Tobacco and nicotine products in Europe - Why stronger EU action is urgently needed

To make matters worse, tobacco also strains Europe’s economies. The European Commission’s Joint Research Centre estimates tobacco-related healthcare costs at €80.7 billion per year, equal to around 0.47% of EU GDP and 2.5% of total healthcare expenditures, while the total economic burden in the EU rises to an estimated €587 billion annually. 

As part of the European Commission’s Call for Evidence on the revision of the Tobacco Products Directive and the Tobacco Advertising Directive, the European Cancer Organisation calls for reinvigoration of Europe’s goal for a tobacco-free generation and recognition and response to the real harm being created by the new addiction industry of novel tobacco and nicotine products.

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Key evidence and concerns raised. 

1. Novel tobacco and nicotine products sustain addiction in a new generation 

The rapid rise of e-cigarettes, heated tobacco products and nicotine pouches is not simply replacing smoking. It is expanding nicotine addiction. 

Recent public health data show that an estimated 4 million adolescents aged 13–15 use tobacco or nicotine products (1 in 7), and 1 in 4 adolescents aged 15–16 in the EU use e-cigarettes, making that adolescent e-cigarette use has increased in 22 EU Member States since 2019. Many of these young people had not previously smoked – meaning new products are creating new users rather than helping existing smokers quit.

This trend is particularly concerning because the WHO European Region has the highest tobacco use of any region in the world and is failing to meet global reduction targets.

2. Industry’s ‘harm reduction’ and ‘cessation’ claims do not match real-world use 

Novel nicotine products are often promoted as tools to quit smoking and framed as ‘less harmful’. However, the World Health Organisation warned that ‘all tobacco, nicotine and related products pose health risks, including risk of addiction’ and according to a 2020 Eurobarometer survey, 59% of e-cigarette users and 79% of heated tobacco users are dual users, meaning they continue to smoke conventional cigarettes as well. This suggests these products often add to nicotine dependence rather than replace it, and continue to impose severe health risks on EU-citizens.

The European Commission’s own evaluation of tobacco legislation indicates that e-cigarette use can make cigarette smoking three times more likely, while the World Health Organization (WHO) reports that young people who use e-cigarettes are more than twice as likely to go on to smoke. 

3. A rapidly growing nicotine market is driving a new addiction challenge 

Today, the tobacco and nicotine industry has a broader range of products than ever before, including heated tobacco, e-cigarettes, and nicotine pouches Between 2012 and 2023, the e-cigarette market in Europe grew by around 450% in value and 421% in volume. Nicotine pouches have grown even faster, with sales value increasing by around 1,697% between 2018 and 2023. 

This rapid expansion highlights a growing commercial market built around nicotine dependence, often driven by a strategy aimed at recruiting new generations of nicotine users, perpetuating addiction and ensuring a future consumer base.

4. Nicotine is highly addictive and poses severe health risks

Nicotine is the core driver of addiction in all tobacco and nicotine products. The European Commission confirms that nicotine is ‘the primary cause of addiction to tobacco products’. Furthermore, Nicotine is highly addictive and can interfere with brain development, particularly in areas related to learning, attention, and impulse control, making its use especially harmful for young people and adolescents. Nicotine has also been associated with an increased risk of mental health issues, including anxiety and depression, as well as higher levels of alcohol consumption.

1.  Industry’s legacy of scientific misinformation and disinformation in the policy field

However novel nicotine products have not been in widespread use long enough to fully understand their long-term health effects.  

There is a well-documented history of the tobacco industry downplaying the harms of its products, including the use of misleading terms such as ‘light’ and ‘mild’, false reassurance about reduced harm, denial of links to cancer, and claims that second-hand smoke is not dangerous. 

This history should provide all policymakers with a healthy baseline scepticism towards those, who while directly targeting children and young adults with advertisements for their harmful and addictive products, cloak that conduct in the public health language of harm reduction.

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