Global and Regional Patterns of Tobacco Smoking and Tobacco Control Policies

Context Tobacco smoking is a major worldwide cause of morbidity and mortality from various diseases, including urologic diseases. Objective We reviewed, at global and regional levels, the prevalence and trends of tobacco smoking and legislative and regulatory efforts around tobacco control. We also provided information about electronic cigarette (e-cigarette) use. Evidence acquisition We used several sources to present the most up-to-date information from national surveys, including the Global Adult Tobacco Survey, the Global Tobacco Control Report, and the Global Youth Tobacco Survey. Evidence synthesis Smoking prevalence has been decreasing globally, although trends in smoking vary substantially across countries and by gender. Among men, smoking prevalence in most high-income countries started to decrease in the mid-1990s, followed after a few decades by generally smaller decreases in some low- and middle-income countries (LMICs). However, there has been no change, or there has even been an increase, in smoking prevalence in many other LMICs. Countries with the highest male smoking prevalence are located in East Asia, Southeast Asia, and Eastern Europe. Similar to men, smoking prevalence for women has been decreasing in most high-income countries and some LMICs, although the decrease began later and was slower than that for men. Except in a few countries, smoking is much less common for women than for men. Most countries with the highest smoking prevalence in women are in Europe. Countries that have implemented the best practices for tobacco control, including monitoring, smoke-free policies, cessation programs, health warnings, advertising bans, and taxation, have been able to reduce smoking rates and related harms. E-cigarette use has rapidly increased since its introduction to the market. Conclusions Health care providers should advise smoking patients about quitting smoking. Countries must improve the implementation and enforcement of tobacco control policies. Particular attention should be paid to preventing an increase in smoking among women in LMICs. Patient summary We reviewed smoking prevalence and tobacco control policies in various regions. Countries with more effective tobacco control programs have seen higher reductions in smoking prevalence and, consequently, in smoking-related mortality. Because both longer duration and higher intensity of smoking (amount of tobacco smoked per day) are associated with an increased risk of tobacco-related diseases, smokers should quit smoking as soon as possible.