Tobacco use is going down globally, but not as much as hoped, the WHO says

Tobacco use rates around the world are falling, but not as much as hoped, according to a new report on global tobacco use by the World Health Organization.

In 2022, there were about 1.25 billion tobacco users ages 15 and older. That number is down from 1.36 billion in 2000, even as the world population has risen.

In 2000, about 33% of adults used tobacco products. In 2020, that number had fallen to about 22%, according to the report released on Tuesday. That's expected to go down to about 18% by 2030. The report counts people ages 15 and up as adults.

The good news is the numbers show that known tobacco control methods can work, says Stella Bialous, who is a professor in the Department of Social Behavioral Sciences at the University of California, San Francisco, and a tobacco control researcher. She was not involved in the report.

"All the policies that we know work actually when properly implemented," she says. That includes providing smoke-free environments, restricting or banning marketing or advertising, adding health warnings, and increasing prices.

"All these things work. Not all countries are doing these things to the maximum extent possible. And I think that's where we would see trends decline a little sharper," she says.

The WHO highlighted Brazil and the Netherlands for seeing huge drops in tobacco use, while adding that six countries — Congo, Egypt, Indonesia, Jordan, Oman, and Moldova — have usage rates still going up.

The United States in 2022 had about 20% of adults report using tobacco, down from about 30% in 2000. The U.S. numbers run close to the global average.

The highest rates of any region are in Southeast Asia, where some 27% use tobacco, followed by Europe with 25%. Europe is projected to have the highest rates of tobacco use in the world by 2030.

Countries around the world had set a goal of reducing tobacco use by 30% in 2025 from where it was in 2010. As of now rates are down about 25% from 2010, and are likely to slightly miss the 30% reduction goal. Only 56 countries will reach the goal, the WHO says.

Globally, about 36% of men used tobacco, compared to about 8% of women, as of 2020. The U.S. rate in 2022 was 24% of men and about 17% of women.

Bialous says one point of concern in the report was some regions where adolescent girls ages 13-15 are now using tobacco at higher rates than adult women, such as in Africa and the Eastern Mediterranean. She worries these girls could "continue to use tobacco and 'catch up' with males," who use tobacco at higher rates. It's "worth continuing attention to ensure that it doesn't lead to higher prevalence in adult women," she adds.

The report doesn't include full data on e-cigarettes

The WHO report's overall tobacco use numbers do not include e-cigarettes because of insufficient data, it says. In the U.S., parents and regulators are concerned about teens getting hooked on nicotine vaping. Studies aren't conclusive on whether vaping leads to cigarette smoking, Bialous says.

However, cigarettes are still the "workhorse" of the global tobacco industry for the time being, she says.

"They're still the main tobacco product used worldwide, if you think at a global scale. But the tobacco industry is anticipating" use going down, she says. "And one of the things they're doing is coming up with all kinds of these new nicotine products, which they're claiming to be safe. And now more and more studies are [showing] that they're not."

In addition to vaping, the industry is putting money into nicotine pouches and lozenges, she says.

Ruediger Krech, director of the WHO Department of Health Promotion, said the tobacco industry was to blame for the continued lure of cigarettes and other tobacco products. The "industry seizes the opportunity to manipulate health policies and sell their deadly products," he said in a statement.

Bialous says another way to cut tobacco use, one that isn't thought of as much, is to help existing users quit.

"Each one of these numbers is a person. And most of them, if you offer help to quit, may want to take that help and try to quit with support. And they are not currently being offered that," she says.