Jan van Reek

It would have been possible to solve the tobacco problem a long time ago, if schoolchildren could be convinced not to start smoking (the direct method). Unfortunately general measures have to be taken in order to achieve changes on the long term (the indirect method).

Devastating effects of smoking on health were found in 1950. Despite this knowledge and a decreasing smoking prevalence, roughly one million Dutch people have died due to smoking since 1950.

Gadourek carried out the first scientific survey on Dutch smoking behaviour ¹. He found that nearly all men and far fewer women smoked in 1958 (see figure).

Little pressure was exerted on the tobacco industry during the fifties. Provocations began when Robert Jasper Grootveld wrote ‘cancer’ on tobacco billboards in Amsterdam. He was arrested in December 1961 and had to spend sixty days in jail. Nationwide anti-smoking campaigns started when the charismatic Dr Meinsma warned for the dangers of tobacco consumption on the only television net at the end of 1963. His crusade continued until 1978. The Foundation on Smoking and Health (STIVORO) had been established in 1974.

We reported about the lacking effects of the campaigns among schoolchildren (the direct method) and advised tobacco tax increases³, support to cessation attempts, a ban of tobacco promotion and smoking restrictions in public places (the indirect method) in 1985 ⁴. Later we investigated if smoking initiation could be influenced directly. Six factors (smoking by age peers, parental smoking, availability of tobacco, pocket money, self-efficacy and beliefs) were statistically significant predictors over the two years but failed to classify new smokers accurately. Who started smoking from the age of 13 to 15 was predicted with the accuracy of the roll of a die! We published about the missing base for the direct method in 1995 ⁵. Willemsen and De Zwart reviewed the literature on smoking reduction among adolescents in 1999. They found the ban of tobacco promotion, price increases and a smoking ban on schools as effective measures ⁶. Therefore, the elements of favourable programmes for schoolchildren are very similar to the previously mentioned general policy. However, effects can only be expected among adolescents if combined measures are taken.

At that time, campaigners at STIVORO lacked the public appeal of Dr Meinsma. The continuing decreases of smoking percentages during the eighties and nineties were a pleasant surprise. The Millennium Campaign for smoking cessation became a turning point. Circa 100,000 smokers had still quitted after one year. Actions against passive smoking by ‘Clean Air Now’ gave an impulse to a new policy. Theo van Iwaarden prepared an improved Tobacco Law at the Ministry of VWS. Sales restrictions for tobacco products, nonsmoking at the workplace and further advertisement restrictions became law in 2003. Nonsmoking in public transport, higher tobacco taxes and a large cessation campaign were the new measures of 2004 ⁷. 300,000 smokers had stopped by the campaign at the end of 2004. The annual decrease of ½% in adult smoking during the 1990's accelerated to 1% in the new millennium. 

A historical overview by age gives interesting information. The percentages of smokers among 15-19-year-olds dropped annually 2% in 1967-1978, little change in 1979-2002, 2% in 2003-2004 and a standstill in 2005. So the fall was highest during the days of Meinsma and during the introduction of the new law. Adolescent smoking drops when real action is taken.

The mentioned trend can be confirmed for the years since 1992, when percentages of daily smokers are available for the adolescents from the NIPO-surveys. Smoking among 13-15 and 16-19-year-olds changes little from 1992 until 2002, drops in 2003 and 2004 and halts in 2005. Also notice how low smoking has become among the elderly.

The drop in adolescent smoking can be revived if comprehensive measures are taken. Important new stimuli would be: 

1. I Gadourek (1963) Riskante gewoonten (hazardous habits). Groningen. 

2. J van Reek (1985) Smoking behaviour in the Netherlands. A striking decrease between 1958-1982. Hygie 4, 19-23.

3. J. van Reek, H Hagen, H Adriaanse, T van Iwaarden (1989) Changes in Dutch tobacco production since World War II: implications for an anti-smoking policy. Health Policy 11, 233-238. 

4. J van Reek, MJ Drop, H. Adriaanse (1985) Stoppen met roken sinds 1958 (smoking cessation since 1958). T Alc Drugs 11, 168-173.

5. J van Reek, R Knibbe et al. (1995) Predictors of smoking behaviour. The Dutch Cohort Study of Secondary Schoolchildren. In: K Slama (ed.) 8th World Conference on Tobacco or Health. Plenum Press. New York and London, 387-389.

6. MC Willemsen, WM de Zwart (1999) The effectiveness of policy and health education strategies for reducing adolescent smoking: a review of the evidence. Journal of Adolesence 22, 587-599.

7. GJJ Prins, MC Willemsen (2004) Tabakswetgeving in Nederland (tobacco legislation in the Netherlands). Hartbulletin 35, 95-97.