Prevalence

Globally, 942 million men and 175 million women ages 15 or older are current smokers. Nearly three quarters of male daily smokers live in countries with a medium or high human development index (HDI), whereas half 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 past century, though this generally happened earlier in very high-HDI countries (the first half vs. second half of the 20^th century). Almost all very high-HDI countries saw a significant decrease in male smoking after the 1950s. Many medium- or high-HDI countries have also seen a decline in prevalence, but mostly a relatively moderate one from the beginning of this century. Smoking prevalence has been historically 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 a moderate increase thus far in other countries.

However, the earlier decreasing trend in smoking prevalence in most very high-HDI countries has stalled in recent years, and smoking prevalence has continued to rise or remained at high levels in many medium- or high-HDI countries. Further, some low-HDI countries (e.g., in sub-Saharan Africa) have seen a recent increase in prevalence. This trend is likely to occur in many other low-HDI countries in the future because of income growth and increasing cigarette affordability, as well as the tobacco industry’s strategy of aggressive marketing in those countries, unless governments implement stronger tobacco control policies, including raising taxes to increase prices of tobacco products.

Another major concern is a recent increase in smoking prevalence among youth, particularly among females, in several low- to high-HDI countries, in some of which smoking among adolescent girls is now more common than among adult women or even adolescent boys.

Nearly two thirds of countries, including 98% of low-HDI countries and 93% of countries in sub-Saharan Africa, have not implemented tobacco use monitoring at best-practice level. 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.