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Smokers consumed more than 5 trillion (5,000,000,000,000) cigarettes worldwide in 2019. Although global cigarette consumption appears to be continuing its slow decline since its peak in 2012, consumption in approximately 40% of countries has either increased or leveled off, making the future path of global tobacco control uncertain. Though major tobacco companies claim a commitment to shifting toward non-combustible products (e.g., e-cigarettes)—and sales of these products are rapidly growing in some countries—every company continues to aggressively market cigarettes, and cigarettes still comprise more than 90% of the global tobacco marketplace. Moreover, tobacco companies have not ceased in devoting their enormous resources to fight nearly every kind of tobacco control effort around the world.

Though cigarette consumption is declining in many higher-HDI countries, it is predicted to increase in some low- and medium-HDI countries. This is due not only to economic and population growth but to the relentless and aggressive marketing and pricing of the industry. The latest WHO projections predict that at least five countries in the Eastern Mediterranean Region will experience smoking prevalence increases by 2025. Around the world, in some countries the predicted small declines in prevalence will be overwhelmed by population growth and the absolute number of smokers in these countries will increase.

A major challenge for tobacco control is the high rates of smoking prevalence among specific marginalized subpopulations within countries. For example, higher cigarette prevalence and consumption are typically associated with lower socioeconomic status, even in low- and medium-HDI countries. These marginalized populations include individuals from certain racial/ethnic groups, persons with mental illness, and, in some countries, the LGBTQ+ community. Targeted tobacco control measures can address these inequities directly. Certain broader measures are also effective—for example, research consistently shows that tobacco taxes reduce consumption in most marginalized groups.

FDA’s successful anti-smoking campaign to reach the US’s LGBTQ+ community.

Smoking in the US LGBTQ+ community is significantly higher than overall adult prevalence. The US Food and Drug Administration implemented a program to reach members of this community better to encourage and support cessation. Used social media—e.g., Facebook Instagram, Twitter and Tumblr among others— to reach a large audience – ~95% of LGBTQ+ and young adults. Tailored ads to specific sub-groups. Worked with young influencers and sought to tell young people’s real stories about tobacco use and cessation. Held local events to promote the campaign in the community.

To maximize profits, tobacco manufacturers make products that are addictive and attractive. To counter these strategies, governments must implement product standards to make products less addictive and attractive. Strategies include banning characterizing flavors that enhance attractiveness and additives that quicken the body’s nicotine absorption. There is also mounting evidence that limiting nicotine to non-addictive levels may show significant promise. Beyond products standards, market-based policies are also effective, including prohibiting the introduction of new brands and restricting a brand to a single presentation to prevent implicit suggestions of a sub-brand’s reduced harm (e.g., “blue” is somehow less harmful than “red”).

The global tobacco industry continues to consolidate through privatization, acquisitions, and mergers: five firms control more than 80% of the global cigarette market. These companies have modernized production and, as a result, factories are employing fewer and fewer workers, decreasing costs, and increasing profitability. When tobacco companies argue that tobacco control policies threaten many manufacturing jobs, it is largely a myth. Most research on tobacco taxes demonstrates that, while the decreased consumption from higher taxes might affect a small number of tobacco manufacturing jobs, the overall effect on employment in the broader economy is typically positive as spending shifts from tobacco to other sectors. This positive effect can be heightened by governments’ wise spending in sectors such as health (e.g., Argentina, Mexico, and Pakistan).

References

Consumption (map and regional figure):

Euromonitor. Passport database (accessed in April 2022).

GlobalData. 2021 database. www.globaldata.com.

Menthol:

Przewoźniak K, Kyriakos CN, Hiscock R, Radu-Loghin C, Fong GT. Effects of and challenges to bans on menthol and other flavors in tobacco products. Tob Prev Cessat. 2021 Nov 15;7:68. doi: 10.18332/tpc/143072.

Villanti AC, Collins LK, Niaura RS, Gagosian SY, Abrams DB. Menthol cigarettes and the public health standard: a systematic review. BMC Public Health. 2017 Dec;17(1):1-3.

Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004–2014. Tobacco control. 2016 Nov 1;25(Suppl 2):ii14-20.

Reduced nicotine cigarettes:

Donny EC, White CM. A review of the evidence on cigarettes with reduced addictiveness potential. International Journal of Drug Policy. 2021 Sep 15:103436.

Smoking prevalence projections:

WHO global report on trends in prevalence of tobacco use 2000-2025, fourth edition. Geneva: World Health Organization; 2021.

This Free Life campaign:

US Food and Drug Administration. 2022. This Free Life Campaign. https://www.fda.gov/tobacco-products/public-health-education-campaigns/free-life-campaign. Last accessed 5/3/2022.

Employment and reduced consumption:

Cruces, G., Cicowiez, M., Falcone, G., & Puig, J. (2021). Incidence of Tobacco Taxation in Argentina: Employment and Economy-Wide Effects [Report]. CEDLAS. https://www.tobacconomics.org/files/research/699/research-report-cedlas-tobacco-2020-en.pdf.

Huesca, L., Sobarzo, H., & Llamas, L. (2021). A General Equilibrium Analysis of the Macroeconomic Impacts of Tobacco Taxation [Report]. CIAD. https://www.tobacconomics.org/files/research/723/reporte-tabaco-en.pdf.

Sabir, M., Saleem, W., Iqbal, M.A., & Aamir, N. (2021). Economic Implications of Cigarette Taxation in Pakistan: An Exploration Through a CGE Model [Report]. SPDC. https://tobacconomics.org/files/research/726/spdc-rp-cge-report-final.pdf.

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