Survival rates among women in the Netherlands are now lower compared to other countries, due to the previous high level of tobacco use. The Netherlands now ranks only 17th in measures of women’s health for the WHO-Europe Region and lung cancer rates have increased faster than almost anywhere else in Europe.

Such high smoking rates may relate to a strong liberal tradition in the Netherlands, including relatively low support for tobacco control. The poorest women in the Netherlands are most likely to smoke, further increasing their risk of early death.

How many women smoke or use tobacco?

• Nearly three in ten women in the Netherlands are still daily cigarette smokers; 27% women vs. 33% men. This rate of smoking among women is slightly higher in the western part of the WHO-Europe Region which is 25%.
• 7% of women smoke during pregnancy. Several new projects for pregnant smokers are being introduced.
• In 1970, smoking among women peaked at 40%. Since 1980, prevalence has been around a third and since the late 1990s, there has been a downward trend.
• Smoking rates are highest among women with a low socioeconomic status (SES), and among those who live in deprived areas, such as younger adults. For example, one in three of the poorest women smoke where as one in five smoke among the wealthiest.
• Women in the Netherlands aged 35-49 have the highest smoking prevalence and those women over 65 are least likely to smoke.
• Smoking also varies by ethnic group. For example, very few Moroccan women smoke.
• Women in the Netherlands are twice as likely as men to choose ‘low tar’ cigarettes which provide no additional health benefit.
• Around half of the women smokers use rolling tobacco, which may have helped maintain high smoking rates. Smoking rolled tobacco is still less common than among men.

Smoking among young women

• Around a quarter of girls in the Netherlands aged 10-19 smoke at least monthly; 22% girls vs. 27% boys. By age 15, three in ten girls are smoking at least monthly.
• Regular weekly smoking usually starts from around age 13-15.
• Daily smoking prevalence rates among young women between ages 15-19, is only 1% lower that that for women of all ages; 26% vs. 27%. This suggests that these young women are likely to be as nicotine dependent as adults.
• Smoking prevalence among adolescent girls and boys has been stable over the past ten years.
• As with adults, smoking rates are higher among young people living in deprived areas compared to young people living in wealthier areas.
• Evidence-based school programs are widely used. The national media campaign ‘….but I don’t smoke’ has promoted non-smoking to be more cool and attractive, especially among girls, and has cut smoking rates by 8 percentage points at age 15.

Health risks

• Every year at least 5,800 women in the Netherlands die as a direct result of smoking. That’s equivalent to 15 deaths per day.
• In 2003, about 18,300 women died of circulatory diseases (coronary, heart failure and cardiovascular). About 1,960 of these can be attributed to smoking.
•In addition, there were around 2,500 deaths from lung cancer (1,900 smoking-related) and 2,500 deaths from respiratory disease (1,600 smoking related).
• The death rate from lung cancer among women in the Netherlands has increased steadily and is now more than double the rate of the early 1980s. The rate of increase has been nearly 5% every year; one of the highest in Europe. Relatively high smoking rates among women aged 35-54 suggest a further increase.

Tobacco control

• The Netherlands has both a national tobacco control action plan and a national coordinating body named ‘STIVORO for a smokefree future’.
• A new Tobacco Act was passed in May 2002. National policy on smoking includes commitments to maintain price, control promotions and boost smokefree provision.
• There has been an increase in real price through tax. A pack of 25 cigarettes ‘costs’ 4,80 Euros which is only 18 minutes average labour.
• The minimum age for purchasing tobacco has been set at 16 in 2003.
• Advertising has been banned since November 7th, 2002 although advertising at the point of sale is still possible.
• There are smoking restrictions in public places and at work, though none in restaurants or bars. Since 2003, the new Tobacco Act has provided all employees the right to a smokefree workplace.
• In May 2003, the Netherlands was the first European Country to introduce warning labels on cigarette packages.

Education and support to quit

• Support for smokers is available through primary care, and smokers’ helplines. Women make most use of services, particularly the helplines, and group courses offered by regional health organizations.
• A minimal intervention strategy implemented in Dutch maternity clinics and among obstetricians focuses on helping pregnant smokers to quit. A new campaign to raise awareness and encourage obstetricians to give advice also gained huge media interest.
• Nicotine replacement therapy (NRT) is available without prescription to smokers, but cost may limit access.
  
  12 July 2004

For more information

• STIVORO http://www.stivoro.nl
• National Institute of Public Health and the Environment at http://www.rivm.nl/nationaalkompas/
• “Women and Smoking: a Report of the Surgeon General” US Dept of Health and Human Services. 2001
• “Women and the Tobacco Epidemic” WHO Geneva: World Health Organisation. 2001