Barriers and opportunities for the expansion of smoke- and aerosol-free environment policies in Europe.

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Comprehensive legislation covering the use of all types of tobacco and nicotine products to provide a smoke- and aerosol-free environment (SAFE) should be part of strategies aimed at phasing out tobacco use. There is a need to identify challenges and opportunities for advancing SAFE policies and their implementation. This study aims to identify barriers and opportunities to extend, enforce, and comply with SAFE policies in Europe. Within the Joint Action on Tobacco Control 2, a cross-sectional expert consultation was launched in 2022. Data obtained through an online questionnaire including closed and open-ended questions on barriers, opportunities, and interference by the tobacco and/or nicotine industry (TNI) on the extension, and compliance with/enforcement of SAFE policies, were analyzed thematically and descriptively. From 29 European countries, 61 experts (response rate: 55.5%) were included in our sample. The most commonly identified barriers for the extension of SAFE policies were tobacco industry lobbying and funding activities, while the most commonly reported opportunity was extending SAFE policies to specific outdoor public or private places, especially where children are present. In terms of compliance with/enforcement of SAFE policies, the lack of human and financial resources and capacity to monitor/enforce compliance were the most commonly identified barriers, while opportunities included more powerful enforcement authorities with increased capacity. The experts identified greater TNI interference on the extension than on the enforcement of SAFE policies. Comprehensive regulation of TNI interference and allocation of human/financial resources for policy enforcement, should be a priority for the extension of SAFE policies in Europe.