Greece recorded a notable rise in smoking and vaping among teenagers in recent years, making it one of the few European countries where youth nicotine use is increasing.
While smoking among adults in Greece declined, remaining at around 30%, data showed worrying levels of use among adolescents. According to the European School Survey Project on Alcohol and Other Drugs (ESPAD), the percentage of 16-year-olds in Greece who reported having smoked conventional or electronic cigarettes rose from 43% in 2019 to 54% in 2024.
João Breda, head of the Athens office for the World Health Organization on Quality of Care and Patient Safety, said policies were originally designed for traditional tobacco products rather than modern nicotine alternatives.
“Taxation, anti-smoking laws, packaging warnings and advertising restrictions were initially designed with conventional cigarettes in mind,” Breda said. He explained that modern products such as e-cigarettes and nicotine pouches often exploited regulatory gaps with sweet flavours, attractive designs and aggressive online marketing.
Breda also noted that tobacco industry marketing increasingly targeted young audiences across Europe. Strategies included partnerships with popular social media creators, sponsorships linked to music and gaming culture, and devices that resembled electronic gadgets rather than tobacco products.
Enforcement of regulations has also weakened in areas where teenagers often obtain nicotine products. Although age restrictions exist, compliance often remains insufficient at kiosks, small shops, online sales platforms and informal networks such as friends or older siblings.
Zenia Saridaki, a medical oncologist and member of the Women in Oncology Hellas network, described the trend in Greece as clearly concerning. She said new nicotine products had not been presented to teenagers as dangerous but rather as modern, harmless and socially acceptable.
According to Saridaki, social media normalisation, influencer promotion, appealing flavours and targeted digital marketing created an environment where nicotine addiction often appeared as a trend rather than a health risk. She noted that more than half of Greek students had already tried e-cigarettes, indicating widespread penetration of vaping among school-age populations.
The WHO expressed strong concern about the rapid rise in the use of e-cigarettes and heated tobacco products among children and adolescents. Breda said these products were not harmless because they contained nicotine, a highly addictive substance that affected the developing brain and increased the risk of early dependency.
Beyond nicotine, vaping aerosols could contain toxic substances including heavy metals, aldehydes, volatile organic compounds, nitrosamines and polycyclic aromatic hydrocarbons. Scientific literature also linked these substances to oxidative stress and inflammatory responses affecting the respiratory and cardiovascular systems, while some were proven carcinogens.
Saridaki added that scientific research had already associated these products with lung damage and addiction risk. However, the full long-term consequences had not yet been fully documented because devices and chemical compositions continued to change.
The WHO stressed that vaping products and heated tobacco were not considered safe alternatives or recommended smoking-cessation tools. Breda said the safest choice remained the complete cessation of all tobacco and nicotine products.
The organisation recommended several measures for governments, including preventing youth initiation, restricting flavours attractive to children, banning advertising and sponsorships, enforcing strict age verification rules and introducing strong health warnings.
The WHO also urged countries to fully implement the WHO Framework Convention on Tobacco Control to protect public health policies from interference by the tobacco industry.
Data suggested that many teenagers now began nicotine use through vaping rather than traditional cigarettes. According to Saridaki, adolescents who vape were about three times more likely to start smoking conventional cigarettes later.
Public health campaigns increasingly aimed to communicate with teenagers in a language they understood. Initiatives by Women in Oncology Hellas used humour, relatable messaging and role models, including members of Greece’s national women’s water polo team, to challenge the perception that vaping was “cool”.
Experts emphasised that preventing youth nicotine addiction required coordinated action from parents, schools, the scientific community and government authorities. They also called for stronger enforcement of age restrictions, tighter regulation of marketing practices and better education programmes starting in primary school.
Breda said Greece was moving in the right direction, particularly with new digital tools designed to strengthen enforcement of tobacco legislation and age-verification systems. However, he stressed that success would depend on strict implementation and consistent public health policies.
