{"id":147929,"date":"2022-12-13T10:28:03","date_gmt":"2022-12-13T09:28:03","guid":{"rendered":"https:\/\/www.erasmusmagazine.nl\/en\/?p=147929"},"modified":"2025-12-19T11:26:34","modified_gmt":"2025-12-19T10:26:34","slug":"if-you-tell-your-patient-that-smoking-is-stupid-youll-never-understand-why-they-smoke","status":"publish","type":"post","link":"https:\/\/www.erasmusmagazine.nl\/en\/2022\/12\/13\/if-you-tell-your-patient-that-smoking-is-stupid-youll-never-understand-why-they-smoke\/","title":{"rendered":"\u2018If you tell your patient that smoking is stupid, you\u2019ll never understand why they smoke\u2019"},"content":{"rendered":"

Leonieke Breunis set up a treatment for women who are or want to become pregnant and are trying to quit smoking and drinking. She received her PhD last week for her thesis titled \u2018Protecting Children Against Tobacco Smoke and Alcohol Exposure from the Start\u2019.<\/p>\n

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\n\t\n\n<\/svg>\n<\/span>\n\tImage by:<\/span>\n\n\t\t\t\n\t\t\t\t\t\t\tLevien Willemse<\/a>\t\t\t\t\t<\/span>\n\t<\/p>\n<\/figcaption><\/figure>

It must be easy for you to explain your research topic at dinner parties.<\/strong><\/p>\n

\u201cYes, everyone understands when you say that you\u2019re doing research on smoking. My thesis consists of two parts. I looked at the smoke-free zone around Erasmus MC and set up a treatment for women who are or want to become pregnant and are trying to quit smoking. I did research beforehand into the moral pitfalls of rewards, what women themselves think about this and how many women drink alcohol during the first 15 weeks of pregnancy.\u201d<\/p>

What were those moral pitfalls?<\/strong><\/p>\n

\u201cYou could question whether it\u2019s ethically responsible to reward women for quitting smoking, since that means women who have never smoked don\u2019t get a reward. And doesn\u2019t this affect their autonomy? Because it\u2019s a topic that everyone understands, it\u2019s something that everyone has an opinion about. It\u2019s also a tricky subject. The rewards were found to be morally acceptable if they meet certain requirements.\u201d<\/p>

Why give a reward, exactly?<\/strong><\/p>\n

\u201cPrevious studies in France and England showed that rewards work. In difficult moments, a cigarette is tempting and the addicted voice in your head wonders whether that one cigarette is really that harmful. The rewards then provide some extra encouragement, since even a single cigarette means they won\u2019t get the reward.<\/p>

\u201cPeople who struggle to quit smoking are often also vulnerable, because they have financial problems or a low income. The treatments that have been available thus far mainly work for a highly educated group that already has an easier time quitting smoking. It\u2019s important that they quit too, but in the meantime the health disparities between people with a low versus high socio-economic status are only increasing.\u201d<\/p>

What was your approach in the end?<\/strong><\/p>\n

\u201cThe women could choose their own vouchers for places like Bol, Zalando or baby shops. And the amount would increase the longer they didn\u2019t smoke. If they stopped smoking for six months, they could earn a total of \u20ac185 worth of vouchers. They also took part in group sessions and were given access to an online platform to help them quit. At the end of the treatment, 28% of the participants had quit smoking.\u201d<\/p>\n\t

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\n\t\t\u2018Cigarettes are just as addictive as heroin, but people don\u2019t realise that because it\u2019s seen as a normal thing\u2019\n\t<\/blockquote>\n\n\t<\/figure>\n\t\t<\/div>\n\t<\/div>\n

What is the biggest misconception about smoking during pregnancy?<\/strong><\/p>\n

\u201cThat smoking is a choice. Cigarettes are just as addictive as heroin, but people don\u2019t realise that because it\u2019s seen as a normal thing. It\u2019s extremely difficult to quit smoking, and I\u2019ve seen so much sadness about this among the women in my study. They\u2019re ashamed of not being able to quit, because they want the best for the health of their child. But they just can\u2019t do it. It becomes even more difficult if you\u2019re also dealing with stress. Thirteen per cent of the women who took part in my study didn\u2019t have a permanent residence. Over half were unemployed, and 72% had a partner who smoked. All those factors make it harder to quit.\u201d<\/p>

What about your research on the smoke-free zone?<\/strong><\/p>\n

\u201cThree-quarters of the adult patients were positive about the smoke-free zone. They\u2019re already sick, so they don\u2019t want to go through a cloud of smoke on top of that. And if they stop after they\u2019ve just had a stressful conversation in the hospital, they\u2019ll be tempted to smoke. We also talked to children at Sophia Children\u2019s Hospital, and they could not understand why people would be allowed to smoke around a hospital.\u201d<\/p>

What were your main conclusions?<\/strong><\/p>\n

\u201cOne in nineteen women drinks alcohol during the first trimester of pregnancy without the healthcare provider\u2019s knowledge. The social pressure to drink is quite high, but at the same time they know they shouldn\u2019t do it. So when the healthcare provider asks, they say \u2018no\u2019.<\/p>

\u201cThe combination of the online platform, group sessions and rewards also seems to be effective in helping women quit smoking.<\/p>

\u201cThe smoke-free zone helps to discourage smoking as well, which protects vulnerable patients and children. Before the smoke-free zone was launched in September 2019, every weekday 4,000 people would stand outside and smoke. This figure has now decreased by half. And thankfully, they no longer stand at the entrance.<\/p>

\u201cFinally, confronting smokers in the smoke-free zone has proven to be very effective. Most people respond positively, put out their cigarette or leave the area.\u201d<\/p>

I read in your acknowledgements that you didn\u2019t want to do a PhD because you thought it was stupid.<\/strong><\/p>\n

\u201cI went to medical school to become a doctor. You have to do a mandatory 20-week research placement, and that seemed really awful to me. Such a boring office job, that\u2019s not why I\u2019m studying medicine, I thought. Except I really liked it. You\u2019re curious about something and you can explore it yourself. You can make an impact. I\u2019ve made a difference in people\u2019s lives with this study. I get birth announcements, and sometimes people still send me baby photos.\u201d<\/p>

Was there anything about the PhD that you did think was stupid?<\/strong><\/p>\n

\u201cThere are loads of rules and it takes a lot of time to prove that you\u2019re following them. And because of COVID-19, the study almost had to be cancelled. But these are the kinds of setbacks you have in any job. On days when I was totally exhausted, I would just go home early. I\u2019d take a long walk with my dog and work harder again later.\u201d<\/p>

Your acknowledgements are four and a half pages. That\u2019s really long. What does that say about you?<\/strong><\/p>\n

\u201cI\u2019m pretty verbose and I\u2019m a grateful person.\u201d<\/p>

Why did you begin your thesis with the quote from life coaches Marc and Angel Chernoff: \u201cIt\u2019s much easier to judge people than it is to understand them: understanding takes extra kindness and patience. So seek to understand before you attempt to judge. And be thankful for the rude and difficult people you meet\u2026 They serve as great reminders of how not to be.\u201d<\/strong><\/p>\n

\u201cI think that all of us in this society are very quick to judge and are becoming increasingly polarised. In discussions, we\u2019re more focused on proving ourselves right than understanding others. I think life is much more fun when you take the time to listen to what someone is saying and try to understand them. Why is someone angry or sad? The same applies to smoking. If you tell patients that smoking is stupid, or that it\u2019s child abuse, you\u2019ll never understand why they smoke, and you\u2019ll never help them to quit.\u201d<\/p>\n\t

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