INTRODUCTION:Visibility of tobacco products at retail tobacco outlets is associated with smoking initiation. To address this, across 2020-2022 the Netherlands banned tobacco product displays, advertisements and vending machines in the retail environment. Tobacco/vape specialist shops were exempted. This study assessed the impact of these policies on tobacco visibility in the retail environment and retailer compliance. METHODS:We conducted observational audits of all tobacco outlets in four Dutch cities (Amsterdam, Haarlem, Eindhoven and Zwolle) between 2019 and 2022 (before and after policy implementation), assessing visibility of tobacco products and advertisements, compliance and remaining sources of tobacco visibility (after implementation). We described results by location and outlet type. RESULTS:The number of tobacco outlets with any tobacco advertising or product visibility declined from 530 to 267 (-50%). Among outlets not exempt from the ban, the number with visibility declined from 449 to 172 (-62%), with lower postban visibility in petrol stations (12%) and supermarkets (6%) than small shops (47%). Visibility among tobacco/vape shops increased by 17%. Tobacco product displays remained the main source of visibility. 93% of tobacco vending machines were removed. Maps showed that non-compliance is concentrated in Amsterdam's city centre and more evenly distributed in other cities. CONCLUSION:The bans on tobacco display and tobacco advertising halved the visibility of tobacco in the retail environment, and the vending machine ban practically eradicated vending machines. To further reduce tobacco visibility, violations in small shops should be addressed and tobacco visibility should be regulated in currently exempt tobacco specialist shops.

Social and community service settings are a promising environment to support individuals with lower socioeconomic positions in quitting smoking. However, there remains a notable lack of support from their professionals in these settings. This study provides an overview of facilitators and barriers to smoking cessation support among these professionals. A systematic review was conducted up to April 2024 using five databases. Data were analysed using thematic synthesis, with themes categorized according to the Social Ecological Model. Eleven studies were included. We found twelve factors that could facilitate professionals in providing support. These factors related to the intrapersonal (i.e. knowledge/skills, self-efficacy, and belief), interpersonal (i.e. trustworthy connection with clients, readiness of clients, and clients' supportive social environment), organizational (i.e. expertise improvement in smoking cessation, availability of resources, and organizational support), and societal level (i.e. availability of appropriate cessation programmes, supportive healthcare financing, and public awareness). We found that these factors often were not present, which hindered professionals from providing support. Professionals working in social and community service settings could reach many people who smoke. However, there are numerous obstacles to overcome before their full potential can be realized. To harness this potential, organizational changes are necessary, with governments playing a supportive role.

ObjectiveWe assessed trends in educational inequalities in obesity-attributable mortality (OAM) and their contribution to educational inequalities in all-cause mortality for people aged 30 years and older, in England and Wales (1991-2017), Finland (1978-2017), and Italy (1990-2018).MethodsIn our population-level study, we estimated the shares of all-cause mortality due to OAM by educational level (i.e., low, middle, and high) by applying the population-attributable fraction formula to harmonized obesity prevalence data by educational level, along with sex- and age-specific relative risks of dying from obesity. We obtained OAM rates by multiplying the shares with individually linked all-cause mortality data by educational level. We measured absolute inequalities in OAM and all-cause mortality by the slope index of inequality.ResultsOAM largely increased for the different sex- and education-specific populations and increased most strongly for those with low educational level up to 2010 to 2015. Educational inequalities in OAM initially increased but stabilized or declined from at least 2008 onward. Obesity contributed, on average, 15% to absolute educational inequalities in all-cause mortality in 1991 through 2017.ConclusionsThe mortality impact of the obesity epidemic by educational level changed over time. Although the observed change from increasing to declining or stable educational inequalities is encouraging, reducing OAM in all socioeconomic groups remains a challenge.

Background:Extrapulmonary tuberculosis (EPTB) poses significant diagnostic and therapeutic challenges in low-incidence settings like the Netherlands. Despite declining overall tuberculosis (TB) incidence, the proportion of EPTB has risen, especially among migrant populations. This study examines sociodemographic, migration-related, and clinical factors associated with EPTB from 1993 to 2022 to inform TB diagnostics and care. Methods:A retrospective quantitative analysis of 34,048 TB patients reported to the Netherlands Tuberculosis Registry (1993-2022) was conducted. Logistic regression was used to identify associations with EPTB. Temporal trends in EPTB and pulmonary TB (PTB) were evaluated, including stratification by age, country of birth, and duration of residency. Results:Over the study period, the proportion of EPTB rose from 37 % to 50 %. EPTB was more common in women (adjusted odds ratio (aOR) 1.53; 95 % CI 1.45-1.62) and children under 14 years (aOR 2.83; 95 % CI 2.46-3.24). Foreign-born individuals, particularly from India, Somalia, Eritrea, Ethiopia and Pakistan, had higher odds of EPTB compared to Dutch-born individuals (aOR range: 2.33-3.86). EPTB was also associated with HIV infection (aOR 1.73; 95 % CI 1.43-2.11) but inversely related to social risk factors like homelessness and problem substance use. TB was notably frequently diagnosed among individuals residing in the Netherlands for over 10 years, more often EPTB than PTB. Conclusion:The rising proportion of EPTB underscores the need for targeted interventions, particularly for high-risk groups such as women, children and migrants. Enhanced screening, early detection, and preventive strategies, especially for tuberculosis infection (TBI) are critical to reducing EPTB morbidity and mortality.

Ideally, in a smoke-free generation, children could practice sports in a smoke-free setting. This article studied the prevalence of smoking at football clubs in two countries. An audit at 45 German and 116 Dutch clubs measured smoking prevalence at three places. In the Netherlands, smoking was less common at playing fields (at 25% of Dutch clubs versus 64% of German clubs), but more common at terraces (44 versus 19%) and entrances (20 versus 11%). Despite more comprehensive anti-tobacco policies, smoking at clubs in The Netherlands was as common as in Germany, possibly due to displacement of smoking from fields towards other places.

Background:Previous studies on socio-economic inequalities in mortality have documented a substantial contribution of alcohol-attributable mortality (AAM) to these inequalities. However, little is known about the extent to which AAM has contributed to time trends in socio-economic inequalities in mortality. Objective:To study long-term trends in educational inequalities in AAM and assessed their impact on trends in educational inequalities in life expectancy in three European countries. Methods:We analyzed cause-specific mortality data by educational group (low, middle, high) for individuals aged 30 and older in England and Wales, Finland, and Turin (Italy) over the 1972-2017 period. To estimate AAM, we used the multiple causes of death approach for England and Wales and Finland (1987-2017), and a recently introduced method for Turin (Italy). We used segmented regression analysis to study changes in absolute educational inequalities in AAM, measured by the Slope Index of Inequality (SII). We assessed the contribution of AAM to trends in educational differences in remaining life expectancy at age 30 (e30) using cause-deleted life tables. Results:AAM increased more among the low-educated than the high-educated in England and Wales (1972-2017) and Finland (1987-2007). In contrast, in Finland (2007 onwards) and Turin (1972-2017), AAM decreased more among the low-educated than the high-educated. In England and Wales, AAM contributed 37% (males) and 24% (females) of the increase in educational inequalities in e30. In Finland in 1987-2007, AAM contributed 50% (males) and 34% (females) of the increase in educational inequalities in e30. AAM also contributed to recent trend breaks, such as to the onset of an increase in educational inequalities in e30 in England and Wales, and to the onset of a decline in educational inequalities in e30 in Finland after 2007. Discussion:AAM mortality contributed substantially not only to levels of, but also to changes in educational inequalities in e30 in the studied populations. Reducing the impact of alcohol on mortality among low-educated groups may positively affect trends in educational inequalities in life expectancy.

Background Patient reported experiences (PREMs) are important indices of quality of care. Similarities in demography between patient and doctor, known as social concordance, can facilitate patient-doctor interaction and may be associated with more positive patient experiences. The aim of this research is to study associations between gender concordance, age concordance and PREMs (doctor-patient communication, involvement in decision making, comprehensiveness of care and satisfaction) and to investigate whether these associations are dependent on a countries’ Gender Equality Index (GEI). Methods Secondary analysis on a multinational survey (62.478 patients, 7.438 GPs from 34 mostly European countries) containing information on general practices and the patient experiences regarding their consultation. Multi-level analysis is used to calculate associations of both gender and age concordance with four PREMs. Results The female/female dyad was associated with better experienced doctor-patient communication and patient involvement in decision making but not with patient satisfaction and experienced comprehensiveness of care. The male/male dyad was not associated with more positive patient experiences. Age concordance was associated with more involvement in decision making, more experienced comprehensiveness, less satisfaction but not with communication. No association was found between a country’s level of GEI and the effect of gender concordance. Conclusion Consultations in which both patient and GP are female are associated with higher ratings of communication and involvement in decision making, irrespective of the GEI of the countries concerned. Age concordance was associated with all PREMs except communication. Although effect sizes are small, social concordance could create a suggestion of shared identity, diminish professional uncertainty and changes communication patterns, thereby enhancing health care outcomes.

Objectives: Research shows that smoking persists in sports clubs with smoke-free policies (SFPs). It is unknown to what extent smoking occurs at such clubs and how much that may differ from clubs without SFPs. This study aimed to determine whether and to what extent smoking differs at Dutch football clubs with and without SFPs. Study design: This cross-sectional study used a purposive sampling method to compare smoking indicators at 117 Dutch football clubs, with 49 clubs (41.8%) having an SFP. Methods: Using a standardised checklist, three smoking indicators were observed (number of people smoking, smoking facilities, and cigarette butts) and combined in a total smoking score (scale 0-9). Multi-level linear regression analysis was used to analyse the association between club SFP, local tobacco control policies (TCPs), and smoking indicators. Results: Significantly fewer smoking facilities were present at clubs with an SFP (-2.35, 95% confidence interval [CI]: -3.61; -1.09), but no significant associations were found between SFP and the number of people smoking and cigarette butts. The total smoking score was 1.74 points lower for clubs with an SFP (95% CI: -2.53; -0.96) and 1.85 points lower for clubs in municipalities with strong local TCPs (95% CI: -2.98; -0.72). Strong local TCPs were associated with significantly fewer people smoking at clubs (-1.79, 95% CI: -3.41; -0.17). Conclusions: SFPs at sports clubs succeed in limiting the number of smoking facilities but do not show differences in terms of smoking rates or smoking-related litter when compared to clubs without SFPs. Our results highlight the need for enhancing implementation of comprehensive SFPs, including clear guidelines for compliance and enforcement. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Local governments may play a key role in making outdoor sports clubs smoke free. This study aims to assess the activities, motives, challenges and strategies of Dutch municipalities regarding stimulating outdoor sports clubs to become smoke free. Semi-structured interviews were conducted with 19 policy officers of different municipalities in the Netherlands. The included municipalities varied in terms of region, population size and degree of urbanization. Data were analyzed using content analysis. Municipalities stimulated sports clubs to become smoke free by providing information and support and, to a lesser extent, by using financial incentives. Motives of municipalities varied from facilitating a healthy living environment for youth, responding to denormalization of smoking and aligning with goals formulated in national prevention policy. Policy officers faced several challenges, including limited capacity and funds, a reluctance to interfere with sports clubs and little support within the municipal organization. These challenges were addressed by employing various strategies such as embedding smoke-free sports in a broader preventive policy, setting a good example by creating outdoor smoke-free areas around municipal buildings, and collaborating with stakeholders in the municipality to join forces in realizing smoke-free sports clubs. Municipalities demonstrated evident motivation to contribute to a smoke-free sports environment. Currently, most municipalities fulfil an informative and supportive role, while some municipalities still explore their role and position in relation to supporting sports clubs to become smoke free. Other municipalities have established, according to them, effective strategies.

BACKGROUND:Socioeconomic mortality inequalities are persistent in Europe but have been changing over time. Smoking is a known contributor to inequality levels, but knowledge about its impact on time trends in inequalities is sparse. METHODS:We studied trends in educational inequalities in smoking-attributable mortality (SAM) and assessed their impact on general mortality inequality trends in England and Wales (E&W), Finland, and Italy (Turin) from 1972 to 2017. We used yearly individually linked all-cause and lung cancer mortality data by educational level and sex for individuals aged 30 and older. SAM was indirectly estimated using the Preston-Glei-Wilmoth method. We calculated the slope index of inequality (SII) and performed segmented regression on SIIs for all-cause, smoking and non-SAM to identify phases in inequality trends. The impact of SAM on all-cause mortality inequality trends was estimated by comparing changes in SII for all-cause with non-SAM. RESULTS:Inequalities in SAM generally declined among males and increased among females, except in Italy. Among males in E&W and Finland, SAM contributed 93% and 76% to declining absolute all-cause mortality inequalities, but this contribution varied over time. Among males in Italy, SAM drove the 1976-1992 increase in all-cause mortality inequalities. Among females in Finland, increasing inequalities in SAM hampered larger declines in mortality inequalities. CONCLUSION:Our findings demonstrate that differing education-specific SAM trends by country and sex result in different inequality trends, and consequent contributions of SAM on educational mortality inequalities. The following decades of the smoking epidemic could increase educational mortality inequalities among Finnish and Italian women.

Abstract Background During the COVID-19 pandemic, provision of non-COVID healthcare was recurrently severely disrupted. The objective was to determine whether disruption of non-COVID hospital use, either due to cancelled, postponed, or forgone care, during the first pandemic year of COVID-19 impacted socioeconomic groups differently compared with pre-pandemic use. Methods National population registry data, individually linked with data of non-COVID hospital use in the Netherlands (2017–2020). in non-institutionalised population of 25–79 years, in standardised household income deciles (1 = low, 10 = high) as proxy for socioeconomic status. Generic outcome measures included patients who received hospital care (dichotomous): outpatient contact, day treatment, inpatient clinic, and surgery. Specific procedures were included as examples of frequently performed elective and acute procedures, e.g.: elective knee/hip replacement and cataract surgery, and acute percutaneous coronary interventions (PCI). Relative risks (RR) for hospital use were reported as outcomes from generalised linear regression models (binomial) with log-link. An interaction term was included to assess whether income differences in hospital use during the pandemic deviated from pre-pandemic use. Results Hospital use rates declined in 2020 across all income groups. With baseline (2019) higher hospital use rates among lower than higher income groups, relatively stronger declines were found for lower income groups. The lowest income groups experienced a 10% larger decline in surgery received than the highest income group (RR 0.90, 95% CI 0.87 – 0.93). Patterns were similar for inpatient clinic, elective knee/hip replacement and cataract surgery. We found small or no significant income differences for outpatient clinic, day treatment, and acute PCI. Conclusions Disruption of non-COVID hospital use in 2020 was substantial across all income groups during the acute phases of the pandemic, but relatively stronger for lower income groups than could be expected compared with pre-pandemic hospital use. Although the pandemic’s impact on the health system was unprecedented, healthcare service shortages are here to stay. It is therefore pivotal to realise that lower income groups may be at risk for underuse in times of scarcity.

INTRODUCTION:Social and Community Service Organizations (SCSOs) are a potential setting to reach and support people with a low socioeconomic position who smoke, yet smoking cessation is not widely supported by SCSO professionals.AIMS AND METHODS:This study aims to identify SCSO professionals' (1) potential activities to support smoking cessation and (2) barriers and facilitators in undertaking these activities. Between July and November 2022, semi-structured interviews were conducted with 21 professionals recruited through SCSOs in Amsterdam North, including participation workers, welfare workers, parent and child counselors, budget coach, debt counselor, welfare work, community sports, and community center coordinators. Data were analyzed using a thematic approach.RESULTS:Eight activities were identified that could support the client either directly (ie, recognizing smoking clients, discussing smoking and smoking cessation, referring clients, providing smoking cessation counseling, offering help around services) or indirectly (ie, collaboration with relevant network partners, implementing smoke-free environments, enhancing professional skills). Various barriers and facilitators were identified related to the (1) client and their environment (ie, clients' readiness and social environment), (2) interaction between professional and client (ie, topic sensitivity), (3) professional (ie, professional is non-smoker, knowledge, and self-efficacy), (4) professionals' work environment (ie, necessity, responsibility, priority, and time), and (5) smoking cessation services (ie, availability of appropriate services and referral process).CONCLUSIONS:There is potential for SCSO professionals to support smoking cessation, but several barriers hinder their efforts. To address these barriers, it is essential to take into account the factors that SCSO professionals believe facilitate the provision of smoking cessation support.IMPLICATIONS:This study provides insight into how the potential of SCSOs in Amsterdam North to support smoking cessation efforts among people with a low socioeconomic position can be harnessed. Barriers were found at multiple levels (client, professional, client-professional interaction, and organizational) and these findings imply that stakeholders across these levels will need to prioritize smoking cessation to facilitate and stimulate SCSO professionals in supporting smoking cessation. A concrete action would be to offer SCSO professionals additional training in conversational skills to discuss smoking. As a prerequisite, easily accessible and suitable smoking cessation services should be available in the neighborhood.

Social and community service organizations (SCSOs) may be a promising new environment to more successfully reach people with a lower socioeconomic position (SEP) for smoking cessation support. However, studies that investigate clients' perspectives of the suitability of SCSOs as a setting to discuss smoking are scarce. This study aimed to (i) investigate the suitability of smoking cessation support provided by SCSOs, according to people with a low SEP, and (ii) explore their reasons for considering it suitable or unsuitable. Semi-structured interviews were conducted with 19 individuals with a low SEP who smoked regularly (N = 14) or had smoked regularly (N = 5). They have been in contact with SCSOs in a specific neighborhood in Amsterdam. Data were analyzed using a thematic approach. Participants generally considered SCSOs as suitable for providing smoking cessation support, as professionals are involved, build a relationship of trust, and offer personalized and holistic support. SCSOs are located nearby and familiar, they provide support in both group and individual settings and might offer additional supportive (group)activities. A number of participants expressed doubts about the waiting time for support, the fact that the needed support might exceed professionals' expertise, and the lack of aftercare. SCSOs can be an additional opportunity for providing smoking cessation support that aligns with the circumstances of lower SEP people. To harness the potential, smoking cessation could be integrated into education programs and training among professionals could be promoted. Policy changes within and outside SCSOs would be needed.

Introduction: The Netherlands will ban tobacco sales from supermarkets in 2024 and from petrol stations and small outlets after 2030 (tobacco specialist shops exempted). Previous studies showed that this will reduce outlet availability, density, and proximity in Dutch urban areas. Aims and Methods: This study assessed the distribution of tobacco outlets in Dutch rural areas, and potential outlet reductions after implementation of these bans. A cross-sectional quantitative audit of tobacco outlets was conducted in seven rural municipalities in the Netherlands. Tobacco outlet availability (N), density (per 10 000 capita and km(2)), and proximity (average distance of a street or city block to the closest tobacco outlet [meters]) were calculated, as well as predicted changes after implementation of upcoming sales bans. Results: 97 tobacco retailers were identified. There were 5.00 outlets per 10 000 capita and 0.09 per km(2). The tobacco sales ban in supermarkets is expected to reduce availability by 57 outlets, and density by 2.94/10 000 per capita and 0.05/km(2), while increasing average distance by 824 m. A tobacco sales ban in petrol stations is expected to further reduce availability (-26), density/10 000 capita (-1.34), and density/km(2) (-0.02), while increasing distance (+1595 m). For small outlets, these numbers are -12, -0.62, and -0.01, respectively, while the closest tobacco outlet will be mostly outside municipality borders. Conclusions: Assuming no new tobacco outlets will emerge in response to future tobacco sales bans, the bans could nearly eliminate tobacco outlets in rural areas. To meet the demand for tobacco, there is a risk that new tobacco specialist shops will be established.

OBJECTIVES:In absence of national legislation, local governments may stimulate outdoor sports clubs to become smoke-free. However, it is unknown whether and to what extent such efforts are effective in encouraging sports clubs to adopt a smoke-free policy (SFP). The aim of this study was to assess the association between tobacco control policies of municipalities and the prevalence of SFPs among outdoor sports clubs. STUDY DESIGN:Retrospective, cross-sectional. METHODS:Information on Dutch sports clubs (N = 3068) was linked to information on tobacco control policies of municipalities (i.e., "smoking prevention policies", "smoke-free environment policies", and "smoke-free sports policies") (N = 218). Multilevel logistic regression models examined the association between municipal tobacco control policies and the prevalence of SFPs among outdoor sports clubs, while controlling for sports clubs' characteristics. RESULTS:We found a positive, dose-response association between tobacco control policies of municipalities and the prevalence of SFPs among outdoor sports clubs. The odds of having an SFP in place was significantly higher for sports clubs in municipalities with moderate "smoking prevention policies" (OR = 1.85, 95%CI = 1.18-2.89), strong "smoke-free environment policies" (OR = 1.95, 95%CI = 1.19-3.20), and strong "smoke-free sports policies" (OR = 1.66, 95%CI = 1.02-2.24) compared to sports clubs in municipalities with no/weak policies. CONCLUSIONS:The results suggest that local tobacco control policies can increase the prevalence of SFPs among outdoor sports clubs. In order to create maximum effect, local policies need to be comprehensive and widely implemented.

BackgroundIt is not known how differences in COVID-19 deaths by migration background in the Netherlands evolved throughout the pandemic, especially after introduction of COVID-19 prevention measures targeted at populations with a migration background (in the second wave). We investigated associations between migration background and COVID-19 deaths across first wave of the pandemic, interwave period and second wave in the Netherlands.MethodsWe obtained multiple registry data from Statistics Netherlands spanning from 1 March 2020 to 14 March 2021 comprising 17.4 million inhabitants. We estimated incidence rate ratios for COVID-19 deaths by migration background using Poisson regression models and adjusted for relevant sociodemographic factors.ResultsPopulations with a migration background, especially those with Turkish, Moroccan and Surinamese background, exhibited higher risk of COVID-19 deaths than the Dutch origin population throughout the study periods. The elevated risk of COVID-19 deaths among populations with a migration background (as compared with Dutch origin population) was around 30% higher in the second wave than in the first wave.ConclusionsDifferences in COVID-19 deaths by migration background persisted in the second wave despite introduction of COVID-19 prevention measures targeted at populations with a migration background in the second wave. Research on explanatory mechanisms and novel prevention measures are needed to address the ongoing differences in COVID-19 deaths by migration background.

Social network research has evidenced the role of peer effects in the adoption of behaviours. Little is known, however, about whether policies affect how behaviours are shared in a network. To contribute to this literature, we apply the concept of diffusion centrality to school tobacco policies and adolescent smoking. Diffusion centrality is a measure of centrality which refers to a person’s ability to diffuse a given property—in our case, smoking-related behaviours. We hypothesized that stronger school tobacco policies are associated with less diffusion centrality of smoking on school premises and of smoking in general. A whole network study was carried out in 2013 and 2016 among adolescents (n = 18,805) in 38 schools located in six European cities. Overall, diffusion centrality of smoking in general and of smoking on school premises significantly decreased over time. Diffusion centrality of smoking significantly decreased both in schools where the policy strengthened or softened over time, but for diffusion of smoking on school premises, this decrease was only significant in schools where it strengthened. Finally, stronger school tobacco policies were associated with lower diffusion centrality of smoking on school premises and of smoking in general, though to a lesser extent. With such policies, smoking may, therefore, become less prevalent, less popular, and less clustered, thereby lowering the risk of it spreading within networks in, and even outside the school.

Introduction Visibility of tobacco products at retail tobacco outlets has been associated with increased susceptibility to smoking. To address this, the Netherlands has recently enacted point-of-sale policies severely restricting tobacco visibility in the retail environment, including advertisements, product displays, and tobacco vending machines. This study assessed the impact of these policies on tobacco visibility at retail outlets. Material and Methods We conducted a multi-wave observational audit of all tobacco outlets in four Dutch cities (Amsterdam, Haarlem, Eindhoven and Zwolle) between 2019 and 2022 (before and after policy implementation), assessing visibility of tobacco as well as compliance with the regulations specific to the outlet type (tobacco/vape specialist shops were exempted). We described compliance and changes in visibility by location, visibility type and outlet type. Results The proportion of non-exempt tobacco outlets with any tobacco advertising or product visibility declined from 73% to 27% after policy implementation (i.e., 73% of tobacco outlets were compliant). Compliance was low in small shops (53%) and high in petrol stations (88%) and supermarkets (94.3%). Tobacco products were the biggest source of tobacco visibility after implementation, which were still visible in 78% of non-exempt outlets with any tobacco visibility after policy implementation. Finally, we found that 93% of tobacco vending machines were removed. Maps showed that non-compliance is concentrated in Amsterdam’s city center and more evenly distributed in other cities. Conclusions Tobacco product and advertising visibility declined substantially after the implementation of bans on product and advertising visibility in the retail environment. Enforcement is needed especially in small outlets.

Objective: This commentary emphasizes the importance of implementing outdoor smoke-free policies at sports clubs, particularly highlighting their limited adoption across Europe. The primary aim was to assess the progress made in the Netherlands, explore the strategies employed, and outline future challenges. Methods: Our methodology involved an examination of national regulations and the voluntary adoption of smoke-free policies at sports clubs throughout Europe. We also assessed the adoption and implementation of these policies using recent evidence, leading to the identification of impending challenges in their implementation across Europe. Results: While only a few European countries currently have national legislation prohibiting outdoor smoking at sports clubs, voluntary initiatives promoting such policies have emerged in various nations. Experiences from the Netherlands have demonstrated the feasibility of implementing outdoor smoke-free policies at sports clubs. To expand these policies across Europe, five key challenges need to be addressed: 1) encouraging smoke-free policies at sports clubs that are less inclined to adopt them, 2) ensuring consistent compliance and enforcement of outdoor smoke-free policies, 3) preventing smoking just outside the sports club, 4) garnering support from various stakeholders to ensure widespread adoption of smoke-free sports clubs, and 5) establishing monitoring and evaluation mechanisms for policy implementation. Conclusion: The Dutch experiences serve as a testimony to the feasibility of outdoor smoke-free policies at sports clubs. By addressing the remaining challenges, we can create healthier sports environments for children and take substantial steps towards realizing a smoke-free Europe.