Report on Tobacco, Nicotine and Related Products in the Czech Republic 2023

This is a summary of the report, which has been published in full in Czech only. The full report is available on the Czech version of this website under the title Zpráva o tabákových a nikotinových výrobcích v České republice 2023.

Summary of the Report on tobacco, nicotine and related products in the Czech Republic 2023

Public health impact of smoking

The impact of tobacco smoking on the overall health burden is substantial. Globally, smoking is one of the leading causes of morbidity and mortality. Smoking accounts for an estimated 13% of the total burden for health, and up to 20% in developed countries.
The health impacts of smoking are most pronounced in cardiovascular and respiratory diseases and in the incidence of malignant neoplasms.
The life expectancy of smokers is on average 10-11 years lower than that of non-smokers.
People who inhale tobacco smoke (second-hand smoking or passive smoking) are also exposed to the health impacts of smoking.
Smoking also causes economic and social harm, including financial losses due to increased health care costs and reduced productivity due to premature death.
In recent years, alternative nicotine delivery systems (ANDS), which do not burn tobacco, have come on the market. These products can be further divided into two main groups: pure nicotine-based products and tobacco-containing products.
Evidence to date shows that some alternative tobacco and nicotine products are less harmful than tobacco smoking.

Tobacco control policy

Global and national policies to reduce the public health impact of smoking are defined by the WHO Framework Convention on Tobacco Control (FCTC).
In the Czech Republic, tobacco policy is part of the addiction policy, which integrates the topics of legal and illegal substances and behavioural addictions. Responsibility for its development and implementation lies with the Government of the Czech Republic. The Government's coordinating and advisory body on addiction issues is the Government Council for Coordination of Addiction Policy (Government Council).
The main strategic document defining the focus of addiction policy is the National Strategy for the Prevention and Reduction of Harm Associated with Addictive Behaviour 2019-2027 and the Action Plan on Addiction Policy 2023-2025, which also includes goals and activities for the tobacco sector.
The harm reduction approach is not sufficiently applied and promoted in the national tobacco control policy. The main reason for this is the concern that acceptance of alternative tobacco and nicotine products will lead to the re-normalisation of smoking. However, available research shows that the use of alternative products is substituting tobacco smoking and the increase in the use of alternative products is one of the reasons for the decline in smoking among children and adolescents.
Responsibility for different parts of the tobacco, nicotine and related products policy is divided between different ministries and institutions, making it difficult to implement effective policy and highlighting the need for inter-ministerial coordination.
The availability of tobacco and nicotine products is restricted by law - there is a ban on sales to minors, a ban on sales in vending machines or on the internet if the age of the purchaser cannot be verified, and a ban on the manufacture, import and sale of food products and toys that mimic the appearance of tobacco products. From March 2023, the regulation on tobacco products is extended also to nicotine sachets.
There is a complete ban on smoking in restaurants, bars, cafés, wine bars and other food service establishments, public transport stops, Zoos, schools, hospitals, public transport, sports halls, playgrounds, entertainment venues and shopping centres.
Smoking bans in restaurants, bars and Zoos do not apply to electronic cigarettes.
Municipalities have the possibility, by means of generally binding ordinances, to prohibit smoking (including electronic cigarettes) in the vicinity of schools, educational establishments and other areas reserved for the activities of children and minors.
In addition to the prohibition of point-of-sale advertising, the ban on display of tobacco products and the introduction of plain packaging, all the measures recommended by the WHO to regulate direct tobacco advertising, have been introduced in the Czech Republic. Regulation of indirect forms of promotion and sponsorship by tobacco companies can be assessed as rather moderate in the Czech Republic.
In the context of the consolidation of public budgets (Act No. 349/2023 Coll.), amendments to the Excise Duty Act (Act No. 353/2003 Coll.) came into force. The amendments will come into force progressively between 2024 and 2027. This change in legislation reflects an effort to regularly update the taxation of tobacco and alternative products in response to market developments and health recommendations.
The excise duty on cigarettes, smoking tobacco and cigars will increase by 10% from the beginning of 2024 and by a further 5% in each year thereafter until 2027. For heated tobacco products, an increase of 15% per year is planned for the period 2024-2027.
Excise duties are also newly introduced for other tobacco products such as chewing tobacco and snuff, and alternative products including nicotine pouches and e-cigarette refills.

Tobacco and nicotine products market

The availability of tobacco and nicotine products is high in the Czech Republic despite the measures in place. They can be sold in grocery stores, newsagents, petrol stations, etc. Their sale is a free trade.
The most widespread tobacco product used in the Czech Republic includes industrially produced cigarettes. Approximately 15 billion cigarettes are consumed annually in the Czech Republic (approx. 1,500 cigarettes per capita, i.e. approx. 75 packs of cigarettes per capita per year, including children). There are about 13.8 thousand different tobacco products on the market, the largest number of items being cigars (3.8 thousand) and cigarettes (3.7 thousand).
There is a relatively large number of different types of e-cigarettes on the market. In recent years, large tobacco companies have also been active in the e-cigarette market. In the Czech Republic, the market for heated tobacco products and nicotine sachets has been developing.
The state currently collects nearly CZK 60 billion a year in excise duty on tobacco products, most of it on cigarettes and other smoking tobacco products. In 2022, revenues from excise duty collections on tobacco products will account for about 5% of the total revenues of the Czech state budget.
According to the Global Youth Tobacco Survey (GYTS) 2022 study, in the last 30 days, 29% of current smokers aged 13-15 purchased cigarettes in a shop/store, 7% from a vending stand or street vendor and 4% from a vending machine. A total of 61% of current smokers have not been refused a cigarette sale because of their young age. According to the ESPAD 2019 study, the majority of 16 year olds (71%) could get cigarettes quite easily or very easily.
In 2022, the State Agricultural and Food Inspectorate carried out a total of 5 age verification checks on the sale of tobacco products by means of distance communication, 4 of which with unsatisfactory findings. Sellers do not meet the legal requirements and do not verify age in a sufficient way.
In 2022, inspections by the Czech Trade Inspection Authority focused on the supply and sale of alcoholic beverages, tobacco products and smoking paraphernalia found violations in more than 50% of cases, most often violations of the ban on the sale or supply of tobacco and nicotine products to minors under 18 years of age. From January to September 2023, the inspection authority carried out a total of 3,434 inspections, with violations found in 78% of cases.
The Customs Administration carried out a total of 1,807 inspections of tobacco products in 2022, of which 31% found violations of Act No. 353/2003 Coll., on excise duties. It also carried out 234 tobacco inspections, of which 33% found infringements of the law. On the basis of the findings, it confiscated 15,147 kg of tobacco.
The share of the illicit (untaxed) market is estimated at 3-10%. In 2022, two illegal large-scale factories specialising in cigarette and tobacco production were detected in the Czech Republic. In both cases they were operated by organised groups from Poland, Ukraine, Belarus and Moldova.
The prices of cigarettes and tobacco in the Czech Republic are gradually increasing, mainly due to the increase in excise duties on tobacco products. The average price of a pack of cigarettes reported by respondents in the NAUTA study among the general population aged 15+ has increased year-on-year from CZK 115.7 in 2021 to CZK 131.6 in 2022.
Another wave of the Czech Public Attitudes to Advertising survey was conducted in 2022. A total ban on cigarette advertising would be supported by 42% of the general population aged 15+ and a further 26% would agree with regulating advertising.

Use of tobacco and nicotine products among children and young people

Approximately 4% of 11-year-olds, 14% of 13-year-olds and 31% of 15-year-olds (HBSC 2022), 34% of 13-15-year-olds (GYTS 2022) and 54% of 16-year-olds (ESPAD 2019) have smoked cigarettes in their lifetime.
The proportion of minors reporting current (in the last 30 days), daily smoking and heavy smoking (i.e. smoking 11 or more cigarettes per day) has been declining over the long term.
Approximately 2% of 11-year-olds, 6% of 13-year-olds, and 14% of 15year-olds (HBSC 2022), 11% of 13-15-year-olds (GYTS 2022), and 24% of 16-year-olds (ESPAD 2019) have experience of cigarette smoking in the past 30 days.
Daily cigarette smoking is reported by 1% of 13-year-olds, 4% of 15-year-olds (HBSC 2022) and 10% of 16-year-olds (ESPAD 2019).
Experience of heavy smoking is reported by 3% of 16-year-olds (ESPAD 2019) and also 3% of 15-19-year-olds (UPOL 2021).
At the same time, adolescents' experience with alternative tobacco and/or nicotine products has been increasing in recent years.
In 2022, approximately 2% of 11-year-olds, 10% of 13-year-olds, and 22% of 15-year-olds and 21% of 13-15-year-olds used e-cigarettes in the past 30 days, that is significantly more than the proportion of adolescents reporting smoking conventional cigarettes (HBSC 2022, GYTS 2022).
Nicotine pouches were used in the past 30 days by 5-8% of 13-15-year-olds and heated tobacco products by 5-11% of 13-15-year-olds (HBSC 2022, GYTS 2022).
Subjectively perceived availability of cigarettes has been declining in recent years, but is still at a relatively high level (ESPAD 2019 and GYTS 2022). In 2022, a total of 61% of current smokers aged 13-15 years have not experienced a refusal of cigarette sales due to young age.
A positive trend in recent years is the increasing perception of the risk of regular cigarette smoking among adolescents (ESPAD 2019).
There are subgroups of children and adolescents with above-average smoking experience and regular smoking, such as socioeconomically disadvantaged children or children in institutional care.

Use of tobacco and nicotine products in the adult population

The trend over the last 10 years has been a slight decline in the prevalence of current and daily smoking in the adult population, which is confirmed by various population-based studies. The biggest decline occurred (especially according to the NAUTA study) between 2012 and 2015, while the situation among men has remained approximately the same since 2015. Among women, a slight decline can be observed in the last 3 years.
According to NAUTA 2022, 24% of the adult population (31% for men and 19% for women) aged 15 years and over in the Czech Republic currently (i.e. in the last 30 days) smoke. Daily (or almost daily) smoking was reported by 16% of people (21% of males and 12% of females). Rates of daily smoking are significantly higher among men and among respondents aged 45-64.
Alongside the decline in conventional cigarette smoking, there has been an increase in the use of alternative tobacco and/or nicotine products in recent years.
In 2022, approximately 10% of adults had used e-cigarettes in the past 30 days, about half of them daily. Heated tobacco products were currently used by 7% (4% daily) and nicotine pouches by 3% of the adult population (1% daily).
There are vulnerable or at-risk population groups where current and daily smoking rates are higher than in the general population. These include, for example, the Roma population, people living in social exclusion or with experience of imprisonment.
Both occasional and regular smoking is perceived as acceptable in the long term by approximately 80% of the adult population. However, tolerance towards regular tobacco smoking in particular has increased significantly in recent years (from 32% in 2015 to 51% in 2023).
The general population has misinformation about the risks of alternative products. According to the NAUTA 2022 study, 45% of the Czech adult population consider smoking of conventional cigarettes to be as harmful as the use of e-cigarettes and heated tobacco products. About 11% consider the use of e-cigarettes and heated tobacco products is even more harmful. Young people aged 15-24 were the most informed.

Health consequences of smoking

Smoking is responsible for around one fifth of all deaths in the Czech Republic. Approximately 16-18,000 people die annually from smoking-related diseases in the Czech Republic, mainly from cardiovascular diseases, respiratory diseases and malignant neoplasms.
In addition to tobacco dependence, smoking is a key factor in malignant neoplasms of the trachea, bronchi and lungs (lung cancer) and chronic obstructive pulmonary disease (COPD), in which it causes about 80% of cases.
Cancer of the trachea, bronchus and lung is the third most common cancer in both men and women. In 2021, 6.2 thousand new cases were diagnosed in the Czech Republic (most in the 65-74 age group). More than 65% of newly diagnosed cases are detected in late stages. While there has been a decline in men since 2013, there has been a significant increase in women.
Chronic obstructive pulmonary disease (COPD) is responsible for more than 30,000 hospital admissions and over 3,000 deaths per year in the Czech Republic. Mortality from COPD has been increasing for a long time.

Exposure to second-hand tobacco smoke

Exposure to tobacco smoke is an important health risk factor. In 2022, a total of 15% of the population, mostly non-smokers (10%), were exposed to tobacco smoke at home.
In the workplace, 21% of the population was exposed to tobacco smoke (17% of non-smokers). Higher exposure to tobacco smoke in the workplace is reported by men in the long term and at home by young people in the 15-24 age group. Their share is about twice that of adults aged 25+ years.
In prisons, 67% of inmates were exposed to tobacco smoke in 2022, which represents an increase compared to the previous period.
According to the GYTS 2022, more than one-third of adolescents (36%) were exposed to tobacco smoke at home.

Social consequences of smoking

The latest estimates of the social costs of tobacco smoking in the Czech Republic are reported by the WHO in 2018 to be in the range of CZK 100-170 billion. The largest part inludes the lost productivity due to increased morbidity and premature mortality and the cost of treatment of smoking-related diseases.
Expenditure on tobacco products has been estimated by various sources in recent years at around 1-4% of household consumption expenditure in the Czech Republic.
In 2022, a total of 20,800 fires were recorded in the country, with smoking being the cause of 7% of fires. This share has been stable in recent years. Direct material damage due to fires caused by smoking totalled CZK 92.5 million (i.e. 1.6% of the total damage caused by fires in the Czech Republic).

Crime related to tobacco use

In 2022, the Ministry of Justice recorded 5,806 tobacco-related misdemeanours, most commonly smoking in a place where smoking is prohibited. There is a noticeable increase in the number of misdemeanours compared to the previous year.
Tobacco-related economically motivated crime is regularly surveyed in a questionnaire study among sentenced prisoners. On average, 14% of inmates committed theft or other illegal acts with the motive of obtaining funds for tobacco.

Prevention and health warnings about the risks of tobacco use

Since September 2016, health warnings on the packaging of tobacco products, e-cigarettes and herbal smoking products have been introduced in the Czech Republic under the European Tobacco Directive. It is also mandatory to provide information regarding smoking cessation (link to koureni-zabiji.cz). From October 2023 (effective from 1 January 2025), the obligation has been extended by adding a link to the National Quitline telephone number.
In 2022, 86% of current smokers noticed the health warning on cigarette packets and 18% considered quitting in relation to the warning. A total of 51% of people have seen information in the media about the health risks of smoking in the last 30 days.
Satisfaction with the introduction of a smoking ban in restaurants in 2022 was reported by 74% of respondents. Satisfaction with the smoking ban has long been higher among women.
The introduction of a smoking ban in restaurants has had a limited impact on smokers - most of them still smoke to the same extent (64%), 22% said they smoke less, 8% have tried to quit, 2% have stopped smoking and 6% have changed their use.
Preventing tobacco use among children and young people is part of a broader framework of risk behaviour prevention coordinated by the Ministry of Education. There are regional school prevention coordinators at regional level, methodists of prevention at former district level and school prevention methodists in schools.
Prevention programmes implemented in schools most often focus on the prevention of bullying and aggression (16.2% of programmes), while 6.3% of programmes in the 2021/2022 school year focused on the prevention of tobacco and nicotine use.
Programmes to prevent smoking and promote smoking cessation among adults are rarely implemented. The National Quitline 800 350 000 has been in operation since 2016.
World No Tobacco Day is commemorated annually on 31 May, which is an opportunity to raise awareness of the topic of tobacco smoking and its impact on health.

Smoking cessation and tobacco dependence treatment

Smoking cessation refers to any practice designed to help people quit smoking - in addition to treatment for tobacco dependence, it includes counselling through telephone helplines and mobile apps. Tobacco dependence treatment is a term encompassing psycho-socio-behavioural counselling and pharmacotherapy aimed at suppressing withdrawal symptoms in a formal treatment context.
Unassisted smoking cessation has an estimated success rate of 3-5%, brief intervention in tobacco dependence treatment has an estimated success rate of approximately 10%, and intensive intervention treatment combined with pharmacotherapy has a success rate of up to 30-35%.
In 2022, tobacco dependence treatment in the Czech Republic was provided in 41 tobacco dependence treatment centres in hospital outpatient clinics, by approximately 200 specialised outpatient physicians, in approximately 200 specialised pharmacies and in some addiction programmes. The network of tobacco dependence treatment centres and outpatient doctors is sponsored by the Society for the Treatment of Tobacco Dependence.
For intensive treatment of tobacco dependence, there are 2 medical procedures available in the Czech Republic for trained physicians.
Another five procedures can be reported to the contracted health insurance companies by addiction clinics.
One of the recommended steps in clinical practice is to conduct brief smoking cessation interventions. In the Czech Republic, their implementation is mandatory for all health professionals. Despite this, only about one in three smokers who see a doctor in the Czech Republic is recommended to quit smoking. Brief smoking cessation interventions are carried out by about half of all doctors, according to a 2022 estimate.
About a third of current smokers have tried to quit in the last 12 months, mostly unsuccessfully. The highest proportion was among the youngest smokers (15-24 years) and among respondents with university education.
Smokers were most likely to try to quit without help (76.0%), 26% used nicotine substitutes from a pharmacy, 9% switched to using e-cigarettes and 4% to using heated tobacco products. Only 2% of those who tried to quit used a smoking cessation treatment programme.
The coverage of the smoking population with tobacco dependence treatment is low. According to the National Registry of Paid Health Services, only 225 people were reported to have received tobacco dependence treatment in 2022.
Pharmacotherapy for the treatment of tobacco dependence is not covered by health insurance in the Czech Republic. Contributions from health insurance funds for tobacco dependence treatment are limited.
In 2022, nicotine replacement therapy products were distributed to pharmacies in a quantity equivalent to 2.8 million recommended daily doses, which corresponds to about 33.4 thousand quit episodes for a 12-week treatment.
For smokers who have not been able to quit, alternative nicotine and tobacco products are an option to reduce health risks. The lower health risk and the reduced consumption of conventional cigarettes are among the main reasons for the use of e-cigarettes. Apart from e-cigarettes and possibly nicotine sachets, the use of alternative tobacco-containing products for smoking cessation is not part of the recommended practices in the Czech Republic, in line with global recommendations.