Prevalence of tobacco use

• 1. Introduction

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  The World Health Organization counted 967 million smokers worldwide in 2012, up from 721 million in 1980. Smoking rates were falling in many countries, but population growth was pushing the absolute total higher. The number of cigarettes smoked each year had also climbed, from 4.96 trillion to 6.25 trillion. In 2004, the WHO projected 58.8 million deaths globally, and 5.4 million of those were attributed to tobacco. Of the 1.22 billion smokers the organization tracked, 1 billion lived in developing or transitional economies. These smokers were not a random cross-section of humanity. Their identities, where they lived, how old they were, and what governments did about it would define the tobacco story for decades to come.

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• 2. The Gender Divide

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  Globally, men smoke at five times the rate of women. In developed countries and among younger age groups, this gap narrows considerably. Sweden's data traces the shift across seven decades. When the first research on smoking in Sweden was conducted in 1946-50% of Swedish men smoked and only 9% of women. By 1977, the figures had moved to 41% of men and 32% of women. By 2011, among daily smokers, the difference had nearly disappeared: 12.5% of men compared to 14.3% of women.

  Romania captured a different trajectory. Between 1991 and 2011, the smoking rate among Romanian women nearly doubled. By 2011-55% of Romania's female smokers were between the ages of 15 and 34. Germany showed similar concentration in younger cohorts: in 2005-38% of men and 30% of women in the 20 to 24 age group smoked daily. A 2010 University of Bielefeld study found 9.9% of 15-year-old males and 10.8% of females the same age in Germany smoked daily. This marked a strong decline from rates earlier in the decade.

  Spain's 2017 National Health Survey documented the historical shift in that country over more than two decades. Among men, the smoking rate fell from 44% in 1993 to 25.6% in 2017. Among women, the decline was far smaller, from 20.8% to 18.8% over those same years. In Israel, smoking prevalence among males had remained relatively constant at 30% in the years 1994 to 2004. Among Israeli females, the rate declined from 25% in 1998 to 18% in 2003. Among Arab males in Israel, 44% smoked in 2009, down from 50% in 1996. That convergence, men's rates declining and women's rates holding steadier, was visible across multiple countries. It was most pronounced among younger age groups, where the next wave of long-term smokers would form.

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• 3. Young Smokers

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  Between 80,000 and 100,000 children begin smoking every day. In 2002, roughly 20% of young teenagers between the ages of 13 and 15 smoked worldwide. Half of those who took up the habit in adolescence were projected to smoke for between 15 and 20 years.

  In the United States in 2017, researchers found that approximately 4,000 minors started smoking every day. In Israel in 2005, research documented a shift: Israeli youth had begun using bidis and hookah as alternative forms of tobacco. A 2001 Israeli publication found that 14% of young people smoked at least once per week.

  Australia's 2011-12 survey found people aged 25 to 34 were the most likely group to smoke, at 24%. Smoking rates declined markedly once people moved past the age of 45. In Canada, youth smoking among those aged 15 to 24 did not begin declining significantly until the mid-1990s. Between 1994-1995 and 2001, youth prevalence fell by 6 percentage points, from 28.5% to 22.5%. New Zealand's tobacco laws were among the world's strictest, yet Māori tobacco use remained persistently elevated. Years of anti-smoking campaigns across television, internet, radio, and print had reduced Māori smoking rates but had not closed the disparity.

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• 4. Poverty and Smoke

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  In Western countries, smoking concentrated among those with mental health problems, alcohol and drug problems, the working poor, and the homeless. The correlation with economic disadvantage appeared consistently across national datasets. In the United Kingdom in 2007, smoking rates among the most affluent patients stood at 14%. Among the most deprived, the rate was 34%. In Australia in 2007-08, 33% of men and 26% of women in the most disadvantaged 20% of areas were current smokers. Among those in the least disadvantaged 20% of areas, the rates were 12% and 11%.

  In the United States in 2005-29.9% of adults below the federal poverty line smoked. Among those at or above the poverty line, the rate was 20.6%. Educational attainment tracked closely with tobacco use. The highest smoking prevalence among U.S. adults was among those with a high school diploma or its GED equivalent, at 43.2%. Among Americans with 9 to 11 years of education, the rate was 32.6%. Tobacco use was generally lower among those with higher education levels.

  In Germany, the same pattern held: smoking prevalence was lower among people with higher education levels. A 2006 comparative study found 25.1% of male and 20.6% of female medical students in Göttingen smoked. In London, the figures for the same category were only 10.9% for men and 9.1% for women. Germany also held the highest number of cigarette vending machines per capita in the world, at one machine per 102.5 people. The WHO described the disease burden from tobacco as falling disproportionately on the poor, along with a greater share of premature mortality. As of 2002-70% of tobacco-related deaths occurred in developing countries.

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• 5. Turning the Tide

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  Before the mid-1990s, smoking prevalence had been declining in English-speaking countries due to tobacco control measures. The global pattern that followed was more uneven. In the developing world, tobacco consumption was rising at 3.4% per year as of 2002, while developed nations continued recording declines. Globally, tobacco use among adults fell from 34.3% in 2000 to 21.7% by 2022.

  A 2017 study on MPOWER policies measured implementation from 2007 to 2014. It found that each one-unit increase in a country's composite policy score reduced adult smoking prevalence by 0.2 percentage points. It also corresponded to one fewer pack of cigarettes consumed per capita per year.

  The United Kingdom traced the decline clearly. A rate of 26% in 2002 fell to 22% by 2007, hit a record low of 16.9% in 2015, and reached 14.4% by 2018. The total number of smokers in the UK was estimated at 13.7 million in 2007. In Australia, the national rate had stood at 28% in 1989-90. By 2011-12, it was 18%. The daily smoking rate fell below 13% by 2016 and to 10.6% by 2022. Among Australia's indigenous population, 50% of men and 44% of women reported smoking in 2007-08.

  In the United States, 23.9% of men and 18.1% of women were current smokers in 2005. By 2022, those figures had fallen to 11.7% and 10.8%, bringing the overall adult rate to 11.2%. In 2005, Native Americans and Alaska Natives had the highest smoking rate of any racial or ethnic group, at 32.0%. Non-Hispanic whites followed at 21.9% and non-Hispanic blacks at 21.5%. Hispanics stood at 16.2% and Asians at 13.3%.

  New Zealand's tobacco consumption had peaked in the mid-1970s when 60% of the population smoked. By 2011, that figure had fallen to 20%. A corresponding rise in vaping, particularly among younger demographics, was taking hold. Statistics Canada published a 17-year dataset on smoking trends in December 2002. The report covered changes from 1985 to 2001 across provinces including Newfoundland and Labrador, Nova Scotia, Quebec, Ontario, Saskatchewan, Alberta, and British Columbia. In 2001, only 5.8% of Canadian daily smokers consumed 26 or more cigarettes per day, down from 14.0% in 1985. The share smoking 1 to 10 cigarettes daily had risen from 18.6% to 31.1% over the same period. Canada's overall smoking rate was estimated at 18% in 2008 and at 17% in a 2011 survey. Under Sustainable Development Goal 3, the United Nations set a 2030 target to strengthen the WHO Framework Convention on Tobacco Control in all countries. Progress toward that target will be tracked by one measure: the age-standardized prevalence of tobacco use among people aged 15 and older.

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