How the New European Union's (Pictorial) Tobacco Health Warnings Influence Quit Attempts and Smoking Cessation: Findings from the 2016-2017 International Tobacco Control (ITC) Netherlands Surveys

In 2016, the Netherlands was required to introduce new European Union (EU)'s (pictorial) tobacco health warnings. Our objective was to describe the pathways through which the new EU tobacco health warnings may influence quit attempts and smoking cessation among Dutch smokers. Longitudinal data from 2016 and 2017 from the International Tobacco Control (ITC) Netherlands Survey were used. Smokers who participated in both surveys were included (N = 1017). Structural equation modeling was applied to examine the hypothesized pathways. Health warning salience was positively associated with more health worries (beta = 0.301, p <0.001) and a more positive attitude towards quitting (beta = 0.180, p <0.001), which, in turn, were associated with a stronger quit intention (health worries: beta = 0.304, p <0.001; attitude: beta = 0.340, p <0.001). Quit intention was a strong predictor of quit attempts (beta = 0.336, p = 0.001). Health warning salience was also associated with stronger perceived social norms towards quitting (beta = 0.166, p