Chapter 12 394 normal in specific areas. Although the general public may play a role in promoting compliance with such smoke-free zones, an evaluation of an inner-city smokefree zone surrounding a university Medical Center showed that very few smokers were approached by others to alert them that smoking was not allowed in a smoke-free zone.6 Doing so is essential for effective implementation, but often people fear negative responses.7,8 However, in our evaluation (Chapter 6), when approached, most smokers adjusted their behaviour or vacated the smokefree zone. Additionally, 83% of smokers indicated that they would be neutral to positive about being approached when smoking in a smoke-free zone.9 While this may be seen as an encouraging sign, an important caveat is that people are likely to be risk averse and therefore might still consider the risk of negative replies (17% of replies in our study) too high to actually address smokers. Another factor for successful implementation of smoke-free policies, is learning from the successes and setbacks of others. In Chapter 7, in collaboration with legal, media, and health experts, we have outlined substantial legal foundations for the implementation of smoke-free policies in areas not yet covered. Insights from public health experts in France and England, who have successfully instituted smoke-free policies in playgrounds and cars with children, respectively, indicated that there is no compelling reason to delay the implementation of such policies in the Netherlands or other nations. Part 2: Supporting smoking cessation The discrepancy between the number of individuals expressing a desire to quit smoking and the percentage of individuals who ultimately succeed doing so underscores the profound challenge posed by nicotine addiction.10 Successful quit attempts are in part dependent on the motivation to quit smoking, but also rely on external factors that influence smoking behaviour.11 In the second part of this thesis we investigated such internal and external factors. In Chapter 8 we examined whether a social care programme aimed at regaining control over one’s life could improve (the intention to improve) health behaviour, including smoking cessation. Set in two of Rotterdam’s most socioeconomically disadvantaged neighbourhoods, Delfshaven and IJsselmonde, the main target group was families facing multi-problem situations. Coaches and clients of the programme jointly set goals to regain control over the clients lives and despite being exposed to harsh living conditions, participants consistently emphasized health related goals as high priority, placed directly after goals related to solving
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