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INTRODUCTION Randomized controlled trials have demonstrated the effectiveness of workplace smoking cessation programs. However, with low participation rates reported, it is important to understand the barriers and facilitators for the reach and participation of employees in workplace smoking cessation programs. The objective of the present study is to uncover the needs of employees regarding reach and participation when implementing a workplace program to address smoking cessation. METHODS We carried out 19 semi-structured qualitative interviews in 2019 based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework with current and former smoking employees of organizations with ≥100 employees in the Netherlands. Some of the interviewees had experience with a cessation program. Data were analyzed using the Framework method. RESULTS The main barriers according to employees were insufficient promotion of the cessation program, completing the program in the employee’s own time and working night shifts and peak hours. Facilitators included being actively approached to participate by a colleague, positive reactions from colleagues about employee’s participation in the program, providing the program on location and integrating the program as part of the organization’s vitality policy. CONCLUSIONS Effective workplace programs for smoking cessation can stimulate cessation but implementers often experience low participation rates. Our study presents recommendations to improve the recruitment and participation of employees in a workplace smoking cessation program, such as using active communication strategies, training managers to stimulate smoking employees to participate and making the program as accessible as possible by reimbursing time spent and offering the program at the workplace or nearby. Integrating the smoking cessation program into wider company vitality policy will also aid

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 stigmatizat

Although support by experiential peers for individuals with criminal behaviour is increasing, an empirical basis for its effectiveness is lacking. The purpose of this review was to investigate outcomes, mechanisms, and contextual factors of individual support by experiential peers for individuals who display criminal behaviour. We conducted a systematic realist literature review to test and refine our initial programme theory, which included seven mechanisms that may play a role in the desistance-supportive outcomes of experiential peer support. We screened 6,530 scientific papers and eventually included 25 articles focusing on asymmetrical one-on-one support for and by individuals with criminal behaviour. The findings suggest that experiential peers show empathy and have a non-judgmental approach, are considered role models, establish a trusting relationship with clients, offer hope, connect clients to other services, and have a recovery perspective on desistance. We found results indicative of act-desistance, positive personal development and improvements in mental health and personal circumstances, although study results were not consistent. The information on contextual factors was too limited for a robust analysis. Future research should not only focus on objective measures (e.g. absence of criminal behaviour), but also on subjective measures (e.g. hope, self-esteem) and investigate long-term effects.

Background: Studies demonstrated that adolescent e-cigarette use is associated with subsequent tobacco smoking, commonly referred to as the gateway effect. However, most studies only investigated gateways from e-cigarettes to tobacco smoking. This study replicates a cornerstone study revealing a positive association between both adolescent e-cigarette use and subsequent tobacco use; and tobacco and subsequent e-cigarette use in the Netherlands and Flanders.Design: The longitudinal design included baseline (n=2839) and 6-month (n=1276) and 12-month (n=1025) follow-up surveys among a school-based cohort (mean age: 13.62). Ten high schools were recruited as a convenience sample. The analyses involved (1) associations of baseline e-cigarette use and subsequent tobacco smoking among never smokers; (2) associations of e-cigarette use frequency at baseline and tobacco smoking frequency at follow-up; and (3) the association of baseline tobacco smoking and subsequent e-cigarette use among non-users of e-cigarettes.Findings: Consistent with prior findings, baseline e-cigarette use was associated with higher odds of tobacco smoking at 6-month (OR=1.89; 95% CI 1.05 to 3.37) and 12-month (OR=5.63; 95% CI 3.04 to 10.42) follow-ups. More frequent use of e-cigarettes at baseline was associated with more frequent smoking at follow-ups. Baseline tobacco smoking was associated with subsequent e-cigarette use (OR=3.10; 95% CI 1.58 to 6.06 at both follow-ups).Conclusion: Our study replicated the positive relation between e-cigarette use and tobacco smoking in both directions for adolescents. This may mean that the gateway works in two directions, that e-cigarette and tobacco use share common risk factors, or that both mechanisms apply.

Background Effectiveness of tobacco taxation can be undermined through smokers applying price-minimizing behaviours rather than quitting or reducing consumption. Common price-minimizing strategies are buying cheaper tobacco [discount brands or roll-your-own (RYO) tobacco], bulk buying and cross-border purchasing. This study analyses trends in and factors associated with such behaviours in four European countries from 2006 to 2020. Methods Data came from adult smokers participating in the International Tobacco Control (ITC) Surveys conducted between 2006 and 2020 in England (9 waves, n = 768-4149), France (4 waves, n = 1415-1735), Germany (5 waves, n = 513-1515) and the Netherlands (10 waves, n = 1191-2177). Country-specific generalized estimating equation regression models were fit to assess trends in smoking RYO tobacco, discount brands, bulk buying and cross-border purchasing within the European Union. Results Buying discount brands or RYO tobacco was the most common strategy in all countries, except France. Except for buying discount brands, estimates of price-minimizing behaviours were highest in France (2019: RYO = 27.2%, discount brands = 17.3%, bulk buying = 34.1%, cross-border purchasing = 34.2%), and lowest in Germany (2018: RYO = 18.6%, discount brands = 43.7%, bulk buying = 8.0%, cross-border purchasing = 9.8%). Direction and magnitude of trends differed by country, and behaviour. Young smokers were less likely to buy in bulk. Low-income and low-education smokers were more likely to purchase RYO tobacco or discount brands. The association with discount brands was not found for French low-income smokers. Conclusions Smoking cheaper tobacco is the most prevalent price-minimizing strategy in three countries (England, Germany and Netherlands), and more prevalent among low-income individuals. Harmonizing prices across products and countries would reduce switching to cheaper tobacco.

Around 2009, ‘recovery’ was introduced in the Netherlands as a new approach to drug addiction and addiction services. Recovery is now featured in practice-level policy but is absent in governmental drug policy. To investigate whether the Dutch recovery vision is coherent with governmental drug policy, we apply Bacchi’s What’s the problem represented to be? approach to analyse problematizations of ‘drug addiction’. We analysed two influential practice-level policy documents and one governmental drug policy document. We found that governmental policy addresses the harms and public nuisance of drug addiction, whilst practice-level policy addresses the wellbeing of persons with addiction. Despite these different starting points, the Dutch recovery vision seems coherent with both problematizations. Its adoption in the Netherlands was less subject to political debate compared to other countries. This may be a result of recovery being driven by bottom-up efforts without government intervention, leading to constructive ambiguity between government- and practice-level policies.

Background: Because of the magnitude of the global tobacco epidemic, the World Health Organisation developed the Framework Convention on Tobacco Control (FCTC), an international legally binding treaty to control tobacco use. Adoption and implementation of specific tobacco control measures within FCTC is an outcome of a political process, where social norms and public opinion play important roles. The objective of our study was to examine how a country’s level of tobacco control is associated with smoking prevalence, two markers of denormalisation of smoking (social disapproval of smoking and concern about passive smoking), and societal support for tobacco control. Methods: An ecological study was conducted, using data from two sources. The first source was the Tobacco Control Scale (TCS) from 2011, which quantifies the implementation of tobacco control policies in European Union (EU) countries. Data on smoking prevalence, societal disapproval of smoking, concern about passive smoking, and societal support for policy measures were taken from the Eurobarometer survey of 2009. Data from Eurobarometer surveys were aggregated to country level. Data from the 27 European Union member states were used. Results: Smoking prevalence rates in 2009 were negatively associated with a country’s TCS 2011 score, although not statistically significant (r = −.25; p = .21). Experience of societal disapproval was positively associated with higher TCS scores, though not significantly (r = .14; p = .48). The same was true for societal support for tobacco control (r = .27; p = .18). The TCS score in 2011 was significantly correlated with concern about passive smoking (r = .42; p =.03). Support for tobacco control measures was also strongly correlated with concern about passive smoking (r = .52, p = .006). Conclusions: Smokers in countries with a higher TCS score were more concerned about whether their smoke harms others. Further, support for tobacco control measures is higher in countries t

Introduction E-cigarettes are popular among youth. There are concerns that e-cigarettes attract youth that would otherwise not use addictive substances. While e-cigarettes are thought to be less harmful than tobacco, there is reason for caution. We examined to what extent adolescent e-cigarette users have characteristics associated with increased risk of substance use.MethodsWe collected cross-sectional survey data in 2018 among 10 schools throughout the Netherlands and Belgium (N=2794; age 10-18 years). We examined differences in characteristics and behaviors between e-cigarette ever users and never users, and former users and current users. We also explored differences in use of flavors and use of nicotine.ResultsCompared to never-users, e-cigarettes users more often were boys, older, had lower education level, non-Dutch or non-Belgian ethnicity, reported more combustible tobacco use, more smoking family members or family with problematic substance use, more smoking friends, more depressive symptoms, more impulsivity, more delinquent behavior, were more susceptible to smoking, had more positive smoking expectancies, and more ever use of substances. Users of non-tobacco flavored e-cigarettes and e-cigarettes without nicotine had fewer characteristics known to be related to an increased risk of substance use, compared to users of tobacco-flavored e-cigarettes and e-cigarettes with nicotine.ConclusionsAdolescent e-cigarette users are more like youths who experiment with addictive substances compared non-users. Thus, e-cigarettes users were more likely to use substances, regardless of whether they used e-cigarettes first. This may not be true for all types of e-cigarettes, as users of e-cigarettes without nicotine or with non-tobacco flavors were less like youths who experiment with substances.

There is a well-established relationship between isolation and both morbidity and mortality in the context of addiction recovery, yet the protective effects of intimate and familial relationships have not been adequately assessed. The current paper uses the European Life In Recovery database to assess the association between relationship status and living with dependent children on recovery capital of people in recovery from drug addiction, operationalised by the Strengths And Barriers Recovery Scale (SABRS). The study participants were drawn from the REC-PATH study and supplemented by a second sample recruited by the Recovered Users Network (RUN) across various European countries, resulting in a combined sample of 1,313 individuals completing the survey, primarily online. The results show that, in recovery, those who are married or co-habiting reported significantly greater recovery strengths and fewer barriers to recovery, and reported greater gains in recovery capital across their recovery journeys. Similar associations are found for participants who have dependent children living with them. There is also some indication that this association is stronger for female than for male participants. Finally, having more people that one can rely on and a greater proportion of people in recovery in the social network are both linked to greater recovery capital and greater self-reported growth in recovery capital. We conclude that this study provides further evidence in favour of a “social cure” in recovery, in which close familial ties are associated with stronger recovery resources.

Closeness between mentor and mentee is previously defined as an important indicator of relationship quality in youth mentoring, but whether this is the case in instrumental mentoring for young adults remains unclear. This is an exploratory study examining how instrumental mentoring serves young adults in their instrumental needs and how relational closeness develops. We applied a mixed-methods design, using quantitative data from a study of an instrumental mentoring program in Rotterdam, The Netherlands (N = 53), and qualitative data from a subsample of participants (N = 10). Two statistically distinctive clusters of closeness were found; 49% of the mentees reported high levels of closeness, and 51% reported low levels of closeness in their mentor relationship. Multivariate analyses of variance (MANOVAs) showed that the cluster with high levels of closeness was correlated with instrumental compatibility, satisfaction, and perceived attitude similarities. Semi-structured interviews were used to illustrate the role and development of closeness for mentees in both clusters, and three cases were presented. Experiencing closeness seemed a result of receiving instrumental support, not a precondition. Mentees’ previous experiences might in some cases explain the lower levels of closeness, but this did not always hinder mentees to profit from their mentors’ support.

Many studies on addiction recovery focus on recovery initiation and short-term outcomes for alcohol addictions. In this study, we examine associations between three recovery stages and recovery markers for persons in drug addiction recovery. Data were collected for a multi-country study (REC-PATH) among 722 individuals living in the UK, the Netherlands, and Belgium, who consider themselves in addiction recovery for a period of three months or more. We focus on typical life domains that characterize recovery: housing, crime, work or education, and substance use. The relation with time in recovery was examined for three recovery stages: early (5 years). Using the Life in Recovery survey, cross-sectional analyses reveal that participants in later recovery stages have lower odds of having housing problems, being involved in crime, and using illicit hard drugs and higher odds of having work or education, when compared to participants in the early recovery stage. This study provides further empirical support for defining drug addiction recovery as a gradual, long-term process that is associated with various life domains beyond abstinence. The findings suggest that drug policy, treatment and research need to be oriented towards long-term objectives and recovery goals that cover multiple life domains in order to support stable recovery.

This study explored factors that contribute to an alcohol intoxication resulting in Emergency Room (ER) admission among underage adolescents. We conducted qualitative interviews with 14 adolescents (14-18 years old) who experienced an alcohol intoxication requiring ER admission. Motivations for drinking were individual (e.g. curiosity) or social (e.g. having fun). While circumstances and motivations were comparable with other studies among (binge) drinking youth in general, most adolescents in this study did not drink with the intention to get drunk. They often unknowingly and unintentionally crossed their limits because they had not enough knowledge or experience to foresee the consequences.

This qualitative study investigates urban at-risk youths’ perspectives on their multiproblem situations and explores their needs for support. Semi-structured interviews were conducted with 23 at-risk youths with varied (externalizing) problems and risk factors. The data analysis was carried out using an inductive thematic approach. Four main themes emerged: desistance from delinquent behavior, need for self-reliance, negative experiences in social relationships and need for support. The participants indicated a strong need to be(come) self-reliant, which was visible in their statements on independence, coping with problems and reluctance to seek or accept help, also regarding desistance from crime. For some, this need for self-reliance seemed to be accompanied by distrust of others, which appeared related to previous negative experiences in social interactions. The participants seemed more open to support coming from someone with similar characteristics or experiences. The findings suggest that in helping at-risk youths, a delicate balance should be sought between stimulating autonomy and providing the necessary resources for support. A focus on strengthening factors that foster resilience is recommended. Future research could investigate the possible benefits of perceived similarity between youths and their care providers.

Objective To investigate whether mentioning free or lower cost smoking cessation medication as a trigger for thinking about quitting is related to higher medication use, more quit attempts and quit success, and whether these associations are modified by education and income.Methods Data were derived from the 2013 and 2014 surveys of the International Tobacco Control Netherlands (n=1164) and UK (n=768) cohort. Logistic regression analyses were used to assess associations between mentioning in 2013 that free/lower cost smoking cessation medication was a trigger for thinking about quitting smoking and the use of medication, quit attempts and smoking cessation in 2014.Results 37.0% of smokers in the UK and 24.9% of smokers in the Netherlands mentioned free/lower cost medication as a trigger for thinking about quitting. Smokers who mentioned this trigger were more likely to have used cessation medication during a quit attempt both in the UK (OR=4.19, pConclusion Free/lower cost smoking cessation medication may increase the use of cessation medication and stimulate quit attempts among smokers with low, moderate and high education and income.