Modeling study reveals significant between-country disparities in tobacco use

1. During the most recent decade (2000-2010), a majority of countries saw a significant decrease in the prevalence of tobacco smoking.

2. Despite progress, only a minority of countries were projected to be on track to achieve their targets for tobacco control.

Evidence Rating Level: 2 (Good)           

Study Rundown: Tobacco smoking is a major risk factor for a variety of serious medical conditions, such as chronic obstructive lung disease, an increased risk of stroke and other cardiovascular diseases, and various types of cancer, to name just a few. As a result, reduction in the prevalence of tobacco smoking has been a public health priority around the world. The authors of this study analyzed tobacco smoking patterns from 1990 to 2010 in over 170 countries based on data from the WHO Comprehensive Information Systems for Tobacco Control. The authors then projected future tobacco use by performing a Bayesian hierarchical meta-regression modelling on the existing data. The study observed a decrease in tobacco smoking in a majority of countries, yet also noted significant between-country disparities. Also noteworthy was the observation that perhaps only a minority of countries were on track to reach their tobacco control targets. The comprehensive nature of this study provides powerful knowledge for public health officials in their efforts to tackle this significant public health challenge. However, the study does not take into account the newer variants of tobacco smoking that have only recently gained media attention, such as e-cigarettes.

The study was funded by Ministry of Health, Labour and Welfare, Japan; Ministry of Education, Culture, Sports and Technology, Japan; Department of Health, Australia; Bloomberg Philanthropies. The funding sources had no role in the design, implementation, analysis, or writing of the study, or choice of journal.

Click to read the study in the Lancet

Relevant Reading: Global effects of smoking, of quitting, and of taxing tobacco

In-Depth [retrospective cohort]: This study performed systematic assessments of trends for four tobacco smoking indicators – current tobacco smoking, daily tobacco smoking, current cigarette smoking, and daily cigarette smoking. The data about tobacco use prevalence was obtained from the WHO Comprehensive Information Systems for Tobacco Control and covered the time period from 1990 to 2014. In total, 26153 data points from 180 countries specific to country, year, sex and age were included in the final analyses.

From 2000 to 2010, 125 (72%) countries saw decreased prevalence in men, whereas 155 (87%) countries saw decreased prevalence in women. The study estimated that if the current trend persisted, there would be 1.1 billion smokers (95% credible interval, CI, 700 million to 1.6 billion) in 2025. The projection showed that only 43 (25%) countries for men and 93 (52%) countries for women will have probability of 95% or greater to observe a decrease in prevalence from 2010 to 2025 with current trends. There was significant geographical variation – high probability (≥95%) of decrease for most countries in the Americas, versus high probabilities of increase for about a third of countries in Africa and Eastern Mediterranean for men.

Additionally, projections based on current trends predicted that only 37 (21%) countries for men and 88 (49%) countries for women were on track to achieve their targets for tobacco control, with low-to-middle income countries particularly prone to having low target achievement probabilities.

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