CONFERENCE PROCEEDING
Trends in secondhand smoke exposure in European hospitality venues 2009-2020
1
CIBER en Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
2
Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center on Tobacco Control, Institut Català d’Oncologia, l’Hospitalet de Llobregat, Barcelona, Spain
3
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
4
National and Kapodistrian University of Athens, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, Athens, Greece
5
Secretariat of Public Health, Department of Health, Generalitat de Catalunya, Barcelona, Spain
Tob. Prev. Cessation 2026;12(Supplement 1):A48
ABSTRACT
BACKGROUND-AIM:
Exposure to secondhand smoke (SHS) causes over 1.2 million deaths annually worldwide. Although the European Union recommended smoke-free environments in 2009, legislative implementation varies significantly across Member States, and most existing evaluations rely on outdated data. This study provides the first decade-long analysis (2009–2020) of SHS exposure in hospitality venues across 27 EU countries to assess the long-term sustainability of these policies.
METHODS:
We analyzed repeated cross-sectional data from five Eurobarometer survey waves, October 2009 (n= 26788), February–March 2012 (n=26751), November-December 2014 (n=26792), March 2017 (n=26853), and August-September 2020 (n=27281), for a total of 134465 respondents. Countries were classified by the timing of their comprehensive smoke-free laws for bars and restaurants: “early adopters” (legislation enacted before 2009), “later adopters” (2009–2020) and “non-adopters”. Multilevel logistic regression models estimated the odds of self-reported SHS exposure, adjusting for individual demographics and country-level factors, including GDP and the tobacco control scale.
RESULTS:
Comprehensive legislation proved highly effective. In later-adopting countries, the adjusted odds of SHS exposure in bars dropped by 90% immediately following implementation. However, effectiveness varied by enforcement; while Spain saw a 98% reduction, Greece experienced increased exposure odds post-ban due to non-compliance. Later adopters demonstrated a “catch-up” effect, rapidly converging to the low exposure levels of early adopters despite starting with a higher prevalence (the unadjusted SHS exposure prevalence went from 68% in 2009 to 16% in 2020). Conversely, early adopters experienced a plateau in progress, with exposure rates stabilizing rather than reaching zero (12% in 2009 and 2020), highlighting a “last mile” challenge. Declines were also observed in countries without comprehensive laws (from 36% in 2009 to 16% in 2020), indicating a broader cultural shift toward protecting non-smokers.
CONCLUSIONS:
Smoke-free legislation delivers immediate, robust protection, and it is never too late to implement bans, as later adopters quickly benefit from “diffusion of innovation”. However, legislation alone is insufficient for permanent success. The plateauing trends in early adopters indicate that sustaining low exposure requires vigilant enforcement and continuous monitoring to overcome compliance fatigue. Future efforts must focus on objective surveillance to protect the gains made toward a
Exposure to secondhand smoke (SHS) causes over 1.2 million deaths annually worldwide. Although the European Union recommended smoke-free environments in 2009, legislative implementation varies significantly across Member States, and most existing evaluations rely on outdated data. This study provides the first decade-long analysis (2009–2020) of SHS exposure in hospitality venues across 27 EU countries to assess the long-term sustainability of these policies.
METHODS:
We analyzed repeated cross-sectional data from five Eurobarometer survey waves, October 2009 (n= 26788), February–March 2012 (n=26751), November-December 2014 (n=26792), March 2017 (n=26853), and August-September 2020 (n=27281), for a total of 134465 respondents. Countries were classified by the timing of their comprehensive smoke-free laws for bars and restaurants: “early adopters” (legislation enacted before 2009), “later adopters” (2009–2020) and “non-adopters”. Multilevel logistic regression models estimated the odds of self-reported SHS exposure, adjusting for individual demographics and country-level factors, including GDP and the tobacco control scale.
RESULTS:
Comprehensive legislation proved highly effective. In later-adopting countries, the adjusted odds of SHS exposure in bars dropped by 90% immediately following implementation. However, effectiveness varied by enforcement; while Spain saw a 98% reduction, Greece experienced increased exposure odds post-ban due to non-compliance. Later adopters demonstrated a “catch-up” effect, rapidly converging to the low exposure levels of early adopters despite starting with a higher prevalence (the unadjusted SHS exposure prevalence went from 68% in 2009 to 16% in 2020). Conversely, early adopters experienced a plateau in progress, with exposure rates stabilizing rather than reaching zero (12% in 2009 and 2020), highlighting a “last mile” challenge. Declines were also observed in countries without comprehensive laws (from 36% in 2009 to 16% in 2020), indicating a broader cultural shift toward protecting non-smokers.
CONCLUSIONS:
Smoke-free legislation delivers immediate, robust protection, and it is never too late to implement bans, as later adopters quickly benefit from “diffusion of innovation”. However, legislation alone is insufficient for permanent success. The plateauing trends in early adopters indicate that sustaining low exposure requires vigilant enforcement and continuous monitoring to overcome compliance fatigue. Future efforts must focus on objective surveillance to protect the gains made toward a
| eISSN: | 2459-3087 |
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