Untapped potential of improved diet, smoking and alcohol consumption in Slovakia II: Deep dive on nicotine consumption

Tobacco consumption cause a myriad of health problems from lung cancer to problems in cardio-vascular health. In Slovakia, approximately 151.3 per 100 000 deaths are attributable to tobacco smoking and 168.9 per 100 000 deaths are attributable to tobacco consumption or second-hand smoke.  Although curbing cigarette consumption has been at the frontline of focus for the past years, other forms of tobacco consumption as well as novelty nicotine products are gaining in popularity.

The aim of this study is to provide an overview of tobacco and nicotine consumption in Slovakia, analyse trends in existing tobacco/nicotine policies in Europe and provide potential solutions and policies that could be implemented in Slovakia. The basis of the study is our own data collection, undertaken by FOCUS in March 2023, based on a survey of 2 2021  respondents about their tobacco and nicotine-related behaviour and a survey called National research on the use of tobacco and nicotine products in the population of children and adolescents, conducted by FOCUS in autumn of 2022. Some of the key findings are:

• 28.5% of Slovaks currently use some kind of tobacco/nicotine product on a regular basis
• Most Slovaks only use cigarettes without combining them with any other product (approximately  22%) while there is only app. 5% of Slovaks who on regular basis only consume alternative tobacco or nicotine products, and roughly 2% of Slovaks who are dual current users.
• The gender gap in cigarette consumption is closing, which is likely going to shift the burden of lung cancer, which is currently affecting more men than women, to women as well, especially in younger cohorts
• Young people are increasingly consuming novel tobacco and nicotine products. There is even a higher share of current users who consume both alternative products and cigarettes among young people aged 12-21 than among adult population, emphasizing the need for further policies targeted at Slovak youth

In the second part of the study, we present an overview of existing policies in Europe and in the world, highlighting their potential for Slovakia informed by the findings about tobacco and nicotine-related behaviour. Global leaders in fighting tobacco and nicotine dependence are increasingly adapting complex policies aiming to achieve smoke-free generations in two main streams of policy: preventing potential smokers (youth) from becoming dependent and supporting smoking cessation for existing smokers, such as New Zealand or Australia.

Based on these findings and results of our survey we also recommend focusing on creating a smoke-free generation by curbing the uptake of cigarettes as well as novel tobacco and nicotine products among Slovak youth. This would require, among other things:

• completely banning all flavoured e-cigarettes from the market in Slovakia except for a very limited number of flavours not attractive to the youth, but which could be potentially used as a tool in smoking cessation programmes for current adult smokers
• completely banning disposable e-cigarettes
• stricter enforcement of age-limit and place of purchase of alternative products, especially due to a growth in online purchases and alternative points of sales (e.g. vending machines)
• stronger regulation of marketing activities focused on children (e.g. social networks, events etc).
• support school-based programs to educate young people about the dangers of not only smoking, but consuming all types of nicotine-based products
• create regular monitoring systems to collect and evaluate data to regularly adjust policies 

Preventing young people from becoming smokers or users of any tobacco or nicotine product is the most cost-effective solution, yet a timely one. Thus, focusing on current smokers is just as important. In fact, according to our data, there is app. 21.5% of Slovaks who smoke cigarettes daily and hence it is clear, that it would not be viable to focus only on novelty products and future generations.

Slovakia is already using a mix of policies and measures to tackle smoking and nicotine addiction.

Some of them have, however, “grey areas” that can be improved, especially in point-of-sale channels (e-commerce) and marketing bundles. Furthermore, currently, there is not a general ban of smoking in all restaurants and bars, which allows for a loophole for some restaurants to allow smoking after modification. According to the Eurobarometer, Slovakia ranked second highest within the EU when asked whether they had experienced smoking in restaurants. In case of smoking inside a club or a bar, Slovakia ranked third worst. We hence recommend  implementing a more extensive ban on smoking and consumption of cigarettes, HTPS and e-cigarettes in public areas. The goal of such intervention is to make smoking less visible and its potential contribution to a decrease in the social value of smoking. At the same time, it goes without saying that these bans would have to be very specific for them to be enforceable and avoiding future legal challenges.

Finally, we recommend further expansion of smoking cessation capacities of Slovak healthcare system and consider considering utilising novelty products with lower risk profiles as a smoking cessation and limitation tool, as is the case in the United Kingdom and New Zealand.