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WHO’s plans for global tobacco use reduction are unlikely to achieve their target. Photo credit: Pickpik
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Tobacco use among women was highest in Europe in 2022. Photo credit: Susanne Nilsson, Creative Commons.
The latest edition of the World Health Organization’s (WHO) global report on trends in prevalence of tobacco use 2000-2030 revealed that smoking prevalence for the total global population is projected to fall short of reaching WHO’s overall global target of 18.4% by an absolute 1.3%. Instead of attaining the 30% relative reduction by 2025 as set forth in the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013– 2020 (NCD GAP), ongoing efforts are expected to result in a global prevalence of approximately 19.8% in 2025, representing a 25% relative reduction since 2010 (a 21% reduction among males and a 40% reduction among females). Based on the current annual absolute decline rate of 0.3%–0.4% per year, it will require an additional 4 years, or until 2029, to achieve a 30% relative reduction from the prevalence of 2010.
Tobacco use prevalence by sex
In 2000, approximately 16.3% of women aged 15 years and older were current users of tobacco. However, by 2025, it is estimated that this rate will decrease to 6.7%, and further reduce to 5.7% by 2030. The projected 2025 prevalence of 6.7% exceeds the 30% reduction target of 7.8% by an absolute 1.1%. Notably, based on current data, a 30% reduction was already achieved among women in 2021. On the other hand, in 2000, the proportion of male tobacco users was three times higher than that of female users. However, by 2022, the rate for males exceeded that of females by more than 4 times, indicating a faster decline in prevalence among females. This gender gap is expected to further widen and reach just over five times by 2030.
Tobacco use prevalence by age
Globally, the average rate of tobacco use among young people aged 15–24 years decreased from slightly over 20% in 2000 to about 13% in 2022, and is expected to reach 12% in 2030. For males aged 15–24 years, tobacco use has declined from 32.3% in 2000 to 21.8% in 2022, and is projected to be 19.6% in 2030. Among women in this age group, the rate of 8.3% in 2000 reduced to 4.3% by 2022, with a further projected decrease to 3.5% by 2030.
There was a consistent decrease in tobacco use for both males and females in each age group from 2000 to 2022. Age-specific rates are projected to continue to decline for both males and females up to 2030. The age-specific rates peak at age group 45–54 for men and at age group 55–64 for women. The absolute prevalence levels in each age group were consistently higher for males compared to females.
Tobacco Use Prevalence by WHO Region
Age-standardized tobacco use prevalence rates are decreasing across all WHO regions. However, the available data indicates that the NCD 2025 target of a 30% reduction in tobacco use prevalence is likely to be met in only two WHO regions: Africa and Southeast Asia. The Americas seemed to be on target in the previous round of WHO estimates two years ago, but it is currently on track for a 27% relative reduction by 2025. The Eastern Mediterranean is forecasting a 20% relative reduction, although it should be noted that data in this region are the least reliable. Meanwhile, Europe is anticipating a 17% relative reduction and the Western Pacific region is projecting a 13% reduction.
When examining tobacco use trends among men and regional averages, none of the WHO regions are forecasting a 30% relative reduction. The most significant reduction in the regional average among men is in Africa at 29%, followed by Southeast Asia and the Americas, at 26% and 25% respectively. Despite the notable reduction rate in Southeast Asia, the prevalence is expected to exceed 40% in 2025, which is as high as the prevalence among men in the Western Pacific, where reductions are the slowest.
With the exception of Europe, all WHO regions are anticipating an average relative reduction among women exceeding 30%. Europe stands out from the other five regions in terms of women’s tobacco use. It is expected that the prevalence will decrease only slightly, from an average of 20% in 2010 to 18.2% in 2025).
Looking at tobacco use among males exclusively, in 2000, Southeast Asia had the highest average prevalence rates (68.9%), followed by the Western Pacific (50.8%). These two regions still maintained the highest rates in 2022, both exceeding 40% at 43.7% and 42.4%, respectively. The Western Pacific exhibited the flattest trend among all regions for men.
In 2000, Southeast Asia had the highest prevalence of tobacco use among females, at 33.5%. However, due to rapidly declining rates, this decreased to 9.4% in 2022. In 2022, Europe had the highest prevalence among females, at 18.5%. Southeast Asia and the Americas have similar prevalence levels at 9.4% and 11.4%, respectively. The lowest average rates among females persist in Africa (2.4%), Eastern Mediterranean (4%), and Western Pacific (2.6%).
Tobacco use prevalence by World Bank income group
Tobacco usage is on a downward trend across all World Bank country income groups. In 2000, lower middle-income countries had the highest average prevalence at 43.1%, but by 2022 their rates were similar to those of high and upper middle-income countries, at approximately 21-22%. Throughout 2000–2022, low-income countries consistently had the lowest average prevalence, declining from 21% to 12% in 2022, and they are projected to reach 11% by 2030. In 2030, it is expected that upper and lower middle-income countries will have the highest average prevalence rates among men, at 35% and 33% respectively. These rates will be significantly higher than those of high-income countries as a whole (24%) and low-income countries (19%).
It is anticipated that the average prevalence among women in all income groups, with the exception of the high-income group, will decrease to below 5% by 2030. In 2010, the average prevalence was highest in high-income countries at 21%, and this group is projected to maintain the highest prevalence at 15% in 2030. The most significant reduction in prevalence among women is observed in the lower middle-income group, where the average prevalence halved from 15% in 2010 to 7.5% in 2022.
Trends in the number of tobacco users
The total number of tobacco users, encompassing both sexes, showed a consistent decline from 2000 to 2022. In 2000, approximately 1.362 billion individuals aged 15 years and older were current users of one or more tobacco products. This figure has steadily decreased to 1.245 billion in 2022 and is anticipated to further reduce to 1.20 billion by 2025. In 2022, around 82% of current tobacco users aged 15 years or above globally were male. From 2000 to 2010, the number of male tobacco users worldwide aged 15 years and older increased annually, despite a reduction in prevalence rates. The count of male tobacco users is estimated to have peaked in 2010 at 1.040 billion. This number is projected to continue declining, and by 2030, it is expected to be reduced to 1.004 billion. However, in four out of six WHO regions, the number of male tobacco users rose between 2000 and 2015. The numbers of male tobacco users in Southeast Asia and Western Pacific peaked in 2015 and started to decrease from then onwards, while the African and Eastern Mediterranean regions are expected to keep increasing until at least 2030 on current trends. The two regions with declining numbers of male tobacco users between 2000 and 2030 are Americas and Europe, where prevalence rates are reducing fast enough to keep ahead of population growth.
The number of female current tobacco users aged 15 years or older declined in all WHO regions from 2000 to 2022, and this trend is anticipated to persist until 2030. In 2022, there were an estimated 115 million fewer female tobacco users (224 million) than in 2000 (338 million). The overall number of tobacco users among females is projected to reduce to approximately 193 million by 2030.
Reduced prevalence but still high numbers of tobacco users
According to the WHO report, only six countries worldwide are experiencing an increase in tobacco use. Three of these countries are located in the Eastern Mediterranean (Egypt, Jordan, and Oman), one Africa (Congo), one in Europe (Moldova), and one in Southeast Asia (Indonesia). It is possible that there are additional countries with rising tobacco use rates among the 29 countries where data is insufficient to measure the trend. However, the report authors believe that even in the unlikely scenario that all 29 countries have increasing rates, the total would be 35 countries, collectively accounting for only 8% of the world’s population.
The report also posited that since 2020, the impact of the Covid-19 pandemic varied significantly across countries, likely influencing trends in many of them. This potentially altered the trajectory toward the 2025 global voluntary tobacco reduction target of 30% using 2010 as a baseline during the pandemic. In addition to individuals changing their tobacco use behavior, it is possible that the number of smokers in some countries decreased due to potentially higher Covid-19 related mortality among smokers.
According to the report authors’ data analysis, even though the prevalence of tobacco use is decreasing in all WHO regions, population growth is delaying the reduction rates from resulting in a decrease in the number of users in two out of the six WHO regions. More significant rate reductions are required to halt the ongoing rise in the number of tobacco users in the African Region and the Eastern Mediterranean Region. The overall decline in the Western Pacific Region is the flattest slope among all regions, but it should be noted that the average rates for all indicators for this region are largely influenced by data from China, as 75% of the region’s population aged 15 years or older resides in China.