Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and initiation among young people in 204 countries and territories, 1990-2019

Abstract

Background: Universally, smoking cessation rates among established smokers are poor. Preventing young people from starting use of and becoming addicted to tobacco products remains a key strategy to end the tobacco epidemic. Previous country-specific studies have found that initiation of smoking tobacco use occurs predominantly among young people and have found mixed progress in reducing the prevalence of smoking tobacco use among young people. Current and comparable estimates for all countries are needed to inform targeted interventions and policies.

Methods: We modelled two indicators: prevalence of current smoking tobacco use among young adults aged 15-24 years, and the age at which current smokers aged 20-54 years in 2019 began smoking regularly. We synthesised data from 3625 nationally representative surveys on prevalence of smoking and 254 on age at initiation. We used spatiotemporal Gaussian process regression to produce estimates of the prevalence of smoking and age of initiation by sex, for 204 countries and territories for each year between 1990 and 2019.

Findings: Globally in 2019, an estimated 155 million (95% uncertainty interval 150-160) individuals aged 15-24 years were tobacco smokers, with a prevalence of 20·1% (19·4-20·8) among males and 4·95% (4·64-5·29) among females. We estimated that 82·6% (82·1-83·1) of current smokers initiated between ages 14 and 25 years, and that 18·5% (17·7-19·3) of smokers began smoking regularly by age 15 years. Although some countries have made substantial progress in reducing the prevalence of smoking tobacco use among young people, prevalence in 2019 still exceeds 20% among males aged 15-24 years in 120 countries and among females aged 15-24 years in 43 countries.

Interpretation: The fact that most smokers start smoking regularly before age 20 years highlights the unique window of opportunity to target prevention efforts among young people and save millions of lives and avert health-care costs in the future. Countries can substantially improve the health of their populations by implementing and enforcing evidence-based tobacco control policies that prevent the next generation from initiating smoking.

Funding: Bloomberg Philanthropies.

Figure 1

Prevalence of smoking tobacco use among females (A) and males (B) aged 15–24 years, in 2019

Figure 2

Prevalence of smoking tobacco use in 2019 vs percentage change in prevalence between 1990 and 2019, among individuals aged 15–24 years, by sex Percentage change exceeded 100% for five countries (Albania, El Salvador, Afghanistan, Zambia, and Zimbabwe) for females and one country (Afghanistan) for males. These values were capped at 100% for visualisation purposes. To avoid visual clutter, only locations with significant increases, significant and large decreases, and high prevalence are labelled.

Figure 3

Individual-level distribution of age at initiation among current tobacco smokers aged 20–54 years in 2019, by super-region and sex The sizes of the bars indicate the total number of current tobacco smokers initiating at a given age. Data for males are displayed to the left of the vertical dashed line and data for females are displayed to the right.

Figure 4

Mean age at initiation of regular smoking of tobacco among current smokers aged 20–54 years in 2019, both sexes combined