Tobacco use is considered the single most important cause of preventable morbidity and premature mortality worldwide, with tobacco being the major single cause for premature deaths in the European Union (EU). Special Eurobarometer 458/2017 indicates that over a quarter (26%) of European citizens are current smokers. While the prevalence amongst the general population remains the same since 2014, an increase in consumption amongst young people aged 15-24 is observed since 2014 (from 24% to 29%). Smoking within the EU is estimated to cause 700.000 deaths annually, and has a significant impact on the provision of health care and pose an additional burden to economies within the Eurozone, many of which are already under significant economic constraints.
As detailed on the FPA proposal, efforts to reduce tobacco-related deaths and illness in the EU are made by the newly adopted binding legislation, the Tobacco Products Directive (TPD), and the ongoing implementation of the WHO Framework Convention on Tobacco Control (WHO-FCTC), within which eight guidelines have been adopted to date by the Conference of the Parties (COP), including Article 5.3: Protection of public health policies with respect to vested interests of the tobacco industry; Article 6: Price and tax measures to reduce the demand for tobacco; Article 8: Protection from exposure to tobacco smoke; Article 9 and 10: Regulation of the contents of tobacco products and regulation of tobacco product disclosures; Article 11: Packaging and labelling of tobacco products; Article 12: Education, communication, training and public awareness; Article 13: Tobacco advertising, promotion and sponsorship; and Article 14: Demand reduction measures concerning tobacco dependence and cessation – all these Articles need further support to be implemented by the EU and across the EU.
Within this context ENSP has been responsible for supporting the European Commission in the development of numerous Commission Implementing Decisions - legislation covering all 28 EU MS – in which ENSP was one of the two partners of the consortium (please, see the FPA proposal for more details). Overall, the European Commission still is in need of support for a full implementation of TPD/FCTC across the 28 EU MS to protect the health and livelihood of the 511 million children and adults that live within the European Union. Within this context in 2018 there is an undisputable need to promote tobacco control efforts across the EU and ensure their timely implementation for which ENSP has the expertise and previous experience to provide this to the EU.

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Despite the adoption of the TPD by the Council and the European Parliament on 29 April 2014 with its Articles to be implemented by 22 May 2016, according to official data on the national transposition communicated by EU MS themselves, many countries are still struggling to implement measures into national legislation, with 2 EU MS having implemented none of the measures and most of the remaining EU MS have only transposed a few. Similar heterogeneity is noted across the EU with regards to the implementation and enforcement of the WHO FCTC, with large differences in cessation measures, smoke free environments, and tobacco advertising across EU MS. Hence there is a need to support the implementation and enforcement of the TPD and the WHO-FCTC into national legislations. This has to be done at the national EU MS level. One central reason for the delay in implementing the TPD/FCTC is the lack of detailed guidance to aid EU MS in the transposition of their Articles, which for the TPD is supported by complex legislative documents and Commission Implementing Decisions. Regulators at the EU MS level -who face significant staff and budget cuts- are in a difficult position to address all these technical implementation issues. With the 2018 work programme, ENSP through its broad network will support this need and enhance the full implementation of the TPD and FCTC and monitor their implementation, significantly contributing to evidence based decision-making by national policy makers in 28 EU MS. Furthermore, another reason behind the delay is the lack of political will and tobacco industry interference. Hence, there is a large need for regional advocacy events so as to increase visibility of tobacco control and ensure that tobacco control is also on the national agenda. ENSP plays a major role in Europe to prevent the tobacco industry from biasing and slowing down the tobacco control process and mobilizing NGOs and tobacco control advocates to join efforts in their fight for a tobacco-free Europe. ENSP members can take advantage of past experience in other countries and adapt such experience to their own needs. In this capacity ENSP, during 2018 will be instrumental in providing EU MS and neighbouring countries with evidence to support policies.
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Smoking is the largest single contributor to socio-economic inequalities in morbidity and mortality. Tobacco use is also directly or indirectly related to all priority areas of the 3rd health programme. Tobacco use, as a substance of human origin, is the strongest preventable determinant of health, and is directly related to chronic disease development, cancer, dementia and severely impacts the quality of life and outcomes of patients with rare diseases, HIV/AID, Tuberculosis and Hepatitis which result in increased needs to access healthcare.
Socioeconomic determinants also play an important role in tobacco use and exposure and in support for tobacco control policies. While most importantly, tobacco use and experimentation is directly associated with age. Almost 70% of all adult smokers in the EU begin smoking by age 18 years, with about 94% starting before the age of 25 years. There are many influential factors that mediate cigarette uptake including peer pressure, the social context, social determinants and industry driven determinants, such as design characteristics and additives which are also key in youth experimentation and subsequent addiction to nicotine. Indeed, the tobacco industry has done extensive research on the hedonic effects of cigarette smoking and has used several cigarette engineering features and marketing strategies to target young consumers and potential consumers – many tactics of which are to be potentially addressable with the newly implemented TPD and its accompanying implementing acts.
It is well acknowledged that sensory characteristics that maintain tobacco product appeal and ease of use are important in influencing smoking behaviour independent of the direct effects of nicotine. For example, the sensory effects of menthol, including its cooling, analgesic and soothing effects, alleviate the irritating and harsh effects of nicotine, thus increasing the ease of smoking experimentation among youths. Additive enhancements such as the use of characterising flavours are often used to increase smoking appeal/attractiveness, particularly among naïve smokers, which are primarily under 18 years of age. These additives are intentionally added to tobacco products by the tobacco industry in order to render toxic tobacco products palatable and acceptable to consumers – additives however are among the aspects that may be regulated under the TPD as characterising flavours – an opportunity that should not be missed.
Hence it is imperative to increase in 2018 health literacy and awareness among the youth of tobacco industry tactics so as to reduce smoking initiation, increase smoking cessation and prevent tobacco use among youth, taking into account other thematic priority issues of the 3rd health programme – all of which are associated with tobacco use.

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Because the funding opportunities in tobacco control remain very scarce, it is imperative to ensure that the knowledge, toolkits, evidence based documents and information produced by tobacco control researchers and advocates are shared as broadly as possible and maintained fully available to all - both now and in the future. Hence it is important that all tobacco control activities become sustainable and available in the long term to researchers, policymakers and advocates across the EU. Moreover, as funding opportunities are often scarce, it is important for ENSP to continue to develop sustainable activities so as to obtain general independence from European Commission funding within the course of the 2018-2021 programme.

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