Best practices for secondhand smoke and secondhand aerosol protection and evidence supporting the expansion of smoke and aerosol-free environments: Recommendations from the 2nd Joint Action on Tobacco Control

Abstract

Exposure to secondhand tobacco smoke (SHS) is a global health threat that causes diseases and kills more than 1.2 million people each year, including 65000 children1-4. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) urges countries to establish comprehensive smoke-free environments5. Although European Union (EU) member states have implemented smoke-free laws, challenges persist with designated smoking rooms (e.g. in hospital venues and in airports) and neglect of emerging products, such as electronic cigarettes (e-cigarette) and heated tobacco products (HTP)6,7. This editorial provides concise recommendations on smoke- and aerosol-free environments (SAFE) in the EU, focusing on evidence-based strategies for SAFE. Promoting the expansion of SAFE throughout EU countries was a key objective of the JATC-2, a project co-funded by the European Commission. To address this objective, WP8 focused on the current framework and potential expansion of SAFE in Europe. As part of this effort, a consultation was conducted in 2022, engaging 110 experts from 27 EU member states, along with Norway, Serbia, and the United Kingdom. The sources to identify experts were the JATC-2 contact list of all authorities and stakeholders working with tobacco regulation (policymakers and regulators, researchers and tobacco inspectors) for countries of the EU; the Catalan Institute of Oncology/WHO Collaborating Center for Tobacco Control list of contacts, including speakers and attendees to five editions of ICO-WHO Symposia on tobacco control; and lists of contacts from Smoke-Free Partnership and the European Network for Smoking and Tobacco Prevention. The responses from these experts provided valuable information on the barriers, opportunities, and best practices associated with SAFE policies across different countries. This collective knowledge, combined with findings from a systematic literature review (covering articles published between January 2010 and August 2022) and dedicated discussions (including a symposium satellite of the 9th European Conference on Tobacco or Health), forms the basis for recommendations on effective strategies and interventions to safeguard individuals from SHS and secondhand aerosol (SHA). The expert consultations are summarized in the following recommendations.