More than half of countries worldwide have shown no progress in reducing smoking among teens and young adults over the past three decades, according to findings from a study of global smoking trends involving 204 nations and territories.
An analysis of Global Burden of Disease study data from 1990 through 2019 showed that 9-out-of-10 (89.1%) new smokers worldwide pick up the habit by the time they are 25, and that close to 1-in-5 (18.5%) smokers began using cigarettes regularly by age 15.
Worldwide in 2019, 155 million teens and young adults between the ages of 15 and 24 years were regular combustible cigarette smokers, with a global prevalence of 20.1% among males and 4.95% among females, wrote researcher Emmanuela Gakidou, PhD, MSc, of the University of Washington Institute for Health Metrics and Evaluation, Seattle, and colleagues.
Their findings were published online May 27 in the journal Lancet Public Health.
In an email exchange with BreakingMED, Gakidou noted that one promising finding from the study is that despite the lack of progress in some nations, significant reductions in youth smoking have been achieved in both economically advantaged and disadvantaged areas.
“This demonstrates that progress is possible in all countries,” she said. “Yet most countries have not fully adopted, implemented or enforced the policies that have been demonstrated to be effective in reducing smoking prevalence among youth. These include reducing the affordability of tobacco products through taxation, comprehensive smoke-free policies, advertising, promotion and sponsorship bans, and eliminating flavors that are particularly appealing to young people.”
During the three-decades between 1990 and 2019, the greatest declines in youth and young adult smoking prevalence were seen in Norway (38.9% in 1990 to 15.3% in 2019; absolute change −23.5%; 95% CI, –19.5 to –27.3), Australia (35.8% in 1990 to 15.1% in 2019; absolute change of –20.6 percentage points [–16.9 to –27.3]), and Brazil (27.5% in 1990 to 7.0% in 2019; absolute change of –20.5 percentage points [–17.9 to –23.1]).
Twelve countries (Albania, Bosnia and Herzegovina, Serbia, Afghanistan, Lebanon, Bahrain, Lesotho, Saudi Arabia, El Salvador, Zambia, Antigua and Barbuda, and Uzbekistan) showed significant increases in the prevalence of smoking among 15-to-24-year-olds between 1990 and 2019.
In the United States, according to figures from the U.S. Centers for Disease Control and Prevention, smoking rates among high school students increased throughout the 1990s to a high of around 36% in 1997.
The latest U.S. National Youth Tobacco Survey (NYTS) data found that by 2020, use of combustible cigarettes had dropped significantly from that high. A total of 4.6% of high school students surveyed reported current combustible cigarette use, but almost 1-in-5 (19.6%) reported regular use of electronic cigarettes.
Gakidou told BreakingMED that the decline in youth smoking in countries that have implemented targeted public health interventions designed to prevent smoking initiation to this age group illustrate the potential impact of these strategies.
“Taxation is one of the most effective tools for reducing tobacco use,” she said. “Other core public health interventions that are desperately needed in many countries include smoke-free policies and comprehensive bans on advertising, promotion and sponsorship. When thinking specifically about reducing youth tobacco use, three important strategies would be to pass comprehensive flavor bans, to leverage social media and influencers for anti-tobacco campaigns, and to increase the minimum age of purchase.”
Study limitations cited by the researchers included the self-reporting of cigarette use, the fact that age at initiation was subject to recall bias, and the restriction of most youth tobacco surveys to children attending schools “which might not be representative of the general population,” the researchers wrote.
The focus on smoked tobacco and the exclusion of other forms of tobacco use including smokeless tobacco, e-cigarettes, vaping products, or heating tobacco products was also cited as a study limitation.
“In 2019, an estimated 155 million people aged 15-24 years—approximately 13% of this population globally—smoked tobacco regularly,” the researchers wrote. “To end the tobacco epidemic, countries must aggressively implement evidence-based strategies to prevent initiation and interrupt the steady stream of new smokers.”
In an accompanying commentary, Anton E. Kunst, PhD, of the University of Amsterdam in the Netherlands, wrote that while tobacco-use surveys are widely relied on to gather quantitative data on youth smoking trends, qualitative approaches such as in-depth interviews, focus group discussions and participatory research could also be useful tools to better understand these trends.
“Qualitative approaches such as these aim for emic (insider) rather than an etic (outsider) perspective,” Kunst wrote. “Emic approaches might aid understanding of how young people might become addicted, what they need to stay smoke-free, and how policies can best help and protect them. In short, to inform policies to end the tobacco epidemic, we need approaches that are emic as well as etic,” he concluded.
More than half of countries worldwide have shown no progress in reducing smoking among teens and young adults over the past three decades, according to findings from a study of global smoking trends.
Worldwide in 2019, 155 million teens and young adults between the ages of 15 and 24 years were regular combustible cigarette smokers.
Salynn Boyles, Contributing Writer, BreakingMED™
This research was funded by Bloomberg Philanthropies.
The researchers and editorial writer declared no relevant competing interests.
Cat ID: 138
Topic ID: 85,138,730,138,143,192,151,154,195,489,925