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Objective: Despite a nationwide ban on tobacco sales to people under 18 years of age, adolescents can still buy tobacco products in Amsterdam. This study aimed to understand the influence of the retail environment in adolescents' activity spaces on their tobacco-purchasing behaviour. Method: Interviews were conducted with 13 adolescents (aged 14-19 years) who went to school in Amsterdam and had ever bought tobacco products. Questions were based on the capability, opportunity, motivation, behaviour (COM-B) model. City maps showing all tobacco outlets were used to visualise respondents' activity spaces and purchasing areas. Transcripts were analysed thematically. Results: Adolescents preferred purchasing tobacco at shops where they had successfully purchased it before, instead of going to just any shop close by. They purchased tobacco products mostly in small shops. Supermarkets were avoided, as employees complied with age-verification procedures. The city centre provided easy access because the density of small shops was high. In adolescents' residential area, acquaintances behind the counter might facilitate tobacco purchase, while it was a barrier for minors who secretly smoked. At school, adolescents developed a collective knowledge of shops that sold tobacco products to minors either near school or further away. Tobacco was also bought on the black market because it was cheaper or because it was possible to buy specific products (e.g. snus). Conclusion: Tobacco purchasing by minors is less about the proximity and more about which stores in their activity spaces sell tobacco products to minors. Policies should therefore be aimed at the enforcement of age limits and reducing the number of small shops selling tobacco.

Background: The cost of tobacco is one of the most reported reasons to quit smoking. The Netherlands increased tobacco taxes twice in the span of nine months: a €1 increase per pack in April 2020, and a €0.12 increase per pack in January 2021. This study examines to what extent people report to think about quitting due to the upcoming tax increase(s), as well as how it relates to their age, income or educational level. Additionally, we examined whether thinking about quitting was associated with quit intention and quit behaviour, and whether these associations were different for the two tax increases. Methods: Longitudinal data from the International Tobacco Control (ITC) Netherlands Surveys, Cohort 2 were used (N = 5919 observations; wave 1 (February – March 2020): n = 2051; wave 2 (September – November 2020): n = 1919; wave 3 (June – July 2021): n = 1949). Generalised Estimating Equation (GEE) regressions were fit to test the associations between thinking about quitting due to the tax increase and post-tax increases in quit intention, serious quit attempts, and quitting smoking (≤ 1 cigarette a month), as well as sociodemographic variables. Results: Circa half of the people who smoke reported thinking about quitting smoking due to the upcoming tax increase (Wave 1 = 51.3% (n = 1052); Wave 2 = 47.3% (n = 849)). Individuals who reported thinking about quitting smoking due to upcoming tax increase(s) were more likely to have increased their quit intention (aOR: 2.00, p ≤.001) or have carried out a serious quit attempt (aOR:1.48, p ≤.001) post-tax increase. More people attempted to quit smoking between wave 2 and 3 (post 2021 increase) than between wave 1 and 2 (post 2020 increase). We did not find an interaction effect between wave and thinking about quitting for quit intention, quit attempts, and quitting smoking. Conclusions: Tax increases stimulate people to think about quitting. Thinking about quitting due to an upcoming tax increase was associated with more positive quit intention and serious quit attempts. [ABSTRACT FROM AUTHOR]

Background Physical distancing is an effective preventative measure during respiratory infectious disease outbreaks. Prior studies on distancing behaviors have largely ignored context characteristics (physical, social) and time. Purpose We investigated patterns in physical distancing over time and across situations, as well as sociodemographic variation herein. Methods We employed data from five rounds of a cohort study conducted throughout the pandemic by the Dutch public health institute (RIVM; N ≈ 50.000 per round). We conducted Latent Class Analyses to investigate patterns of physical distancing in a range of situations, followed by regression models to investigate associations between distancing behavior and sociodemographic and context characteristics. Results Participants differed in their general tendency to adhere to distancing guidelines across situations, but there were also substantial differences in distancing behavior between situations, particularly at work, with friends and family and outdoors. Distancing at work was strongly associated with work environment characteristics. Younger age groups reported less distancing behavior, particularly with close relations (friends or family) and at work. In periods when the pandemic situation was most severe, people adhered more strongly to distancing guidelines and age differences were most pronounced during these periods. Conclusions Physical and social context matters for physical distancing, highlighting the importance of developing strategies for pandemic preparedness that improve opportunities for physical distancing (e.g. reducing crowding, one-way traffic) and accommodate young people to safely meet even in times of high pandemic severity and lockdowns. Future studies should account for the physical and social context in which distancing behavior is observed. [ABSTRACT FROM AUTHOR]

Introduction Little is known about smoking cessation among gender minority populations compared to cisgender individuals (whose gender matches their sex assigned at birth). We examined differences between smokers from gender minority populations, cis-women, and cis-men in the heaviness of smoking, quit intentions, use of cessation assistance, quit attempts (ever tried and number), and triggers for thinking about quitting. Aims and Methods We used cross-sectional data from the 2020 International Tobacco Control Netherlands Survey. Among smoking respondents, we distinguished (1) cis-women (female sex, identified as women, and having feminine gender roles; n = 670), (2) cis-men (male sex, identified as men, and having masculine gender roles; n = 897), and (3) gender minorities (individuals who were intersex, who identified as nonbinary, genderqueer, had a sex/gender identity not listed, whose gender roles were not feminine or masculine, or whose gender identity and/or roles were not congruent with sex assigned at birth; n = 220). Results Although gender minorities did not differ from cis-women and cis-men in the heaviness of smoking, plans to quit smoking, and quit attempts, they were significantly more likely to use cessation assistance (20% in the past 6 months) than cis-women (12%) and cis-men (9%). Gender minorities were also significantly more likely to report several triggers for thinking about quitting smoking, for example, quit advice from a doctor, an anti-smoking message/campaign, and the availability of a telephone helpline. Conclusion Despite equal levels of quit attempts and heaviness of smoking, gender minority smokers make more use of smoking assistance, and respond stronger to triggers for thinking about quitting smoking. Implications Smoking cessation counselors should be sensitive to the stressors that individuals from any minority population face, such as stigmatization, discrimination, and loneliness, and should educate their smoking clients on effective coping mechanisms to prevent relapse into smoking after they experience these stressors. Developing tailored smoking cessation programs or campaigns specifically for gender minority populations can also be useful. Based on the results of our subgroup analyses, programs or campaigns for younger gender minority smokers could focus on the availability of telephone helplines and on how friends and family think about their smoking behavior. [ABSTRACT FROM AUTHOR]

Objective: One explanation for the relationship between TV viewing and obesity is that people may (over)eat while watching TV. The current study investigated associations between TV viewing and the time spent on (concurrent) eating in a naturalistic setting among a general population sample. Design: Preregistered secondary data analyses were performed of a diary survey in which respondents reported their time use in 10-min blocks for 7 d. Setting: Concurrent TV viewing and eating was operationalised as all blocks in which TV viewing and eating occurred simultaneously. Furthermore, the TV content respondents watched was coded as food-related (i.e. culinary content) or non-food related. Participants: The sample composed of 2292 adults (58·9 % female) in the Netherlands, aged ≥ 20 years, from all educational levels (18·1 % low, 29·8 % middle and 51·4 % high). Results: More than half of the respondents (51·3 %) reported concurrent TV viewing and eating at least once during the 7-d diary period. The average eating occasion was longer in duration while watching TV (v. without media use), and the total time spent on eating was longer on days of concurrent TV viewing and eating (v. days of eating without media use). The percentage of TV viewing time spent on concurrent eating did not differ between food-related and non-food-related TV content. Conclusions: Eating while watching TV was related to an increased time spent on eating. Even though energy intake was not assessed, these findings from a naturalistic setting provide further evidence that concurrent TV viewing and eating may contribute to overeating. [ABSTRACT FROM AUTHOR]

Introduction: Cigarette affordability, the price of tobacco relative to consumer income, is a key determinant of tobacco consumption. This study examined trends over 12 years in individualised factory-made cigarette affordability in the Netherlands, and whether these trends differed by sex, age, and education.Methods: Data from 10 waves (2008-2020) of the International Tobacco Control (ITC) Netherlands Surveys were used to estimate individualised affordability, measured as the percentage of income required to buy 100 cigarette packs (Relative Income Price, RIP), using self-reported prices and income. The higher the RIP, the less affordable cigarettes are. Generalised estimating equation regression models assessed trends in individualised affordability over time and by sex, age, and education.Results: Affordability decreased significantly between 2008 and 2020, with RIP increasing from 1.89% (2008) to 2.64% (2020) (p≤.001), Except for 2008-2010, no significant year-on-year changes in affordability were found. Lower affordability was found among subgroups who have a lower income level: females (versus males), 18-24 and 25-39 year olds (versus 55 and over) and low or moderate educated individuals (versus high educated). Interactions between wave and education (p=.007) were found, but not with sex (p=.653) or age (p=.295). A decreasing linear trend in affordability was found for moderately (p=.041) and high-educated (p=.025), but not for low-educated individuals (p=.149).Conclusions: Cigarettes in the Netherlands have become less affordable between 2008 and 2020, yet this was mostly due to the decrease in affordability between 2008 and 2010. There is a need for more significant increases in tax to further decrease affordability.Implications: Our findings suggest that cigarettes have become less affordable in the Netherlands between 2008 and 2020. But, this appears to be the result of a steep decrease in affordability between 2008 and 2010. Affordability was lower among groups who have on average lower incomes (females, young adults, low- and moderate educated individuals), and differences in trends across education levels could be explained by per capita income changes. Our individualised measure indicated lower affordability than published aggregate affordability estimations. Future tax increases should be large enough to result in a lower affordability. [ABSTRACT FROM AUTHOR]

Aims: Exposure to tobacco products and advertising at the point of sale may be associated with pro‐smoking cognitions. However, previous studies on this topic measured exposure based on self‐report and did not include European countries. The aim of this study was to assess the association between objectively measured exposure to tobacco outlets and non‐smoking adolescents' smoking attitudes, beliefs and norms. Design: This cross‐sectional study combined survey data with Global Positioning Systems data using geographic information system. Setting: The four Dutch cities of Amsterdam, Eindhoven, Haarlem and Zwolle. Participants: We retrieved data of 308 13 to 17‐year‐old non‐smoking adolescents, mainly girls (61%), adolescents attending pre‐university secondary education (71%) and without smoking friends (58%). Measurements Exposure was measured with a smartphone app registering for 2 weeks how often participants were within 10 m of a tobacco outlet. We distinguished between outlets without visible tobacco promotion (i.e. supermarkets), with only internal visibility and with both internal and external visibility. Participants' reported smoking cognitions were dichotomised into pro‐smoking or anti‐smoking. We applied multi‐level logistic regression analyses and adjusted for age, sex, educational level and smoking friends. Findings On average, adolescents were exposed to 1.18 (SD = 1.23) tobacco outlets per day. Higher exposure to tobacco outlets was associated with higher odds of pro‐smoking injunctive norm (OR = 1.35, 95% CI = 1.04–1.75). Associations with attitude (OR = 1.12, 95% CI = 0.91–1.38), social beliefs (OR = 1.15, 95% CI = 0.93–1.43), health beliefs (OR = 1.18, 95% CI = 0.97–1.44) and descriptive norm (OR = 1.15, 95% CI = 0.91–1.44) were also positive, but non‐significant. Overall, associations were strongest for outlets with internal visibility, for instance, for injunctive norm (OR = 1.37, 95% CI = 1.03–1.81). Conclusions: Global Positioning Systems‐measured exposure to tobacco outlets was associated with pro‐smoking cognitions among non‐smoking adolescents in the Netherlands. [ABSTRACT FROM AUTHOR]

School-based health interventions are potentially an effective method to communicate health messages to adolescents. Unfortunately, effectiveness of such interventions is limited. Research in other contexts has shown that interpersonal communication can influence the effectiveness of health programs, but this has not been thoroughly tested for school-based health interventions. Therefore, our study investigated interpersonal communication (i.e., conversational valence and frequency) in a school-based intervention context. We used a three-wave randomized-controlled trial with 1056 students to study three aims. The first aim was to investigate the influence of a health intervention on conversational frequency and valence about drinking, snacking, and exercising. Our second aim was to investigate the influence of conversational frequency and valence on (predictors of) drinking, snacking, and exercising. Our third aim was to investigate whether the health intervention indirectly influenced the program outcomes through conversational frequency and valence. Findings showed that conversational frequency and valence were related to (predictors of) the three behaviors. Additionally, findings showed that the intervention did not influence conversational frequency and valence. Accordingly, findings showed no indirect influence of the intervention on program outcomes through conversational frequency and valence. Our findings show the potential of interpersonal communication for health behaviors and predictors; however, they also stress the importance of a health intervention to properly influence interpersonal communication. If health interventions can successfully influence interpersonal communication, intervention effectiveness can be improved. [ABSTRACT FROM AUTHOR]

Introduction: Political acceptability and successful implementation of tobacco control policies at the point of sale may depend on, among other factors, tobacco retailers' level of support for these policies. This study quantified the level of support among small tobacco retailers for four point-of-sale tobacco control policies and its association with three predictors.Methods: We used cross-sectional telephone survey data (August 2019) of 508 small tobacco retailers in England. Weighted logistic regression analyses examined associations between support for the product display ban, price display ban, minimum pack size, and standardized packaging, and self-reported importance of tobacco sales for a business, contact with the tobacco industry, and the perceived impact of the policy on their overall business.Results: A majority of retailers support minimum pack size (66%), product display ban (65%), price display ban (54%), and standardized packaging (55%). The importance of tobacco sales was not associated with support for the policies. More frequent contact with the tobacco industry was associated with higher odds of support for minimum pack size (OR: 2.01, 95%CI:1.25-3.21), but not with the other three policies. The negative perceived impact of the policies, compared with neutral, was associated with 1.5 to three times lower odds of support for all four policies.Conclusion: In England, small retailers' support for the four point-of-sale tobacco control policies varied between 54% and 66%. Support seems unrelated to the perceived importance of tobacco sales, and contact with the tobacco industry, but seems strongly related to the perceived impact of tobacco control policies on their business.Implications: This study shows that small independent retailers' support for point-of-sale (PoS) tobacco control policies is fairly high and that the lack of support voiced by retail trade organizations is not representative of the views of retailers in England. Support rates may be further improved by addressing retailers' perceptions of the impact of policies on their business. Support was not related to retailers' perceived importance of tobacco sales for their business and their contact with the tobacco industry. The industry rhetoric is not supported by our findings, as the majority of small independent retailers in England support tobacco control regulations. [ABSTRACT FROM AUTHOR]

Introduction: Macroeconomic studies have shown that young individuals who smoke, and have a low socioeconomic status respond more strongly to price increases. Most of this evidence stems from research on factory-made (FM) cigarettes. With the rising popularity of roll-your-own (RYO) tobacco, there is a need for studies on cigarette demand that distinguish between both.Aims and Methods: This study examined whether individual demand differed for FM and RYO tobacco, and across age, and socioeconomic (income and education) groups. Purchase tasks for FM and RYO cigarettes were included in the 2020 International Tobacco Control (ITC) Netherlands Survey. Adults who smoke daily (n = 1620) stated how many cigarettes they would smoke in 24 hours across eight prices. Four demand indices were derived: intensity (consumption at zero costs), alpha (rate of change in elasticity), Pmax (turning point elasticity), and breakpoint (lowest price where consumption equals zero). The indices were tested for subgroup differences.Results: Individuals who smoke RYO tobacco indicated higher intensity, and greater alpha than individuals who smoke FM cigarettes. Participants aged 25-39 had lower Pmax, and 18-24 year olds displayed higher breakpoints. Participants with low income displayed higher intensity, and lower Pmax than other income groups. No associations were found with education.Conclusions: Individuals who smoke RYO tobacco indicated higher price sensitivity than those smoking FM cigarettes, supporting the need to harmonize tobacco taxation. Taxation may be especially beneficial to reducing consumption among individuals with a low income or smoke RYO tobacco. Substantially higher prices are needed in the Netherlands to achieve the desired results.Implications: Individuals who smoke daily were willing to pay substantially higher prices than the current market prices, indicating the room and need for much higher taxation levels. Demand for RYO tobacco was more sensitive to price changes than demand for FM cigarettes. Taxation should be raised at equivalent rates for FM and RYO cigarettes. Taxation appears to be especially effective in reducing consumption among people who smoke RYO tobacco and low-income individuals. It remains important to combine increased taxation with other tobacco control measures. [ABSTRACT FROM AUTHOR]

School-based health interventions often have limited and inconsistent effects. Although interpersonal communication likely is important, hardly any studies have investigated interpersonal communication of students with their friends, classmates, and parents about the health programs and health behaviors in school-based health interventions. In a two-wave prospective study of 389 adolescents focusing on three health behaviors (i.e., alcohol use, snack intake, and exercise), we addressed two aims. Our first aim was to investigate how student evaluations of a school-based health intervention influenced interpersonal communication about health behaviors (i.e., valence and frequency of conversations). Findings showed that positively evaluating a school-based health intervention increased how often students talked about the intervention with friends, classmates, and parents, as well as how they discussed the three health behaviors. Our second aim was to investigate the influence of interpersonal communication with friends, classmates, and parents on predictors of health behaviors. We found for conversational frequency that frequently discussing health behaviors resulted in healthier (more positive) predictors of exercise, but also in unhealthier (more positive) predictors of snacking and drinking. Furthermore, findings showed that positively discussing exercising, and negatively discussing snacking and drinking, resulted in healthier predictors of these behaviors. Our findings show that it is important to understand the impact of post-intervention communication and that post-intervention communication with peers and parents about health behaviors are predictors of health behavior. [ABSTRACT FROM AUTHOR]

During major long-term crises, such as the COVID-19 pandemic, news media are crucial sources of information for the public. This study aimed to explore the frequency of COVID-19-related news consumption based on (1) phase of the pandemic, (2) socio-demographic characteristics, and (3) news information channels. The study used a dynamic cohort design with 18 rounds of data collection, including 306,692 responses from 83,180 unique respondents in the Netherlands from 17 April 2020 to 11 September 2022. Results showed that the frequency of general COVID-19-related news media consumption varied throughout the pandemic, following a general decreasing trend with relative spikes often coinciding with periods of stricter behavioural regulations. TV news, newspapers, and online news websites were the most popular news information channels among the respondents. Furthermore, multilevel regression analyses identified several socio-demographic factors influencing news consumption and preferred channels, namely age, migration background, living status, health status, and trust in government — these results remained stable throughout the pandemic. This study highlights the importance of selecting appropriate news channels to effectively reach different socio-demographic groups and shows that during a prolonged crisis, news consumption about the crisis fluctuates with worsening conditions but generally follows a decreasing trend. [ABSTRACT FROM AUTHOR]

Introduction: The public health impact of a tobacco tax increase depends on the extent to which the industry passes the increase onto consumers, also known as tax-pass through. In 2020, the Netherlands announced tax increases aimed to increase the retail price by €1 per 20 factory-made cigarettes and €2.50 per 50 grams of roll-your-own tobacco. This study examines the pass-through rate after the tax increase, and whether this differed by type of tobacco and brand segment., Methods: Self-reported prices of 117 tobacco brand varieties (cigarettes=72, roll-your-own=45) pre- and post-tax increase were extracted from the 2020 International Tobacco Control (ITC) Netherlands Surveys (n=2959 respondents). We calculated the tax pass-through rate per variant, examining differences between type of tobacco and brand segments., Results: On average, cigarette prices increased by €1.12 (SD=0.49) (112% of €1) and roll-your-own prices by €2.53 (SD=0.60) (101% of €2.50). Evidence of differential shifting across segments was found, with evidence of overshifting in non-discount varieties. The average price of discount varieties increased with €0.20 less than non-discount varieties. Similarly, the net-of-tax price decreased in discount varieties (cigarettes=-€0.02; roll-your-own=-€0.05), but increased in non-discount varieties (cigarettes= +€0.14; roll-your-own= +€0.20)., Conclusions: Despite the large tax increase, the industry increased prices in line or above the required level. Through differential shifting, the price gap between discount and non-discount varieties has widened, which may reduce the public health impact of the tax increase. Measures aimed at reducing price variability should be strengthened in taxation policy, such as the European Tobacco Tax Directive., Implications: We found that the industry used differential shifting after a significant tobacco tax increase in the Netherlands. Prices increased more than required in higher-priced products, but not in lower-priced products. This pattern was found both for factory-made cigarettes and roll-your-own tobacco. Through differential shifting, the industry undermines the potential public health impact of tobacco tax increases, by offering a relatively cheaper alternative, which discourages people to quit or reduce consumption. The revision of the European Tobacco Tax Directive (TTD) provides an opportunity to address the widening price gap - both between and within product segments - across the European Union., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Objectives: Physical distancing and handwashing can be important infection prevention measures during an infectious disease outbreak such as the COVID-19 pandemic. To stimulate these behaviours, knowledge of psychosocial determinants as well as contextual factors is vital. We present longitudinal, within-person analyses of the impact of contextual and psychosocial factors on handwashing and distancing behaviour., Design: We used individual-level data (186,490 participants completing 971,899 surveys) from the Corona Behavioural Unit COVID-19 Cohort, a dynamic cohort study conducted during 26 months of the COVID-19 pandemic in the Netherlands., Methods: Fixed-effects models were employed to estimate within-person associations between psychosocial factors and behaviour, combined with main and moderating effects of contextual factors., Results: Pandemic severity was associated with more handwashing and distancing behaviour, while the duration of the pandemic had little effect. Within-person changes in response efficacy were most relevant for changes in both handwashing and distancing behaviour, while self-efficacy, descriptive norms and perceived severity of infecting others affected behaviour indirectly. These effects were stable over time. Associations were larger in cross-sectional models, indicating that such models tend to overestimate effects., Conclusions: Our study highlights the importance of longitudinal data and within-person models to detect possible causal associations. The results suggest that during an outbreak, government and public health professionals should clearly communicate the severity of the pandemic (e.g., hospitalization rates) and the effectiveness of recommended prevention measures in reducing that risk; and seek to improve people's capabilities and opportunities to adhere to guidelines, for example, by modifying the environment., (© 2024 The Author(s). British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)