Smoking increases the likelihood of illness. We therefore focus on tobacco control. Researchers are developing knowledge for healthcare and social welfare professionals which they can use to help people to give up smoking, as well as knowledge to help local authorities achieve a smoke-free environment, where not smoking is the norm.

Knowledge about smoking and tobacco control

Smoking is the most important avoidable cause of illness and death. Each year over 19,000 people die in the Netherlands as a result of active and passive smoking. Each week, hundreds more children become addicted to smoking.

People with a low level of education have more difficulty quitting smoking, and are less likely to use services to help them stop. Smoking is also more common among people with lower socioeconomic status. In fact, smoking accounts to a large degree for the health differences between people with high and low socioeconomic status. 

The Tobacco Control Research Agenda (Gezondheidsfondsen voor Rookvrij, ‘Smoke-free Health Funds’) was drawn up in 2017, in collaboration with scientists and health funds. In the agenda, we highlighted the knowledge needed in relation to tobacco control. Researchers are now developing this knowledge and making it applicable for practitioners, using grants awarded by ZonMw.

This newly developed knowledge will allow healthcare and social welfare professionals to offer their clients better support to help them quit smoking. But it will also be useful to local authorities and sports clubs, for example, helping them to achieve a smoke-free environment in which children are not tempted to start smoking, because not smoking is the norm.

Local smoke-free policies and the role of the social domain in quitting

The National Prevention Pact encourages local authorities to adopt a local smoke-free policy. Local authorities are now increasingly engaging in activities designed to achieve a ‘smoke-free generation’. This report  contains a list of elements that have proved effective in local tobacco control policies (available in Dutch)

Strengthening the local infrastructure allows local partners to collaborate better on initiatives to help people quit smoking. This benefits residents with low SES in particular. Kennemerland (available in Dutch) regional authority is introducing a local strategy to successfully and sustainably implement quit smoking initiatives in three development neighbourhoods.

People with a low level of education (available in Dutch) have more difficulty quitting smoking, and are less likely to use services to help them quit. What role can the social domain play at local and national level? And what forms of collaboration are possible involving healthcare services and residents? This project is exploring the potential at local and national level. Another project is focusing on the same subject in the Amsterdam Noord district (available in Dutch)

GP practices and help with quitting smoking

No fewer than 80% of all smokers want to stop smoking. Only a small proportion manage to do so without help. The Very Brief Advice Plus (available in Dutch) method allows GPs to issue patients with a warm referral for professional counselling and guidance. Patients do not then need to pursue the referral or make an appointment themselves.

GPs often have plenty of assistance to offer, but people are not always aware of the help available to them. A learning network (available in Dutch) has been established in The Hague consisting of healthcare providers, residents and local policymakers. The network ensures that residents and healthcare and social welfare professionals know where to access quit smoking support services.

By building better connections between primary healthcare, public healthcare and the social domain, we hope to ensure that GPs provide more effective lifestyle advice (available in Dutch). The projects should help achieve a successful, comprehensive and accessible supply of local prevention services.

Helping pregnant women (with low SES) to quit smoking

Almost 7% of Dutch women smoke during pregnancy. The figure for women with a low level of education is as high as 22%. Smoking during pregnancy can lead to miscarriage, premature birth, congenital defects and even the death of the foetus. Quitting smoking produces major health benefits for both mother and child.

It is not easy to stop smoking. Pregnant women with low socioeconomic status (available in Dutch) often experience stress, too, which tends to perpetuate their smoking habit, as it provides a way to relax for a moment. Researchers are developing an app and measuring whether it does indeed help women to stop smoking more quickly, reduce their stress levels, and/or improve their child’s development after birth.

The Trimbos Institute has developed guidance for pregnant women (available in Dutch) who wish to stop smoking. It is now being adapted for women with low socioeconomic status.

Research to protect children from smoking

The National Prevention Pact aims to achieve a ‘smoke-free generation’ by 2040. Research into tobacco control can help us create a society where no one suffers the effects of or dies from smoking.

Smoke-free Health Funds has developed a roadmap to create a smoke-free generation, protecting children from smoking and from the temptation to start themselves. The movement is an integrated strategy for local tobacco control policy that aims to protect children from active and passive smoking.

Since active and passive smoking is more common in groups with low socioeconomic status (SES), the smoke-free generation initiative could potentially make a huge contribution towards efforts to reduce socioeconomic health inequalities. This study is exploring whether low SES groups benefit from the initiative to the same degree (available in Dutch) as high SES groups.

Children will be more inclined to take up smoking if they see others doing it. To achieve a smoke-free generation, it is therefore important that smoking becomes less and less visible, particularly to children. One way of achieving this is to ban smoking at sports clubs, as many children spend a lot of their free time there. The Dutch Heart Foundation has produce a step-by-step plan to making sports clubs smoke-free zones. Researchers are now working on the implementation of the plan.

Gender differences in the effectiveness of tobacco control policy and campaigns

Do tobacco control policies and campaigns work equally well for all people? Research suggests that women have more difficulty staying off cigarettes than men once they have quit. How can the effect of gender and sex be measured in research? This project (available in Dutch) is investigating gender, sex, age and socioeconomic differences in the effects of tobacco control policies and campaigns on smoking behaviour.

Quit smoking courses in the workplace

Previous research has shown that quit smoking courses in the workplace (available in Dutch) combined with financial rewards for success is an effective way of helping smokers with low socioeconomic status (SES) to stop smoking. Researchers are now performing an implementation study to establish how quit smoking courses with financial rewards can be expanded in the private sector.

Research in collaboration with Smoke-free Health Funds

The Smoke-free Health Funds’ Tobacco Control Research Agenda (Smoke-free Health Funds) was drawn up in 2017, in collaboration with scientists and health funds. The agenda highlights what knowledge is needed for tobacco control. 

Nine studies were launched on the basis of the research agenda in 2017 and 2019. Four consortiums funded with ZonMw grants are performing effect or implementation studies to ensure better use and reach for existing interventions. The Smoke-free Health Funds, the  Trombosestichting (Thrombosis Foundation) and the Diabetes grant scheme also donate to five other studies in this area, including studies on policy.

Prevention research

By funding prevention research, ZonMw helps provide innovative knowledge on disease prevention and health promotion, so that everyone can live as healthily as possible in a healthy environment. Our focus is on lifestyle, the living environment and socioeconomic health inequalities.


Met preventieonderzoek zorgt ZonMw voor innovatieve kennis over preventie en gezondheidsbevordering, zodat iedereen zo gezond mogelijk kan leven in een gezonde leefomgeving. Dit doen we door in te zetten op leefstijl, leefomgeving en sociaaleconomische gezondheidsverschillen.