.
Vardavas CI, Filippidis FT, Agaku I, Mytaras V, Bertic M, Connolly GN, Tountas Y, Behrakis P. Tobacco taxation: the importance of earmarking the revenue to health care and tobacco control. Tob Induc Dis. 2012 Dec 27;10(1):21. doi: 10.1186/1617-9625-10-21.
World Health Organization. WHO Report on the Global Tobacco Epidemic; World Health Organization: Geneva, Switzerland, 2008. Available at: (accessed 10 February 2016).
Choi K, Boyle RG. Minnesota smokers' perceived helpfulness of 2009 federal tobacco tax increase in assisting smoking cessation: a prospective cohort study.BMC Public Health. 2013 Oct 18;13(1):965. doi: 10.1186/1471-2458-13-965.
Scollo M, Hayes L, Wakefield M: What price quitting? The price of cigarettes at which smokers say they would seriously consider trying to quit. BMC Public Health 2013, 13:650. doi: 10.1186/1471-2458-13-650.
MacFarlane K, Paynter J, Arroll B, Youdan B: Tax as a motivating factor to make a quit attempt from smoking: a study before and after the April 2010 tax increase. J Prim Health Care 2011, 3(4):283–288.
Centers for Disease Control and Prevention: Decrease in smoking prevalence — Minnesota, 1999–2010. MMWR Morb Mortal Wkly Rep 2011,60(5):138–141.
Godfrey C, Maynard A. Economic aspects of tobacco use and taxation policy. BMJ 1998;297:339–43. doi: 10.1136/bmj.297.6644.339.
12. (The Greek Tobacco Epidemic). (assessed 10 February 2016).
Joossens L, Lugo A, La Vecchia C, Gilmore AB, Clancy L, Gallus S. Illicit cigarettes and hand-rolled tobacco in 18 European countries: a cross-sectional survey. Tob Control. 2014 May;23(e1):e17-23. doi: 10.1136/tobaccocontrol-2012-050644. Epub 2012 Dec 10.
Sutton S, Smith S, Jamison J, Boase S, Mason D, Prevost AT, Brimicombe J, Sloan M, Gilbert H, Naughton F. Study protocol for iQuit in Practice: a randomised controlled trial to assess the feasibility, acceptability and effectiveness of tailored web- and text-based facilitation of smoking cessation in primary care. BMC Public Health. 2013 Apr 10;13:324.
Strayer SM, Heim SW, Rollins LK, Bovbjerg ML, Nadkarni M, Waters DB, Hauck FR, Schorling JB. Improving smoking cessation counseling using a point-of-care health intervention tool (IT): from the Virginia Practice Support and Research Network (VaPSRN). J Am Board Fam Med. 2013 Mar-Apr;26(2):116-25. doi: 10.3122/jabfm.2013.02.110078.
Douglas L, Szatkowski L. Socioeconomic variations in access to smoking cessation interventions in UK primary care: insights using the Mosaic classification in a large dataset of primary care records. BMC Public Health. 2013 Jun 5;13:546. doi: 10.1186/1471-2458-13-546.
Twardella D, Brenner H. Lack of training as a central barrier to the promotion of smoking cessation: a survey among general practitioners in Germany. Eur J Public Health. 2005 Apr;15(2):140-5. doi: 10.1093/eurpub/cki123
Keogan S, Burns A, Babineau K, Clancy L. Dental Practitioners and Smoking Cessation in Ireland. Tob. Prev. Cessation 2015;1(October):5. doi : /10.18332/tpc/59482.
Vardavas CI, Symvoulakis EK, Lionis C. Dealing with tobacco use and dependence within primary health care: time for action. Tob Induc Dis. 2013 Feb 26;11(1):6. doi: 10.1186/1617-9625-11-6.
Piper ME, Baker TB, Mermelstein R, Collins LM, Fraser DL, Jorenby DE, Smith SS, Christiansen BA, Schlam TR, Cook JW, Oguss M, Fiore MC. Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record. Transl Behav Med. 2013 Sep;3(3):253-63. doi: 10.1007/s13142-012-0178-8.
Centers for Disease Control and Prevention. Quitting smoking among adults - United States 2001–2010. MMWR. 2011; 60:1513-1519.
Goldstein MG, DePue JD, Monroe AD, et al. A population-based survey of physician smoking cessation counseling practices. Prev Med 1998;27(5 Pt 1):720 –9. doi: 10.1006/pmed.1998.0350
Eisner D, Zoller M, Rosemann T, Huber CA, Badertscher N, Tandjung R. Screening and prevention in Swiss primary care: a systematic review. Int J Gen Med. 2011;4:853-70. doi: 10.2147/ijgm.s26562
Von dem Knesebeck O, Hoehne A, Link C, Marceau L, Adams A, Roland M, Campbell S, Siegrist J, McKinlay J. Talking about smoking in primary care medical practice--results of experimental studies from the US, UK and Germany. Patient Educ Couns. 2012 Oct;89(1):51-6. doi: 10.1016/j.pec.2012.04.011.
Josseran L, King G, Guilbert P, Davis J, Brücker G. Smoking by French general practitioners: behaviour, attitudes and practice. Eur J Public Health. 2005 Feb;15(1):33-8. doi: 10.1093/eurpub/cki108
Goumas GS A cigarette, doctor? ... No thanks! Hellenic J Cardiol. 2013 May-Jun;54(3):157-8.
Thyrian JR, Panagiotakos DB, Polychronopoulos E, West R, Zatonski W, John U. The relationship between smokers' motivation to quit and intensity of tobacco control at the population level: a comparison of five European countries. BMC Public Health. 2008 Jan 3;8:2. doi: 10.1186/1471-2458-8-2.
Uppal N, Shahab L, Britton J, Ratschen E. The forgotten smoker: a qualitative study of attitudes towards smoking, quitting, and tobacco control policies among continuing smokers. BMC Public Health. 2013 May 3;13:432. doi: 10.1186/1471-2458-13-432.
Benson F, Nierkens V, Willemsen M, Stronks K. Effects of different types of smoking cessation behavioural therapy in disadvantaged areas in the Netherlands: an observational study. Tob. Prev. Cessation 2016;2(February):4, doi: 10.18332/tpc/61616.
Farrelly M.C., Nonnemaker J.M., Watson K.A. The consequences of high cigarette excise taxes for low-income smokers. PLoS ONE. 2012;7. doi: 10.1371/journal.pone.0043838.
Widome R, Joseph AM, Hammett P, Van Ryn M, Nelson DB, Nyman JA, Fu SS. Associations between smoking behaviors and financial stress among low-income smokers. Prev Med Rep. 2015 Oct 29;2:911-5. doi: 10.1016/j.pmedr.2015.10.011. eCollection 2015. doi:10.1016/j.pmedr.2015.10.011.
Journals System - logo
Scroll to top