The Union has had its headquarters in Europe since it was founded in Paris in 1920. Today the Paris office provides leadership and support for the four scientific departments, five administrative departments, 12 offices, 300 staff and consultants worldwide and a network of 3,000 members.

Two other offices are also located in Europe. The Union Europe Office in Edinburgh (UK) has housed the Department of Tobacco Control since 2007. It supports the work of governmental and non-governmental tobacco control programmes around the world by providing financial and technical assistance under the Bloomberg Initiative to Reduce Tobacco Use. This office is now an independent organisation and member of The Union in its own right.

The Union Russia Office in Moscow provides support for tobacco control activities in that region.