Cigarette use fell in most countries over the past three decades, but increased in some nations, notably China, a new global study says.
Researchers analysed data from 71 countries that represent 85% of the world's population and account for more than 95% of global cigarette use.
Decreases and increases
While overall cigarette use declined, there were significant differences between countries.
About 2.5 million metric tons (MMT) of cigarettes were smoked in China in 2013, more than Russia (0.36 MMT), the United States (0.28 MMT), Indonesia (0.28 MMT), Japan (0.20 MMT), and the next 35 highest consuming countries combined.
The United States and Japan had reductions of more than 0.1 MMT over a decade, while Russian consumption plateaued, and Chinese and Indonesian consumption rose by 0.75 MMT and 0.1 MMT, respectively.
The study was published in The BMJ.
A second study in the same issue of the journal looked at global cigarette use after adoption of the World Health Organization's Framework Convention on Tobacco Control, a 2003 international treaty meant to reduce tobacco use.
It found that wealthy and European countries had a decrease in annual consumption of more than 1 000 cigarettes per adult, but low- and middle-income and Asian countries had an annual increase of more than 500 cigarettes per adult.
Increases in e-cigarette use
The findings "should motivate greater implementation of proven tobacco control policies" and "encourage more assertive responses to tobacco industry activities", the study authors wrote. Both studies were led by Steven Hoffman, from York University in Toronto.
A third study in the same issue of the journal examined data from the United States, Canada and England and found that e-cigarette rose use among teens ages 16-19 in the United States and Canada in 2017 and 2018, and that smoking increased among Canadian teens in that age group.
The study, led by David Hammond, of the University of Waterloo in Ontario, also found that use of Juul brand e-cigarettes rose in the United States, Canada and England.
"Taken together, these new studies emphasise the value of comparative research for tobacco control across different countries," Linda Bauld wrote in an accompanying editorial.
"They also warn against complacency in our attempts to address smoking, now and in the future," said Bauld, of the University of Edinburgh in Scotland.
Continued investment in international tobacco control is more important than ever, particularly in low- and middle-income countries with limited resources to fight tobacco industry attempts to undermine anti-tobacco policies, she concluded.
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