General introduction 13 1 control policies are framed positively, i.e., from the perspective of protecting child health rather than restricting smoking.19 Smoking cessation Achieving a smoke-free generation promises long-term public health benefits, but in the short term, it is also essential to further support current tobacco users in quitting. Although 70% of tobacco users express a desire to quit at some point in their lives, only 30% attempt to do so, and among them less than 10% reports a successful quit attempt in the last year.21,22 Research indicates that nicotine replacement therapy (NRT) and individual or group-based counselling can enhance the success rate of quit attempts, but most individuals attempt to quit without assistance.23 Additionally, many cessation programs offer one-size-fits-all solutions, despite significant personality differences among smokers. As smoking is influenced by social and environmental contexts, integrating contextual and personal factors into cessation programs could be a promising approach. Socioeconomic position and smoking cessation Historically, smoking was introduced into society by men of higher socioeconomic standing. Nowadays however, it is most prevalent among individuals with a lower socioeconomic position (SEP). For instance, in the Netherlands, the average smoking prevalence in 2021 was 20%, while among lower educated men between the age of 25 and 45 it was 40%.24 That smoking is more prevalent among individuals with a lower SEP is not solely due to a lack of knowledge or motivation. Indeed, research has shown no social gradient in the intention to quit, quit attempts, use of medication to aid quitting, or the use of stop smoking services. 25 26 Lower SEP individuals do however, face many additional challenges when trying to quit smoking. Often, their addiction is stronger as a result of younger age of smoking initiation and of larger quantities of tobacco used. And finally, when trying to quit, lower SEP smokers often face detrimental conditions to quit smoking, and often experience less peer support due to higher acceptability of smoking in their social environments,29 or due to the poorer quality social networks.30 31 Stress and smoking cessation In addition to, or stemming from, external factors influencing the number and success of quit attempts, personal characteristics may facilitate or hamper quit
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