The number of smokers worldwide has increased to 1.1 billion in 2019, with tobacco smoking causing 7.7 million deaths, according to three new studies published by the Global Burden of Disease collaboration in The Lancet and The Lancet Public Health. The studies were led by the Institute for Health Metrics and Evaluation and funded by Bloomberg Philanthropies and the Bill and Melinda Gates Foundation.
Using data from 3,625 nationally representative surveys, the studies provide global estimates on smoking prevalence in 204 countries in men and women aged 15 and over, including age of initiation, associated diseases and risks among current and former smokers as well as the first analysis of global trends in chewing tobacco use.
Published ahead of World No Tobacco Day on May 31, the authors called on all countries to urgently adopt and enforce a comprehensive package of evidence-based policies to reduce the prevalence of tobacco use and prevent initiation, particularly among adolescents and young adults.
“Smoking is a major risk factor that threatens the health of people worldwide, but tobacco control is woefully insufficient in many countries around the world,” said says Emmanuela Gakidou, senior author, Institute for Health Metrics and Evaluation, University of Seattle, Washington, USA, in a press note.
“Persistently high smoking prevalence among young people in many countries, along with the expansion of new tobacco and nicotine products, highlight an urgent need to double down on tobacco control. If a person does not become a regular smoker by age 25, they are very unlikely to become a smoker. This presents a critical window of opportunity for interventions that can prevent young people from starting smoking and improve their health for the rest of their lives.”
Since 1990, global smoking prevalence among men decreased by 27.5 percent and by 37.7 percent among women. However, 20 countries saw significant increases in prevalence among men, and 12 saw significant increases among women.
In half of countries, reductions in prevalence have not kept pace with population growth, and the number of current smokers has increased. The 10 countries with the largest number of tobacco smokers in 2019, together comprising nearly two-thirds of the global tobacco-smoking population, are China, India, Indonesia, the U.S., Russia, Bangladesh, Japan, Turkey, Vietnam and the Philippines. One in three current tobacco smokers (341 million) live in China.
7.4 trillion cigarette equivalents of tobacco (combining smoked tobacco products include manufactured cigarettes, hand-rolled cigarettes, cigars, cigarillos, pipes, shisha and regional products such as bidis and kreteks) were consumed in 2019, amounting to 20.3 billion each day worldwide. Countries with the highest consumption per person were mostly in Europe. Globally, one in three male and one in five female smokers consume 20 or more cigarette equivalents per day.
In 2019, there were an estimated 155 million smokers aged between 15 and 24—equivalent to 20.1 percent of young men and 5 percent of young women globally.
Two-thirds (65.5 percent) of all current smokers began smoking by age 20, and 89 percent of smokers began by age 25.
In 12 countries and territories in 2019, more than one in three young people were current smokers, including Bulgaria, Croatia, Latvia, France, Chile, Turkey and Greenland, as well as five Pacific islands.
Globally, smoking prevalence among young people decreased between 1990 and 2019 among both young men (-32.9 percent) and young women (-37.6 percent). Progress varied across countries, with 81 achieving a significant decrease in prevalence among young people. More than half of countries experienced no change.
In many countries, progress in reducing the prevalence of smoking has not kept pace with population increases, resulting in significant increases in the number of young smokers. India, Egypt and Indonesia had the largest absolute increases in number of young male smokers. Turkey, Jordan and Zambia had the largest increases in number of young female smokers.
Globally, the average age at which individuals began smoking regularly is 19. The youngest average ages of initiation were observed in Europe and the Americas—with the youngest average age of initiation in Denmark (16.4). The oldest average ages of initiation were seen in East and South Asia and sub-Saharan Africa—with the oldest average age of initiation in Togo (22.5 years).
Globally, 273.9 million people used chewing tobacco in 2019, equivalent to age-adjusted prevalence of 6.5 percent among men and nearly 3 percent among women over the age of 15. Most people (228.2 million; 83.3 percent) who used chewing tobacco in 2019 resided in the South Asia region. The largest population of people who use chewing tobacco are in India with 185.8 million users, corresponding to 68 percent of all chewing tobacco users globally. Bangladesh, Nepal and Bhutan also had very high prevalence of chewing tobacco use.
The authors of the studies lamented the lack of progress in tobacco control among signatories of the World Health Organization’s Framework Convention on Tobacco Control (FCTC).
Since 2005, the FCTC has been ratified by 182 parties, but as of 2018, only 62 countries had comprehensive smoke-free policies, according to the studies. Twenty-three offered the full range of cessation support services; 91 mandated pictorial health warnings; 48 had comprehensive advertising, promotion and sponsorship bans; and 38 had the recommended level of tobacco taxation.
Measures to decrease the affordability of cigarettes through taxation have been lagging too, according to the authors.
Between 2008 and 2018, the affordability of cigarettes decreased in only 33 percent of low-income countries compared with 38 percent in middle-income countries and 72 percent of high-income countries. Low-income and middle-income countries face the additional challenge of population growth expanding their smoking population. Despite this, only one low-income country, Madagascar, taxes tobacco at the rate recommended by the WHO.