Overview
The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing over 8 million people globally each year. More than 7 million of those deaths are the result of direct tobacco use, while around 1.3 million are the result of non-smokers being exposed to second-hand smoke. Among the WHO regions, Europe has the second highest prevalence of tobacco use among both adults (25.3%) and adolescents (10.8%).
Tobacco and nicotine products
Cigarette smoking is the most common form of tobacco use. Other tobacco products include waterpipe tobacco, cigars, cigarillos, roll-your-own tobacco, pipe tobacco, smokeless tobacco products and a relatively recent addition – heated tobacco products, which have proliferated on markets globally. Nicotine consumer products include electronic nicotine delivery systems (ENDS) – a rapidly changing category of products colloquially referred to as e-cigarettes – and nicotine pouches (similar in appearance to snus). Electronic non-nicotine delivery systems are essentially the same as ENDS, but the e-liquids used are marketed as nicotine-free, but this claim is not always accurate.
Tobacco use among adults
The age-standardized prevalence of current tobacco use among people aged 15 years and older in the WHO European Region in 2022 ranged from 5.4% to 39.5%, demonstrating a large disparity in rates across countries in the Region.
While tobacco use was previously largely a male phenomenon, the gap in prevalence between male and female adults is now very small (<5%) in countries such as Andorra, Denmark and Iceland. The WHO global report on trends in prevalence of tobacco use 2000–2030 shows that 18.5% of women aged 15 and above in the WHO European Region used tobacco in 2022. This is a high average compared to those for women in the WHO African, Eastern Mediterranean and Western Pacific regions (2–4%).
WHO has projected that the prevalence rates in 2025 in the WHO European Region will reach 30.6% among males and 18.2% among females. Over the period from 2010 to 2025, this equates to a relative reduction of 22% among the male population, and of 9% among the female population. Only 11 countries in the Region are currently on track to achieve a 30% relative reduction by 2025. Therefore, the WHO European Region must intensify its efforts in tobacco control to meet the global target.
The current use of e-cigarettes among people aged 15 years and older varies greatly across countries, from 0.2% in Uzbekistan (2019) to 7.7% in Lithuania (2021).
Tobacco use among adolescents
As of 2021, in the WHO European Region, about 10.8% of adolescents aged 13–15 used tobacco, constituting an estimated 4 million people. The prevalence of the use of any tobacco product varied, ranging from 24.4% in Bosnia and Herzegovina (2018–2019) to 0.3% in Turkmenistan (2015) according to the Global Youth Tobacco Survey. The region also observes the least differentiation between boys’ and girls’ tobacco use rates (11% and 10%, respectively). Furthermore, among girls, the European Region has the highest average rate of tobacco use globally. Use of e-cigarettes among adolescents aged 13–15 is on the rise in most of the countries. It ranges from 0.7% in Uzbekistan (2021) to 23.3% in Bulgaria (2023). European countries are also increasingly documenting higher rates of e-cigarette use compared to cigarette smoking in youths, with some countries observing a twofold or even threefold difference.
To date, only a few countries surveyed heated tobacco product use among adolescents. It ranges from 3.1% in Romania (2017) to 13.7% in Italy (2022).
Health consequences of tobacco and e-cigarette use
All forms of tobacco use are harmful and there is no safe level of exposure to tobacco. Eighteen percent of NCD deaths in Europe were attributable to tobacco use in 2020. Almost 1 in 5 premature NCD deaths could be avoided if tobacco use was eliminated from the Region.
- The proportion of NCD deaths attributable to tobacco use is almost 3 times higher for men (27%) than for women (10%).
- The proportion of deaths from cardiovascular diseases (heart diseases, stroke and others) due to tobacco use is estimated to be 25% for men and 8% for women.
- The overall proportion of cancer deaths attributed to tobacco is 37% for men and 15% for women. Eight out of 10 lung cancers in men are related to tobacco use.
Electronic cigarettes are harmful. Some of the substances they generate are known to cause cancer and, on their own, these products are associated with increased risk of lung disorders, poisoning, injuries and burns and immediate nicotine toxicity through inhalation. E-cigarettes can have negative effects on cardiovascular health, including increased heart rate and blood pressure. Exposure to emissions from e-cigarettes also poses risks to bystanders.
WHO/Europe response
Tobacco control is a primary entry point for achieving the global goal, agreed upon by the World Health Assembly in 2013, of a 25% reduction in premature mortality from noncommunicable diseases (NCDs) by 2025. One of the 9 voluntary global targets that were also endorsed by the World Health Assembly refers to a 30% relative reduction in prevalence of current tobacco use in persons aged 15 years or older by 2025.
Health has a central place in United Nations Sustainable Development Goal (SDG) 3 – “Ensure healthy lives and promote well-being for all at all ages” – one of the 17 SDGs that all UN Member States collectively aim to achieve by the year 2030. SDG Target 3.a refers particularly to strengthening the implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) in all countries.
Implementation of the WHO FCTC
The WHO FCTC is a powerful legal instrument to help countries fight the tobacco epidemic. The WHO European Region has made great advances in the implementation of this Treaty, which has been ratified by 51 of the 53 Member States. However, full implementation of the Treaty and most of its obligations still remains low. For example:
- of the countries that have ratified the WHO FCTC, only 28 have raised taxes to the point where excise taxes account for at least 75% of the retail prices of tobacco products;
- only 18 countries have introduced comprehensive bans to make all public places completely smoke-free;
- 11 countries offer cessation support at best practice level (national quit line, as well as both nicotine replacement therapy and some cessation services, with costs covered); and
- 13 countries have a comprehensive ban on all forms of direct and indirect advertising of tobacco products.