Rewarding non-smokers

Around Erasmus MC are signs bearing the message: "This hospital is working towards a smoke-free generation". From 1 September 2019 onwards, the hospital and its surroundings are to be completely smoke-free. Gone are the smoking rooms and public ashtrays. The ban also applies to smoking outdoors.

TEXT: Pauline Bijster


The PERSIST study was initiated to help the university achieve its anti-smoking objective, including amongst hospital staff. PhD student Nienke Boderie is a key figure in the study: "When you make a hospital smoke-free, you also have an obligation to help people quit."

Boderie specialised in disease prevention for her research master's degree in health sciences. Now she’s helping to make and keep the hospital and its staff smoke-free. As part of her intervention study, any member of staff who smokes is offered free smoking-cessation coaching through SineFuma, which specialises in this. "PERSIST assesses the effect of personalized incentives on people trying to quit for good," she adds.    

Choose your reward

She elaborates: "Participants are tested at intervals over the course of a year to check that they haven’t started smoking again. Each time this is ascertained, the participant is given a reward with a monetary value, say a voucher. There’s an important personalised element to the reward: research has shown that the most effective reward differs per individual. So we’re offering a selection of reward schemes, along with advice as to which of these might suit a participant best. We’re running four schemes in total. The first offers a reward of a fixed monetary value at each interval. The next offers rewards of diminishing monetary value over the course of the year. The third does the opposite: starts low and ends high. And the last is a deposit scheme: participants deposit 100 euros of their own money at the start of the study. If they fail to remain abstinent, they lose their deposit. But if they remain abstinent for the duration of the study, they stand to make 450 euros. This last one will likely prove to be the most effective of the lot, because not only do people earn nothing if they slip up, they also lose their stake."

"We’re assessing the effect of personalized incentives on people trying to quit for good’"

Less likely to start again

The study is based on the idea that people who manage to remain abstinent for an entire year are less likely to start smoking again. The testing intervals occur at three, six and twelve months into the study. Boderie and her fellow researchers are hoping for participation from at least 220 of the hospital’s staff. They also hope their findings can be implemented on a larger scale in the near future: "Might we be able to guarantee that people quit for good? And could such a reward system be offered by companies in the future, or by health insurers?"

Rotterdam leads the way

The goal is to make smoking-cessation programmes effective at getting people to quit for good. A national prevention agreement by the government has declared that all educational institutions must be smoke-free from 2020 onwards, and all Dutch hospitals from 2025. That means that Rotterdam’s institutions are actually ahead of the curve. The Albert Schweitzer Hospital in Sliedrecht is already a smoke-free zone, along with its streets and surrounding neighbourhood, and the Ikazia Hospital and Maasstad Hospital are preparing to do the same.

A smoke-free generation

Figures from the Dutch National Institute for Public Health and the Environment show that the number of smokers in the Netherlands has been dwindling for years. So, given the downward trend, does the problem still require this additional effort? "We’re still a long way from where we need to be; thirty per cent of the population in Rotterdam still smokes. And there’s a marked difference between high and lower socio-economic groups: our reward system works somewhat better for people in the latter groups." As stated by the signs around Erasmus MC, the ultimate goal is a truly smoke-free generation.

Choose smarter

PERSIST is part of the university’s Smarter Choices for Better Health initiative, and is supported by the Erasmus Trust Fund Foundation. Erasmus University Rotterdam aims to contribute to better health worldwide through smarter choices. As health and healthcare are complex issues, the initiative focuses on long-term multidisciplinary research.


  • NAME: Nienke Boderie

    EDUCATION: Master in Health Sciences at Erasmus University Rotterdam

    FUNCTION: Working on PERSIST as a PhD student

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