TOBACCO AND RELATED PRODUCTS

In Slovenia, we have already done a lot in reducing the prevalence and consequences of tobacco and nicotine products, but we still face many challenges.

Tobacco smoking has extensive consequences for individual health and society, which are entirely preventable.

Tobacco smoking causes many types of cancer, respiratory diseases, cardiovascular diseases and many other diseases - diabetes, rheumatoid arthritis, eye diseases, which can result in blindness, erectile dysfunction and many others. About half of smokers die from diseases caused by smoking, who lose an average of 10 to 15 years of life, and spend many years before death with a very poor quality of life. In Slovenia, more than 3,100 residents of Slovenia die every year from diseases caused by smoking, or 60 every week. As many as 40% of these deaths are premature, i.e. before the age of 70. Tobacco smoking is associated with high costs, both for the individual and for society. In Slovenia, tobacco remains one of the leading preventable risk factors for death and lost healthy years of life.

The use of electronic cigarettes, heated tobacco products, nicotine pouches and smokeless tobacco products is harmful to health

New tobacco and nicotine products are available in Slovenia, including heated tobacco products, electronic cigarettes (vape, e-cigarette, puff, pod, mod…) and nicotine pouches, while smokeless tobacco products are also becoming increasingly popular. Both nicotine pouches and smokeless tobacco products are known as fuge, while smokeless tobacco products are also known as chewing tobacco or snus.

Electronic cigarettes Heated tobacco products Nicotine pouches Smokeless tobacco products

Users of electronic cigarettes, heated tobacco products and nicotine pouches are exposed to significant levels of harmful substances, both in tobacco smoke and those not found in tobacco smoke. These products contain nicotine, are addictive and have adverse health effects, some in the short term, and long-term use increases the risk of cardiovascular, respiratory and cancer diseases. The extent to which, if any, the risk is reduced with long-term use of these products compared to cigarette smoking is not yet fully understood or known, and there is insufficient quality research. The effects of long-term use of these products are not yet fully known, as these products have only been on the market for a short time.

Electronic cigarettes have significant harmful effects even with short-term use. In addition to nicotine addiction, these include nicotine poisoning, epileptic seizures and chemical damage to the lungs, various forms of pneumonia and other lung diseases, cough, wheezing, worsening of asthma, headache, throat irritation, dizziness, nausea, increased blood pressure, heart rate and stiffness of arterial walls... Electronic cigarettes can explode or catch fire and cause serious injuries and/or burns.

Most users of heated tobacco products and electronic cigarettes also smoke cigarettes, which is at least as harmful as, and probably significantly more harmful than, cigarette smoking.

Smokeless tobacco products expose the user to harmful substances that are also contained in tobacco smoke. The consequences of long-term use of smokeless tobacco products range from nicotine addiction, damage to the oral mucosa, gum disease, caries, tooth loss, precancerous changes in the oral cavity, to cancer of the oral cavity, esophagus, pancreas, including stomach, rectum, heart attack and stroke with fatal outcome, and type 2 diabetes.

The use of nicotine products among adolescents is associated with a number of additional risks

Adolescents are highly susceptible to nicotine addiction, and more so than adults. The younger an individual is when they start using nicotine, the more likely they are to become addicted and the more addicted they will be. Adolescence is also a critical period for brain development, which continues to develop until about age 25. Research shows that exposure to nicotine during a time of intense brain development disrupts normal brain development and can lead to lasting adverse effects on cognitive (thinking) abilities, working memory impairment, attention and mood disorders, increased impulsivity or anxiety, and a higher risk of using other drugs. Even short-term exposure to low levels of nicotine can lead to lasting changes in an adolescent's brain. In addition, the use of electronic cigarettes and smokeless tobacco products by adolescents increases the risk of starting to smoke cigarettes or becoming cigarette smokers, but there is no research on this for other products.

GROUPS THAT ARE PARTICULARLY VULNERABLE TO THE EFFECTS OF NICOTINE, IN ADDITION TO CHILDREN, ADOLESCENTS AND YOUNG ADULTS, ARE ALSO NON-SMOKERS, PREGNANT AND NURSING MOTHERS, AND PATIENTS WITH HEART AND VASCULAR DISEASES DUE TO THE STRONG EFFECTS OF NICOTINE ON THE CARDIOVASCULAR SYSTEM.

The percentage of users of electronic cigarettes, heated tobacco products, nicotine pouches, and smokeless tobacco products is higher among adolescents than adults and is increasing rapidly, which is particularly concerning given the specific risks of nicotine use among young people and the development of addiction.

Sources: Health-Related Behavior in School Age Survey 2022 and National Survey on Tobacco, Alcohol and Other Drugs 2023

More data from both studies are available in the publications at link 1 and link 2 .

The use of various tobacco and nicotine products in the general population varies between individual statistical regions. More information on this is available in the publication at this link .

The Act on Restricting the Use of Tobacco and Related Products represents a comprehensive program of tobacco control measures and includes the most modern and effective measures to prevent and reduce the use of these products. The currently valid law is available at this link .

Related products include heated tobacco products, electronic cigarettes, and nicotine pouches.
Key measures of the legislation include:

• a complete ban on advertising (direct and indirect), display, promotion of tobacco, tobacco and related products, as well as sponsorships and donations;
• a ban on smoking tobacco products and the use of heated tobacco products and electronic cigarettes in all enclosed public and work spaces and in all vehicles in the presence of minors and on functional land of facilities in which education or training activities are carried out;
• uniform packaging of cigarettes and rolling tobacco;
• large pictorial and text health warnings on the packaging of tobacco products for smoking;
• ban on the sale of tobacco and related products to persons under the age of 18;
• mandatory permits for the sale of tobacco, tobacco and related products at individual points of sale (the permit may be temporarily or permanently revoked in the event of violations);
• ban on cigarettes, roll-your-own tobacco and heated tobacco products with a characteristic aroma, etc.

A ban on flavorings in electronic cigarettes, with the exception of certain tobacco flavors, will also come into effect in April 2025.

Exposure of non-smokers to smoke from tobacco products, heated tobacco products, and electronic cigarettes is also harmful to their health.

Exposure to tobacco smoke has a wide range of adverse health effects on non-smokers, similar to those of smokers. In adults, these include lung cancer, stroke, ischemic heart disease, various other cancers, respiratory diseases, cough, expectoration of mucus, difficulty breathing, and many other diseases and conditions that are entirely preventable if exposure is avoided. Unborn children, infants and young children, and pregnant women are particularly vulnerable to the effects of exposure to tobacco smoke. The consequences of exposure can include premature birth, low birth weight, cleft lip, cleft palate, sudden infant death syndrome, lower respiratory tract infections, middle ear diseases, asthma or its exacerbation, and many other diseases and health problems that are more common than in unexposed children. The use of heated tobacco products and electronic cigarettes also increases the levels of harmful and potentially harmful substances in indoor air, and can be harmful to health.

Despite existing legislative prohibitions, exposure to tobacco smoke from cigarettes, heated tobacco products, and electronic cigarette smoke remains present and is not negligible.

Sources: National Survey on Tobacco, Alcohol and Other Drugs 2023.

More information is available in the publication at this link.

Municipalities can further contribute to reducing exposure to tobacco smoke from cigarettes, heated tobacco products and electronic cigarette smoke by introducing additional bans in various environments (parks, children's playgrounds, beaches or swimming pools by lakes or rivers and outdoor swimming pools, open sports fields and open spaces belonging to sports buildings, mass outdoor events, areas in front of entrances to enclosed public spaces, various work organizations and in front of entrances to multi-apartment buildings).

A survey by the National Institute of Public Health, in which 83 municipalities (39% of Slovenian municipalities) participated, showed that most representatives of the municipalities included in the survey are not aware that municipalities can introduce additional bans in various areas within the municipality. Additional bans were introduced by only 6% of Slovenian municipalities included in the survey (5 municipalities), namely on children's and sports playgrounds, parks, open spaces belonging to sports buildings, outdoor picnic areas and at events in outdoor areas. The ban mainly includes classic tobacco products for smoking, and in only one municipality also heated tobacco products and electronic cigarettes. The main reasons for introducing the ban were ensuring health protection and managing the amount of waste.

There are still many challenges ahead in reducing the prevalence and consequences of tobacco and nicotine product use. We know of effective measures and programs to further reduce the prevalence and consequences of tobacco and related product use. The most important further measures are increasing taxation of tobacco and related products to reduce their affordability and significantly reducing the number and types of points of sale, including restrictions on the locations of points of sale. Other important measures and programs are listed in the Strategy for Reducing the Consequences of Tobacco Use 2021–2030, which is available at this link .

WE CREATE AN ENVIRONMENT THAT ENCOURAGES HEALTHY CHOICES AND DOES NOT INCLUDE CLUES FOR SMOKING OR THE USE OF VARIOUS TOBACCO AND NICOTINE PRODUCTS.

Slovenia has various forms of easily accessible assistance for quitting tobacco and nicotine products, many of which are free of charge.

In health centers throughout Slovenia, within the framework of Health Education Centers and Health Promotion Centers, trained experts offer free support for quitting in the form of group workshops or individual counseling. More information about where the centers are located and their contact details are available here .

On the free smoking cessation helpline 080 2777, which operates every day from 7:00 to 10:00 and from 17:00 to 20:00 , callers can obtain all the necessary information regarding quitting, and proactive telephone counseling and guidance is also provided, in which the counselor provides the smoker/user with personal help and support in the quitting process over a longer period of time. More information about the counseling line is available here .

Quitting advice is also available on the Med.Over.net online forum, and more information is also available on the Quitting Smoking website.

Authors: Helena Koprivnikar, Dunja Šulc, Zala Jan

Date 17.12.2024