Exposure to secondhand tobacco smoke (SHS) has been classified as a “Group 1” carcinogen (known human carcinogen) by the International Agency for Research on Cancer and has been shown to have adverse health effects on adults and children, including heart disease and respiratory disorders. Electronic cigarettes (e-cigarettes), the most common “electronic nicotine delivery system”, have irrupted in the past 5 years with sales volumes increasing considerably across the European Union.

The TackSHS Project will try to elucidate the comprehensive impact that SHS and e-cigarettes emissions have on the respiratory health of the European population and how health impacts vary according to socio-economic parameters with particular emphasis on specific vulnerable groups (patients suffering from pre-existing chronic lung diseases, heavy smokers, and other disadvantaged groups).

By means of an integrated series of work packages, we will investigate the determinants of SHS exposure, assessed at the individual level and in the environment (survey and air quality assessment in 12 countries), the overall burden of disease caused (lung diseases and cardiovascular diseases), including the specific respiratory health changes in patients and healthy people, the economic impact of both mortality and morbidity caused by these exposures, the methods to better characterize these exposures and novel interventions to reduce them.

This comprehensive, integrated approach will enable significant step-change beyond the current state-of-the-art in understanding SHS and e- cigarette emission exposure. The participating partners have been at the forefront of cutting edge research in this discipline, with prior collaboration between them in specific projects.

The TackSHS Project will put together for the first time all these firstline research teams, and the conjunction of the work packages will result in a step forward to tackle exposure to SHS and e-cigarettes emissions.


A multidisciplinary team of public health scientists, medical and environmental epidemiologists, occupational health specialists, respiratory physicians, health economists and policy specialists will work together within the TackSHS Project with the overall aim of providing scientific evidence on exposure assessment, burden of disease, and development and evaluation of interventions to tackle secondhand tobacco smoke and electronic cigarettes emissions upon respiratory health. In order to achieve this overall aim, the TackSHS Project will carry out the following objectives:

  • To analyze the determinants of the exposure of the European population to secondhand smoke using self-report exposure through questionnaires (WP3) and objective environmental markers (WP2);
  • To characterize the attitudes towards smoke-free measures and secondhand smoke exposure and the associated perception of risk of the general population and vulnerable populations (WP3);
  • To assess the morbidity and mortality from chronic lung diseases and cardiovascular diseases due to secondhand smoke exposure in the European population, with emphasis on disadvantaged and vulnerable groups (WP9), and to evaluate the economic burden of these exposures (WP10);
  • To design, implement, and evaluate new interventions to reduce secondhand smoke exposure in vulnerable populations (WP4); with emphasis on finding methods to increase the uptake of smoke-free homes and cars;
  • To characterize secondhand tobacco smoke exposure and exposure to electronic cigarettes emissions upon patients with chronic lung diseases (WP5) and healthy subjects (WP6);
  • To develop feasible, sensitive, and cost-effective methods for secondhand tobacco smoke and electronic cigarette emissions assessment (WP7);
  • To systematically review the scientific published literature on secondhand exposure to electronic cigarette emissions and assess these emissions in real-life conditions (WP8);
  • To disseminate the findings, new interventions, and policy recommendations produced by the project through a final project conference for stakeholders and policy makers, together with scientific publications and press stories for the general public (WP11); and
  • To adhere to the principles of good governance, ethical conduct, and accountable


The main characteristic of the TackSHS Project is the comprehensive and innovative approach going beyond what has been done previously as isolated efforts and not-always connected research.

For the first time, this project will consider the integration of data on secondhand smoke tobacco exposure from a validated, homogenous survey, this is the perceived exposure by the population, carried out in several countries together with the objective assessment of secondhand tobacco smoke using environmental markers. Whilst this is the nucleus of the TackSHS Project, additional WP will address specific questions regarding exposure to secondhand tobacco smoke and e-cigarettes emissions, including its impact on health and its economic burden in specific populations and patients with chronic lung diseases.
The characterization of secondhand tobacco smoke exposure across different countries will allow the evaluation of smoke-free laws and the information to further develop them, that will translate in an increase number of Europeans protected from secondhand smoke and its consequences on health. Moreover, if the low-cost intervention developed to prevent secondhand smoke exposure proves to be reliable and efficient, we will transfer this knowledge to interested public health agencies across Europe.
They should be the responsible entities to implement these modifications at the population level.

The TackSHS Project is an ambitious mission, involving eleven high profile research Institutes in six different European countries. Our research plan is innovative in Europe and has a high relevance and impact on health. This comprehensive, integrated approach will enable significant step-change beyond the current state-of-the-art in understanding second-hand tobacco smoke and electronic cigarette emission exposure. The participating partners have been at the forefront of cutting edge research in this discipline, with some collaboration between them in specific projects. The TackSHS Project will put together for the first time all these first-line research teams, and the conjunction of the WPs will result in a step forward to tackle exposure to secondhand tobacco smoke and e-cigarettes emissions.