Skip to main content

Tackling secondhand tobacco smoke and e-cigarette emissions: exposure assessment, novel interventions, impact on lung diseases and economic burden in diverse European populations. The TackSHS Project.

Periodic Reporting for period 3 - TackSHS (Tackling secondhand tobacco smoke and e-cigarette emissions: exposure assessment, novel interventions, impact on lung diseases and economic burden in diverse European populations. The TackSHS Project.)

Reporting period: 2018-11-01 to 2019-10-31

TackSHS overall aim was to provide scientific evidence on exposure assessment, burden of disease, development and evaluation of interventions to tackle secondhand tobacco smoke (SHS) and electronic cigarette (e-cigarette) aerosol (SHA) upon health of bystanders.

The Project specific objectives were to:
• Analyse the determinants of the exposure of the European Union (EU) population to SHS
• Characterise the attitudes of the EU population towards smoke-free measures
• Assess the morbidity and mortality attributable to SHS exposure in the European population
• Evaluate the economic burden of SHS exposure
• Design, implement, and evaluate new intervention to reduce SHS exposure in vulnerable populations
• Characterise exposure to SHS and SHA upon patients with chronic lung diseases and healthy subjects
• Develop feasible, sensitive, and cost-effective methods for SHS and SHA measurement

The TackSHS project impacts are:
• Insights for development and improvement of current smoke-free laws to protect the health of non-smokers
• Knowledge of exposure to SHS in open spaces and exposure to SHA in different places
• Evaluation of an intervention to promote smoke-free homes and recommendations for other interventions to be developed
• Improvement of the methods to measure exposure to SHS and aerosols of e-cigarettes and evaluation of new low-cost air quality analysers
• First estimations of morbidity and mortality attributable to SHS at the European level and their cost impact through purpose-built economic models
• Bringing into the national and EU agenda attention to the hazards derived from SHS and e-cigarette aerosols
• Training of young researchers in the area of SHS and e-cigarette exposure evaluation

The main results of the action are described below; as a general conclusion, TackSHS project showed that SHS exposure is still present in Europe and considerable part of the population is exposed to SHS contributing to an increased burden of diseases among children and adults and posing additional costs for national economies. Strengthening of current legislation to protect bystanders is needed in Europe and current population attitudes favour such changes, creating a window of opportunity to amend the regulations and further raise awareness among smokers and non-smokers about SHS exposure harms.
Overall, the project achieved the objectives defined and completed all the studies planned. In October 2019, the Final Conference of the project was held in the EU Parliament during which main project results and policy recommendations were presented to key stakeholders. The main project results and key messages are summarised below.

• At least weekly exposure to SHS among non-smokers is highly prevalent in most European countries (31% overall, ranging between 24% in Ireland and 68% in Greece), especially in indoor and outdoor settings of hospitality venues, workplaces, homes and cars
• Smoking occurs and SHS is present in almost all outdoor terraces of bars and restaurants across Europe, with higher levels during evening and night periods and in more enclosed terraces, even in countries with legislation in these settings
• Smoking occurs and SHS is present in most playgrounds and entrances to schools across Europe, especially in deprived neighbourhoods and countries with lower tobacco control climate
• Occasional exposure to SHS in outdoor settings worsens some respiratory parameters in non-smoking patients with asthma and COPD
• Across Europe, three out of five smokers allow smoking in their home, with very high levels of SHS exposure detected, potentially affecting children and other bystanders
• Personalised feed-back provided to smokers on how their smoking impacts household air quality encourages them to reduce their consumption indoors and make their homes smoke-free
• SHS levels in cars of smokers are very high, with nicotine concentrations exceeding those observed in smokers’ homes
• The burden attributable to SHS exposure is still substantial in the EU, mainly due to SHS exposure at home
• In 2017 in children aged 0-14 years, exposure to SHS at home was associated with 344 deaths and 37,000 disability-adjusted life years (DALYs) across the EU. The figures for non-smoking adults were 30,000 deaths and 712,000 DALYs
• The annual cost of lost DALYs due to exposure to SHS is 356 million (of Purchasing Power Parity Adjusted euro of year 2017) on average in the EU 28 Member States
• Despite the generally low prevalence of e-cigarette use in Europe, exposure to aerosols is frequently reported in various indoor settings. In Europe, one out of six non-users are at least weekly exposed to e-cigarette aerosol
• E-cigarette aerosol impairs air quality with particulate matter, nicotine, volatile organic compounds, and heavy metals
• Individuals exposed to e-cigarette aerosol showed immediate alterations of their lung function and experienced symptoms of eye, nose and throat irritation
The exploitation and dissemination of the results was conducted during the project and will be continued after the official end of the project. Dissemination activities include presentation to European Commission bodies, scientific manuscripts and scientific conferences, mass media (newspapers, radio, TV, etc.) and social media.
By the end of the project, all TackSHS studies were completed, results obtained addressed the objectives and their expected impact, described in the first section. These results are expected to have an important added value for different target groups such as policy makers, researchers and the general public. To maximise the project impact, the main policy recommendations were formulated and are used for project results dissemination, they are described below.

• Comprehensive policies and interventions to tackle tobacco consumption continue to be necessary with targeting of specific population groups with higher prevalence rates
• Increased monitoring and enforcement of smoke-free legislation is necessary, especially in workplaces and hospitality venues
• Smoke-free legislation should be extended to outdoor areas (terraces, playgrounds, entrances of public buildings) to discourage smoking, protect bystanders and increase public awareness
• Patients with asthma and COPD should be advised of the risks posed to their respiratory health when spending time in outdoor spaces where smoking takes place and SHS is present
• European governments should set national targets to reduce the proportion of children exposed to SHS
• Smoke-free homes should be promoted through evidence-based interventions at multiple levels
• European governments should introduce smoke-free policies to regulate smoking inside private cars
• Burden of diseases indicators should be incorporated in the planning and evaluation of tobacco control targets at national and European level
• Smoke-free laws should be planned and supported by multiple national agencies, from health promotion to economy departments, as bystanders’ protection from SHS exposure represents significant budget savings
• Policies restricting the use of e-cigarettes in enclosed public spaces should be introduced to protect bystanders from their secondhand aerosol
• More research on the mid- and long-term effects of acute and chronic exposure to aerosol of e-cigarettes by bystanders is needed, targeting specific vulnerable population groups
TackSHS Final Conference at the European Parliament, Brussels (October 8th 2019)