Oh et al. BMC Public Health 2010, 10:74 http://www.biomedcentral.com/1471-2458/10/74 Though the five countries included in our study were at different stages of the tobacco epidemic [27] factors associated with smoking initiation were very similar. The association between friends and family smoking was found in all countries, but was strongest in Sweden and Czech Republic, two countries with very different tobacco epidemics. Mean age of smoking initiation was youngest in Sweden, which is in the more advanced stages of the tobacco epidemic. Mean age of initiation was oldest in the Czech Republic, which is in an earlier stage of the tobacco epidemic. As rates of smoking are still rising among women in much of Europe, there is much to be done to prevent smoking-attributable mortality rates from also rising. The recent changes in Europe’s tobacco policy have shown promising signs of slowing the epidemic. In a cross-sectional study of 18 European countries, coun- tries with more developed tobacco control policies had higher levels of smoking cessation than in countries with less developed tobacco policies [66]. In Ireland, Mullally et al. found a significant decline in cigarette consumption among bar workers and a significant drop in smoking prevalence in the general population one year after a nationwide ban on workplace smoking in March 2004 [67]. In Scotland, Fowkes et al. found that smoking quit rates increased in the three months prior to introduction of the Scottish smoke-free legislation in March 2006 [68]. Conclusions This study showed that among European women, friends are the primary factor influencing both ever smoking and smoking initiation, especially among young women. We also found that over 80% of European women begin smoking by the age of 20 and that average age of smoking initiation varies by country, income, and age cohort, with Swedish women most likely to start smoking at a young age. The results from this study may serve as a helpful baseline for future studies on the long-term effect of the recent European tobacco laws. Acknowledgements This publication arises from the project Women in Europe Against Lung Cancer and Smoking (WELAS) which has received funding from the European Union, in the framework of the Public Health Programme. Debora L Oh worked on this project under the tenure of a special training award from the International Agency for Research on Cancer. Author details 1International Agency for Research on Cancer, Lyon, France. 2Department of Epidemiology, University of California Los Angeles, School of Public Health, Los Angeles, California, USA. 3Tobacco Prevention and Cessation Program, Arkansas Department of Health, Little Rock, Arkansas, USA. 4Department of Public Health and Primary Care, Trinity College Dublin, Republic of Ireland. 5Tobacco Control, National Institute of Public Health, Östersund, Sweden. 6Health Professionals Against Tobacco, Stockholm, Sweden. 7Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and Page 9 of 11 General University Hospital, Prague, Czech Republic. 83rd Medical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. 9INSERM U 754 - IFR69, Villejuif, France. 10Regione del Veneto - Direzione Prevenzione, Servizio di Sanità Pubblica e Screening, Venezia, Italy. 11Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 12Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA. Authors’ contributions DLO analyzed the data and drafted the manuscript. JEH assisted in the design of the study and the statistical analysis. CD, SA, M Haglund, SSDM, EK, IS, ET, and ERG helped to draft the manuscript. M Hashibe conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript. Competing interests This research was funded by the European Union, in the framework of the Public Health Programme. Received: 12 October 2009 Accepted: 17 February 2010 Published: 17 February 2010 References 1. WHO. Regional Office for Europe: Tobacco control database. WHO 2008. 2. Warren CW, Jones NR, Eriksen MP, Asma S: Patterns of global tobacco use in young people and implications for future chronic disease burden in adults. The Lancet 2006, 367:749-753. 3. Bosetti C, Levi F, Lucchini F, Negri E, Vecchia CL: Lung cancer mortality in European women: recent trends and perspectives. 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