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E-cigarettes and other alternative nicotine products‘ rising popularity and easy availability represent a particular risk for children and adolescents, while at the same time, a significant proportion of minors continue to smoke tobacco products. According to the 2022 Global Youth Tobacco Survey (GYTS), approximately 21.4% of 13-to-15-year-old pupils in Czechia reported using e-cigarettes and 16.4% of pupils currently smoked tobacco (SZU et al., 2022). Rising popularity of e-cigarettes among minors aligns with trends observed across Europe (ESPAD Group, 2025). Furthermore, data from the NAUTA study indicate that the prevalence of e-cigarette use among 15-to-24-year-olds tripled between 2020 and 2023, and 27.1 % of 15-to-24-year-olds currently smoked tobacco (SZU, 2024). This rapidly growing trend in the use of new nicotine products and the continuing significant proportion of smokers is raising alarming concerns about long-term addiction, unhealthy lifestyle choices and lung cancer incidence. The EU average incidence of lung cancer is 95 per 100 000 among men and 44 per 100 000 among women (OECD/European Commission, 2025), and death rates due to lung cancer declined by 14.0% in the EU between 2012 and 2022 (Eurostat, 2025). Nonetheless, lung cancer was the main cause of preventable mortality in Czechia in 2020 (European Observatory on Health Systems and Policies/OECD, 2023). As the principal risk factor for developing lung cancer remains tobacco smoking, which is responsible for approximately 85% of cases, public health interventions focusing on smoking prevention are essential.
Effectively addressing youth nicotine addiction and its related health risks requires coordinated action from schools, public health institutions, policymakers, and communities. Building on the World Health Organization’s (WHO) Tobacco and Nicotine-Free Schools toolkit, the National Institute of Public Health (SZU) started developing the Nicotine Free School (that is, Škola bez nikotinu) preventive programme in 2023 (SZU, n.d.). This national programme aims to reduce tobacco and nicotine use among children and adolescents. Based on a comprehensive, evidence-based approach to health education, it uses interactive educational materials (videos, worksheets, presentations, quizzes and online interactive sections) to raise awareness at school on the health risks associated with nicotine and tobacco products among children and adolescents. To further empower the youth in making informed choices and embracing nicotine- and tobacco-free lifestyles, the initiative also educates young people about the marketing strategies used by the tobacco industry to sell their products.
Now available nationwide, the Nicotine-Free School programme is open to all schools across Czechia. Currently, over 70 schools are engaged, with more expected to join in upcoming implementation phases, reflecting a growing national commitment to tobacco and nicotine prevention. Participating schools have to develop their own strategies for implementing the programme. However, teachers are provided with specialized training and a range of interactive resources, such as videos, worksheets, quizzes and teaching guides, to help them deliver interactive, evidence-based lessons on nicotine and tobacco prevention.
While the programme is implemented by the SZU, the WHO office in Czechia remains a key partner, providing funding, expert review of materials, guidance, monitoring and sharing of best practices with other countries. The Nicotine Free School programme has been monitored since 2023, using multiple evaluation tools. A student questionnaire (official WHO questionnaire) tracks the use of nicotine and tobacco products, while a teacher evaluation questionnaire collects feedback to adapt the programme to schools’ needs. For example, based on teachers’ responses, animated educational videos were developed to better support classroom activities. Additionally, each school develops an implementation strategy, outlining relevant implementation details, such as specific prevention plans and the number of participating students.
Enablers: support from the WHO Czech Office and the Ministry of Health in developing websites, online training platforms, and educational materials (resources, information); financial stability throughout the pilot implementation (financing); offering the programme for free, which enabled broader accessibility (financing, governance); and evidence-based design led by the SZU ensuring alignment with national strategies (e.g., Health 2030 and the National Cancer Plan) and international strategies and guidelines (e.g., Europe’s Beating Cancer Plan (EBCP) and WHO guidelines) (governance).
Barriers: long-term financing remains uncertain, particularly for monitoring, evaluation and local coordination, which could affect the programme’s continuity (financing); limited long-term systems for data collection, monitoring, and evaluation of the programme (information); and variable implementation capacity among schools across the country (governance).
The Nicotine-Free School programme contributes to the main health system goals. Aligned with national policies such as the Health 2030 Strategy and the National Cancer Plan, as well as the EBCP, it reduces health risk factors, strengthens health literacy, prevents chronic disease, and supports a sustainable, school-based prevention model, therefore contributing to improving overall health outcomes. Integrating prevention modules directly into the curriculum guarantees systematic health education from an early age. By offering free nationwide access to nicotine and tobacco prevention tools to every school, regardless of the location or socioeconomic background, it ensures that every child benefits from prevention education and advances equity goals. Moreover, the programme builds on existing school structures and trained teachers combined with the use of online education tools, enhanced efficiency, keeping costs low and supporting sustainable implementation, while also ensuring better accessibility and scalability across schools. Quality is strengthened by the use of an evidence-based approach that follows WHO guidelines and is regularly updated to address new nicotine products. Finally, the programme also applies a people-centred approach, actively involving pupils, teachers, parents, and communities to reinforce prevention messages.
Nonetheless, teachers’ heavy workload, the limited classroom time for additional modules, and the unequal digital infrastructure across the country create disparities in access to the programme and implementation capacity. Although the programme offers pre-developed tools to schools, minimizing the required time and human resources, its successful implementation still requires continuous coordination both from SZU side and from the schools themselves. School capacities are limited, with many institutions that are already engaged in a variety of other projects. As a result, this area is not always a top priority, which explains why some schools have not yet introduced the programme and underscores the need for ongoing support and guidance to ensure full and effective adoption. Further coordinated actions across sectors are needed to reinforce the sustainability and impact on children and adolescents’ protection against nicotine- and tobacco-related risks.
Lessons learned: Overall, flexibility in the implementation is vital, as such a programme requires a tailored approach to each beneficiary entity (in this case, the schools), and the rapidly evolving landscape calls for regular programme and tools updates. The alignment of the programme with broader national and European plans and strategies was also key to success. Although many stakeholders are involved in the implementation of the programme, a stronger engagement with schools, parents, and regional education authorities could further enhance effectiveness and collaboration. Other key lessons for countries that would like to replicate such a programme include providing the resources for free, anticipating staff training, and incorporating monitoring systems early.
For more information
The National Institute of Public Health (SZU) provides methodology, free resources and expert advice to support effective implementation:
