The TackSHS Survey: a Cross-sectional Study on Secondhand Smoke in 12 European Countries

Study characteristics The TackSHS survey is a face-to-face population-based cross-sectional survey that will be conducted in 12 selected European countries, coordinated by Dr Silvano Gallus, Department of Epidemiology of the "Mario Negri" Institute (Milan, Italy).

Background Exposure to secondhand smoke (SHS) has serious adverse health effects on adults and children, causing more than 600,000 deaths each year worldwide. Estimates of prevalence of non-smokers exposed to SHS range between 20% and 60% in various European countries. The WHO recommend to develop smoke-free policies to protect non-smokers from SHS exposure. E-cigarettes have irrupted in the market over the last 5 years, and their sales and popularity have considerably grown in the European Union (EU). Approximately 7% of Europeans ever used e-cigarettes. TackSHS is a new research project funded by the European Commission (EC) within the Horizon 2020 programme (grant agreement: 681040). Within the TackSHS Project, selected work packages (WP; i.e., WP3, WP9 and WP10) involve the conduction of a survey in 12 EU countries: the TackSHS survey.

Objectives Objectives of this cross-sectional study include: i) to estimate prevalence, and investigate individual-level and country-specific determinants, of smoking, e-cigarette use, and exposure to SHS and to e-cigarette aerosol in selected European countries (WP3); ii) to analyze the attitudes, perceptions and behaviours of the adult European population towards policies to limit SHS exposure (WP3); iii) to compare selected smoking-related data collected through the TackSHS survey with those from a companion pan-European survey conducted in 2010 (WP3); iv) to assess morbidity and mortality from selected respiratory and cardiovascular diseases attributable to SHS exposure among adults and children in the European population (WP9); v) to quantify the economic burden associated to the exposure to SHS and e-cigarette aerosol in Europe (WP10).

Methods The cross-sectional survey will be conducted in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain), representing geographical, legislative and cultural variations across the EU. In each of the 12 selected countries, approximately 1000 individuals, representative of the general population aged 15 years and over will be enrolled. The final sample will therefore include a total of approximately 12,000 subjects. The sample size in each specific country will allow us to obtain prevalence estimates with a maximum standard error (SE) lower than ± 1.6%. Therefore, with such a sample size we will be able to provide stable prevalence estimates (with a relatively small 95% confidence interval), overall, but also in each specific country.

Survey participants will have to satisfy the following inclusion criteria: i) 15 years and over of age; ii) residence in one of the 12 selected countries; iii) ability to understand and answer the questions of the questionnaire of the study in the country-specific language; iv) formal acceptance to participate in the study.