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The government believes we should get rid of cigarettes. All sorts of measures are making it increasingly difficult for smokers, but is it enough? Not so according to the Trimbos Institute, which therefore wants to focus more on advice when trying to quit.
In 2018, the government concluded the National Prevention Agreement. Part of this is the “smoke-free generation”: by 2040, every child must grow up in a smoke-free environment. In addition, the number of adults who smoke must have fallen to less than 5 percent.
“Measures are having an impact”
Since then, many deterrent measures have also been taken. For example, cigarettes are now only available in plain packaging, smoking areas have disappeared and smoking is no longer permitted near schools and other educational institutions. This year there will be a sales ban for supermarkets and excise taxes on tobacco products will be increased again.
Marc Willemsen sees these measures as having an effect. He is head of the tobacco program at the Trimbos Institute and conducts research on deterrence of tobacco products such as cigarettes and roll-your-own tobacco. “We even received a compliment from the World Health Organization.”
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The decline in smokers is stagnating
Figures from CBS, RIVM and Trimbos Institute also show that things are moving in the right direction: ten years ago, more than a quarter of Dutch people smoked, and by 2022 this number has fallen to around 19 percent. “But you can see that this value is stagnating slightly again and smoking is increasing slightly again, especially among young people,” says Willemsen.
The popularity of e-cigarettes and vapes plays a major role. For a long time they were allowed to contain all sorts of sweet flavors, which allowed the tobacco industry to reach a new target group. To put a stop to this, there has been a ban on this type of flavors since January 1st, only the flavor of tobacco is allowed.
“Cigarettes still very affordable”
But according to Willemsen, that’s not enough to stop young people (and others) from smoking. “An increase in excise taxes is the most important thing,” he emphasizes. “Cigarettes are actually still very affordable in the Netherlands. It is important that the price of cigarettes continues to rise and that this happens by at least 10 percent annually, as the WHO advises.”
He sees another important point: “Of course you also have to help smokers to stop smoking.” According to him, it is “very important” that smokers receive “much more generous” support. “So that health care is also much more involved. That general practitioners advise smokers to stop smoking and refer them to specialist smoking cessation support.”
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Instructions for quitting
This is already happening in various places in the country, including Nijmegen. There, Willem and Miriam receive instructions from trainer Fianne Eijkman in their attempt to quit smoking. Through exercise, they work towards a healthy lifestyle that does not include smoking.
“I have a concussion and therefore can’t work or play sports at the moment,” says Miriam. “It made my social life completely different, so I started smoking again. Coincidentally, I had to go to the doctor, who told me that I could join such a group. She said that at exactly the right time.”
Last longer
At Eijkman, participants receive a total of six group sessions spread over several weeks, explains the trainer. “The first three are all about: How do you stop smoking? What is my motivation? What are my impulses? And what are my pitfalls? How do you sustain this longer term?”
“After that, it’s much more about: How can I relax?” she continues. Many smokers relapse. This also applies to 73-year-old Willem, who started smoking at the age of fifteen. Like Miriam, he had tried to quit several times, but without success. “Until my urologist said, ‘I’m giving up on you now.’ I had no objection to it.
“Peer pressure helps”
Said and done. During the training, Miriam and Willem learn to recognize their impulse moments and to move in such moments so that they can more easily suppress the urge for a cigarette. After six sessions, both are convinced that they have finally stopped.
“It helps when you are with several people,” says Willem. “I really can’t say I’ve learned something if the others haven’t either,” adds Miriam. Willem: “And we have a group app where we all cheer each other up a little, that helps.”
Miriam and Willem follow a stop training with trainer Fianne Eijkman (left)
Four times more likely to stop
The Trimbos Institute has calculated that this type of guidance, combined with nicotine aids such as patches or tablets, increases the likelihood of quitting smoking four times. Since 2020, everyone has been able to make a free exit attempt once a year, as health insurance companies do not charge a deductible for advice on the first exit attempt.
But according to the knowledge center, the compensation should not only apply to the first attempt to exit. “Since smokers often relapse, you should be able to stop smoking at any time,” says program manager Willemsen. “And you shouldn’t put it off because you’ve already tried to quit this year.”
Financed with excise taxes
More comprehensive compensation doesn’t have to cost much; the revenue from the excise tax could be used for it, he suggests. “Nowadays the proceeds from tobacco sales often end up going to other problems in the country, but this should be put much more into large public campaigns so that people can find this support.”
The excise tax on cigarettes will increase by 60 cents in April, meaning a pack will cost an average of 10.70 euros. It has not yet been decided whether tobacco products will become even more expensive later. If the Trimbos Institute has its way, that will happen.
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“Takes very long”
At the same time, Willemsen emphasizes that other measures to prevent smoking are also important and therefore need to be taken more quickly. For example, stricter sales rules: From next year, e-cigarettes will only be available in specialist retailers, but from 2032 this will only apply to tobacco.
“This takes a really long time. Then you give the entrepreneurs a lot of space and opportunity to think of all kinds of ways so that they can keep selling,” he says. “And a smoke-free generation in 2040: why does it have to take so long? That’s in 16 years. Politics can advance this. After all, it’s about public health.”
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