While global smoking prevalence decreased from 22.7% in 2007 to 17% in 2021, in many countries there was either no change or prevalence increased. In several regions, despite a reduction in per capita consumption, total consumption has increased significantly due to a much faster increase in the number of smokers. In some countries, a combination of rapid economic growth and aggressive industry marketing generates a higher risk of future significant increases in smoking.
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Although global smoking prevalence has declined (from 22.7% in 2007 to 17% in 2021), the total number of smokers remains high due to population growth. Globally, at least 940 million males and 193 million females ages 15 or older were current smokers in 2019. More than 75% of male daily smokers live in a country with a medium or high human development index (HDI), whereas more than 53% of female daily smokers live in very high-HDI countries.
Male smoking prevalence in most medium-to-very high-HDI countries substantially increased in the 20th century, though this generally happened earlier (the first half of the century) in very high-HDI countries. Almost all very high-HDI countries saw a significant decrease in male smoking after the 1950s. Many medium- or high-HDI countries also have seen a decline in prevalence from the beginning of the 21st century, but for the most part the decline was relatively moderate. Historically, smoking prevalence has been modest in most low-HDI countries, though this still translates into tens of millions of smokers.
Female smoking prevalence in very high-HDI countries peaked a few decades later than the peak in male smoking, but it has remained relatively low or had only a moderate increase thus far in most low-, medium-, and high-HDI countries.
The earlier decreasing trend in smoking prevalence in most very high-HDI countries has stalled in recent years, however, and smoking prevalence has continued to rise or remain at high levels in many medium- or high-HDI countries. Since 1990, consumption per capita has declined in all WHO regions while, at the same time, the number of smokers has significantly increased in at least three (and possibly four), leading to greater overall consumption. Male smoking prevalence has increased in about one-third of medium- or high-HDI countries, while in almost all very high-HDI countries prevalence has either declined or remained unchanged. On the other hand, female smoking prevalence has increased in more than one-third of high-HDI countries and in about one-fifth of very-high HDI countries.
Notably, some countries—mostly in Africa—are experiencing increases in prevalence. In the future this trend is likely to occur in many others, especially low-HDI countries, due to income growth and increasing cigarette affordability as well as the tobacco industry’s strategy of aggressive marketing in those countries. This trend can be reversed if governments implement stronger tobacco control policies, including raising taxes to increase the prices of tobacco products.
Another major concern is a recent increase in smoking prevalence among youth, particularly among females in several countries, in some of which smoking among adolescent females is now more common than among adult females or even adolescent males (see Youth).
Article 20 of the WHO Framework Convention on Tobacco Control obliges Parties to conduct surveillance on the magnitude, patterns, determinants, and consequences of tobacco use. From 2007 to 2020, however, about half of African countries and more than 40% of Eastern Mediterranean countries have regressed in their implementation of prevalence monitoring measures. Moreover, more than 70% of all countries with no recent monitoring data are in Africa. Effective monitoring at the national level must be a priority for governments, as this is essential for estimating the tobacco-related burden and evaluating the success of tobacco control policies.
Although tobacco use remains a major health issue worldwide, the declines in prevalence in countries with active tobacco control efforts demonstrate that we can reduce smoking with effective strategies.
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