New WHO report reveals that while smoking continues to decline among European adolescents, the use of electronic cigarettes by young people is on the rise

Tobacco use among young people in the WHO European Region remains a public health concern. Despite the overall downward trend, several countries of the Region observed an increase in tobacco use prevalence among young people in the latest round of the Global Youth Tobacco Survey. While cigarettes remain the most used form of tobacco products, there is a concerning trend emerging from the use of electronic cigarettes (or e-cigarettes). According to the latest available data, young people are turning to these products at an alarming rate. The new report reveals that in some countries the rates of e-cigarette use among adolescents were much higher than those for conventional cigarettes. In Poland, for example, 15.3% of students smoked cigarettes and 23.4% used electronic cigarettes in 2016.

E-cigarettes and other novel and emerging nicotine- and tobacco-containing products, such as heated tobacco products (HTPs), are the next frontier in the global tobacco epidemic. While the latter is a tobacco product, e-cigarettes do not contain tobacco, and may or may not contain nicotine. Nonetheless, there is clear evidence that these products are addictive and harmful to health. HTPs expose users to toxic substances and chemicals, similar to those found in cigarette smoke, many of which can cause cancer, while e-cigarette use increases the risk of cardiovascular disease and lung disorders. Furthermore, both e-cigarettes and HTPs are particularly risky when used by children and adolescents, as exposure to a highly addictive substance like nicotine can have long-lasting and damaging effects on the developing brain.

Some countries that monitor e-cigarette use among young people have shown marked increases over the years. In Italy the prevalence of current e-cigarette use increased from 8.4% in 2014 to 17.5% in 2018, in Georgia – from 5.7% in 2014 to 13.2% in 2017, while in Latvia it was 9.1% in 2011 and 18% in 2019.

The Smoke Free Partnership (SFP) is one of the organizations at the forefront of the struggle against the tobacco pandemic. “We are a coalition of public health organizations working to make the WHO Framework Convention on Tobacco Control (WHO FCTC) a political priority,” explains Ms Anca Toma, the SFP’s Director.

SFP advises partners in its coalition on policy processes and emerging trends in the global tobacco epidemic. Although the national members of SFP have a wide range of positions on e-cigarette regulation, depending on the national context, political environment and domestic prevalence, the partnership plays a crucial supporting role in promoting and sharing best practices.

Like other tobacco control advocates, SFP emphasizes the importance of the WHO FCTC for safeguarding people against harmful tobacco products. “The top priority action for tobacco control, in our view, is implementation of the WHO FCTC in a comprehensive, consistent and incremental manner,” says Anca Toma. “Using existing tools, we can anticipate and counteract the tobacco industry strategies that undermine public health.”

In Ms Toma’s view, one of the most urgent actions is closing of regulatory and enforcement loopholes with respect to advertising, promotion and sponsorship. This holds true both for conventional tobacco products and for e-cigarettes and HTPs. The regulation of novel products at European level is fragmented and varies across countries, which the tobacco industry exploits to target children and young people. Ms Toma points to the repurposing of traditional product design strategies such as flavoured products and the rise of social media influencers, sponsorship of music festivals and other cultural events. “Some of these tactics have exploited existing regulatory gaps, while others have circumvented or even breached advertising and sponsorship bans,” she says. “Despite online advertising of tobacco and novel products being banned in most European countries, the industry plays on the difficulties of enforcing these rules cross-border and in the digital sphere.”

Nonetheless, progress is being made in the Region. There has been an increase in legal actions across Europe against these campaigns, with companies being fined and ordered to take down illegal content. Although there are challenges involved in regulating these products, a rigorous application of the WHO FCTC would close advertising loopholes and deny the industry the ability to push its products to young people with impunity.

WHO FCTC implementation is a mechanism to protect young people. It is proven to reduce tobacco use across the population and it is hoped that it will simultaneously prevent uptake of e-cigarettes. Ms Toma is optimistic about its effectiveness. “Evidence shows significant reduction in youth tobacco use in countries with the highest levels of implementation of the WHO FCTC. This happens without new products filling that gap. Where tobacco is no longer cool for kids, it is likely that neither are these new products”, she says.

Another crucial tool in the fight against tobacco- and novel nicotine-containing products is collaboration between research institutes and governments. For several years, the Smoke Free Partnership has been highlighting the need for governments and the European Union to invest in tobacco control policy research, ensuring that research is supported, population-focused and policy-relevant. “Too often, governments and advocates have to fight the industry’s undermining of evidence, or the industry attacking scientific evidence because it comes from other countries,” explains Ms Toma. “The other risk is that the tobacco industry is now trying to co-opt researchers through funding front groups, and that speaks to the need for governments to promote and protect independent research that supports, informs, monitors, and evaluates tobacco control policy.”

The tobacco industry has been ruthless in its attempts to maintain and increase profits, with e-cigarettes and heated tobacco being just another means to preserving and expanding its markets. However, with good guidance, research and a rigorous implementation of the WHO FCTC, a path can be built towards a tobacco and nicotine-free future. Protecting health and saving lives is the thrust of tobacco control and organizations like Smoke Free Partnership. As Anca Toma explains, “tobacco control is a fight for the lives of young generations”.