Tobacco consumption remains the leading cause of preventable mortality in the EU, resulting in nearly 500 000 deaths in 2021 (IHME, 2024[1]). As a key risk factor for several cardiovascular and respiratory diseases, it also contributes significantly to various types of cancer, most notably lung cancer that accounted for nearly 20% of all cancer deaths in the EU in 2021. The harmful effects of tobacco use extend beyond the individual, placing a significant burden on healthcare systems and society, with the cost of smoking-attributable diseases estimated at 2.5% of Europe’s annual GDP (Goodchild, Nargis and D’Espaignet, 2018[2]).
In 2022, an average of 18.4% of adults smoked daily across EU countries. The proportion of daily smokers varied more than two‑fold, ranging from 25% or more in Bulgaria, Greece, Hungary and France to below 12% in Denmark, Finland and Sweden (Figure 4.3). Men consistently smoked more than women across all Member States, with an average of 22.3% compared to 14.8%. The gender gap was most pronounced in Romania and Lithuania, while it was non-existent in Sweden, Finland, Norway and Iceland (Figure 4.4). Over the last decade, smoking rates declined in all EU countries except three, with an average 15% reduction since 2012. Progress has however been uneven, with the largest reductions in Estonia (over 10 percentage points), Czechia and Germany (over 6 percentage points), while rates stagnated in Malta and Bulgaria and Luxembourg saw an increase.
Over the last decade, the implementation of more stringent tobacco control policies at the national level such as smoke‑free environments, advertising bans and excise tax increases have played a significant role in reducing smoking rates across many EU countries. These efforts have been complemented by the revised 2014 EU Tobacco Products Directive and the 2011 EU Directive on tobacco excise duties, which introduced EU-wide measures such as larger health warnings, restrictions on advertising and a requirement for a minimum rate of excise duties on tobacco products (European Commission, 2021[3]).
Against the backdrop of gradual declines in tobacco smoking, the use of electronic cigarettes (i.e. vaping products) has emerged as a new public health challenge. While vaping rates remain relatively low overall, they are significantly higher among young people (Figure 4.5). In 2022, 3.4% of individuals aged over 15 were regular users of vaping products across EU countries. Luxembourg, Estonia and Czechia reported the highest vaping rates (over 10%), while Bulgaria, Austria and Croatia had the lowest (less than 1%). Among the 15‑24 age group, the average vaping rate was 6.5% in 2022, with particularly high rates in Estonia (30%), Czechia (25%) and Luxembourg (20%). The strong increase in vaping rates among young people in Estonia and Czechia in recent years was accompanied by a significant reduction of those smoking tobacco.
While some countries have explored the potential of vaping as a possible smoking cessation tool, evidence suggests it may lead to tobacco smoking, especially among youth (Martinelli et al., 2023[4]). According to the Eurobarometer survey, in 2020 over 50% of vaping users in EU countries mentioned stopping or reducing tobacco consumption as the main reason for taking up e‑cigarettes, but almost 60% of them were “dual users”, using both traditional tobacco products and e‑cigarettes (European Commission, 2021[5]). Policies to regulate vaping products include age restrictions, taxes, indoor vaping bans and sales regulations. In the EU, advertising and promotion of e‑cigarettes are prohibited in various media and contexts. Some countries are also considering outright bans on specific vaping products as part of their anti-tobacco strategies. For instance, Belgium plans to ban the sale of disposable vapes by 2025, with several other EU countries contemplating analogous measures.
