Impact of cigarette prices and age-of-sale policies on smoking prevalence among youth in 26 European Member States (2012–2023): a longitudinal ecological study using repeated cross-sectional data

Abstract

Background Reducing tobacco and nicotine use and preventing smoking initiation among youth are key public health priorities. We evaluated the impact of cigarette prices and age-of-sale laws on youth smoking prevalence in the European Union (EU). Methods In this ecological study with 26 EU Member States as the unit of analysis, we estimated smoking prevalence among individuals aged 15-24, using five Eurobarometer waves (2012-2023, n = 12,087). We used fixed-effects panel regression models to assess the association between cigarette prices, the introduction of 18+ age-of-sale laws for tobacco products and changes in youth smoking prevalence, controlling for time and tobacco control policy implementation. Findings Weighted youth smoking prevalence decreased from 28.4% (841/2818) in 2012 to 22.2% (490/2222) in 2023, although the trend was not consistently downward. A 1 increase in inflation-adjusted cigarette prices per pack was associated with a 3.4 percentage point reduction in male youth prevalence (95% CI: -6.40 to-0.45), while there was no significant association for females or at the EU level. Regional variation was observed, with price increases associated with substantial reductions in youth smoking among both sexes in Southern Europe and among males in Northern Europe. In contrast, no such associations were found in Western or Eastern Europe. Age-of-sale laws were not significantly associated with youth smoking prevalence at the EU level. Interpretation Current taxation and age-of-sale policies remain insufficient, with impacts varying by sex and region. Achieving the tobacco endgame requires harmonised EU-level measures and stronger enforcement, particularly of these two policies, to prevent the ongoing influx of new youth smoking initiates. This study suggests that their potential impact has been constrained by inadequate enforcement to date rather than by policy ineffectiveness. Funding None. Copyright (c) 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).