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Health risks of second-hand smoke and aerosols

The EU is encouraging member states to update and expand the existing legislation on smoke and aerosol-free environments. 

Tobacco use and second-hand smoke

Tobacco remains one of the leading preventable causes of premature death and the primary risk factor for cancer, with 1 in 4 cancer deaths in the EU, Iceland, and Norway linked to smoking.

Second-hand smoke, also known as passive smoke, poses serious health risks to non-smokers. According to the World Health Organisation (WHO), at least 69 of the 7000 compounds in tobacco smoke can cause cancer, and many are toxic.  

While the full extent of the health impact of second-hand aerosols emitted by heated tobacco products is not yet clear, research suggests potential harm, particularly to heart and lung health, including respiratory issues and asthma.

Around 31% of Europeans are estimated to be exposed to second-hand tobacco smoke at home, at work, during leisure activities, in educational institutions or in public settings, while nearly a quarter (24%) of the EU population aged 15 and up are smokers, according to a recent study by the European Commission.

A Eurobarometer survey of March 2009 found 84% of EU citizens in favour of smoke-free offices and other indoor workplaces, 79% in favour of smoke-free restaurants, and 61% supporting smoke-free bars and pubs.

Health benefits of smoke-free legislation

Studies from EU member states indicate the health benefits of smoke-free legislation, following the Council recommendation on smoke-free environments from 2009.

These benefits include substantial reductions in the incidence of heart attacks in the general population, as seen in Italy, and reductions in hospital admissions for myocardial infarction and other acute coronary events in countries such as Germany and Italy.

Denmark, Italy, and Malta also reported reductions in morbidity among the general public.

In Ireland, rapid improvement in respiratory health was observed, and in Sweden, smoke-free legislation was associated with significant reductions in respiratory and sensory symptoms, particularly among workers in game centres.

Malta reported a reduction in annual mortality in the general public due to decreased exposure to second-hand smoke.

Protecting Europeans

The EU aims to better protect citizens, especially children and young people, from second-hand smoke and aerosols.

On 3 December 2024, the Council adopted an updated recommendation on smoke and aerosol-free environments, aiming to reduce exposure to harmful emissions in public spaces, transport, and workplaces.

It also encourages member states to include emerging products such as e-cigarettes and heated tobacco in their current rules. 

The recommendation advises member states to:

  • expand smoke and aerosol-free policies to key outdoor areas, including playgrounds, amusement parks and transport stations
  • expand these provisions to include emerging tobacco products, such as e-cigarettes and heated tobacco, which are increasingly used by young people

The update is in line with the European Commission initiative, a Tobacco-Free Generation by 2040 - part of Europe’s Beating Cancer Plan - aiming to reduce tobacco use in the EU from 25% in 2021 to below 5% by 2040.

Second-hand smoke is linked to respiratory and cardiovascular issues

Adults and children exposed to second-hand smoke inhale many of the same carcinogens as smokers do.

Second-hand smoke can cause lung cancer in people who have never smoked, and it may also be linked to other cancers in adults (e.g. breast cancer) and children. 

People who breathe second-hand smoke face a 25-30% higher risk of heart disease and up to a 16% increased cancer risk.

According to the WHO, the annual global death toll attributed to second-hand smoking is more than 1.2 million people. The main causes of death are illustrated in the chart below.

Text version

This chart presents the global annual number of deaths caused by second-hand smoke exposure, categorised by specific diseases. Each disease type is listed alongside the corresponding number of deaths.

  • ischemic heart disease: 414 640 deaths
  • stroke: 280 052 deaths
  • chronic obstructive pulmonary disease: 266 124 deaths
  • lower respiratory infections: 151 938 deaths
  • tracheal, bronchus, and lung cancer: 97 910 deaths
  • breast cancer: 7 518 deaths

More than 1 in 4 deaths caused by second-hand smoking occurs in children

The chart bellow illustrates the percentage split between women, men and children (under 15 years of age) of the annual global death toll attributed to second-hand smoking.

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The pie chart illustrates the way the percentage of deaths by second-hand smoke is split:

  • Women: 47%
  • Children: 28%
  • Men: 25%

1 in 4 people in the EU are smokers

A Eurobarometer survey on tobacco usage in the EU, published in June 2024, found that 24% of respondents smoke cigarettes, cigars, cigarillos, or a pipe, while 20% no longer smoke and 56% have never smoked.

Men (28%) are more likely to smoke than women (21%), with the highest smoking rates among those aged 25-39 (32%), followed by 44-54 (28%) and 15-24 (22%).

Bulgaria, Greece and Croatia have the highest smoking rates

This map illustrates smoking rates in the EU, including former smokers.

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The chart illustrates a breakdown of smoking habits across the EU27 countries:

  • Belgium: 21% currently smoke, 21% used to smoke but stopped, 58% have never smoked.
  • Bulgaria: 37% currently smoke, 18% used to smoke but stopped, 45% have never smoked.
  • Czech Republic: 23% currently smoke, 21% used to smoke but stopped, 56% have never smoked.
  • Denmark: 14% currently smoke, 27% used to smoke but stopped, 59% have never smoked.
  • Germany: 24% currently smoke, 18% used to smoke but stopped, 58% have never smoked.
  • Estonia: 25% currently smoke, 25% used to smoke but stopped, 50% have never smoked.
  • Ireland: 16% currently smoke, 18% used to smoke but stopped, 66% have never smoked.
  • Greece: 36% currently smoke, 21% used to smoke but stopped, 43% have never smoked.
  • Spain: 24% currently smoke, 24% used to smoke but stopped, 52% have never smoked.
  • France: 27% currently smoke, 24% used to smoke but stopped, 49% have never smoked.
  • Croatia: 35% currently smoke, 17% used to smoke but stopped, 48% have never smoked.
  • Italy: 24% currently smoke, 15% used to smoke but stopped, 61% have never smoked.
  • Cyprus: 29% currently smoke, 14% used to smoke but stopped, 57% have never smoked.
  • Latvia: 33% currently smoke, 18% used to smoke but stopped, 49% have never smoked.
  • Lithuania: 29% currently smoke, 22% used to smoke but stopped, 49% have never smoked.
  • Luxembourg: 19% currently smoke, 24% used to smoke but stopped, 56% have never smoked, and 1% don't know.
  • Hungary: 26% currently smoke, 14% used to smoke but stopped, 60% have never smoked.
  • Malta: 22% currently smoke, 17% used to smoke but stopped, 61% have never smoked.
  • The Netherlands: 11% currently smoke, 34% used to smoke but stopped, 55% have never smoked.
  • Austria: 32% currently smoke, 22% used to smoke but stopped, 46% have never smoked.
  • Poland: 27% currently smoke, 14% used to smoke but stopped, 59% have never smoked.
  • Portugal: 21% currently smoke, 11% used to smoke but stopped, 68% have never smoked.
  • Romania: 34% currently smoke, 8% used to smoke but stopped, 58% have never smoked.
  • Slovenia: 24% currently smoke, 21% used to smoke but stopped, 55% have never smoked.
  • Slovakia: 27% currently smoke, 19% used to smoke but stopped, 54% have never smoked.
  • Finland: 15% currently smoke, 31% used to smoke but stopped, 54% have never smoked.
  • Sweden: 8% currently smoke, 36% used to smoke but stopped, 56% have never smoked.
  • EU average: 24% currently smoke, 21% used to smoke but stopped, 56% have never smoked, with 0.02% uncertain.

Emerging tobacco and other products 

Emerging tobacco and related products like e-cigarettes and heated tobacco products increase the risk of nicotine addiction and may encourage the use of traditional tobacco products.

According to the WHO, heated tobacco products and e-cigarettes imitate the action of smoking traditional cigarettes.

While frequently marketed as safer alternatives to cigarettes, emissions from emerging tobacco and related products contain harmful and addictive compounds and chemicals, such as nicotine, which users inhale.

Beyond being addictive, nicotine can have harmful health effects including on brain development in children and adolescents.

3% of people in the EU use e-cigarettes

The chart outlines the reported usage of e-cigarettes among respondents in the 27 EU countries.

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The chart outlines the reported usage of e-cigarettes among respondents in the 27 EU countries.

The data is divided into the following categories: currently use e-cigarettes, used to use e-cigarettes but stopped, tried e-cigarettes once or twice, never used e-cigarettes, and don’t know.

1. Current Use:

  • across the EU, an average of 3% of respondents currently use e-cigarettes
  • Ireland has the highest percentage of current e-cigarette users (9%), while Malta and Sweden report the lowest (1%)

2. Former Use:

  • on average, 3% of respondents used e-cigarettes but have since stopped
  • Poland shows the highest percentage of former users (9%), while Romania and Slovenia have the lowest (1%)

3. Tried Once or Twice:

  • an average of 8% of respondents reported trying e-cigarettes once or twice.
  • Sweden has the highest percentage of people who tried e-cigarettes (14%), while Slovenia reports the lowest (2%)

4. Never Used:

  • the majority of respondents, averaging 85%, have never used e-cigarettes
  • Lithuania has the lowest percentage of non-users (68%), while Romania has the highest (96%)

5. Uncertainty:

  • on average, 1% of respondents were unsure about their e-cigarette use.
  • Latvia and Lithuania have the highest rates of uncertainty (5%), while some countries like Ireland report no uncertainty.

2% of people in the EU use heated tobacco products

This chart refers to the use of heated tobacco products in the EU. 

Text version

This chart is about the use of heated tobacco products in the EU. 

1. Current Use

On average, 2% of respondents currently use heated tobacco products. Usage rates vary by country:

  • higher usage is observed in Cyprus and Lithuania (5%), and Spain (3%)
  • in some countries, such as Germany and Slovenia, current usage is negligible or not reported

2. Former Use

About 1% of respondents used heated tobacco products in the past but have since stopped:

  • the highest rate is reported in Poland (7%)
  • most other countries report 1-2% in this category

3. Tried Once or Twice

An average of 4% of respondents have tried heated tobacco products only once or twice:

  • the highest experimentation rates are found in Bulgaria (10%), Spain (10%), and Lithuania (9%)
  • lower experimentation rates are reported in Germany and Slovenia (1-2%)

4. Never Used

The vast majority of respondents, averaging 92%, have never used heated tobacco products:

  • rates are highest in Germany and The Netherlands (96%) and consistently above 90% in many countries, including Estonia, Ireland, and France
  • the lowest rates of non-use are found in Latvia (79%) and Poland (80%)

Uncertainty

A small percentage (1%) of respondents across the EU are unsure about their use of heated tobacco products:

  • the highest levels of uncertainty are reported in Germany (4%) and Latvia (6%)
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Last review: 3 December 2024