We 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 there 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.