Tobacco Use and Trends
- In 2022, an estimated 3.0 million people (1.7 million males and 1.3 million females) aged 15 years and older were tobacco product users in Netherlands. This positions the country as the 48th globally and the 12th in the WHO European Region in terms of number of tobacco users.1,2
For comparison, according to the Attitudes of Europeans Towards Tobacco and Electronic Cigarettes survey in 2020, 12% of respondents (13% male and 11% female) were currently smoking tobacco products (cigarettes, cigars, cigarillos or pipe). Tobacco smoke was more prevalent in the oldest age group 55 years and over at 14%, followed by the 25-39 age group at 12%, and the youngest 15-24 age group at 11%, then the 40-54 age group at 10%.
Among those tobacco smokers, 43% were daily cigarettes and 30% were daily hand-rolled cigarettes smokers.
In 2019, 15% of youths (15% boys and 14% girls) aged 15-16 years were current cigarette smokers.
Demand for cigarettes per capita reduced by 37% in Netherlands from 75 packs in 2002 to 47 packs in 2021. The demand for per capita fine-cut tobacco (e.g. roll your own RYO) has been increasing in Malta a notable 2.2-fold from 2.4 packs of 20gr weight in 2002 to 5.2 packs of 20gr weight in 2021. (Figure 1)
Figure 1 Cigarette and Fine Cut Tobacco Consumption in Netherlands 2002-2021
Source: European Commission, Releases for consumption of cigarettes and fine cut tobacco (2002-2022)
Nicotine Alternatives
In 2020, 10% of respondents (11% male and 9% female) said they at least tried e-cigarettes.
The “at least tried out” category, the rate was the highest among the youngest 15-24 age group at 21%t, followed by the 25-39 age group at 13%, then the 55 years old and older age group at 7% and lastly the 40-54 age group at 6%.
1% of adults were current e-cigarettes users.
In 2020, 4% of respondents (6% male and 2% female) said they at least tried heated tobacco products (HTPs).
The “at least tried out” category, the rate was more prevalent among the youngest 15-24 age group at 7%, followed by the 25-39 age group and the 55 and over age group at 4%, and lastly the 40-54 age group at 3%.
In 2020, 86% of respondents said they had either quit or attempted to quit without any assistance.
Approximately 11% utilized Nicotine replacement products (NRTs), and 6% sought medical support. Meanwhile, 8% utilized e-cigarettes. Nearly none were opted for HTPs and oral, chewing, nasal tobacco products in their quitting journey.
In 2019, 9.3% of youths (11% boys and 8% girls) aged 15-16 years were current e-cigarettes users.
Health and Economic Burden From Tobacco Use
In 2021, it was estimated that tobacco was the 1st highest risk factor driving the most death and disability combined in Netherlands.
Tobacco was responsible for an estimated 21.3 thousand deaths, which is about 29.0% of total deaths.
Of tobacco-related deaths, 20.6 thousand or 96.7% were due to smoking, and 1.0 thousand or 4.9% were due to secondhand smoke.
In 2021, the top 10 causes of the most deaths in Netherlands included Ischemic Heart Disease (IHD) ranking 1st, Lung Cancer ranking 2nd, Stroke ranking 5th, and Chronic Obstructive Pulmonary Disease (COPD) ranking 6th.
Tobacco was responsible for an estimated 2.2 thousand or 16.8% of all IHD deaths, 1.1 thousand or 11.1% of all Stroke deaths, 7.5 thousand or 81.7% of all Lung Cancer deaths, and 4.5 thousand or 71.3% of all COPD deaths.
In 2021, tobacco use caused an estimated loss of 493.9 thousand disability-adjusted life years (DALYs), which was about 28.1% of total DALYs. Tobacco accounts for 44.5 thousand DALYs for IHD, 24.3 thousand DALYs for Stroke, 158.5 thousand DALYs for Lung Cancer, and 86.2 thousand DALYs for COPD.
Regulatory Environment and Economics
Public Health Commitment
Netherlands ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005, and WHO Illicit Trade Protocol in 2020.
Netherlands adopted graphical health warnings (GHWs) on combustible cigarettes (CCs) in 2016, covering 65% of the front and 65% of the back of the packages. In addition, plain packaging (PP) for CCs was implemented in 2021.
Diverse Tobacco Market
HTPs and e-cigarettes with and without nicotine content are available. HTPs are classified as “smokeless tobacco”. E-cigarettes irrespective of nicotine content are subject to same regulations.
The flavor ban is imposed on HTPs and e-cigarettes, allowing only tobacco flavors.
Product restrictions for e-cigarettes include a maximum nicotine concentration to 20mg/ml for those containing nicotine, a tank capacity not exceeding 2ml, and refill containers limited to a maximum 10ml, regardless of nicotine content.
Text health warnings cover 30% of both surfaces for HTPs and e-cigarettes (bottle and any outside packaging).
Text health warnings are required for those with nicotine as “this product contains nicotine, which is a highly addictive substance. It is not recommended for use by non-smokers”, while those without nicotine content as “this product harms your health. Its use is not recommended for non-smokers”.
Taxation Policy
In 2022, total tax rate on retail prices of a pack of cigarette was 76.9%.
By the definition of tax application, a differential excise tax policy is applied between CCs and HTPs. The excise value for HTPs is EUR 1.32/pack, with its share (22.03%) on the retail price (EUR 6.00/pack) in 2023. The excise value of CCs is EUR 5.87/pack, with its share (71.6%) on retail selling price (EUR 8.20/pack) in 2023.
Smoking and Advertising Bans3
- Complete smoking bans with complete level of compliance, and complete advertising bans with complete level of compliance were enforced in Netherlands in 2022.
Age Restrictions
- Tobacco products and e-cigarettes cannot be sold to individuals younger than 18 years of age.
Illicit Cigarette Trade
Estimated figures suggest an upward trend in illicit cigarette trade, yet the Netherlands has managed to keep it consistently below 10%, ranging from 4.3% in 2008 to 8.4% in 2022.
In 2021, an estimated 2.2 billion counterfeit & contraband (C&C) cigarettes were consumed in Netherland. The market share of C&C was approximately 18.4% of the total cigarette market, costing the government an estimated EUR 656 million in total tax revenue
Tobacco Production and Diversification
- Detailed data is not readily available from the Food and Agriculture Organization for Netherlands. (FAOSTAT [accessed January 2024])