When I Twitter_60830064_illustrationstarted using Twitter five years ago I had a simple goal in mind. I wanted to organize a symposium and I wanted relevant people to be there. So I started collecting followers first and then used my account to advertise my symposium. This strategy worked well for me and later on I also found many other ways in which Twitter can be useful and add value to my work as public health researcher. However, I often get surprised reactions from researchers who do not use Twitter that I am “wasting my time” with that. Of course Twitter can be a waste of time for people who get distracted on Twitter easily and keep reading and clicking until they realize that several hours have past. Here is a three step approach for using Twitter as a researcher without wasting your time.


Note that this is not a guide for how to use Twitter. Twitter is intuitive, so you can probably figure this out yourself. If not, there are guides available on how to set up an account, how to get followers, how to use hashtags, twitter terminology, and many more.


Step 1: Deciding whether you want to use Twitter (10 minutes)

  • Think about pros and cons of using Twitter for your specific situation. If you are a newbie to using Twitter as a researcher then start with reading a blog about this (for example this one). Pros can be that you can follow interesting news and publications in your research field, that you can advertise your publications, call for papers, blogs, or job adverts, that you can easily connect with researcher whom you don’t (yet) know personally, and that you can ask questions and get quick answers. A possible con of using Twitter is that it takes time; it doesn’t have to be much time (as you can read below) and the pros can outweigh this con, but Twitter does take some time. Are you the type of person who would get lost in a Twitter feed during office hours while losing track of time? Then starting Twitter while you also have a very busy work schedule is probably not very smart and you can stop reading this post.
  • If you think there could be more pros than cons for your specific situation, then take a look at twitter.com. Hit the search button and find some interesting people that you know (colleagues, famous researchers in your field, organizations that you like). Read a few of their tweets and retweets and decide whether you like what you see. You can also search for the hashtag (go here if you don’t know what this is) of a conference that you have or have not attended and read what other conference attendees have shared about their conference experience. You now have a good enough idea of what Twitter is like. If you think you like it, then go to step 2. If you don’t like it, then decide that you will not join Twitter and stop reading this post.


Step 2: Getting started (30-45 minutes)

  • Depending on the goal you have with using Twitter, collecting lots of followers can be more or less important. If you only want to use Twitter to follow other people (not to advertise your work and get connected with others) you can skip the next bullet.
  • Start with uploading a photo and writing a bio. There are blogs about how to choose the best profile picture and how to write a good bio, but you can also use common sense (this takes less time). Then write three tweets and post them. This may feel strange to do because you don’t have followers yet, so you are tweeting to nobody. However, when people decide whether they want to follow you, they look at your previous tweets to see whether you are interesting enough to follow. Therefore you need some tweets to start with.
  • Start following some interesting people. There are two strategies if you don’t want to waste time on Twitter:
    • Follow a small selection of people who tweet the kind of things that are very interesting for you. Be picky by checking out someone’s previous tweets before you decide to follow them. If only 10% of what someone tweets is interesting, then do not follow this person. Unfollow people if it turns out that they are not so interesting as you thought at first. This ensures that your timeline is always full of interesting information for you.
    • Follow many potentially interesting people if you want to collect many followers yourself (again: this depends on the goals you have with using Twitter). If you follow someone, they get a notification and they may decide to follow you back. Retweeting or liking interesting tweets can also get their attention. If you follow this strategy and also want to read interesting stuff on Twitter without wasting too much time, you need lists. You can create a list easily and only add people who tweet the kind of things that are very interesting for you. Instead of reading your entire timeline you can just read the timeline of your list. This list can be kept private if you want, so people do not know whether they are on your list or not.


Step 3: Regular use (5 minutes per day)

  • Posting tweets can be done very efficiently:
    • Try to get a routine for posting certain things that you would normally email to your colleagues like interesting publications, conference announcements, call for papers, or job adverts. If you are already emailing someone a link then the extra effort of tweeting this is minimal.
    • If you read something interesting on a news or journal website, you can often click on the Twitter icon of the article and the tweet is constructed automatically. This will only take you a few extra seconds.
    • Tweet interesting things that you hear during conferences. You can do this during the conference presentation, so it won’t cost you any extra time. Also, you can tweet instead of making notes. Make sure to use the conference hashtag.
  • The thing that can consume most of your time on Twitter is reading tweets of others. Do not try to read everything that everybody that you follow is tweeting. Read part of your timeline (or the timeline of your list) for only a few minutes each day or on some days, retweet something interesting and then stop. There are also apps that warn you when you spend too much time on Twitter (e.g. RescueTime or MeeTimer), but it is probably not a good sign if you need these.


Do you have anything to add? Post a comment!

Last Friday, everyone involved in tobacco research in the Netherlands came together for the third NNvT conference in Utrecht. Besides researchers, there were also many practitioners and policy makers present. Although the Netherlands is a relatively small country, there were as many as 40 presentations of recent studies about smoking.

jizzo-bosdriesz jessamina-lie
marie-elske-gispen slide-prof-mackenbach

One of the major themes of the conference was vulnerable groups and socioeconomic inequalities in smoking. The day started with a keynote by Prof. Johan Mackenbach, who had the disheartening message that more tobacco control means more socioeconomic inequalities. An exception is reimbursing and targeting smoking cessation treatment to low socioeconomic status groups, like in the United Kingdom. Another exception may be tobacco tax increases, but Prof. Mackenbach and one of the other speakers of the day were not entirely sure anymore that tobacco tax increases reduce socioeconomic inequalities. What did became clear during the day is that new solutions are needed for vulnerable groups who experience more life stress and a more pro-smoking social network than others. Individual counseling with motivational interviewing remains important, but innovative approaches like rewarding smoking cessation are worthy of further investigation.


Almost one third of the presented studies dealt with tobacco control policy. The importance of societal support for tobacco control policies was emphasized many times. Several presentations focused on policies that are part of the ‘smokefree generation’ strategy of the Dutch Alliance for a Smokefree Society such as a tobacco display ban and outdoor school ground smoking bans. A very interesting finding was that a focus on protecting children from tobacco can unite people with very different ideologies and political beliefs in supporting these policies. Other presentations focused on the smoking ban in bars, for which one of the main messages was that smoking rooms undermine the effectiveness of the law. This is an important point, because the Netherlands Food and Consumer Product Safety Authority announced on the same day that the number of smoking rooms in bars has increased in the last year.


More literature reviews and meta-analyses were presented than during the previous NNvT conference. I think this is an excellent development. It is not always needed to start new research in the Netherlands, sometimes we can learn enough from previous research. Interesting was that quite a few researchers applied the realist review methodology. This is a relatively new method that examines how and why interventions or policies have certain effects instead of only examining whether and how much effects occur. It gives important insights into mechanisms and contexts, which can be used to improve tobacco control strategies.


A lot of research presented at the conference also focused on smoking cessation. A new clinical guideline for the treatment of tobacco addiction was released at the end of 2016, which made this conference an ideal opportunity to discuss the changes in these guidelines. An important topic remains how to increase commitment for smoking cessation advice and treatment among health professionals. Keynote speaker Prof. Daniel Kotz argued that health professionals should give opportunistic stop smoking advice without first selecting smokers who are already motivated to quit. E-cigarettes were also a point of discussion at the conference. Use among smokers seems to be motivated mainly by harm reduction and the intention to quit smoking, but there is now also evidence that Dutch youth who experiment with e-cigarettes are more likely to start using tobacco. The e-cigarette is not actively recommended as smoking cessation treatment in the new clinical guideline.


The day ended with a plenary discussion about priorities in Dutch tobacco research and the possibility of creating a national center of tobacco research with a shared research agenda. As part of the research agenda, the following topics were mentioned by the panel and public: smoking prevention, improving the reach and use of evidence-based interventions, social and political determinants of national and local tobacco policy, vulnerable groups and inequalities in smoking, and how to increase commitment among health professionals.


In sum, a very interesting conference with important discussions between researchers, practitioners, and policy makers. All attendees voted in favor of a yearly NNvT conference, so see you next year!


Four years ago, I made a work trip to the USA. I visited research groups in San Diego (California), San Francisco (California), Scottsdale (Arizona), Chicago (Illinois), Charleston (South Carolina), and Columbia (South Carolina). At these visits, I presented about tobacco control in the Netherlands. At the end of my presentation I asked each research group for advice: “What should the Netherlands do about tobacco?”advies

I thought it was time to look at their advice again and take stock of what has been realized in the meantime and what has not. If you first want to read more about the advice that I got in the USA, then see my blogs from four years ago here.

Let me start positively with advice from the USA that has been (partly) realized:

  • Probably the most important advice that I got in the USA was that we need to denormalize smoking in the Netherlands. Although we are definitely not there yet, there have been several denormalization campaigns in the Netherlands. For example, the recent campaign from the Dutch Cancer Society that show that it is quite strange that there are more places where you can buy tobacco than bread.
  • Communicating about the costs of smoking, showing the productivity loss, and that tobacco control does not have a negative impact on the economy. This was done in a social cost-benefit analysis of tobacco control in the Netherlands by Maastricht University, RIVM, and the Trimbos Institute.
  • Campaigning about the tobacco industry to denormalize this industry among the general public. A campaign was launched by STIVORO this month. It shows how a tobacco company’s office party would look like if everyone there were totally honest…
  • Follow the example of the USA and start lawsuits against the tobacco industry. Anne Marie van Veen has metastatic lung cancer and is suing the tobacco industry for deliberately harming her health with intent.
  • Another piece of advice was to stimulate employers to financially incentivize their employees for quitting smoking. Last year we started a research study at Maastricht University in which we do just that. Employers don’t pay for the incentives themselves yet, but they may start doing that once we have shown it is (cost) effective.
  • Last but not least, we got the advice to fight for 100% comprehensive smokefree laws without smoking rooms. The Dutch non-smokers group ‘Clean Air Nederland’ started a lawsuit to ban smoking rooms, but lost the case unfortunately. To be continued?

And then the advice that the Netherlands still needs to work on:

  • Prevent that young people start smoking by banning all advertising, strictly enforcing the minimum age for buying tobacco, and banning vending machines.
  • Raising taxes for all tobacco products (including cigars and roll-your-own tobacco) in large steps and do not worry about border crossing for cheaper cigarettes in neighboring countries.
  • Educate the public about the health dangers of second-hand smoke.
  • Reimburse health professionals for helping patients to stop smoking and learn them how to support their patients.
  • Make nicotine replacement therapy more easily available by reimbursing this regardless of smokers’ willingness to participate in counselling.
  • Make it obligatory for a Minister of Health to have formal training in public health or medicine.

Although these last pieces of advice have not been followed yet, there is currently a lot of positive momentum to start working on the first point of banning advertising to prevent that young people start smoking. Unfortunately, there seems to be less political support for large tobacco tax increases and educational campaigns about the harms of secondhand smoking. It seems we are currently in need of advice on how to make these things happen. Any suggestions are very welcome, so please leave a reply below.

word-cloud-2016-publications-gvoAt the beginning of the year, universities look back at what they have achieved in the year before. Number of PhD defenses, number of publications, impact factors, amount of grant money obtained, etcetera. But what is more interesting than the numbers is the content of the research that has been done. At our department of Health Promotion of Maastricht University in the Netherlands the main topics that were published about in 2016 were: energy balance behaviors, tobacco smoking, and family planning. This blog contains very brief explanations about what our publications from 2016 were about. If you want to learn more, click on the links to the papers or ask your questions in the comments section below.


Energy balance behaviors

  • Dave van Kann and co-authors concluded that a school-centered multicomponent physical activity intervention holds the potential to activate children, but a comprehensive set of intervention elements with a sufficient magnitude is necessary to achieve at least moderate effect sizes. [link]
  • The same authors concluded that a multicomponent schoolyard physical activity intervention was effective in making children spend a larger proportion of recess time in light physical activity. [link]
  • And another study from Van Kann and co-authors examined the correlates of moderate-to-vigorous physical activity and sedentary behavior of children aged 8-11 years at schoolyards. Fixed equipment, such as high bars and soccer goals, teacher-initiated activities, and the presence of a ball games policy were correlates of more moderate-to-vigorous physical activity and less sedentary behavior. [link]
  • Ester Sleddens and co-authors found an association between parental impulsivity and (12-15 year old) child body mass index, which could possibly be explained by parenting styles and practices. [open acces link]
  • In a study from Dominique Reinwand and co-authors the behavioral change method ‘action planning’ is examined. The researchers conclude that increasing the motivation to change behavior should be prioritized in interventions concerning changes in health behavior before participants are asked to generate action plans. [open access link]
  • Jessica Gubbels and co-authors found that changes in greenery did not yield consistent positive results on physical activity and mental health among residents of severely deprived neighborhoods in the Netherlands. However, there were some indications regarding positive effects of greenery in certain subgroups. [link]
  • A focus group study by Kristina Romeike and co-authors focused on the beliefs and barriers that underlie socio-cognitive and planning constructs related to healthy eating and physical activity among lower-educated Dutch, Turkish, and Moroccan adults. The importance of cultural and religious factors appeared to be the most significant difference between the Turkish/Moroccan groups and the Dutch groups. [open access link]
  • Another publication by the same authors describes a protocol for the evaluation of two computer-tailored nutrition and physical activity interventions for lower-educated Dutch, Turkish and Moroccan women. One version is tailored to socio-cognitive variables (traditional tailoring), while the other is additionally tailored to ethnic identity (EI-tailoring). A randomized controlled trial will show whether the interventions are effective among these target groups and whether EI-tailoring is beneficial. [open access link]
  • Sanne Gerards and co-authors argue in their study that efforts to explain children’s nutrition behavior or weight often involve investigating the parent-child relationship. However, these behaviors are embedded in a broader system: general parenting and the family health climate. They recommend that more studies include a measure of the broader family system, in order to get a broader view of the mechanisms explaining child health behaviors and weight status. [open access link]


Tobacco smoking

  • Iman Elfeddali and co-authors reported on the results of a randomized controlled trial of a multiple-sessions Web-based Attentional Bias Modification (ABM) self-help intervention. The intervention turned out to be ineffective in fostering cognitive bias reduction and continued smoking abstinence. However, there were some positive effects in heavy smokers. [link]
  • A development protocol by Iman Elfeddali and Hein de Vries focuses on implicit pictorial assessment and modification tasks aimed at targeting cognitive biases underlying the pros and cons of smoking. The study resulted in 30 pro-con picture pairs matched on valence, arousal and complexity, which were used to develop a training. [open access link]
  • Karin Hummel and co-authors assessed trends as well as factors associated with acceptance of smoking in public places and implementation of home smoking bans in the Netherlands. Social acceptance of smoking restrictions increased, despite a suboptimal implementation process of smoking restrictions. Acceptance of smoking is still quite high for some public venues like bars. [link]
  • Another study by Karin Hummel and co-authors examined the external validity of the Motivation To Stop Scale (MTSS) among Dutch smokers. The authors conclude that the MTSS is an externally valid instrument to predict quit smoking attempts in the next 12 months. [link]
  • A randomized controlled trial by Mutaz Mohammed and co-authors aimed to examine the efficacy of a smoking prevention program which aimed to address smoking-related cognitions and smoking behavior among adolescents aged 13 to 15 from Saudi-Arabia. The prevention program reinforced non-smoking cognitions and non-smoking behavior. [link]
  • Dennis de Ruijter and co-authors describe the development of a web-based computer-tailored program and the design of a randomized controlled trial testing its (cost)effectiveness. [link]


Family planning

  • Matthijs Eggers and co-authors identified socio-cognitive determinants of primary and secondary abstinence intentions and of early sexual activity among 12 to 16 year old students of non-private South African high schools. The authors conclude that addressing socio-cognitive factors in order to motivate adolescents to delay sex is more likely to be successful before they experience sexual debut. [open access link]
  • Trends in teenage pregnancy and associations with other health risk behaviors in South African school-going adolescents were examined by Kim Jonas and co-authors. Girls continue to become pregnant at unacceptably high rates. Sexual intercourse among adolescents has decreased slightly. However, among those who are sexually active pregnancy prevalence rates have increased. [open access link]
  • Another study by Kim Jonas and co-authors was conducted to gain an understanding of nurses’ and midwives’ intentions to provide maternal and child healthcare and family planning services to adolescents in South Africa. Self-efficacy had a strong and positive association with the intentions to provide both maternal and child healthcare and family planning services. [open access link]


Other topics

  • Latifa Abidi and co-authors report on the results of a Delphi study among healthcare professionals and addiction prevention experts on strategies to overcome barriers to implementation of alcohol screening and brief alcohol intervention in general practice. [open access link]
  • Vera Heijnert and Claudia de Wilde published a short Dutch-language article based on their bachelor thesis research on health warning labels on alcoholic beverages that they performed at our department under my supervision. [link]
  • Hein de Vries published a commentary on corporate social responsibility (CSR) and public health. He concludes that monitoring, identification and combatting CSR activities should be an integral part of preventive medicine, public health, and health promotion. [link]
  • Hein de Vries also published a comment on a publication about self-efficacy by David Williams and Ryan Rhodes. He concludes that we need to skip the main factor paradigm but adopt the interaction paradigm providing more details under which conditions and for whom things work. [link]
  • Polina Putrik and co-authors explored whether age, gender or education influence the time until initiation of the first biological disease-modifying anti-rheumatic drugs (bDMARD) in patients with rheumatoid arthritis from Norway. [link]


Happy New Year!

Building SuccessHave you also noticed that there exist many blogs
about habits of successful people? They all claim to have a list of the most important habits of successful people, but how do you know which blog to trust? It’s simple, you just perform a content analysis of blogs about habits of successful people and then make a top ten based on all these blogs!

The ten most mentioned habits of successful people according to the first 25 blogs I found when I typed ‘habits success’ on Google:

#1: Reflect on your goals
The absolute number one habit of successful people (according to 16 out of 25 blogs) is reflecting on your goals. Think about what you want to achieve and work to accomplish that goal.

#2: Exercise
Although you may tell yourself sometimes that you don’t have time for exercise, the number two habit of successful people is working out. It helps to clear your mind and keep your body healthy. You can even reflect on your goals at the same time!

#3: Relax and meditate
Although becoming successful takes hard work (see habit #5), you also need relaxation. Plan vacations and spend time with your family in weekends. Also make sure you make time for daily relaxation. For example, by making meditation part of your daily routine.

#4: Planning and prioritizing
If you have reflected on your goals (habit #1), you need to plan and prioritize accordingly. Many blogs stress the importance of daily planning. For example, planning what you want to accomplish on the following day.

#5: Working hard
Surprisingly, only half of all blogs about habits of successful people mention working hard. This is perhaps because you should think first about which things you want to work hard on (habit #1 and #4). But as soon as you have your focus in mind, working hard is the thing to do.

#6: Read every day
Reading can learn you new things, get you inspired, and helps you to relax. Do you need to read every day? That’s what 11 out of 25 blogs that I analyzed say.

#7: Wake up early
Set the alarm at 6:00 AM seven days a week, because waking up early will make you successful. Most blogs do not really explain how this works, they just mention some names of successful people who wake up early each day. Let me do the same: Barack Obama, Richard Branson, Jack Dorsey, Larry Schultz, Tim Cook, Robert Iger, Marissa Mayer, and Ursula Burns.

#8: Eating healthy
Eating healthy gives you energy, prevents diseases, keeps you in shape, and generally makes you feel better. This is a habit that everyone should have, not just successful people.

#9: Sharing
Successful people don’t keep everything they own for themselves. They share their success with other people. Sharing can be done in different ways, such as giving to charity, sharing ideas, giving advice, and volunteering.

#10: Networking
In business and in academia, your network is everything. So spend time talking with people, listen to them, and learn from them. One day you may end up in a business or working relation with them.


Sources: 10 Morning Habits Successful People Swear By, 10 Habits of Ultra Successful People: The Secret Sauce to Success, 5 Daily Habits of Highly Successful People, 16 Rich Habits – Your autopilot mode can make you wealthy or poor, 11 Essential Habits for Success, Fifty Habits of Highly Successful People, 12 Weekend Habits of Highly Successful People, 11 habits of highly successful people, 6 Daily Habits of Hugely Successful People, Hack Your Day: Morning to Nighttime Habits of Highly Successful People, 10 Habits of Successful People, 9 Success Habits of Wealthy People That Cost Nothing, 20 Habits That Will Make You Highly Successful, 11 Daily Habits of Exceptionally Successful People, 12 Powerful Habits I Have Stolen From Ultra-Successful People, 7 Great Habits Of The Most Successful People, 20 Habits for Success I Learned Working for Two Billionaires, 43 Experts Reveal Their No. 1 Daily Success Habit, 20 productive Habits of Successful (and Very Wealthy) People, Eight habits of highly successful people you can try today, How to Master the Habits of Successful People, 3 daily habits of the world’s most successful people, Habits Of Highly Successful Men, The 10 Must-Have Success Habits, 10 Habits of Successful People.

Shifting focus

During the past year, I have been shifting my focus to include other research topics than smoking cessation, I have learned new research methodologies, and started focusing more on teaching. Is it a smart move to change so much and ‘start over’ with having to learn many new things? I honestly don’t know. Is it always a conscious decision that these kinds of changes happen during your academic career? Definitely not. But more importantly: Is it fun and interesting to learn new stuff? For me it certainly is!

My new experiences
challenges-experience-signAfter a PhD study and a first post-doc study on the impact of tobacco control policies on smoking cessation, I started a second post-doc study last year on the impact of economic recessions on illegal drug use. A very interesting study in which we used the realist review method to describe the mechanisms that explain how economic recessions may change individuals’ illegal drug use. A publication on this topic is on its way, and I will definitely mention it here when it’s published. Meanwhile, if you are interested in the realist review method (which is relatively new and gaining popularity fast), read the book or paper by Ray Pawson. If you are interested in our project, check out our website or this short video.

After years of mainly focusing on doing my own research at Maastricht University, I am now supervising four PhD students there and I became a lecturer at a University of Applied Sciences (de Haagse Hogeschool). The PhD students that I supervise all study (different aspects of) smoking cessation, but at the Haagse Hogeschool I teach research methodology at the study program Nutrition and Dietetics. It turns out that I really like the supervision and teaching role and I also like it very much to learn things about Nutrition and Dietetics.

Finally, I started a few months ago with a new research project about health behavior change among multi-problem families. Multi-problem families have to cope with multiple problems and stressors in their family lives, such as socio-economic problems (e.g. financial problems, unemployment), psycho-social problems (e.g. domestic violence, psychiatric disorders), and problems associated with the upbringing of their children (e.g. neglect, maltreatment). In this project we examine smoking behavior, but also alcohol abuse, unhealthy nutrition, and physical inactivity. I have now started a series of qualitative interviews with members of multi-problem families to talk about their experiences with health behavior change. Both the new topics and learning to do qualitative research has been very inspiring.

What about you?
Should you change research topics or methods after your PhD or should you stick to what you know? It’s hard to say. Changing topics might increase your chances when you are looking for a new job, because you can show that you are versatile. However, sticking to your topic might increase your chances when you are applying for a grant, because grant reviewers and funding organizations have the trust that you know what you’re doing. But you should probably not worry too much about this, because more often than not it isn’t a conscious decision. In my case, I wrote two large grant proposals last year. One was about tobacco control policy and one about health behavior change among multi-problem families. The last one was accepted and the first one was not, which made the choice for me what I was going to do.

Time for Change - ClockIf you do have the choice, I would say: Go for it! It is fun and interesting to learn new stuff. Sometimes you feel a bit like you have to ‘start over’, like you are in the first year of your PhD again. But why would you be afraid of that? And you might feel like this, but in the end you have learned a lot of research skills already, which makes you learn and pick up new things much faster than when you just started. Are you considering a change to an entirely different research field? Then this blog post might be of interest to you.

Should you be afraid to lose everything you build up in the years that you worked on your previous topic? My experience is that you don’t have to stop working on your previous topic when you are starting new things. I am still involved in many smoking cessation research projects and in the network that comes with that. You don’t have to work twice as hard to work on two (or more) topics, you just have to learn to divide your attention.

As always, I am interested to learn about other people’s experiences. Feel free to post your experience, thoughts or questions below.

Good newsWe often focus on the bad news for tobacco control in the Netherlands. Smoking prevalence has stagnated at a quarter of the population. Socioeconomic inequalities in smoking are widening. The Dutch government is mediocre in implementation of tobacco control policies and when they do implement policies they sometimes reverse them later. But in the last couple of months some good news about tobacco control in the Netherlands came to light and that is the focus of my blog today.

In June of this year, Maastricht University, RIVM, and the Trimbos Institute completed a social cost-benefit analysis of tobacco control in the Netherlands. The analysis showed that tobacco control can decrease the number of smokers substantially and this gives a positive financial net benefit for society. Although the health benefit is the main reason why we should implement tobacco control policies, financial gains may help convince policy makers.

In July, the Trimbos Institute reported a sharp decline in smoking among schoolchildren aged 12 to 16 years between 2011 and 2015. Not only tobacco smoking declined, but also cannabis smoking and alcohol use. Use of e-cigarettes did increase, but most schoolchildren only try that once and do not become regular users. Moreover, a ban on the sales of e-cigarettes to minors has been implemented after this study came out.

In August, two scientific papers were published with good news for tobacco control in the Netherlands. The first paper was published in BMC Public Health and dealt with the prevalence of ‘hardcore smoking’. Smokers were considered ‘hardcore’ if they smoked every day, smoked on average 15 cigarettes per day or more, had not attempted to quit in the past 12 months, and had no intention to quit within 6 months. The prevalence of hardcore smoking decreased among smokers as well as among the general population. Therefore, the idea that as smoking prevalence declines, the smoking population becomes hardened and more difficult to reach was not supported for the Netherlands.

The second scientific paper that came out in August was published in Nicotine & Tobacco Research. It showed that the social acceptability of smoking has been decreasing over the past ten years in the Netherlands. Nowadays, smoking is only considered socially acceptable on the street, on a terrace, and in a bar. This last finding can be explained because smoking is still allowed in smoking rooms in bars and some bars do not comply with the smoke-free legislation. Additionally, the exception on the smoking ban for small bars was still in place when this study ended. The study also showed that the number of people with a home smoking ban increased.

More good news is expected in the coming months, because the Stoptober campaign will again take place in the Netherlands this year. Last year, almost 70,000 people participated in the Dutch version of Stoptober. Although Stoptober is about temporarily stopping smoking for 28 days in October, most participants were still stopped two months after Stoptober. The mean number of cigarettes per day of those who did go back to smoking decreased from 17 to 10 cigarettes per day.

Of course there are also downsides to the positive news. The report about smoking in schoolchildren and both scientific papers that came out this month showed large socioeconomic differences. People with a lower socioeconomic status smoke more, are more often hardcore smokers, think it is more socially acceptable to smoke, and less often have a smoke-free home. Targeted interventions are needed to prevent smoking initiation and stimulate smoking cessation among groups where smoking prevalence is still high, such as people with a low socioeconomic status and people with mental health conditions. Another issue is that people should not be stigmatized when they really cannot quit or don’t want to quit. This is something that needs increasing attention in a society in which smoking is no longer considered socially acceptable, where people talk about a smoke-free generation, and where Stoptober makes you believe that quitting smoking can be easily done. We should not forget that tobacco is highly addictive, that some people really cannot quit, and that they are victims who made a wrong decision when they were young.

Although theRaise tobacco taxesre are now several media campaigns that discourage smoking and smoking bans are being strengthened in the Netherlands, the most important policy to decrease smoking ánd decrease socioeconomic differences in smoking is large increases in tobacco taxes. Without large tax increases we will not reach the reduction in smoking prevalence that the social cost-benefit analysis has calculated. Thus, so much positive news does not mean that no further action is needed.