Monitoring and Evaluation of Dutch Tobacco Control Activities: The International Tobacco Control (ITC) Netherlands Study.

Smoking is the number one preventable cause of death in the Netherlands. Population-level environmental policies and interventions are the best strategy for reducing this health threat. It is essential to rigorously evaluate tobacco control policies by providing concrete evidence for their effectiveness and better understanding how they impact on population smoking. The ongoing ITC Netherlands Study created a national-level system to evaluate the National Tobacco Action Plan in 2005-2010. This led to strong, high-profile recommendations to improve existing Dutch policies. Continuation of ITC Netherlands Survey is relevant with a view on current and future tobacco control initiatives. Alread, two initiatives have presented themselves. First, the financial reimbursement for smoking cessation be health care insurance in 2011. Given the current political and economical situation, it is not yet clear whether the reimbursement for smoking cessation will continue after 2011. Discontinuation will provide a natural experiment demonstrating how smokers’ help seeking behavior and their quitting behavior are affected by the on- and offset of reimbursement. Second, continuation of ITC Netherlands will also make it possible to evaluate the 2011 cigarette tax. It is crucial to continue the ITC Netherlands Survey cohort in order to be able to evaluate these new initiatives, using an established rigorous research monitoring system. In addition, it is expected that various new EU tobacco control policies will be implemented from 2012/13 onwards. Since EU directives are mandatory for Member States, the Netherlands has to implement these measures as well and they need to be evaluated. Furthermore, by being part of the International Tobacco Control Policy Evaluation Project, the Netherlands will continue to learn from progress made in other countries that implement stronger tobacco policies. It is important, for the same rigorous tools of the ITC Project to be used where such policies are not being implemented or when those policies, such as smoke-free laws, are weakened, such as is the case in the Netherlands. It is precisely in this climate in our country in which funding is being reduced for strong tobacco control that the existing ITC evaluation system is more critically needed. We therefore propose to continue the ZonMw-funded ITC Netherlands study, surveying a longitudinal sample of smokers for three more years, using the extensive ITC Survey, being conducted in 20 countries, allowing cross-country comparisons. The aims of the study are to evaluate the effect of specific tobacco control environmental policy measures on smoking cessation and to uncover factors that hinder or strengthen the effectiveness of these policy measures and hinder or strengthen the implementation of new measures in the Netherlands. The study results will be used to formulate recommendations on effective new Dutch tobacco policy and how to implement this in the specific Dutch cultural and political context.