Tobacco smoking and exposure to second-hand and third-hand smoke in adults


Tobacco smoking is the most important cause of premature morbidity and mortality. The WHO Framework Convention on Tobacco Control (FCTC) and the Tobacco Products Directive (TPD) provide the European Union Member States with policies aimed at reducing the onset of tobacco use, increasing tobacco cessation rates and reducing the demand for tobacco products.

The International Tobacco Control Policy Evaluation Project pioneered the systematic evaluation of FCTC policies at the population level in different countries. As part of this project, a study has been proposed to evaluate the impact of the TPD at European level in the context of the FCTC, entitled European Regulatory Science on Tobacco: Policy implementation to reduce lung diseases (EURESTPLUS). This study set up a cohort of 1000 smokers in each of the 6 participating countries (Germany, Greece, Hungary, Poland, Romania and Spain), who were interviewed in 2016 and 2018.

The project entitled “Tobacco smoking and exposure to second-hand and third-hand smoke in adults: EURESTPLUS-Spain cohorts” has a dual purpose: a) to extend the follow-up of the Spanish cohort of smokers from the EURESTPLUS study, and b) to set up a new cohort of non-smokers living with a smoker and to objectively study their exposure to second-hand and third-hand tobacco smoke.


  1. To determine changes in the smoking pattern of smokers and its determinants after the transposition of the Tobacco Products Directive in Spain.
  2. To characterise the exposure to second-hand smoke and its determinants in non-smoker population.
  3. To characterise the exposure to third-hand smoke and its determinants in non-smoker population.


Follow-up of the Spanish cohort of smokers from the EURESTPLUS study and set-up of the new cohort of non-smokers (and smokers).

EURESTPLUS-Spain cohort: Follow-up of approximately 1000 adult smokers. The same face-to-face questionnaire from the previous waves of the study is used.

EURESTPLUS-BCN cohort: Setting-up of a sample of 100 non-smokers living with smokers to obtain their basal information. A questionnaire about exposure to tobacco smoke is used along with objective markers of use and exposure to second-hand and third-hand exposure to tobacco smoke.


3 years (January 2018 to December 2020; extended to June 2022).


Grant PI17/01338, AES-ISCIII (72.800€/88.088€).

Research team

Yolanda Castellano (ICO-IDIBELL)

Francesc Centrich (ASPB)

Nuria Cortés (ASPB)

Esteve Fernández (ICO-IDIBELL)

Marcela Fu (IP, ICO-IDIBELL)

Noelia Ramírez (IISPV-URV)

Olena Tigova (ICO-IDIBELL)

Collaborating researchers

Geoffrey T. Fong (ITC Project)

José A. Pascual (IMIM)

Constantine I. Vardavas (EURESTPLUS Study)



Soriano JB, Fu M, Castellano Y, Ancochea J, Fong GT, Fernandez E. Face Mask Exemptions, Respiratory Patients, and COVID-19 in Spain. Data From the 2021 ITC EUREST-PLUS Spain Survey. Open Respiratory Archives. 2023 January-March;5(1):100218. doi: 10.1016/j.opresp.2022.100218. Epub 2022 Oct 12. PMCID: PMC9554315.

Communications at conferences and congresses:

Comunicació pòster: Tigova O, Castellano Y, Fu M, Martínez C, Fong GT, Fernández E. Smoking rules at home among Spanish adult smokers in 2021: findings from the EUREST-PLUS ITC SPAIN SURVEY. 15as Jornadas de Formación del Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 24-25 novembre 2022, Madrid.