COMMISSION STAFF WORKING DOCUMENT Accompanying the document Proposal for Council Recommendation on Smoke- and Aerosol-Free Environments replacing Council Recommendation 2009/C 296/02
Date: 2024-09-17
Institutions: Directorate-General for Health and Food Safety, European Commission
Subjects: cancer, carcinogenic substance, disease prevention, occupational health, public awareness campaign, public health, smoking, tobacco industry, toxic substance

EN 

  EN 

   EUROPEAN COMMISSION  Strasbourg, 17.9.2024  SWD(2024) 55 final  COMMISSION STAFF WORKING DOCUMENT      Accompanying the document Proposal for Council Recommendation on Smoke- and Aerosol-Free Environments    replacing Council Recommendation 2009/C 296/02 {COM(2024) 55 final} - {SWD(2024) 56 final}  
 
 
1.  Introduction and context 

This  report  is  an  informative  document  supporting  the  revision  of  the  2009  Council 
Recommendation  on  smoke-free  environments1  and  explains  its  potential  health,  social, 
environmental, and economic impacts.  

The  2009  Council  Recommendation  on  smoke-free  environments  was  adopted  on  30 
November  2009  following  a  consultation  process  which  showed  a  clear  support  for  the 
introduction of smoke-free rules. It recommended that EU Member States act in three main 
areas: 1) Adopt and implement rules to fully protect their citizens from exposure to tobacco 
smoke in enclosed public places, workplaces and public transport; 2) Enhance smoke-free 
laws with supporting measures such as protecting children, encouraging efforts to give up 
tobacco use and pictorial warnings on tobacco packages; 3) Strengthen cooperation at EU 
level by setting up a network of national focal points for tobacco control. 

The Recommendation was  also  adopted in  line  with  and with the aim of  supporting the 
implementation of the WHO Framework Convention of Tobacco Control (WHO FCTC) to 
which  the  Union  and  all  Member  States  are  parties.  Article  8  of  the  FCTC  requires  its 
parties  to  tackle  exposure  to  tobacco  smoke  in  workplaces,  public  transport  and  indoor 
places.  The  guidelines  for  its  implementation2  aim  to  assist  parties  in  meeting  their 
obligation under Article 8 of the FCTC. s 

The  2009  Council  Recommendation  called  on  Member  States  to  introduce  smoke-free 
environments by November 2012. To follow up on this, in 2013, the Commission published 
an  Implementation  Report3  presenting  the  state  of  implementation  of  the  Council 
Recommendation (2009/C 296/02). The report found that all Member States had adopted 
measures  to  protect  citizens  against  exposure  to  tobacco  smoke,  but  that  the  national 
measures  or  policies  differed  considerably  in  their  extent  and  scope.  As  a  result  of  the 
measures taken, the exposure rates from tobacco smoke dropped from 2009 to 2012. The 
report  also  found  that  the  health  effects  of  smoke-free  environments  are  immediate  and 
include a reduction in the incidence of heart attacks and improvements in respiratory health, 
while the economic effect of smoke-free environments is positive or neutral. 

The  Council  Recommendation  on  smoke-free  environments  included  only  traditional 
tobacco products, which were perceived to be the main issue at the time, and some public 
spaces, such as indoor and enclosed spaces, in its scope. Other spaces, including specific 
outdoor spaces, were only covered based on a case-by-case hazard assessment. In 2009, 
heated tobacco products had not yet entered the EU market and electronic cigarettes only 
to  a  minor  extent.  The  Recommendation  therefore  targeted  only  traditional  smoking 
tobacco  products  by  referring  to  ‘tobacco  smoke’,  meaning  that  it  cannot  currently  be 
directly applied to emerging products. 

1 Council Recommendation of 30 November 2009 on smoke-free environments (OJ C 296, 5.12.2009, p. 4) 
2 WHO Framework Convention on Tobacco Control: Guidelines for implementation of Article 8  
3 Report on the implementation of the Council Recommendation of 30 November 2009 on Smoke-free Environments 
(2009/C 296/02)  

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The information and evidence presented in this report is based on: 

•  The 2009 impact assessment accompanying the Council Recommendation (2009/C 
296/02), which will be referred to simply as the ‘impact assessment’ throughout this 
report4 

•  The 2021 evaluative study on smoke-free environments and advertising of tobacco 
related  products5,  commissioned  by  the  European  Commission’s  Directorate-
General  for  Health  and  Food  Safety  (DG  SANTE).  It  serves  as  an  important 
document  that  identifies  some  shortcomings  and  gaps  of  the  existing  Council 
Recommendation. It also provides an analysis of the progress made since the earlier 
2013  report  on  the  implementation  of  the  2009  Council  Recommendation  on 
smoke-free  Environments  and  analyses  the  various  impacts  of  smoke-free  rules. 
This study will be referred to simply as ‘evaluative study’ throughout this report. 
•  The  2021  WHO  Report  on  the  global  tobacco  epidemic:  addressing  new  and 

emerging products6. 

•  The 2021 Scientific Opinion of the Scientific Committee on Health, Environmental 

and Emerging Risks (SCHEER) on electronic cigarettes7. 

•  The 2023 Special Eurobarometer report on ‘Attitudes of Europeans towards tobacco 
and electronic cigarettes. This survey report is the most recent in a series and aims 
to assess the prevalence of tobacco use and exposure to tobacco smoke in public 
places, to  explore the motivations  for smoking,  and to  help  identify measures to 
reduce the number of smokers in the EU and address issues related to  electronic 
cigarettes and heated tobacco products8. 

•  The  2023  WHO  Report  on  the  global  tobacco  epidemic:  protect  people  from 

tobacco smoke 9 

•  The 2023 WHO Technical note on the call to action on electronic cigarettes10 
•  The 2023 WHO Call to action on electronic cigarettes 11 
•  The Weight of Evidence paper for the evidence supporting the expansion of Smoke 
and  Aerosol  Free  Environments  (SAFE)  in  the  EU:  Assessment  of  barriers, 
opportunities,  and  best  practices  for  SAFE12.  This  report  is  a  deliverable  of  the 
Work Package 8 of the Joint Action on Tobacco Control (JATC-2)13 and aims to 
provide up to date information and address questions on barriers, opportunities, and 
best practices to support the expansion of smoke- and aerosol-free environments in 
Member States. 

4 Accompanying document to the Proposal for a Council recommendation on smoke-free environments - Impact assessment 
(SEC/2009/0894 final)  
5 European Commission, Directorate-General for Health and Food Safety. Study on smoke-free environments and advertising 
of tobacco and related products. 2021. ISBN: 978-92-76-42343-0 
6 World Health Organization. Report on the global tobacco epidemic 2021: addressing new and emerging products. 2021. 
ISBN: 978 92 4 003209 5 
7 SCHEER (Scientific Committee on Health, Environmental and Emerging Risks). Opinion on electronic cigarettes. 16 April 
2021. 
8 Special Eurobarometer 539. 2023. Attitudes of Europeans towards tobacco and related products. ISBN: 978-92-68-07599-9 
9 World Health Organization. Report on the global tobacco epidemic 2023: protect people from tobacco smoke. 2023. ISBN: 
978-92-4-007716-4 
10  World  Health  Organization.  Technical  note  on 
https://www.who.int/publications/m/item/technical-note-on-call-to-action-on-electronic-cigarettes  
11 World Health Organization. Electronic cigarettes call to action. 2023. https://www.who.int/publications/m/item/electronic-
cigarettes---call-to-action  
12 Carnicer-Pont, D., et al. 2023. Weight of Evidence (WoE) paper for the evidence supporting the expansion of Smoke and 
Aerosol  Free  Environments  (SAFE)  in  the  EU:  Assessment  of  barriers,  opportunities  and  best  practices.  JATC-2. 
https://jaotc.eu/wp-content/uploads/2023/10/D8.1-Weight-of-eviedence-paper-on-the-evidence-for-supporting-the-
expansion-of-smoke-free-environments.pdf  
13 Joint action on Tobacco Control 

to  action  on  electronic  cigarettes.  2023. 

the  call 

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•  The  Workshop  report  “Novel  tobacco  and  nicotine  products  and  their  effects  on 
health”14. This document outlines the results of a workshop conducted by the ENVI 
committee health working group in the European Parliament. 

This report also presents the outcomes of the consultation activities conducted in support 
of the revision. Namely: 

•  Feedback from 207 responses resulting from the call for evidence on the ‘Have your 
say’ platform from 22 June until 20 July 202215, through which the Commission invited 
the public and stakeholders to provide feedback and other relevant input regarding the 
revision  of  the  Council  Recommendation  on  Smoke-free  Environments.  Responses 
were  received  from  citizens  (52%),  Non-Governmental  Organisations  (13.5%), 
business associations, business organisations and trade associations (19%), consumer 
organisations (3.9%), academic/research institutions (2.9%) and Member State Public 
authorities (1.9%) and other respondents (7.2%). 

•  Results  of  the  targeted  consultation  activities  gathering  input  from  the  following 
relevant stakeholder groups: 1) representatives of Member State competent authorities; 
2)  civil  society  organisations;  3)  Economic  Operators  in  the  tobacco  and  related 
products  industry;  4)  representatives  from  the  HORECA  sector;  4)  other  relevant 
stakeholders  such  as  those  in  education  and  sports  associations.  The  targeted 
consultation  activities  consisted  of  a  targeted  survey,  targeted  interviews,  and  focus 
groups. 
Input and feedback from representatives of Member States competent authorities (26 
EU  Member  States  plus  Iceland  and  Norway)  who  participated  in  a  meeting  of  the 
Expert Group on Tobacco Policy organised on 3 May 202316. 

• 

2.  Problem definition and objectives 

Problem 1: Emerging products and the risk of exposure to second-hand aerosols is 
not considered in the current Recommendation 

Since 2009, emerging products such as electronic cigarettes and heated tobacco products 
have consolidated their market shares and their appeal, in particular to young consumers 
and  their  use  is  rapidly  becoming  a  trend  among  young  people  in  the  EU.  Based  on 
Eurobarometer data from 2023, the prevalence of electronic cigarette use across the EU is 
3% and the prevalence of heated tobacco products  use is 2%. A particularly concerning 
aspect  of  the  uptake  of  emerging  products  in  recent  years  has  been  their  appeal  among 
children and young people. The Eurobarometer from  2023 also  highlighted that 54% of 
current and past smokers start regularly before the age of 19 and 14% start before the age 
of 158. 

Second-hand emissions from emerging products have potentially harmful health impacts. 
The  World  Health  Organization  highlights  that  second-hand  emissions  from  emerging 
products expose bystanders to quantifiable levels of particulate matter and key toxicants, 
albeit at a lower level than from second-hand smoke of traditional tobacco products. In its 
opinion on electronic cigarettes, a European Commission’s advisory committee known as 

14 European Parliament, Directorate-General for Internal Policies of the Union. Novel tobacco and nicotine products and 
their effects on health. 2023. ISBN: 978-92-848-0226-5 
15 Have Your Say. Smoke-free environments- updated recommendation. Call for evidence. 22 June 2022- 20 July 2022 
16 Flash report of the 20th Meeting of the Expert Group on Tobacco Policy 

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Scientific Committee on Health, Environment and Emerging Risks (SCHEER) concluded 
that  there  is  weak  to  moderate  evidence  of  risks  of  respiratory,  cardiovascular,  and 
carcinogenic  damage  due  to  second-hand  exposure  to  electronic  cigarette  aerosols.  The 
World  Health  Organization  considers  that  electronic  cigarettes  with  nicotine  are  highly 
addictive and are harmful to health and all tobacco measures should be applied to them 10 
and that no level of exposure is safe or acceptable and that a careful approach should be 
taken.  Given  this  situation,  the  revision  of  the  Council  Recommendation  to  include 
emerging products is justified and appropriate to ensure proper public health protection. 

Problem  2:  The  coverage  of  outdoor  spaces  is  not  specific  in  the  current 
Recommendation 

In the current Council Recommendation (2009/C 296/02) ‘indoor’ (or enclosed) areas are 
defined very broadly, i.e. any space covered by a roof or enclosed by one or more walls or 
sides, regardless of the type of material used for the roof, wall or sides, and regardless of 
whether the structure is  permanent or temporary. Places where groups of people gather, 
regardless of ownership or right of access, which include outdoor and quasi-outdoor spaces, 
are  only  covered  based  on  a  case-by-case  assessment  of  possible  health  hazards  by  the 
individual  Member  States.  This  means  that  certain  outdoor  spaces  are  not  necessarily 
specifically  covered  by  the  Recommendation,  despite  the  risk  of  possible  hazardous 
exposure to second-hand smoke and aerosols. 

In  conclusion  and  given  the  market  developments  since  2009,  the  current  situation 
undermines the objectives of the 2009 Council Recommendation, as it cannot sufficiently 
address  the  risks  from  emerging  products  or  from  exposure  to  second-hand  smoke  and 
aerosols  in  certain  outdoor  spaces.  Therefore,  the  revision  of  the  2009  Council 
Recommendation  on  Smoke-free  Environments  is  necessary  and  appropriate  in  order  to 
contribute  to  the  better  protection  of  people  in  the  EU  from  second-hand  smoke  and 
aerosols,  to  discourage  the  uptake  of  related  products  and  addiction,  and  to  resist  any 
normalisation of such products and behaviour. 

Objectives  of  the  new  Council  Recommendation  on  Smoke-  and  Aerosol-free 
Environments 

In response to the issues identified in the above sections, the revision of the current Council 
Recommendation has the following objectives: 

Objective 1 

To strengthen the protection of people in the Union from the risks related to the exposure 
to second-hand smoke originating from the use of traditional tobacco products and second-
hand aerosols originating from the use of emerging products. 

Objective 2 

To encourage current smokers and users of emerging products to quit, which will contribute 
to the reduction of the prevalence of smoking and use of emerging products. In addition, 
the Recommendation  aims  to  support the  denormalisation the use of traditional  tobacco 
products and the use of emerging products, and fight addiction, especially among young 
people and discouraging its general social acceptance. 

Objective 3 

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To positively contribute towards the tobacco-related objective set out in Europe’s Beating 
Cancer Plan which is the achievement of a ‘Tobacco-Free Generation’ where less than 5% 
of the EU population uses tobacco by 2040, compared to around 24% today. 

3.  Suggested revisions of the Recommendation 
3.1 Specific revisions  
The revised Council Recommendation would include the following specific revisions adding 
towards the already existing ones: 

Extension of the scope to specifically include the following emerging products 

•  Emerging products that emit smoke or aerosols. For example, heated tobacco products 

and electronic cigarettes (whether containing nicotine or nicotine-free) 
•  Tobacco surrogates and any other smoke and/or aerosol emitting products  

Given the above revisions, the title of the Recommendation has been adapted to include 
aerosol-free environments.  

Extension of the coverage to specifically include the following specific outdoor spaces 

•  Designated outdoor recreational areas, especially where children may often be present. 
These should include public playgrounds, amusement parks, swimming pools, zoos and 
other similar outdoor spaces; 

•  Any  outdoor  or  semi-outdoor  (e.g.  partially  covered,  walled,  fenced,  or  otherwise 
delineated  areas  next  or  close  to  an  establishment,  including  rooftops,  balconies, 
porches  or  patios)  areas  associated  to  service  establishments.  These  should  include 
outdoor spaces of restaurants, bars, cafes, and outdoor spaces of other similar premises. 
•  Any outdoor or semi-open areas related to public transportation, including at bus, tram 

and train stops and airports; 

•  Any outdoor area associated to a place of work; 
•  Any  outdoor  area  of  premises  related  to  healthcare.  These  should  include  hospitals, 

clinics, health centres, nursing homes and other similar premises; 

•  Any outdoor area of premises that provide education and training to children and young 
people.  Such  areas  should  include  pre-school  childcare  institutions,  primary  and 
secondary schools, vocational educational institutions, universities, youth centres and 
other similar premises;  

The Recommendation complementarily refers to the following spaces in order to encourage a 
comprehensive approach: 

•  Other outdoor areas in which members of the public, including children and minors, 
are likely to congregate. Such spaces could include, among others, outdoor areas where 
events  are  organised,  auditoriums  and  spectator  areas  at  public  events,  and  spaces 
associated with buildings open to the public that are likely to see heavy foot traffic (e.g. 
entrances to shopping malls, courtyards of buildings open to the public) 
•  Other areas, such as private cars where children and minors are present. 

3.2 Rationale for the revisions 
Inclusion of emerging products in the scope 

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Emerging  products  emit  aerosols  and  thus  expose  people,  in  particular  children  and  young 
people,  to  second-hand  aerosols.  As  described  under  problem  1,  these  products  were  not 
relevant and/or not considered in the 2009 Council Recommendation. The WHO, in its reports 
on  the  global  tobacco  epidemic,  highlights  those  second-hand  emissions  from  emerging 
products expose bystanders to quantifiable levels of particulate matter and key toxicants, even 
if  at  a  lower  level  than  from  second-hand  smoke  of  traditional  tobacco  products.  There  is 
variation in the conclusions of studies analysing the harms of second-hand exposure to aerosols 
originating from the use of emerging products. Some studies show that users and bystanders 
who  were  exposed  to  heated  tobacco  products  were  exposed  to  reduced  levels  of  harmful 
substances,  such  as 
tobacco-specific  N-nitrosamines,  cadmium,  polycyclic  aromatic 
hydrocarbons  and  carbon  monoxide,  compared  to  conventional  cigarette  smoke.  However, 
other  studies  show  that  emissions  of  heated  tobacco  products  may  contain  higher 
concentrations  of  potentially  toxic  substances,  including  carcinogenic  substances,  in  higher 
amounts  than  in  conventional  cigarette  smoke17.  In  addition,  the  WHO6,9,10,11recently 
highlighted among other concerns related to emerging products, the negative health effects of 
exposure to second-hand aerosols. For example, there is evidence that exposure to second-hand 
emissions  from  heated  tobacco  products  is  associated  with  significant  respiratory  and 
cardiovascular abnormalities in bystanders18,19,20,21,22,23. In addition, second-hand aerosols from 
electronic cigarettes, both with and without nicotine, expose bystanders to quantifiable levels 
of particulate matter and key toxicants and contaminants24,25,26,27,28,29,30. For context, the WHO 
considers that electronic cigarettes with nicotine are highly addictive and harmful to health10,11. 

In its opinion on electronic cigarettes, the SCHEER concluded that there is weak to moderate 
evidence of risks of respiratory, cardiovascular and carcinogenic damage due to second-hand 
exposure  to  e-cigarette  aerosols.  For  second-hand  exposed  persons,  the  overall  weight  of 

17 European Parliament, Directorate-General for Internal Policies of the Union. Novel tobacco and nicotine products and their 
effects on health. 2023. ISBN: 978-92-848-0226-5 
18 World Health Organisation. Heated tobacco products: summary of research and evidence of health impacts. 2023. p. 12-13. 
https://www.who.int/publications/i/item/9789240042490 
19 World Health Organisation: WHO study group on tobacco product regulation: Report on the scientific basis of tobacco 
product regulation: eighth report of a WHO study group. 2021. https://www.who.int/publications/i/item/9789240022720 
20 Yoshioka T, Shinozaki T, Hori A, Okawa S, Nakashima K, Tabuchi T. Association between exposure to secondhand aerosol 
from heated tobacco products and respiratory symptoms among current non-smokers in Japan: a cross-sectional study. BMJ 
Open. 2023;13:e065322. doi: 10.1136/ bmjopen-2022-065322 
21 Imura Y, Tabuchi T. Exposure to secondhand heated-tobacco-product aerosol may cause similar incidence of asthma attack 
and chest pain to secondhand cigarette exposure: the JASTIS 2019 study. Int J Environ Res Public Health. 2021;18(4):1766. 
doi: 10.3390/ijerph18041766 
22 Uguna CN, Snape CE. Should IQOS emissions be considered as smoke and harmful to health? A review of the chemical 
evidence. ACS Omega. 2022;7(26):22111–24. doi: 10.1021/ acsomega.2c01527. 
23 Auer R, Concha-Lozano N, JacotSadowski I, Cornuz J, Berthet A. Heat-not-burn tobacco cigarettes: smoke by any other 
name. JAMA Intern Med. 2017;177(7):1050–2. doi: 10.1001/ jamainternmed.2017.1419. 
24 Fernández E, Ballbè M, Sureda X, Fu M, Saltó E, Martínez-Sánchez JM. Particulate matter from electronic cigarettes and 
conventional  cigarettes:  a  systematic  review  and  observational  study.  Curr  Environ  Health  Rep.  2015;2(4):423–9.  doi: 
10.1007/s40572- 015-0072-x. 
25  Li  L,  Lin  Y,  Xia  T,  Zhu  Y.  Effects  of  electronic  cigarettes  on  indoor  air  quality  and  health.  Annu  Rev  Public  Health. 
2020;41(1):363–80. doi: 10.1146/ annurev-publhealth-040119-094043. 
26 Hess I, Lachireddy K, Capon A. A systematic review of the health risks from passive exposure to electronic cigarette vapour. 
Public Health Research & Practice. 2016;26(2). 
27 Borgini A, Veronese C, De Marco C, Boffi R, Tittarelli A, Bertoldi M et al. Particulate matter in aerosols produced by two 
last generation electronic cigarettes: a comparison in a real-world environment. Pulmonology. 2021. 
28 Exposure to aerosols from smoking-proxy electronic inhaling systems: a systematic review. Barcelona: Tobacco Control 
Unit, Institut Català d’Oncologia; 2016. 
29 Lerner CA, Sundar IK, Yao H, Gerloff J, Ossip DJ, McIntosh S et al. Vapors produced by electronic cigarettes and e-juices 
with flavorings induce toxicity, oxidative stress, and inflammatory response in lung epithelial cells and in mouse lung. PLoS 
One. 2015;10(2):e0116732 
30 Glantz, S.A., Nguyen, N., & Oliveira da Silva, A.L. (2024). Population-Based Disease Odds for E-Cigarettes and Dual Use 
versus Cigarettes. NEJM Evidence, 3(3). DOI: 10.1056/EVIDoa2300229. 

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evidence is moderate for risks of local irritative damage to the respiratory tract mainly due to 
exposure to glycols; the overall weight of evidence for risks of systemic cardiovascular effects 
in second-hand exposed persons due to exposure to nicotine is weak to moderate; the overall 
weight of evidence for carcinogenic risk due to cumulative exposure to nitrosamines is weak 
to  moderate.  In  addition,  in  a  recently  published  call  to  action,  the  WHO  highlights  that 
electronic cigarettes with nicotine are highly addictive and are harmful to health and all tobacco 
control measures should be applied to them 10. Electronic cigarettes are relatively new in terms 
of exposure to  humans and a continuous development  of research and of the evidence base 
should be pursued, in particular on their long-term health effects. 

In addition to this, emerging products are often marketed and promoted by the tobacco industry 
as ‘safer’ alternatives to conventional tobacco products and thus as useful smoking cessation 
tools.    However,  the  evidence  on  the  use  of  emerging  products  as  a  cessation  aid  is 
inconclusive. In fact, in its opinion on electronic cigarettes the SCHEER concluded that “There 
is a lack of robust longitudinal data on the effect of electronic cigarettes on smoking cessation. 
Until such research is available, electronic cigarettes should only be considered to support 
smoking cessation for a limited time and under supervision”. Moreover, the WHO report on 
the  global  tobacco  epidemic  highlights  that,  in  some  cases,  emerging  products  containing 
nicotine  could  hinder  smoking  cessation  efforts  in  some  individuals  by  prolonging  or 
increasing their addiction to nicotine. Data from the 2023 Eurobarometer report show that for 
42% of the respondents, using electronic cigarettes or any similar devices did not result in a 
decrease of their tobacco consumption. 

Taking into consideration the scientific assessment of the SCHEER and the WHO reports, it is 
clear that second-hand exposure to aerosols from emerging products is potentially harmful. The 
WHO considers that no level of exposure that is safe or acceptable. Taking into consideration 
the EU’s precautionary principle31, which can be applied in cases where potentially dangerous 
effects  from  a  product,  among  other  things,  have  been  identified,  and  where  scientific 
evaluation does not allow the risk to be determined with sufficient certainty, it is important that 
the current Recommendation is updated to specifically include emerging products in its scope 
to  fulfil  its  main  objective  of  protecting  people  from  the  harms  of  second-hand  smoke  and 
aerosol exposure. 

Some emerging products may contain nicotine which is a highly addictive substance which 
poses  a  risk  of  addiction.  Nicotine  can  have  harmful  impacts  in  particular  on  brain 
development, leading to long-term consequences for children and adolescents. Given that many 
emerging products are marketed to be attractive to young people, they have been taken up by 
many adolescents  and children in  the Union.  Young people who experiment  with  emerging 
products are more likely to progress to regular use of conventional tobacco products than those 
who  do  not32,7  In  addition,  emerging  products  are  often  used  as  complements  to  cigarette 
smoking and not as substitutes, especially in the smoke-free environments where their use is 
banned. This can result in ‘dual use’ where many users of emerging products use both these 
products and conventional tobacco products, such as cigarettes33, moreover, this can result in 
situations where dual users consume both conventional tobacco and emerging products at the 
same  time  and  often  switch  between  the  two  depending  on  where  smoke-free  rules  apply 

31 Communication from the Commission on the precautionary principle (COM/2000/0001 final) 
32 According to the 2020 Eurobarometer, among 15-24-year-olds who were users of electronic cigarettes, 16.9% transitioned 
to regular users. The SCHEER opinion refers to a study showing that the pooled probabilities of cigarette smoking initiation 
were 30.4% for baseline electronic cigarette users while it was 7.9% for baseline never electronic cigarette users. 
33 According to the 2020 Eurobarometer, 59% of users of electronic cigarettes were dual users. 

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6,34,35,36. This pattern of consumption may also sustain prolonged nicotine dependence and is 
associated with increased risk of respiratory and cardiovascular conditions relative to single 
use6. 

It is important to note that, in some cases, the use of emerging products has also been linked to 
physical  injuries,  including  burns  from  explosions  or  malfunctions.  In  addition,  accidental 
exposure to high nicotine concentrations in the e-liquid and accidental ingestion of the e-liquid 
are also some concerns associated with their use6,7. 

The proposed Council Recommendation on Smoke- and Aerosol-free Environments includes 
an extension to emerging products which may not contain nicotine. Although some emerging 
products,  specifically  electronic  cigarettes,  do  not  contain  nicotine,  they  may  still  contain 
various  flavours  which  can  increase  their  palatability  and  aid  in  their  marketing  towards 
children and young people. Some of the flavours used within these products have been shown 
to increase their toxicity in their aerosols5. In addition, it is important to note that while some 
electronic  cigarettes  are  said  not  to  contain  nicotine,  in  practice  many  e-liquids  marked  as 
containing “zero-nicotine” have been found to contain nicotine when tested6. Moreover, the 
WHO highlights that there are health concerns related to the e-liquid contained in electronic 
cigarettes, which might contain potentially harmful components, which when inhaled may have 
long-term health impacts. In addition, the act of using emerging products, even those that do 
not contain nicotine, mimics the use of conventional cigarettes, which is a behavioural pattern 
that can prevent those trying to quit tobacco from doing so successfully; it may even contribute 
to  the  renormalisation  of  smoking  leading  to  non-smokers,  particularly  children  and  young 
people,  taking  up  the  use  of  conventional  tobacco  products,  such  as  cigarettes6.  Given  this 
evidence,  if  not  included  in  smoke-  and  aerosol-free  rules  these  emerging  products  can 
potentially generate loopholes and could be exploited by commercial interests. 

Although some Member States already include emerging products in their smoke- and aerosol-
free  policies,  the  level  of  coverage  and  approach  of  inclusion  of  these  products  differs 
considerably  among  the  Member  States.  Some  Member  State  approaches  may  not 
comprehensively cover electronic cigarettes that contain nicotine (e.g. Bulgaria) or electronic 
cigarettes without nicotine (e.g. Ireland) while others do not encompass tobacco surrogates that 
may emit smoke or aerosols (e.g. Spain, Lithuania). Other national approaches include all non-
tobacco oral nicotine products as part of smoking bans (e.g. Netherlands). Moreover, countries 
report that a major related challenge in this area is the need to “denormalise” the use of all 
types  of  tobacco  and  nicotine  products.  This  was  mentioned  as  being  helpful  for  the 
enforcement of legislation (e.g. Latvia). An additional challenge with emerging products is that 
they  are  more  difficult  to  detect  (e.g.  Belgium),  even  as  their  use  especially  among  young 
people, becomes an increasing concern (e.g. Denmark). 

Inclusion  of  specific  outdoor  spaces 
Recommendation 

in  the  scope  of  the  proposed  Council 

At  present,  there  is  a  significant  exposure  to  second-hand  smoke  and  aerosols  in  various 
outdoor spaces such as the outdoor spaces of hospitality venues, outdoor spaces intended for 

34 Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and 
meta-analysis. Lancet Respiratory Medicine. 2016;4(2):116–28. 
35 Felicione NJ, Ozga-Hess JE, Ferguson SG, Dino G, Kuhn S, Haliwa I et al. Cigarette smokers’ concurrent use of smokeless 
tobacco: dual use patterns and nicotine exposure. Tobacco Control. 2021;30(1):24–29 
36 Wang JB, Olgin JE, Nah G, Vittinghoff E, Cataldo JK, Pletcher MJ et al.  Cigarette and e-cigarette dual use and risk of 
cardiopulmonary symptoms in the Health eHeart Study. PLoS One. 2018;13(7):e0198681. 

8 

 
 
 
 
children and outdoor spaces of public spaces. In addition, the level of protection from exposure 
to second-hand smoke and aerosols in indoor spaces varies in Member States.   

The  level  of  coverage  of  smoke-free  rules  varies  greatly  based  on  the  type  of  smoke-free 
environments, and the general level of coverage  of outdoor spaces in smoke-free policies is 
low.  The  level  of  coverage  also  varies  based  on  the  product  considered:  while  the 
implementation  is  good  for  traditional  products  for  smoking,  it  is  less  the  case  for  heated 
tobacco products and electronic cigarettes. Overall, Member States which have stricter rules 
for tobacco products also have stricter rules for emerging products5. A few Member States have 
a comprehensive approach of including outdoor spaces in national smoking bans (e.g. Latvia 
broadly protects educational and healthcare premises, outdoor recreational areas, public spaces, 
outdoor  spaces  of  work  areas,  restaurant  terraces  and  public  transportation  hubs).  Many 
Member States, however, have narrower approaches, explicitly covering only a limited set of 
outdoor spaces (e.g. Slovakia). Member States report challenges related to implementation and 
enforcement of bans in outdoors spaces (e.g. open public transportation hubs in Sweden) and 
note that these increase if different rules apply to different products (e.g. Finland). 

Based on 2023 Eurobarometer data, 74% of respondents said that they have experienced people 
smoking in outdoor terraces in the past 6 months and 71% of respondents have experienced 
people  using  electronic  cigarettes  and  heated  tobacco  products  in  the  same  places.  42%  of 
respondents said that people were smoking in outdoor places intended for use by children and 
adolescents and 49% of respondents experienced people using electronic cigarettes and heated 
tobacco products in the same places. 

Various  studies  show  that  the  use  of  emerging  products  raises  airborne  concentrations  of 
particulate  matter  above  baseline  levels  when  measured  indoors.  The  levels  of  nicotine, 
particulate  matter  and  potential  carcinogens  in  second-hand  aerosols  exceed  the  maximum 
recommended  levels  set  out  in  the  WHO  FCTC  guidelines.  This  is  of  importance  because 
exposure  to  particulate  matter  generated  through  the  use  of  emerging  products  has  been 
associated  with  increased  risk  of  heart  and  lung  disorders6,9.  The  2021  evaluative  study 
highlights  that  the  locations  with  the  highest  exposure  to  electronic  cigarettes  and  heated 
tobacco products are workplaces, public parks and bars. 

A  literature  review  conducted  within  the  context  of  the  Joint  action  for  Tobacco  Control 
(JACT-2) found that several studies using environmental markers to assess second-hand smoke 
exposure in various places including in the hospitality sector, work areas and outdoor settings 
indicate high second-hand smoke exposure in these settings12. These figures show that people 
in  the EU, especially  children and young people, can be better protected  from  second-hand 
smoke and second-hand aerosols. 

The 2023 Eurobarometer results highlight that two thirds of the respondents in the EU (66%) 
are in favour of banning the use of electronic cigarettes or heated tobacco products in places 
where  smoking  is  prohibited.  The  proposed  extension  of  coverage  of  the  existing 
Recommendation to the outdoor spaces mentioned in this section of this report would extend 
the protection of people through a more comprehensive Council Recommendation. 

4.  Impacts of the proposed measures of the revision 

Health and Social impact 

By  reducing  exposure 
the  revised  Council 
to  second-hand  smoke  and  aerosols, 
Recommendation  on  Smoke  and  Aerosols  free  environments  is  expected  to  have  positive 

9 

 
 
 
impacts on health and result in reduced morbidity and mortality associated to the consumption 
and exposure of smoking tobacco and emerging products. The impact assessment for the 2009 
Council Recommendation on smoke-free environments37 showed that smoke-free policies may 
reduce smoking prevalence and result in health benefits. In addition, due to the inclusion of 
emerging products and specific outdoor spaces, there will be less risk of unintended exposure 
to second-hand smoke and aerosols which results in maximising protection of people in the EU 
from hazardous exposure. 

This  positive  impact  was  expressed  by  the  majority  of  respondents  during  the  consultation 
activities  for  the  revision  and  in  the  responses  to  the  call  for  evidence  for  this  initiative, 
particularly  by  representatives  of  Member  States  competent  authorities  and  civil  society 
organisations who highlighted the positive impact of the initiative in protecting children and 
adolescents from exposure to second-hand smoke and aerosols. Representatives of employees 
of  the  HORECA  sector  highlighted  the  positive  impact  of  this  initiative  on  the  health  and 
wellbeing  of  their  employees.  Additionally,  representatives  of  Member  States  competent 
authorities, during the meeting of the Expert Group on Tobacco Policy, highlighted that this 
initiative  is  a  timely  measure  given  its  particular  benefit  to  children  and  young  people.  In 
contrast,  the  response  from  industry  regarding  the  health  impacts  of  the  revision  of  the 
Recommendation  was  different:  only  a  minority  believed  that  the  revision  would  have  a 
positive health impact. 

The  2021  evaluative  study  on  smoke-free  environments  and  advertising  of  tobacco  related 
products  highlights  that  smoke-free  legislation  results  in  a  significant  decrease  in  smoking. 
Smoking cessation is likely to increase among smokers who are exposed to a smoke-free law, 
a systematic review found a 6.4% increase in smoking cessation among smokers exposed to a 
smoke-free law38. The evaluative study also highlights that positive impacts appear promptly 
after starting to implement smoke-free legislation (for example, reduction in the incidence of 
heart attacks in the general population and improvements in respiratory health) and enacting 
national  legislative  smoking  bans  leads  to  improved  health  outcomes  for  smokers  and  non-
smokers  in  terms  of  cardiovascular,  respiratory,  perinatal  health  outcomes  and  reduced 
mortality.  A  systematic  review  demonstrated  that  across  21  countries,  enacting  national 
legislative smoking bans, there were improved health outcomes for smokers and non-smokers 
in terms of cardiovascular, respiratory, and perinatal health outcomes39. In Ireland, which was 
the first country in the world to implement a national workplace smoking ban in March 2004, 
the smoking ban was associated with reductions in early mortality40. Similarly in Belgium, a 
study showed that smoking ban interventions were associated with reductions in the population 
rate of myocardial mortality, with public health gains even before and during the middle-age 
period of life 41. 

Comprehensive smoke-free legislation has increased benefits in comparison to partial smoke-
free  bans  (comprehensive  smoke-free  legislation  or  policies  means  without  exemptions  or 

37 Accompanying document to the Proposal for a Council recommendation on smoke-free environments - Impact assessment 
(SEC/2009/0894 final) 
38 Hopkins, D. P., Razi, S., Leeks, K. D., Priya Kalra, G., Chattopadhyay, S. K., & Soler, R. E. (2010). Smokefree policies to 
reduce tobacco use: A systematic review. Cochrane Database of Systematic Reviews, (2), CD005992 
39 Frazer, K., Callinan, J. E., McHugh, J., van Baarsel, S., Clarke, A., Doherty, K., & Kelleher, C. (2016). Legislative 
smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. 
Cochrane Database of Systematic Reviews, (2), CD005992 
40 Stallings-Smith, S., Zeka, A., Goodman, P., Kabir, Z., & Clancy, L. (2013). Reductions in cardiovascular, 
cerebrovascular, and respiratory mortality following the national Irish smoking ban: interrupted time-series analysis. PLOS 
ONE, 8(6), e62063 
41 Cox B, Vangronsveld J, Nawrot TSImpact of stepwise introduction of smoke-free legislation on population rates of acute 
myocardial infarction deaths in Flanders, BelgiumHeart 2014;100:1430-1435. 

10 

 
 
 
permission  to  smoke/use emerging  products  in  certain  spaces). Comprehensive laws  have  a 
positive effect on quit attempts and quit success while partial smoke-free laws have no such 
impacts42.  In  addition,  the  introduction  of  comprehensive  smoke-free  policies  results  in 
increased  public  support  for  such  smoke-free  rules:  a  study  from  France,  Germany  and  the 
Netherlands indicated that support for smoke-free rules increases once they are in place, and 
that  this  effect  is  more  pronounced  with  comprehensive  compared  to  partial  smoke-free 
policies43. This points to the likelihood that more comprehensive smoke- and aerosol-free rules 
might be a beneficial policy option. 

Smoke-free rules can also reduce health disparities between socio-economic groups although 
the results of some studies are mixed in some cases5. Voluntary regional or partial smoke-free 
policies  are  more  likely  to  have  negative  equity  impact  in  comparison  to  national  and 
comprehensive smoke-free policies and rules44. The effect of non-comprehensive and differing 
smoke-free  rules  among  the  Member  States  is  seen  in  the  existing  inequalities  among  the 
Member  States.  Some  representatives  of  Member  States  competent  authorities,  during  the 
meeting  of  the  Expert  Group  on  Tobacco  Policy  expressed  the  importance  of  smoke-  and 
aerosol- free rules being uniform across Member States in order to reduce inequalities in the 
exposure and consequently in health outcomes. In the consultation activities, representatives 
from Member States and civil society organisations have also highlighted that this initiative 
will also result in better public support for the expansion of smoke- and aerosol-free rules at 
the national level. In connection to this, during the meeting of the Expert Group on Tobacco 
Policy and in the responses to the call for evidence, it was highlighted that the revision of the 
2009  Council  Recommendation  would  be  helpful  in  Member  States  to  overcome  political 
challenges. This initiative would therefore offer an important opportunity to coordinate smoke-
and aerosol-free legislation both within and between Member States and help introduce more 
comprehensive and ambitious smoke- and aerosol-free policies. As a result, this comprehensive 
approach will have a positive impact on the denormalisation of smoking and use of emerging 
products as well as help in the fight against nicotine addiction, especially among young people. 

Economic impact 

The  economic  analysis  included  in  the  impact  assessment  accompanying  the  2009  Council 
Recommendation is largely still valid even if the proposal for a revised Recommendation  has 
an  extended  scope  and  coverage  in  terms  of  products  and  spaces.  The  impact  assessment 
accompanying the 2009 Council Recommendation and the 2021 evaluative study both showed 
that  for  the  2009  Recommendation  the  potential  negative  impact  was  outweighed  by  the 
positive  economic  impact.  45  The  consultation  activities  carried  out  in  preparation  of  the 
proposal for a revised Recommendation confirm this finding. 

The impact assessment highlights that there will be reductions in medical costs as a result of 
smoke-free  rules.  This  assessment  is  also  confirmed  by  the  2021  evaluative  study  and  the 

42 Nagelhout, G. E., de Vries, H., Boudreau, C., Allwright, S., McNeill, A., van den Putte, B., Fong, G. T., & Willemsen, M. 
C. (2012). Impact of smoke-free legislation on smoking cessation in three European countries. European Journal of Public 
Health, 22(suppl_1), 4-9 
43 Mons, U., Nagelhout, G.E., Guignard, R., McNeill, An. Van de Putten, B., Willemsen, M.C., Brenner, H., Potschke-
Lange, M., & Breitling, L.P. (2012). Comprehensive smoke-free policies attract more support from smokers in Europe than 
partial policies. European Journal of Public Health, 22(suppl_1), 10-16 
44 Brown, T., Platt, S., & Amos, A. (2014). Equity impact of population-level interventions and policies to reduce smoking 
in adults: A systematic review. Drug and Alcohol Dependence, 138, 7-16. https://doi.org/10.1016/j.drugalcdep.2014.03.001 
45 European Commission, Directorate-General for Health and Food Safety. Study on smoke-free environments and 
advertising of tobacco and related products. 2021. ISBN: 978-92-76-42343-0 (p. 157-162). 

11 

 
 
 
consultation  activities.  Throughout  the  consultation  activities,  the  positive  long-term  health 
gains resulting from the revision were further highlighted. 

The  2021  evaluative  study  highlighted  that  any  lost  taxation  revenue  due  to  a  decrease  in 
smoking  levels  would  be  offset  by  the  alternative  investments  and  expenditures  of  the 
disposable income of households. Throughout the consultation activities, the loss of taxation 
revenue was not an issue which was particularly highlighted by the Member States. When this 
was mentioned, it was rather highlighted as one of the possible challenges that could be raised 
by the national Ministries of finance when trying to implement the revised provisions of the 
smoke- and aerosol-free environments at the national level. Some civil society organisations 
highlighted  that  the  long-term  reduction  of  mortality  and  morbidity  from  tobacco  related 
diseases,  the  subsequent  reduction  of  the  cost  to  treat  tobacco-related  diseases  and  the 
substantial  environmental  benefits  (such  as  reduction  in  waste  and  the  reduction  of 
deforestation as a result of tobacco growing) will outweigh any loss of income from tobacco 
taxation. 

The  impact  assessment  highlights  several  potential  microeconomic  benefits  of  smoke-free 
rules,  including  reducing  cleaning,  maintenance,  redecorating,  and  fire  damage  costs  and 
highlights  its  total  savings.  The  2021  evaluative  study  also  reached  a  similar  conclusion,  it 
points to research showing that businesses that allow smoking experience higher cleaning and 
maintenance costs than those that are smoke-free46, 47. The consultation activities show that this 
conclusion is also corroborated by Member States’ representatives, civil society organisations 
and some representatives from the HORECA sector. Another impact highlighted in the impact 
assessment is the potential productivity gains that could be expected from a reduced number 
of smoking breaks due to the introduction of smoke-free bans. This aspect was also highlighted 
by the 2021 evaluative study which shows that a few Member States reported an increase in 
workers productivity related to smoking breaks. In addition, that study also shows the views 
from a representative from the hospitality sector who noted that smoke-free rules had a positive 
health impact on the health of the employees and in turn on their productivity and presenteeism. 
However, the impact assessment and the evaluative study also note that there might be a loss 
of productivity due to the time spent by smoking workers or employees to find an appropriate 
place to smoke or their ability to concentrate less due to the reduced opportunities to smoke. 

Regarding the economic impact of the initiative, the 2021 evaluative study highlights that the 
overall economic impact of smoking bans on the hospitality and tobacco industry is limited, 
and that smoke-free policies had either limited negative economic impact or a positive impact. 
This analysis is to a large extent still valid for the proposal for a revised Recommendation. 

The  impact  assessment  showed  that  there  would  be  no  negative  economic  impact  from  the 
introduction of smoke-free policies in restaurants and bars. This conclusion is corroborated by 
the results of the evaluative study which shows that the economic impact of smoking bans on 
the  restaurant/hospitality  sector  is  limited  (neutral  or  positive)48.  During  the  consultation 
activities supporting this initiative, two representatives from the hospitality sector participated 
and shared opposing views about the economic impact  on hospitality businesses: while one 
highlighted  that  the  extension  of  scope  of  the  Recommendation  might  result  in  loss  of 
customers in premises such as hotels, bars and restaurants, the other highlighted that some of 

46 Ekpu, V. U., & Brown, A. K. (2015). The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of 
Evidence. Tobacco Use Insights, 8, 1-35 
47 Javitz, H. S., Zbikowski, S. M., Swan, G. E., & Jack, L. M. (2006). Financial burden of tobacco use: an employer’s 
perspective. Clinics in Occupational and Environmental Medicine, 5(1), 9-29 
48 Brown, T. J., Platt, S., & Amos, A. (2014). Systematic review and meta-analysis of the economic impact of smoking bans 
in restaurants and bars. Addiction, 109(5), 720-727 

12 

 
 
 
the concerns related to the negative economic impact for hospitality businesses are ‘unfounded’ 
and that it is likely that it would not have any major negative economic impacts. The  2021 
evaluative study provides some national examples: in Norway, where the ban on smoking was 
extended to all drinking and eating establishments in 2004, the smoke-free law had no long-
term  impact  on the revenue of these establishments even if there was a  short-term  negative 
effect 49. Similarly, in Hungary an amendment strengthening the Protection of Non-Smokers 
Act came into effect in 2012 in an effort to minimise exposure to second-hand smoke. This 
amendment was followed by an increase in the number of hospitality venues (i.e. restaurants, 
confectioneries, drink shops, music clubs), an increase in the income of the hospitality industry, 
as  well  as  an  increase  in  guest  flow  and  income  from  accommodation  charges.  Finally,  in 
Belgium  the  smoking  ban  came  to  effect  in  January  2007  and  no  negative  impacts  were 
observed in terms of the number of restaurants and the revenues for the hospitality sector. 

The impact assessment showed that the expected negative impact of introducing smoke-free 
rules would be relatively small despite the potential reduction in the sales of tobacco or related 
products. This is demonstrated through the revenue loss estimation done as part of the impact 
assessment. The 2021 evaluative study highlights potential job losses due to the introduction 
of smoke-free rules in some Member States, however, these losses can be offset by increased 
employment in other sectors as the money once spent on cigarettes is spent on other goods and 
services. During the consultation activities, the response from representatives of the tobacco 
industry was that the revision of the Recommendation and its extension of scope would result 
in a reduction of demand for both traditional tobacco products as well as emerging products 
such  as  electronic  cigarettes  which  would  also  lead  to  reduced  employment  levels  in  the 
tobacco  and  emerging  products  sector.  Nevertheless,  no  quantitative  or  factual  estimation 
information was provided in support the mentioned negative effects and concerns. Throughout 
the consultation activities, particularly throughout the targeted survey, a common pattern of 
responding  with  ‘don’t’  know  or  can’t  answer’  was  observed  for  questions  related  to  the 
economic impact of the initiative. 

The impact assessment highlights that the implementation and enforcement costs, which might 
arise as a result of smoke-free bans for both public authorities and private actors, are likely to 
be small compared to the costs savings achieved through the health benefits from the reduction 
of  medical  costs  related  to  tobacco-related  issues.  The  potential  implementation  and 
enforcement  costs  were  an  issue  raised  by  Member  State  representatives  during  the 
consultation  activities.  Although  representatives  from  Member  States  competent  authorities 
throughout the consultation activities have noted that they might experience higher costs in the 
short term, the long-term public health and societal benefits would outweigh these costs. 

Environmental impact 

The WHO notes that second-hand exposure to e-cigarette vapour is a new air contamination 
source  for  particulate  matter,  including  fine  and  ultrafine  particles,  as  well  as  some  heavy 
metals6.  Smoke-free  rules  may  improve  air-quality,  this  fact  was  corroborated  by  several 
representatives  of  civil  society  organisations  and  Member  State  representatives  during  the 
consultation activities. 

The 2021 evaluative study highlights that, for example, the level of air pollution inside smoke-
free Irish pubs was 93% lower than the level found in Irish pubs where smoking was permitted 

49 Melberg, H. O., & Lund, K. E. (2012). Do smoke-free laws affect revenues in pubs and restaurants? European Journal of 
Health Economics, 13(1), 93-99 

13 

 
 
 
50.  Similarly,  in  New  Zealand,  it  was  found  that  air  quality  improved  in  hospitality  venues 
following a smoke-free law in 200451. In Greece, hospitality venues were assessed for their 
indoor concentrations of particulate matter (PM2.5), before and after the smoke-free legislation 
implemented in 2010. Indoor air levels of PM2.5 attributable to second-hand smoke dropped 
by more than a third following the transition from a partial to a complete ban52. In Spain, after 
the 2011 Spanish smoking ban, both nicotine and PM2.5 concentrations decreased by more 
than 90% in indoor hospitality venues in three Spanish regions53. 

The  proposed  inclusion  of  specific  outdoor  spaces  in  the  Council  Recommendation  would 
result in environmental benefits by reducing emissions, thus having a positive impact on air 
quality and by reducing waste. In particular, by reducing littering and the use and disposal of 
single-use plastics. Moreover, when consulted on the proposed revisions, the Joint Action on 
Tobacco Control noted that the mention of open outdoor spaces such as parks is relevant as 
these places suffer from the environmental pollution caused by all kinds of tobacco products 
(cigarette  butts,  plastic  filters  from  Roll  Your  Own  and  disposable  devices  from  electronic 
cigarettes). They also highlighted that smoking combustible tobacco products in natural areas 
is  a  well  characterised  risk  factor  for  fires  which  creates  a  hazardous  situation  for 
environmental safety. 

50 Connolly, G. N., Carpenter, C. M., Travers, M. J., Cummings, K. M., Hyland, A., Mulcahy, M., & Clancy, L. (2009). 
How smoke-free laws improve air quality: a global study of Irish pubs. Nicotine & Tobacco Research, 11(6), 600-605 
51 Edwards, R., Thomson, G., Wilson, N., Waa, A., Bullen, C., O’Dea, D., Gifford, H., Glover, M., Laugesen, M., & 
Woodward, A. (2008). After the smoke has cleared: evaluation of the impact of a new national smoke-free law in New 
Zealand. Tobacco Control, 17(1), e2 
52 Vardavas, C. I., Anagnostopoulos, N., Patelarou, E., Minas, M., Nakou, C., Dramba, V., Giourgouli, G., Bagkeris, E., 
Gourgoulianis, K., Pattaka, P., Antoniadis, A., Lionis, C., Bertic, M., Dockery, D., Connolly, G. N., & Behrakis, P. K. 
(2012). Five-year trends of second-hand smoke exposure in Greece: a comparison between complete, partial, and 
prelegislation levels. Tobacco Control, 21(5), 473-477 
53 María J. López PhD, Esteve Fernández PhD, Mónica Pérez-Rios PhD, Jose M. Martínez-Sánchez PhD, Anna Schiaffino 
MPH, Iñaki Galán PhD, Albert Moncada BsC, Marcela Fu PhD, Agustín Montes PhD, Esteve Saltó MPH, Manel Nebot 
PhD. “Impact of the 2011 Spanish Smoking Ban in Hospitality Venues: Indoor Secondhand Smoke Exposure and Influence 
of Outdoor Smoking.” Nicotine & Tobacco Research, vol. 15, no. 5, 2013, pp. 992–996 

14