40% of countries show no progress in reducing adolescent smoking over the past 20 years

Despite an overall reduction in cigarette consumption over the past 20 years, almost one in 5 boys (17.9%) and more than one in 10 girls (11.5%) worldwide have used tobacco at least once in the past month between 2010 and 2018, according to a new study published today in The Lancet Child & Adolescent Health newspaper.

Smoking kills over 8 million people worldwide each year and can lead to cancer, heart disease, lung disease, and chronic obstructive pulmonary disease, as well as impair fertility. Smoking among teens and children is a critical issue, as most adult smokers start in their teens or childhood.

In the new study, the authors looked at data from the global youth smoking surveys between 1999 and 2018 to assess trends in smoking prevalence. All the countries included have carried out at least two surveys, i.e. 1.1 million 13-15 year olds from 140 countries included between 1999-2018 and 530,000 adolescents from 143 countries between 2010-2018.

In the study, the prevalence between 2010 and 2018 of smoking cigarettes for at least one day in the past 30 days was about twice as high at age 15 compared to age 13 among boys and girls (6.8% vs. 15.4% for boys; 3.4% vs. 8.7% for girls). The prevalence of smoking was highest in the Western Pacific region for boys (17.6%), with Tokelau having the highest prevalence of 49.3%. The European region had the highest prevalence of smoking among girls (9.0%), with a prevalence of 23.7% in Bulgaria and 23.6% in Italy.

The study also looked at the use of other tobacco products, such as chewing tobacco, snuff, dip, cigars, cigarillos, pipe, or electronic cigarettes.

Between 2010 and 2018, the prevalence of the use of these products was higher at 15 years old than at 13 years old (8.4% vs 13.9% in boys, 5.1% vs 9.3% in girls), and there was a significant increase in the use of other tobacco products among 15-year-old boys over the past 20 years, where it increased by about 2.1%. The prevalence of the use of tobacco products other than cigarettes was highest in the Eastern Mediterranean region (16.7% among boys and 9.0% among girls). The Americas and Europe regions had the lowest prevalence (7.5% and 9.3% in boys and 5.4% and 5.5% in girls respectively), according to the study. The authors note that they could not distinguish between the different types of tobacco products in this category.

Professor Bo Xi, Shandong University, China, and lead author of the study, said: “Cigarette consumption may have decreased in the majority of the study countries, but there is still a large number of young people who smoke. The fact that in many countries the prevalence of the use of tobacco products other than cigarettes is higher or as high as the prevalence of cigarette consumption shows us that there is still a lot More work to be done. The need to strengthen tobacco control efforts, which include specific policies for different tobacco products and a focus on adolescent health education around the world is more important than ever. “

In the study, the prevalence of smoking and the use of other tobacco products varied by region, which the researchers said was due to differences in the way tobacco control measures are implemented and monitored. For example, Uruguay has been at the forefront of tobacco control, with a complete ban on tobacco promotion and advertising and strict picture health warnings. As a result, smoking has decreased by 17% every 10 calendar years (from 20.1% in 2007 to 8% in 2014), the authors estimate.

The Western Pacific region showed an improvement in the prevalence of smoking and the consumption of other tobacco products between 1999 and 2018, where it decreased by 6.2% and 4.2%, respectively, by 10 calendar years . The prevalence of smoking has also decreased in the European region by 5%. However, even though the region has shown improvement, not all countries in the region have performed as well. For example, Bosnia and Herzegovina experienced an increase of 10.6% every 10 years (from 11.7% in 2008 to 17% in 2013). The authors suggest that the possible reasons for an increase in smoking in this country and others could be due to the low cost of cigarettes, poor enforcement of indoor smoking bans, weak measures tobacco advertising and promotion or the sale of individual cigarettes.

Some regions have shown an increase in the prevalence of consumption of other tobacco products. In the Eastern Mediterranean region, the prevalence increased by 3.5%, and in the Southeast Asian region, it increased by 3.3% every 10 calendar years. For example, in Saudi Arabia, in the Eastern Mediterranean region, the prevalence of consumption of other tobacco products increased by 33.3% every 10 years (from 11.2% in 2007 to 21.2% in 2010). In Bhutan, Southeast Asia, it increased by 18% (from 7.2% in 2004 to 23.4% in 2013).

Prof Yajun Liang, Karolinska Institute, Sweden, said: “The biggest reductions in tobacco use have been seen in countries that have ratified the WHO Framework Convention on Tobacco Control, emphasizing the importance of a change in policy to reduce smoking. But there is still a lot of work to be done in particular to reduce the use of other tobacco products. “

“The prevalence of the use of any tobacco product was two or three times higher among 15-year-olds than 13-year-olds in most countries. Peer pressure, the desire to experience new things, and the ability to buy cigarettes could all explain this trend. Fortunately, many countries have implemented partial or total bans on tobacco advertising. However, it is difficult to deal with advertising or promotions on the Internet and on social networks. Health education from an early age on the dangers of tobacco remains crucial. “

In a linked commentary, co-authors Mohammed Jawad and Christopher Millett of Imperial College London, UK, and Rima Nakkash, American University of Beirut, Lebanon, (who were not involved in the study) claim that the study “describes a grim situation” and “[the] The results revealed a steadily growing phenomenon that has manifested itself as an urgent priority for the global tobacco control agenda: the rise of non-smoking tobacco products. “

They discuss in depth the increase in the use of other tobacco products in the Eastern Mediterranean region and suggest that this is due to the growing popularity of the water pipe (known locally as shisha, hookah or arghil) because of the new flavored tobacco, a thriving Middle Eastern coffee culture, and the misperception that water pipe tobacco is less harmful than cigarettes. They agree with the study authors that different policies may be needed for different tobacco products and that existing anti-smoking laws are based on reducing smoking and are less effective when applied to products such as tobacco. water pipe.

The authors write: “Merely extending existing laws to waterpipe tobacco seems reasonable in theory, but in practice it is far from adequate and may be unenforceable. In the absence of an effective policy response to the emergence of a more nuanced landscape of tobacco use, tobacco tobacco use among adolescents will remain high … It is not yet certain that the The peak in cigarette smoking among adolescents in the Eastern Mediterranean region has been caused by an increasing consumption of waterpipe tobacco, but this is certainly plausible. At a minimum, increasing smoking without cigarette use is likely to undermine progress in reducing smoking and, at worst, could significantly worsen the tobacco epidemic. “

The authors note certain limitations. Not all countries in the world were included in the study because they did not respond to a survey within the allotted time. Surveys were not carried out in the same year in all countries and some countries (53 out of 140) carried out only two surveys instead of more. This weakened the ability to assess changes in prevalence over time. In addition, the survey is based on self-report and therefore participants may have understood and interpreted the questions differently; and the survey did not distinguish between different products other than tobacco.