Report on tobacco, nicotine ... in Czechia 2021

Overview of the current situation in the field of tobacco, nicotine and related products in the Czech Republic

This situation overview summarises the Tobacco, Nicotine and Related Products in the Czech Republic 2021 Report, which was published in February 2022. The report is part of the information package of annual reports on the situation of addiction in the Czech Republic.

Public health impacts of smoking

Tobacco control policy

Market for tobacco and nicotine products

Use of tobacco and nicotine products among children and young people

Use of tobacco and nicotine products in the adult population

Passive exposure to tobacco smoke

Health consequences of smoking

Social consequences of smoking

Crime associated with tobacco use

Prevention and health warnings about the risks of smoking

Smoking cessation and treatment for tobacco dependence

Impacts of COVID-19 on the supply of tobacco and nicotine products and on smoking

Public health impacts 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. In developed countries, including the Czech Republic, tobacco smoking is the most important risk factor along with physical inactivity. In particular, cardiovascular diseases, respiratory diseases and malignant neoplasms account for the highest proportion of the health burden caused by tobacco smoking.
• In addition to the impact on smokers themselves, smoking causes health impacts in people exposed to tobacco smoke (second-hand smoking or passive smoking). Passive exposure to tobacco smoke accounts for approximately 13% of the health burden caused by smoking.
• The harm of tobacco is mainly due to smoking. Tobacco smoke contains over 7 000 chemicals, 70 of which are proven carcinogens. The mechanisms of action of these substances are different and interact and potentiate each other. Nicotine is addictive but non-carcinogenic and much less harmful than other components of tobacco smoke.
• In addition to smoking tobacco products, a number of alternative nicotine delivery systems (ANDS) that do not burn tobacco have been marketed in recent years. These include pure nicotine-based (tobacco-free) products that do not heat up (e.g. nicotine sachets) and heated nicotine products that allow nicotine to be ingested in the form of an aerosol produced by heating simple alcohols (e-cigarettes). Tobacco-based products are unheated oral forms (cut tobacco, snus, chewing tobacco) or snuff, as well as heated tobacco products. Nicotine replacement therapy is also available in the form of gum, lozenges and oral spray.
• The use of alternative nicotine products is associated with significantly lower public health risks than tobacco smoking and some are effective in smoking cessation. They should be part of an effective tobacco control policy, but given the critical attitudes and opinions of expert authorities such as the World Health Organisation (WHO), this is a controversial issue.

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Tobacco control policy

• Global and national policy on reducing the public health impact of smoking is defined by the WHO Framework Convention on Tobacco Control (FCTC), which entered into force in 2005. The Czech Republic was the last EU country to ratify it in 2012.
• The WHO recommends 6 priority tobacco control policy strategies to help countries implement the measures set out in the FCTC: (1) monitoring tobacco use and tobacco control policies, (2) consistent enforcement of smoking bans in public places, (3) promotion of smoking cessation services, (4) warnings of the harms of smoking, (5) enforcement of bans on advertising, promotion and sponsorship, (6) raising the price of tobacco through excise tax increases.
• The Harm Reduction approach to tobacco, which works with the risk continuum of tobacco and nicotine products and favours alternative, significantly less risky products and routes of administration, is underpinned by the growing body of research and available data in this area.
• The harm reduction approach is not sufficiently used and promoted in national tobacco control policy. The main reason for this is the concern that acceptance of alternative products will lead to a re-normalisation of smoking and undermine the tobacco control strategies recommended by the WHO. There is also concern that alternative nicotine products are a gateway to smoking for ex-smokers and non-smokers, especially children.
• Available research shows that the use of alternative products does not lead to renormalisation of tobacco smoking but is a competitive substitute for tobacco smoking and that the increase in the use of alternative products is one of the reasons for the decline in smoking among children and adults.
• Tobacco policy in the Czech Republic is part of the addictions policy, which since 2014 integrates the topics of legal and illegal substances and non-substance addictions. Responsibility for its development and implementation rests with the Government of the Czech Republic. The Government's coordinating and advisory body on addiction issues is the Government Council for Drug Policy Coordination (GCDCP). The main strategic document determining the focus of the addiction policy is the National Strategy for Prevention and Harm Reduction Associated with Addictive Behaviours 2019-2027 and its Action Plan for 2019-2021, which also include targets and activities for tobacco.
• Responsibility for the different parts of the policy on tobacco, nicotine and related products falls under different ministries: (1) the area of tobacco as a commodity falls under the Ministry of Agriculture, with the exception of electronic cigarettes and non-tobacco smoking products, which fall under the Ministry of Health, (3) the area of smoking prevention and cessation primarily under the Ministry of Health (the area of school prevention under the Ministry of Education), (4) the area of advertising under the Ministry of Culture (audiovisual broadcasting) and the Ministry of Industry and Trade (for other advertising), (5) the area of pricing policy and taxation under the Ministry of Finance.
• This division of responsibilities complicates the implementation of an effective tobacco policy and highlights the need for inter-ministerial coordination.

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Tobacco and nicotine products market

• The availability of tobacco and nicotine products is very high in the Czech Republic. They can be sold in grocery stores, newsagents, petrol stations, etc. Their sale is a free trade.
• 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 unless the age of the buyer can be verified, and a ban on the manufacture, import and sale of food products and toys that mimic the appearance of tobacco products.
• There is a complete ban on smoking in all restaurants, bars, cafés, wine bars and other food service establishments (the ban does not apply to electronic cigarettes and hookahs), and a ban on smoking at public transport stops (also applies to electronic cigarettes), a ban on smoking in zoos (does not apply to electronic cigarettes), a ban on smoking in schools, hospitals, public transport, sports halls, playgrounds, entertainment venues and shopping centres (also applies to electronic cigarettes).
• At the same time, the establishment of smoking rooms in cinemas, theatres, concert and exhibition halls, sports halls and on the premises of medical establishments, with the exception of closed psychiatric wards, is prohibited.
• Municipalities have the possibility to prohibit smoking (including electronic cigarettes) in the vicinity of schools, educational establishments and other areas reserved for the activities of children and minors. Between 2015 and 2020, according to MoI records, only 17 ordinances (or amendments to ordinances) regulating tobacco smoking or the use of electronic cigarettes were issued. Of the 27 statutory cities, only the cities of Frýdek-Místek and Třinec have issued an ordinance regulating smoking, according to records.
• The most widely used tobacco product in the Czech Republic is industrially produced cigarettes, followed by tobacco intended for hand-packaging cigarettes. Approximately 23 billion cigarettes are consumed annually in the Czech Republic (approx. 2 thousand cigarettes per capita, i.e. approx. 100 packs of cigarettes per capita, including children). There are about 5 thousand different tobacco products on the market for smoking, including about 490 brands of cigarettes.
• From May 2020, the sale of menthol flavoured cigarettes, including menthol capsules and menthol flavoured hand rolling tobacco, is banned in the EU. Other flavours have already been banned. The aim of this measure is to reduce the attractiveness of smoking, especially among children and adolescents. Menthol cigarettes are estimated to be used by around 15% of smokers in the Czech Republic, i.e. around 350 000 people.
• The supply of alternative products in the Czech Republic is growing, currently accounting for approximately one tenth of the tobacco and nicotine market.
• As regards e-cigarettes, around 5 thousand different products from a large number of manufacturers were registered on the Czech market as of June 2021, and large tobacco companies are also currently entering the e-cigarette market. Several brands of heated tobacco products from different companies are currently sold in the Czech Republic. The range of nicotine sachets is expanding, with approximately 80 different products currently on sale.
• The price of smoking tobacco products in the Czech Republic is gradually increasing as the excise duty increases. In March 2020 and also in February 2021, tax rates increased by leaps and bounds, and further (more modest) increases are planned from 2022 and 2023. Thus, from 2020, the price of cigarettes has increased by about 12% (by CZK 12-13 per pack of 20 cigarettes), and from 2021 by a further increase of about 8% (by about CZK 8 per pack of 20 cigarettes). Approximately 80% of the price of a cigarette is paid to the state in excise duty (60%) and VAT (21%). An excise duty on heated tobacco products is also being introduced from April 2019.
• The state currently collects around CZK 60 billion a year in excise duty on tobacco products, most of which is on cigarettes and other smoking tobacco products. In 2020, revenues from the collection of excise duty on tobacco products will account for about 4% of the total revenues of the state budget of the Czech Republic.
• In addition to the ban on advertising at the point of sale and the ban on display of tobacco products, 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.
• It is estimated that up to 30 % of estimated cigarette sales in the Czech Republic are purchases by foreign citizens in border areas with Germany and Austria. The reason for these purchases is the cheaper price of cigarettes in the Czech Republic due to lower taxation.
• The share of the illicit (untaxed) market is estimated at 3-10 %. Cigarettes are smuggled into the Czech Republic mainly from Poland, Ukraine, Belarus, Moldova or Slovakia. On the other hand, cigarettes are smuggled from the Czech Republic to Western or Northern European countries. Organised or individual smuggling of cigarettes is motivated by the high price differences between cigarettes in different European countries and the profits that result. No excise duty, VAT or other taxes are paid on smuggled cigarettes in the country of consumption.
• It is estimated that up to 150 million cigarettes are illegally produced in the Czech Republic every year. In 2020, the Customs Administration detected 3 illegal cigarette and tobacco factories in the Czech Republic, all controlled by organised groups from Poland and Eastern Europe. In 2020, the Customs Administration dealt with a total of 578 cases of breaches of customs regulations in the marketing of tobacco products, 87 of which were dealt with in criminal proceedings. 45 million illegal cigarettes and 138 tonnes of tobacco were seized.

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Use of tobacco and nicotine products among children and young people

• Approximately 3% of 11 year olds, 18% of 13 year olds and 40% of 15 year olds (HBSC 2018), 54% of 16 year olds (ESPAD 2019), and 54% of 13-15 year olds (GYTS 2016) have experience of smoking in their lifetime.
• Regular or daily smoking is reported by 11.3% of 13-15 year olds (GYTS 2016), 11.0% of 15 year olds (HBSC 2018) and 10.3% of 16 year olds (ESPAD 2019).
• On average, the first experience of cigarette smoking occurs at just under 13 years of age, and the first experience of e-cigarettes at 14 years of age (ESPAD).
• The proportion of minors who report current (within the last 30 days) and daily smoking has been declining over time (both HBSC and ESPAD studies).
• Adolescents' experience with e-cigarettes has been increasing in recent years. 60.4% of students have had experience with e-cigarettes at some point in their lives, more than the number of students who have had experience smoking conventional cigarettes (ESPAD 2019). In the past 30 days, 19.8% of students have used e-cigarettes, slightly less than how many have used conventional cigarettes (23.6%). Regular/daily use is at a significantly lower level than daily smoking of conventional cigarettes (ESPAD 2019). According to the GYTS 2016, 11.2% of 13-15 year olds reported using e-cigarettes in the last 30 days.
• When e-cigarettes are included in the aggregate category of tobacco and nicotine products, they show a fairly stable prevalence of current use - so it is likely that the decline in smoking prevalence is partly due to an increase in the prevalence of e-cigarette experience and that e-cigarettes are also acting as a substitute for cigarette smoking in this age group.
• Subjectively perceived availability of cigarettes has been declining in recent years, but is still at a relatively high level (ESPAD and GYTS). A total of 69.1% of current smokers aged 13-15 years have not experienced being refused cigarette sales due to young age, and 24.6% reported that they could buy cigarettes individually, which is prohibited by law (GYTS 2016).
• A positive trend in recent years is the increasing perception of the risk of regular cigarette smoking by adolescents (ESPAD 2019).
• Children and adolescents from vulnerable or socioeconomically disadvantaged groups (Roma, clients of low-threshold facilities for children and youth, children and adolescents in institutional care) report a higher prevalence of smoking and regular smoking than their peers in the general population.

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Use of tobacco and nicotine products in the adult population

• Studies carried out in 2020 show that 30-34% of the adult population in the Czech Republic currently (i.e. in the last 30 days) smoke (38-45% for men and 18-23% for women). Daily (or almost daily) smoking is reported by 17-23% of people (21-31% of men and 12-14% of women). Rates of daily smoking are significantly lower among respondents aged 15-24 and 65+. Current smokers (daily and occasional) smoke most often 15-24 cigarettes per day.
• Approximately 18% of people (slightly more men than women) report experience with e-cigarettes in their lifetime. Use of e-cigarettes in the last 30 days is reported by around 5% of the adult population (slightly more males than females), most in the 15-24 age group (10%). Daily use of e-cigarettes is reported by around 2% of the population aged 15+ (6% aged 15-24).
• Smoking rates decrease with respondents' education - among respondents with primary education, they are 2-7 times higher than among university students in different studies.
• Around 7-15% of the adult population (more men than women) have tried heated tobacco products at least once in their lifetime, and around 2% of the population have used them in the last 30 days.
• 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 largest decline occurred (especially according to the NAUTA study) between 2012 and 2015, and the situation has remained approximately the same since 2015. The decline in current and daily smoking is particularly evident among women. In particular, the prevalence of smoking in the 15-24 age group has been declining over the long term.
• However, when trend prevalence data from different studies are adjusted for the influence of different and changing age structures, it appears that smoking prevalence in the Czech Republic has rather remained stable over the last 15 years or so and in some studies has even increased, especially among men.
• Alongside the decline in conventional cigarette smoking, there has been an increase in the use of e-cigarettes and heated tobacco products in recent years. Increases in current and daily e-cigarette use have been observed among both men and women and in all age groups, with the largest increases among 15-24 year olds and 25-34 year olds.
• Smoking is also relatively widespread during pregnancy. A total of 13% of women reported having smoked at some point during pregnancy - 8% before detection and the remaining 5% continued to smoke during pregnancy.
• The prevalence of smoking is higher in some population groups, e.g. among Roma, among residents of socially excluded localities, among persons in prison.
• Regular daily smoking of a pack of conventional cigarettes is considered risky by 82.7% of the population. In a comparison of opinions on the riskiness of different tobacco and nicotine products, nicotine substitutes from pharmacies, chewing and snuff tobacco and hookah are considered the least risky (i.e. the least harmful to health), whereas the most risky, according to the respondents, are classic cigarettes (and cigars and pipes). The social acceptability of smoking has been declining over the long term, but up to 80% of people still consider it to be an acceptable behaviour compared to other problematic behaviours.
• The public has misinformation about the risks of alternative products. According to a survey (NAUTA 2020), half of the Czech adult population think that smoking conventional cigarettes is as harmful as using e-cigarettes and heated tobacco products. 11% think that using e-cigarettes and heated tobacco products is even more harmful than smoking conventional cigarettes. Young people aged 15-24 were the most knowledgeable, with the proportion identifying cigarette smoking as the most harmful decreasing with age.

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Passive exposure to tobacco smoke

• Exposure to tobacco smoke is an important health risk factor. A total of 17% of the population is exposed to tobacco smoke in the home (14% in 2019), mostly non-smokers. In the workplace, 20% of the population is exposed to tobacco smoke (16% in 2019). Thus, second-hand smoke rates have increased year-on-year (NAUTA). Higher exposure to tobacco smoke is reported by men and young people in the 15-24 age group.
• In prisons, 58.9% of inmates are exposed to second-hand smoke.
• Up to one-third of adolescents are exposed to tobacco smoke at home (GYTS 2016).

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Health consequences of smoking

• Smoking is responsible for about one fifth of 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. On average, 15 years of life are lost for every 1 smoker who dies.
• In addition to tobacco dependence, for which tobacco is a necessary cause, smoking is a decisive factor in malignant neoplasms of the trachea, bronchus and lungs (lung cancer) and chronic obstructive pulmonary disease (COPD), for 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 and the most common cause of cancer deaths. Less than 7,000 new cases of the disease and over 5,000 deaths from lung cancer have been diagnosed annually in the Czech Republic in recent years.
• Most cases of lung cancer are diagnosed in the 60-69 age group, with a significant increase in incidence after the age of 55. More than 70% of newly diagnosed lung cancers are caught at late stages.
• The incidence of lung cancer is twice as high in men as in women, and both incidence and mortality rates in men have been declining over the long term. In women, both incidence and mortality are increasing slightly. The lowest lung cancer incidence and mortality rates have long been in the Zlín Region, while the highest rates are in the Ústí nad Karlovy Vary Region.
• Chronic obstructive pulmonary disease (COPD) causes 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.
• In 2020, the Toxicology Centre of the VFN in Prague dealt with a total of 45 cases of a child in the Czech Republic being intoxicated or exposed to e-cigarette refills, 70% of which were children under the age of two. However, only a few cases per year are treated for nicotine poisoning in the Czech Republic.

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Social consequences of smoking

• No current estimate of the social costs of smoking is available. It has been estimated that tobacco smoking causes social costs in the Czech Republic in the order of 80-100 billion CZK per year, most of which are due to treatment costs and productivity losses due to increased morbidity and premature mortality.
• According to various sources, spending on tobacco products has accounted for approximately 1-4 % of household consumption expenditure in the Czech Republic in recent years.
• Smoking is associated with adverse socio-economic status, with up to 70% of respondents to the SVL survey reporting smoking in the last 30 days.
• In 2020, 17.3 thousand fires were recorded in the country, with 6% of fires caused by smoking. This proportion has been relatively stable in recent years. Direct material damage due to fires caused by smoking totalled CZK 43.6 million in 2020. This represents 1.7% of the total damage caused by fires in the Czech Republic.

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Crime related to tobacco use

• In 2020, the Ministry of Health (MoH) recorded 2 525 tobacco-related offences, most commonly smoking in a place where smoking is prohibited (89%). There is a marked decrease in the number of offences compared to the previous year.
• Economically motivated tobacco-related offences are regularly surveyed in a questionnaire study among sentenced prisoners. Theft or other unlawful conduct with the motive of obtaining funds for tobacco was sometimes committed by 14% of inmates.

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Prevention and health warnings about the risks of smoking

• Since September 2016, health warnings (consisting of text or text and image) on the packaging of tobacco products, electronic cigarettes and herbal smoking products have been introduced in the Czech Republic under the European Tobacco Directive.
• The health warning on cigarette packs was noticed by 90% of current smokers in 2020 and 15% (18% in 2019) thought they could quit smoking in relation to the warning. In total, 46% of people have seen information about the health risks of smoking in the media in the last 30 days.
• Satisfaction levels with the introduction of a smoking ban in restaurants have been increasing slightly over the long term, although 70% of respondents reported satisfaction in 2020 (compared to 76% in 2019). Satisfaction has fallen particularly among men and young adults aged 15-34.
• The introduction of the smoking ban in public catering establishments has had a limited impact on smokers, with the majority reporting that they still smoke the same amount (67%), 24% saying they smoke less, 5% have tried to quit, 0.5% have stopped smoking and 2% 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 MoEYS. There are regional school prevention coordinators at regional level, prevention methodologists at former district level and school prevention methodologists in schools. In 2020, the implementation of prevention activities was negatively affected by the situation related to COVID-19.
• In the 2019/2020 school year, a total of 65,739 cases of risky behaviour were registered in primary and secondary schools; tobacco use was addressed in 12,199 cases (18.6%), most often in the first year of secondary school (2,547 cases).
• The prevention programmes implemented in schools most often focused on the prevention of bullying and aggression (16.6% of programmes), while 6.6% of programmes focused on the prevention of tobacco and nicotine use. Pupils and students receive 21.7 hours on the prevention of tobacco use throughout their attendance at primary and secondary schools, with the highest number of hours in the first year of secondary school (2.5 hours). A number of prevention activities are also carried out in schools by the State Institute of Health (SZU).
• Smoking prevention and smoking cessation support programmes among adults are rarely implemented. The MoH is implementing a Smokefree Hospital project, and corporate strategies and policies are being developed for smokefree workplaces and support for employees to quit smoking - but these activities are unlikely to be widespread.
• In 2016, the National Quitline 800 350 000 (now the National Quitline) was established and a related website chciodvykat.cz and email counselling service poradte@chciodvykat.cz are operational. The telephone number of the line is owned by the Office of the Government of the Czech Republic and operated by the Czech Coalition Against Tobacco.
• In the Czech Republic, there are a number of websites dedicated to smoking and smoking cessation support National Smoking Cessation Support Site koureni-zabiji.cz (a link to this site is a mandatory part of the health warning on tobacco product packaging), the Society for the Treatment of Tobacco Dependence operates the website slzt.cz, and the ÚZIS launched the National Health Information Portal nzip.cz in 2020.
• The annual World No Tobacco Day on 31 May is an opportunity to raise awareness of tobacco smoking and its impact on health. A number of media activities are also carried out on the occasion of World Lung Cancer Day, International No Smoking Day or World Chronic Obstructive Pulmonary Disease Day.

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Smoking cessation and tobacco dependence treatment

• Smoking cessation is a broader term that refers to any process designed to help people quit smoking - in addition to tobacco dependence treatment, it includes advice via telephone helplines and mobile apps, information leaflets, self-help cessation guides and brief interventions.
• Tobacco dependence treatment is a concept that includes 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 %, while tobacco dependence treatment in the form of psychosocial-behavioural counselling has an estimated success rate of approximately 10 %, and even 30-35 % when accompanied by pharmacotherapy.
• In 2020, tobacco dependence treatment in the Czech Republic was provided in 43 tobacco dependence treatment centres in hospital outpatient clinics, by approximately 200 outpatient physicians, in approximately 300 specialised pharmacies and in some addiction programmes. A structured telephone intervention is also provided by the National Quitline.
• The network of tobacco dependence treatment centres and outpatient physicians is sponsored by the Society for the Treatment of Tobacco Dependence (STD). The centres are mainly located in the pneumology and internal medicine departments of hospitals as part of their outpatient facilities.
• For intensive treatment of tobacco dependence, there are 2 medical procedures available in the Czech Republic, the reimbursement of which can be contracted by the health service provider with health insurance companies (25501 - initial intervention, 25503 - follow-up visit).
• The brief intervention lasts up to 10 minutes and has a three-point scheme - a question about smoking, an intervention (recommendation to quit and explanation of the principle of treatment) and a transfer of contacts to a telephone line or a specialist centre. The advantage of brief interventions is their potential wide population coverage.
• The implementation of brief smoking cessation interventions is mandatory by law for all health professionals in the Czech Republic. Despite this, only about one in three smokers who see a doctor in the Czech Republic is recommended to quit. Short smoking cessation interventions are performed by only half of all doctors, according to a 2020 estimate. The situation is not improving in the long term.
• A quarter to a third of current smokers have tried to quit in the last 12 months. Most attempts are unsuccessful. The highest percentages of those who have tried to quit were in the youngest smoking age group (15-24 years) and among respondents with a university education (NAUTA). Respondents aged 25-34 years were more likely to have quit, with the highest proportion of unsuccessful attempts in the 45-54 age group (National Survey).
• Smokers were most likely to attempt to quit without help (76.0% of smokers or ex-smokers who attempted to quit), 25.9% used nicotine substitutes from a pharmacy, 8.9% switched to an e-cigarette, and 3.8% switched to heated tobacco products. Only 1.8% of those who tried to quit used a smoking cessation treatment programme. Those who successfully quit reported an average of 3 quit attempts, those who failed 5 attempts (National Survey).
• There are several online counselling sites and mobile apps aimed at smoking cessation. The online counselling service koncimshulenim.cz is aimed at smokers and cannabis users.
• The slzt.cz website, run by the Society for the Treatment of Tobacco Dependence, lists contacts for tobacco dependence centres, outpatient doctors, specialist pharmacies and addiction clinics providing treatment for tobacco dependence. Links to mobile apps for smoking cessation in the Czech language are also provided.
• The coverage of the smoking population with formal tobacco dependence treatment is low. According to the National Register of Covered Health Services, only 1 316 people were reported to have received tobacco dependence treatment in 2020, of whom 775 were men (59%) and 541 were women (31%). The highest number of people were treated in 2017 (2 161).
• The majority of smokers who attempt to quit smoke do so on their own without professional support. This is indicated by a higher consumption of medications for tobacco dependence treatment (nicotine replacement therapy or varenicline) than would be consistent with formal treatment data.
• In 2020, nicotine replacement therapy (NRT) products were distributed to pharmacies in quantities equivalent to 2.9 million recommended daily doses, equivalent to about 239 000 quitting episodes over a 12-week treatment period.
• In 2020, varenicline (Champix) was distributed to pharmacies in the Czech Republic in a quantity equivalent to about 197 000 recommended daily doses of varenicline, which corresponds to about 2,300 quit episodes with the recommended 12-week treatment. Neither NTN nor varenicline are covered by health insurance.
• For smokers who have been unable to quit, either with professional help or otherwise, alternative nicotine and tobacco products are an option to reduce health risks. The lower health risks and reduced consumption of conventional cigarettes are among the main reasons why people use e-cigarettes (National Research 2020). However, apart from e-cigarettes, the use of alternative products in smoking cessation is not yet part of the formal recommended practices in the country.

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Impact of COVID-19 on the supply of tobacco and nicotine products and on smoking

• Available studies show that smokers are likely to have a lower risk of infection with SARS-CoV-2 (the causative agent of COVID-19) but a higher risk of hospitalisation and severe COVID-19.
• The impact of the epidemic on the rate and frequency of smoking is not clear according to data from different countries. It appears that some smokers may have reduced or quit smoking during the epidemic, while others may have increased or returned to smoking.
• Data from the National Survey on Substance Use 2020 suggest that heavy substance users tended to increase use on average during the emergency and occasional users to decrease it, but for smoking, there was on average a decrease in use even among daily smokers. This change may have been influenced by the closure of catering outlets, but also by reports of an increased risk of serious COVID-19 among smokers.
• In the context of the COVID-19 epidemic and related anti-epidemic measures, there has been a large decrease in cigarette sales in the border areas with Austria and Germany, where citizens of these countries purchase cigarettes for personal consumption.
• The decline in cigarette sales associated with frontloading was the main reason for the lower than expected year-on-year increase in tobacco excise duty collections in 2020. The Ministry of Finance (MoF) expected an increase in excise duty collections of CZK 7.7 billion, but in reality there was only an increase of CZK 3.6 billion. Increasing consumption of heated tobacco products (which are subject to a lower excise duty rate) and other nicotine alternatives to smoking tobacco may also have an impact.
• On the other hand, the COVID-19 pandemic is unlikely to have had an impact on the illicit production and smuggling of cigarettes; on the contrary, given the busyness of security and control authorities across Europe, the period was favourable for illicit traders. Following the relaxation of anti-epidemic measures, an increased supply of illicit cigarettes can be expected.

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More information

The text above is the first part of the full report; it was translated by DeepL.

Full Report on Tobacco, Nicotine and Related Products in the Czech Republic 2021 is available in Czech language under the title Zpráva o tabákových, nikotinových a souvisejících výrobcích v České republice 2021.