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Protection from secondhand smoke in countries belonging to the WHO European Region: an assessment of legislation
  1. Cristina Martínez1,2,
  2. Jose María Martínez-Sánchez1,
  3. Gillian Robinson3,
  4. Christina Bethke4,
  5. Esteve Fernández1,5
  1. 1Tobacco Control Unit, Cancer Prevention and Control Department, Institut Català d'Oncologia-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
  2. 2Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain
  3. 3City and Hackney Public Health Directorate, NHS North East London and the City, London, UK
  4. 4Independent Lawyer, specialized in tobacco legislation, Berlin, Germany
  5. 5Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
  1. Correspondence to Cristina Martínez, Tobacco Control Unit, Cancer Prevention and Control Department, Institut Català d'Oncologia, Av. Gran Via de L'Hospitalet, 199-203, L'Hospitalet de Llobregat, Barcelona E-08908, Spain; cmartinez2{at}, cmartinez{at}


Objectives Comprehensive smokefree laws, as recommended by the WHO Framework Convention of Tobacco Control (WHO FCTC), are the most effective tool to protect the population from secondhand smoke (SHS) and to ensure healthy environments. Studies evaluating how laws govern SHS protection are scarce. This study assessed the level of protection from SHS of laws from countries belonging to the WHO European Region.

Methods A new methodology system was developed to evaluate the smokefree legislation according to the principles provided by the WHO guidelines for the correct implementation of Article 8 of the FCTC. For each law, six main sectors and 28 facilities were evaluated.

Results Overall 68 laws from 48 countries from the WHO European Region were reviewed. ‘Education’ and ‘Public transport’ were the most protected sectors from SHS. Many WHO European laws do not provide protection from SHS across all public sectors. For example, 48.5% of general health facilities and 71.2% of restaurants are unprotected from SHS. The level of protection provided in the 28 facilities studied was low; many WHO European laws still allow smoking under certain conditions, permitting smoking in designated and/or ventilated areas.

Conclusions Nine years after the adoption of the WHO FCTC there are still legal formulas in which smoking is allowed in several facilities, through the inclusion of separated areas, ventilated areas and other conditions. Tobacco control efforts still face the challenge of eradicating the legal clauses that prevent 100% smokefree environments.

  • Public policy
  • Secondhand smoke
  • Environment

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