Recent declines in smoking in Europe can be largely attributed to the aggressive tobacco control policies implemented across the continent [20]. Almost all European countries have ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), an international public health treaty launched in 2003 which outlines key evidence-based policies to curb the tobacco epidemic [35]. Close to 450 million people are also covered by the EU Tobacco Products Directive (TPD) which mandates additional tobacco control measures, such as pictorial warning labels [36]. According to the WHO, the majority of countries in the European region score highly in monitoring tobacco use, banning tobacco advertising, implementing health warnings regarding the dangers of tobacco use, taxing tobacco products and supporting smoking cessation [19], making Europe the region with the best adherence to the WHO MPOWER recommendations (Table 1; Fig. 2). Although only few countries have implemented all these policies to the highest level as recommended by the WHO, including comprehensive smoke-free legislation in public places, sustained increases in tobacco taxation, free support for smoking cessation and large pictorial warning labels [19], some have adopted additional tobacco control policies, such as smoking bans in vehicles when children are present and plain packaging. Overall, implementation is lacking in several countries, especially in areas such as smoke-free environments. Fourteen out of 36 European countries received a score below 50 (out of 100) in the most recent Tobacco Control Scale (TCS), which ranks countries based on a number of tobacco control indicators [37]. The TCS recognises the UK, France and Ireland as tobacco control leaders within Europe, with Germany, Switzerland and Luxembourg performing most poorly.
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These measures to reduce smoking among the general population can benefit children by reducing the exposure of children to SHS as well as denormalising the act of smoking. For example, smoke-free laws in public places are one of the most well-evaluated tobacco control interventions in both Europe and other high-income countries. Systematic review evidence points to reductions in preterm births, and in hospital attendance for severe RTIs and asthma hospitalisations among children from these measures [38]. These interventions can work to reduce SHS exposure in public places covered by these laws, through potential reductions in smoking prevalence in their own right, and through norm-spreading behavioural changes such as reducing smoking in the home. These impacts can be enhanced by strong mass media messaging and advertising: recent data from Scotland indicates that a novel campaign called Take It Right Outside, focused on reducing domestic SHS exposure, was successful in reducing asthma admissions among children under 5 years old [39].
Children have the right to grow up free from the substantial hazards associated with tobacco use and they need to be acknowledged as important stakeholders in its regulation. Strong tobacco control policies are associated with clear population health benefits, including among children. Although European smoking rates are relatively high, particularly among women, they are decreasing steadily under influence of effective policy-making. Substantial between-country variation however exists and much more can and still needs to be done to work towards reaching the ultimate goal of attaining a tobacco-free generation. 2ff7e9595c
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