The reason for the symposium was the GP researcher Floor van den Brand’s PhD ceremony. Her research, carried out among six hundred employees from 61 different companies and organisations, showed that one and a half times the number of people quit smoking – until one year after training – if they receive gift vouchers in addition to the training programme.
After her research, Van den Brand says during the symposium, she designed the website www.samensterkerstoppen.nl. This is meant to help employers get started. The PhD graduate pre-calculated that smoking breaks and absence due to illness – smokers are sick three days more per year, on average – costs more than five thousand euro per year, working on the basis of an hourly wage of 34 euro. At the same time, the group training plus the reward cost less than a one-off six hundred euro.
But why reward unhealthy behaviour, employers and non-smokers sometimes say? ‘I don’t get anything, those who smoke do.’ It’s not about rewarding unhealthy behaviour, says Van den Brand. “The rewards are meant to condone healthy behaviour, to give smokers extra motivation.”
In 2018, twenty-four per cent of workers in the Netherlands smoked (of whom 17 per cent on a daily basis), according to the Trimbos Institute. That is comparable to the percentages among the population as a whole. Of the unemployed, 29 per cent smoked and of those unable to work, 35 per cent.
In Van den Brand’s research, participants received a total of 350 euro if they still hadn’t smoked after a year: first it was three times fifty euro (after the group training and then after three and six months) and two hundred euro at the end. In Rotterdam, among health care staff, there is an experiment in which smokers choose their own type of reward.
Some want the highest amount at the end, as in the Maastricht study, others at the beginning. But surprisingly enough, says the Rotterdam PhD researcher Nienke Broderie, most of the participants chose a completely different variant, in which they could even lose money.
This is the so-called deposit option, in which they invest one hundred euro themselves. “They bring in actual cash, which we keep in the safe. Anyone who doesn’t make it, loses their deposit. Despite everything, they like to pay something, maybe to avoid the impression that they are being given money, that it is easy money.”
No matter what, the rewards result in more people stopping, regardless of income or education level. So not just among employees of modest means, although the greatest profit can be gained in this group. Where 15 per cent of higher educated still smoke, for the lower educated the figure is 26 per cent.
Quitting smoking for them is not easy, says speaker Gera Nagelhout. She is an endowed professor at the UM, specialised in the health and well-being of people with a low socioeconomic position. “They are often more addicted and experience more stress, which has a negative effect on their self-discipline. They can’t rely on much social support from their environment when they are trying to stop.”
To reach this group, you need more than just waving some gift vouchers before their eyes. It already begins at the recruitment stage. How can you make this group interested in participating? A report about best practises, which Nagelhout collaborated on, was published last week. To mention but a few: be careful of your tone, it should be understanding and not judgemental; allow participants to become acquainted but without obligation and help them to sign up, in order to also get around the problem of being unlettered; and the stop programme should have a low threshold and be free of charge.
The recommendations are welcome, as few employees are participating in the training, the Trimbos Institute reckons. “No, not everyone is joining in,” says Van den Brand. “Some people are just not ready for it, for others the timing is just not right, and again others may prefer to choose individual guidance instead of group training. On the other hand, some employers only offer the odd group training to a maximum number of participants and are satisfied when it is full.”
Then it’s Lesley Sinclair’s turn, a researcher at Edinburgh University. Extra concentration is required because of her heavy Scottish accent. Sinclair has been trying for years to convince pregnant women to stop smoking. In 2008, thirty per cent of pregnant women from lower classes in the United Kingdom still smoked.
Financial rewards in the form of shopping vouchers, with which they have been experimenting for about ten years, proved to show real results. Many more pregnant women participated in the stop programmes and turned their backs on smoking. Someone in the ‘hall’ asks whether the partners are also involved in the attempt to quit smoking. Yes, that appeared to be the case, although the researchers didn’t register how many of them stopped.
A difference with the Netherlands is that in the United Kingdom and the US more money – 750 euro or dollar – is set aside to reward smokers. Van den Brand: “It is much more common in those countries to reward healthy behaviour. Employers sometimes pay high insurance premiums and medical costs for employees. Higher rewards then still turn out to be lucrative.”