Exposure to secondhand smoke from cigarettes and secondhand aerosol from tobacco and nicotine products in indoor and outdoor public spaces in the European Union: a cross-sectional study

Abstract

Introduction In December 2024, the Council of the European Union (EU) adopted a recommendation to expand regulations on the use of nicotine-containing products both in indoor settings and specific outdoor areas. This study aimed to examine sociodemographic factors associated with exposure to conventional tobacco smoke and aerosols across the EU and support for relevant regulations.Methods We performed a secondary analysis of cross-sectional data from the Special Eurobarometer 99.3 (n=26 358, May-June 2023) across 27 EU Member States (MS). We estimated the weighted prevalence of secondhand exposure to tobacco smoke and aerosols and support for bans on smoking, e-cigarettes and heated tobacco products in public settings. Multilevel Poisson regression models explored associations between sociodemographic factors and these outcomes.Results Exposure to secondhand smoke and aerosols varied across EU MS. Younger individuals, those with higher education, living with children, and current and former tobacco and nicotine users (prevalence ratio (PR) 1.16, 1.01-1.33; and PR 1.22, 1.05-1.41, respectively) were more likely to report exposure to both tobacco smoke and aerosol from emerging products. Women (PR 1.05, 1.02-1.08; and PR 1.03, 1.02-1.05, respectively), those living with children (PR 1.05, 1.02-1.07; and PR 1.04, 1.02-1.07, respectively) and those with higher education levels (PR 1.10, 1.04-1.15; and PR 1.10, 1.06-1.14) were more likely to support bans, whereas those with financial difficulties (PR 0.94, 0.89-0.99 and PR: 0.95, 0.91-0.99, respectively), as well as current and former smokers (PR 0.61, 0.55-0.67; and PR 0.78, 0.73-0.84, respectively) and emerging product users (PR 0.84, 0.76-0.92; and PR 0.69, 0.62-0.76, respectively), were less supportive.Conclusion Our analysis found that both exposure to secondhand smoke and aerosol and support for bans in public spaces vary substantially between population subgroups and across countries. Our findings can support EU MS in implementing targeted interventions to increase population support for and implement the recent EU Council recommendations.