Inadequate support for tobacco and vaping addiction in Belgium

According to a survey by the Belgian Cancer Foundation and the Federal Public Service (FPS) Public Health, tobacco and vaping addiction remains insufficiently integrated into the Belgian healthcare system.[1]. The study, conducted among more than 18,000 healthcare professionals—doctors, nurses, midwives, clinical psychologists, and pharmacists—using a questionnaire, highlights a lack of resources, specialized training, coordination, and follow-up for patients who smoke or vape. In Belgium, nearly 9 out of 10 smokers started before the age of 21, and tobacco still causes more than 9,000 premature and preventable deaths each year.

A proactive role for healthcare professionals is still limited.

The survey examined the importance healthcare professionals place on discussing smoking, vaping, and cessation with patients; the frequency and actual content of these conversations; the obstacles encountered in addressing the topic; the perceived impact of these discussions on patient behavior; and respondents' opinions on various public policy measures aimed at improving smoking cessation. It also considered several contextual variables, including profession, seniority, frequency of contact with patients, and the impact of smoking on the care process.

The authors emphasize that tobacco addiction requires structured support that goes beyond one-off advice such as "You should quit smoking," as nicotine is a substance as addictive as, or even more addictive than, some illegal drugs, and its effects act very rapidly on the brain. Sixty percent of the healthcare professionals surveyed, across all professions, acknowledge that tobacco is highly or very highly detrimental to the healing or treatment process for patients, and three-quarters believe it is important to talk to patients who smoke or vape about the dangers of their habit and the benefits of quitting.

However, only 21% of respondents reported taking a proactive approach to encouraging their patients to quit smoking, even though treating tobacco addiction earlier could prevent the development of many health problems. Ten healthcare professionals almost never inquire about smoking habits, whether with new or long-term patients, a finding particularly pronounced among pharmacists, nurses, and psychologists.

Regarding vaping, it is consistently less discussed and addressed by healthcare professionals than smoking. For example, 51% of healthcare professionals ask their patients about their smoking habits, but half of those professionals who asked their patients about smoking also inquired about their vaping.

However, some specialties stand out: 80 % of pulmonologists, 70 % of cardiologists and 58 % of health professionals who have completed certification in tobacco studies regularly intervene on this subject, meaning that taking a training course in tobacco studies is a real added value in the care of smokers.

The fact remains that the actions taken too often remain "« superficial and abstract » according to the Foundation: 13 % provide practical advice, 12 % refer to a tobacco specialist or tools to help quit, 4 % offer pharmacological assistance, whether it be nicotine replacement treatments (patches, gums, inhalers, oral sprays…) or others and 4 % establish an individualized action plan.

Recommendations from the survey to improve tobacco cessation care

Most of the measures suggested by the survey receive broad support among healthcare professionals themselves: 86 support integrating smoking cessation support into care pathways (pregnancy, cancer, diabetes, etc.), 77 support better reimbursement for smoking cessation consultations, 69 support reimbursement for nicotine replacement therapies and the presence of smoking cessation specialists in hospitals, 64 support the presence of smoking cessation coordinators in hospitals and expanding the patient history to include the use of new nicotine products (e-cigarettes, nicotine pouches, etc.), and 63 support the organization of major campaigns on smoking cessation, 62 % support the mandatory recording of smoking cessation behavior and journey in each patient's medical record and 61 % are in favor of mandatory communication on smoking cessation support in waiting rooms.

The authors, for their part, call for the systematic integration of smoking assessment into the medical history taken by all healthcare professionals—that is, the collection of medical history to establish a diagnosis—in order to ensure earlier treatment of tobacco dependence, before the onset of tobacco-related illnesses.[2].

They also recommend including tobacco addiction treatment by default in care pathways using the "opt-out" method, as with diabetes or hypertension: tobacco addiction treatment is automatically offered to all patients, unless the patient explicitly chooses to refuse it.

Finally, they recommend strengthening links between professionals, particularly with tobacco specialists, in order to ensure continuity between detection and treatment of tobacco addiction.

According to the survey, better coordination and structured support are therefore essential to improve the effectiveness of care and address the public health challenges related to tobacco.

The Belgian Federal Public Service for Health has also decided to put these recommendations into practice by allocating a budget of over €2 million to develop a pilot project in 12 Belgian hospitals. The aim is to make every contact or hospital stay an opportunity for healthcare professionals to discuss smoking cessation with smokers and to provide follow-up after their discharge.

The Cancer Foundation welcomed this initiative and hopes that it will pave the way for a sustainable strengthening of the resources devoted to the treatment of tobacco addiction.

©Generation Without Tobacco

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[1]Jurgen Minnebo, Wouter Samyn, Smoking cessation support in healthcare in Belgium – Study report, Cancer Foundation, published on December 11, 2025, accessed the same day

[2]Cancer Foundation, Raising awareness and banning things is no longer enough!, Published on December 11, 2025, accessed the same day

National Committee Against Smoking |