In her speech on the sensitive topic of “Minors’ protection from tobacco and alcohol products”, Ms. Christina-Maria Kravvari, Secretary General of Public Health, presented the main points of the new Act regulating tobacco and nicotine products, as well as the new legislation on alcohol. The session was chaired by Prof. Ignatios Ikonomidis and Prof. David T. Sweanor who also commented on the new legislation presented, together with by Prof. Anastasia Barbouni.
At the beginning of her speech, Ms Kravvari stressed that the new Greek Law 5216/2025 on protection from tobacco and alcohol is an important milestone for public health. The strategy behind this law focuses on three main pillars: 1) strengthening the enforcement and monitoring of the anti-smoking legislation, 2) promoting prevention and smoking cessation through the NHS and primary health care structures, and 3) raising public awareness through systematic information campaigns, with particular emphasis on adolescents and young adults.
The landscape in Greece
The high prevalence of smoking in Greece country remains a pressing public health issue, she said, and cited the causes, that are multi-factorial and related to social, cultural and structural factors: 1) limited enforcement of legislation in certain professional sectors, particularly in night-life venues and tourist areas, 2) a deep cultural tolerance towards tobacco use, and 3) limited access to and insufficient public visibility of the smoking cessation services that exist in public health care structures.
Historically, Ms Kravvari said, Greece has recorded some of the highest smoking rates in Europe. Despite a slight decrease in recent years, the smoking rate still remains at about 25%, well above the EU average of 18%. This number represents thousands of people fighting against serious diseases, while it also indirectly affects families and children. The National Health System bares enormous costs and the economy suffers losses in productivity. For Greece, a country with limited resources and constant pressures on the health system, prevention is not merely a health necessity, it is also an economic imperative, the speaker emphasized.
She pointed out the current global trend of increasing use of nicotine and non-nicotine electronic cigarettes, especially among 13-15 year-old adolescents -with some starting vaping as early in the age of 11- a situation that raises serious concerns. Scientific evidence shows that nicotine consumption at these ages leads to harmful effects on brain development, such as reduced cognitive function, lower attention span, and impacts on short-term memory. Moreover, the fact that minors’ brains are not yet fully developed makes them particularly vulnerable to all forms of addiction.
Provisions of the new Greek legislation
The new Greek Law 5216/2025 establishes a coherent framework, in which new tobacco products, e-cigarettes, refilled containers and herbal products are fully equated with traditional cigarettes, ultimately closing legislative gaps, Ms Kravvari stated.
Since 2019, our tobacco control policy has been based on evidence and strict scientific evaluation of new nicotine products including their relative harmfulness.
This approach, the speaker sais, led to Greece achieving the second largest reduction in smoking prevalence in the EU during 2020 to 2023 according to the EU barometer. “It is an approach rooted in realism and in our duty to strengthen public health protection.”
In virtue of the new law, all products are subject to strict rules of control, sale and distribution. At the same time, strict bans on the sale and distribution of tobacco and nicotine products to minors are established, she explained. More specifically, verification by sellers of the consumer’s age through physical or digital identification is now obligatory.
Thus, Greece adopts zero tolerance for the exposure of minors to tobacco, nicotine and alcohol to provide youth an environment free of addiction and harm as a strategic choice for the future of Greek society. said the speaker. and sent a clear message on behalf of the Greek government: Ms Kravvari also reaffirmed the Greek Minister of Health’s position that
Greece welcomes the revision of the Tobacco Products Directive provided that all preparatory steps such as evaluation report, proper impact assessment, public consultation, etc. are carried out correctly and that revision is based on real and up-to-date scientific evidence.
Greece’s policy is not only a moral commitment -Ms Kravvari emphasized- it is a strategic choice for the future of our society.
Acknowledging that smoking is a social phenomenon, the government is taking steps also on social issues, to provide for educational programs in schools, awareness campaigns for parents and communities, and to cover the need for cooperation with civil societies and organizations that support those who want to quit. For example, organizations, such as the National Public Health Organization, and NGOs are developing prevention programs and school interventions, while local authorities participate in awareness campaigns.
Measures on alcohol abuse
Ms Kravvari also referred to the issue of alcohol abuse, a problem with serious public health consequences. The WHO considers it one of the major risk factors for the global burden of disease. Moreover, key findings of a 2024 WHO report show that alcohol consumption is strikingly widespread and normalized among teenagers.
A Greek study involving about 6,000 students showed that the majority of 15-year-olds have consumed alcohol at least once in their lifetime. Nearly half had consumed alcohol in the past 30 days. One in three reported having been drunk at least once in their lifetime. One in eight had been drunk in the past month. Girls reported higher lifetime alcohol use and drunkenness compared to boys.
Greece is currently implementing new legislation to strengthen the enforcement of the existing ban on alcohol sales to minors. The law also introduces measures against binge drinking among teenagers. Specifically, the new legal framework includes, among other, a total ban on the sale of tobacco, e-cigarettes, and alcoholic beverages to minors; mandatory ID checks before sale; strict penalties for violations; criminal prosecutions for selling or providing alcohol and tobacco to minors or for allowing minors to enter or work in bars and night-clubs.
In conclusion, Ms Kravvari stressed that public health protection is the most essential investment in the future of our societies. In a world that bombards young people with confusion, conflicting role models and commercialized desire, public health must serve as a compass. “Prevention is not deprivation; it is a freedom with awareness”, she said. “It is the most ethical and cost-effective health policy. Public health builds protective walls before it needs to build rescue bridges,” she said, stressing the importance of the state and society assuming a responsible role.
Discussion
In the discussion that followed, Professor Ikonomidis expressed his agreement with the view that prevention starts from school and from the family but underlined the fact that we need the support of the state for people who still smoke. “We need the state to support smoking cessation clinics, which are not yet fully developed, or which are actually supported by the universities,” he said. He added that there is a great need for awareness and education among all medical specialties, because they tackle the problems that smoking creates. For example, research showed that 40% of patients who had been admitted with a heart attack were smokers. At three months, all of them said that they wanted to quit on their own, and indeed 70% of them succeeded, but at six months 70% had relapsed. So, we need to tackle these problems and try to get the lowest possible percentage of smokers, Prof. Ikonomidis concluded.
Based on his experience from Canada, Professor Sweanor said that a decrease of smoking rates in his country was followed by a new challenge, with the advent of new methods of tobacco use. And although there was a concern about young people turning to vaping –something that led to stricter rules against vaping– a trend towards less tobacco and alcohol use is observed among teenagers in Canada and globally (despite the fact that governmental decisions do not always help this trend). We do not know if this is due to the Internet (because they are afraid that if they get drunk, their picture will be on the Internet forever), or to fitness concerns, or something else. Those in charge of public health need to understand people’s experience, he stressed; they need to have all the information, in order to make better decisions. We all want to protect minors, but that makes us prone to having slogans instead of a risk-benefit analysis. Minors will suffer if their parents, grand-parents, coaches or any significant others die or become incapacitated due to smoking, because they wanted to quit, but did not have access to low-risk alternatives.
Finally, Professor Barbouni commented that we need to recognize the specific cultural context in Greece, where smoking and especially alcohol use are an important part of social and family life. This means that enforcement could be a real challenge and that retailers or bar tenders will have a hard time controlling tobacco or alcohol use. In her opinion, education is key for young people; we need educational strategies that could support families and minors to build skills for resisting peer pressure and making healthy choices. All in all, the law is a great step, but for it to work we need strong enforcement, education, risk assessment and a broader cultural change.