WHO global report on trends in prevalence of tobacco use 2000-2030

WHO global report on trends in prevalence of tobacco use 2000–2030 WHO global report on trends in prevalence of tobacco use 2000–2030 WHO global report on trends in prevalence of tobacco use 2000–2030 ISBN 978-92-4-008828-3 (electronic version) ISBN 978-92-4-008829-0 (print version) © World Health Organization 2024 Some rights reserved. This work is available under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Photo credits: Cover page photo: Filadendron / E+ via Getty Images, Page 24 photo: Morsa Images / Digital Vision via Getty Images, Page 40 photo: LeoPatrizi / E+ via Getty Images. iii Contents Foreword ............................................................................................................................................... iv Preface ................................................................................................................................................... v Acknowledgements ................................................................................................................................ vi Abbreviations ........................................................................................................................................ vii 1. Introduction ................................................................................................................................... 1 2. Methods ......................................................................................................................................... 2 3. Results ............................................................................................................................................ 6 3.1 Trends in prevalence of tobacco use .................................................................................... 6 3.1.1 Characteristics of data used to calculate WHO trends in tobacco use, tobacco smoking and cigarette use among adults ........................................................................................... 6 3.1.2 Estimates of global trends in prevalence of tobacco use among people aged 15 years and older, by sex, 2000–2030 .............................................................................................. 7 3.1.3 Trends in prevalence of tobacco use by age .................................................................. 9 3.1.4 Trends in prevalence of tobacco use by WHO region ................................................... 11 3.1.5 Trends in prevalence of tobacco use by World Bank income group .............................. 15 3.1.6 Trends in the number of tobacco users ...................................................................... 16 3.1.7 Levels of tobacco use, smoking and cigarette use among adults in 2022 ...................... 18 3.2 Progress towards meeting tobacco use reduction targets ................................................... 22 3.3 Smokeless tobacco use among people aged 15 years and older .......................................... 25 3.4 Smokeless tobacco use among adolescents aged 13–15 years ............................................ 27 3.5 Any tobacco use among adolescents aged 13–15 years ...................................................... 29 3.6 Cigarette smoking among adolescents aged 13–15 years .................................................... 32 3.7 Use of electronic nicotine devices including e-cigarettes ..................................................... 35 4. Discussion .............................................................................................................................. 37 5. Conclusion .............................................................................................................................. 39 References ............................................................................................................................................ 41 Annex 1: Tables .......................................................................................................................... 43 Annex 2. Statistical Annex ................................................................................................................... 106 iv Foreword This WHO global report on trends in prevalence of tobacco use 2000–2030 is a useful companion to the WHO report on the global tobacco epidemic, which tracks the global adoption of tobacco control measures and interventions designed to reduce the use of tobacco. Together these reports allow us to both monitor progress every two years and to identify gaps, challenges and hinderances. This report brings some good news and reminds us that there is more work ahead. Globally we are getting closer to the global voluntary target of a 30% relative reduction in current tobacco use by 2025, as set out in the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Already by 2022, the projected relative reduction is 24.9%. But progress is uneven across countries and regions of the world, and more effort is needed to achieve the overall reduction target of 30%. In some countries there have been setbacks in tobacco policy adoption and implementation. There are four fewer countries on track to meet the goal compared to findings two years ago of the WHO global report on trends in prevalence of tobacco use 2000–2025, fourth edition. Six countries worldwide are still experiencing an increase in tobacco use, and nine are seeing no significant change. Considering the enormous burden that tobacco places on individuals, communities and health systems, this is totally unacceptable. WHO and the Secretariat to the WHO Framework Convention on Tobacco Control (WHO FCTC) work together as co-custodians of the Sustainable Development Goal indicator 3.a.1. This report contributes to the global monitoring of Sustainable Development Goal 3.a, which calls for strengthening implementation of the WHO FCTC in all countries, as appropriate. The measures that are effective for reducing tobacco use are known. When countries commit to protecting their people from tobacco, we see the results – a reduction in tobacco use prevalence rates, and correspondingly healthier populations. Dr Ailan Li Dr Rüdiger Krech Assistant Director-General Director Division of Universal Health Coverage\Healthier Populations Department of Health Promotion World Health Organization World Health Organization v Preface On behalf of the Joint Medical School of the University of Newcastle and the University of New England, Australia, we congratulate the World Health Organization (WHO) for publishing its global report on trends in prevalence of tobacco use 2000–2030. Tobacco use continues to be a major potentially avoidable threat to public health around the world. This threat applies not only to those who directly use tobacco but also to people who themselves choose not to use tobacco but who may be exposed to harmful tobacco residues and smoke. In response to the threat posed by tobacco to public health globally, WHO Member States in 2003 unanimously adopted the WHO Framework Convention on Tobacco Control. The preamble to the treaty emphasizes the special contribution that academic institutions can play in international tobacco control efforts. The Joint Medical School is proud to have engaged with and supported the WHO in the production of this important report. It is satisfying to know that despite the challenges thrown at them throughout the COVID-19 pandemic, most countries during these difficult years have nevertheless continued to try to control the tobacco epidemic and monitor progress by conducting population health surveys. The report reveals the encouraging progress made by the WHO, countries and civil society in combatting the tobacco epidemic. Despite this improvement, much remains to be done to ensure that the damage caused by tobacco use is truly ended. Finally, we wish to thank our colleagues at the Joint Medical School and University of Newcastle Priority Research Centre for Health Behaviour for their commitment and for sharing their technical know-how to help the WHO and all countries improve the lives of people everywhere. Professor Chris Armstrong Deputy Vice Chancellor Research University of New England Armidale, Australia Professor Kent Anderson Deputy Vice Chancellor Global Engagements and Partnerships University of Newcastle, Australia vi Acknowledgements Main contributors to this report: Alison Commar (WHO Geneva), Vinayak Prasad (WHO Geneva), Edouard Tursan d’Espaignet (University of Newcastle and University of New England, Australia). The World Health Organization (WHO) would like to thank the many individuals who contributed to the development of this report. These include: WHO Geneva: Douglas Bettcher (Office of the Director-General), and Ruediger Krech, Ranti Fayokun, Hebe Gouda, Benn McGrady, Marine Perraudin, Kerstin Schotte, Simone St Claire (Department of Health Promotion). WHO Regional Offices: Nivo Ramanandraibe (Regional Office for Africa); Adriana Bacelar, Rosa Sandoval (Regional Office for the Americas); Fatimah El-Awa, Heba Fouad (Regional Office for the Eastern Mediterranean); Angela Ciobanu, Liza Lebedeva (Regional Office for Europe); Jagdish Kaur (Regional Office for South-East Asia); Xi Yin, Ada Moadsiri, Melanie Aldeon, Mina Kashiwabara (Regional Office for the Western Pacific). Secretariat to the WHO Framework Convention on Tobacco Control: Tibor Szilagyi. The WHO acknowledges the support given to countries for data collection or reporting on tobacco- specific surveys or multi-risk factor surveys that include tobacco: WHO Geneva: Lubna Bhatti, Melanie Cowan, Patricia Rarau, Leanne Riley, Stefan Savin. WHO Regional Offices: Nivo Ramanandraibe (Regional Office for Africa); Adriana Bacelar, Rosa Sandoval (Regional Office for the Americas); Heba Fouad (Regional Office for the Eastern Mediterranean); Angela Ciobanu, Liza Lebedeva (Regional Office for Europe); Jagdish Kaur (Regional Office for South-East Asia); Ada Moadsiri, Melanie Aldeon, Mina Kashiwabara (Regional Office for the Western Pacific). Funding This report would not have been possible without the support of Bloomberg Philanthropies. vii Abbreviations ENDS Electronic nicotine delivery systems GPW 13 Thirteenth Global Programme of Work 2019–2023 GSHS Global school-based student health survey GYTS Global youth tobacco survey HBSC Health behaviour in school-aged children survey HTP Heated tobacco product NCD Noncommunicable disease NCD GAP WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013– 2020 SDG Sustainable development goal WHO FCTC WHO Framework Convention on Tobacco Control 1 1. Introduction In recognition of the global threat of tobacco use to public health, the WHO Framework Convention on Tobacco Control (WHO FCTC) was the first global health treaty negotiated under the auspices of the WHO (1). Adopted in 2003, 182 countries and the EU are parties to this treaty. Only 11 of WHO’s Member States are not parties to the treaty. The United Nations Sustainable Development Goal (SDG) Target 3.a is to “Strengthen the implementation of the WHO FCTC in all countries, as appropriate”. The official indicator used to measure progress towards this target is 3.a.1, “Age-standardized prevalence of current tobacco use among persons aged 15 years and older” (2). WHO tracks the global progress of this indicator, in collaboration with the Secretariat of the WHO FCTC, and submits country-level WHO estimates to the United Nations every two years. The WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013– 2020 (NCD GAP) (3), since extended to 2030, includes a target for reducing the global prevalence of tobacco use (smoked and smokeless tobacco) by 30% by the year 2025, relative to 2010 (4). This report uses data from Member States to monitor progress towards the target, and to project the likelihood of achieving it. Many countries are setting their own targets to reduce tobacco use, and calculating their own tobacco use trends and projections. The value of WHO estimates is mainly to compile a global picture of tobacco use trends using a unified set of definitions and a single estimation method for all countries. All estimates are supported by nationally representative surveys. The data used are described in the Methods section of this report. All WHO estimates undergo a country consultation prior to publication. Previous rounds of estimates, published in the 2015, 2018, 2019 and 2021 editions of the WHO global report on trends in prevalence of tobacco use 2000–2025, presented a timeseries of estimates running from 2000 to 2025. These estimates are fully revised in this report, and projections up to 2030 have been added for the first time. In addition to tobacco use prevalence trends and target assessments, other global analyses presented in this report include global estimates of the prevalence of cigarette smoking and smokeless tobacco use among adults, and the prevalence of tobacco use, cigarette smoking and smokeless tobacco use among adolescents. An estimate the global prevalence of e-cigarette use was attempted, however data are missing in too many countries. Details on the methods used for these global estimates, along with data sources, are in Annex 2. This report may be used as a companion to the biennial WHO report on the global tobacco epidemic (5), an advocacy tool that supports adoption of the demand-reduction measures in the WHO FCTC, and which highlights the successes of Member States towards full adoption of the measures. 2 2. Methods 2.1 WHO’s global estimates of trends in tobacco use among persons aged 15 years and above The source data behind the trend analysis in this report are nationally representative population- based surveys that have collected data on one or more forms of tobacco use between 1990 and 2022. The population of interest is people aged 15 years and above. WHO gathers the surveys provided by: parties to the WHO FCTC in their biennial reports submitted to the Secretariat of the WHO FCTC; surveys completed under the aegis of the Global Tobacco Surveillance System (in particular, the Global Adult Tobacco Survey); other WHO-supported surveys including WHO STEPwise surveys and World Health Surveys; and surveys undertaken by cross- national organizations, such as Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Survey (MICS). For countries not regularly participating in any of the above, WHO regional offices and WHO country offices made efforts to identify surveys conducted independently by those countries. Data from these national surveys are compiled into a single dataset of prevalence classified by type of tobacco, use frequency, year, country, sex and age of respondent, and sample size. The dataset was closed on 1 February 2023. Among the surveys used there are many different approaches to asking people about their tobacco use, as well as the types of tobacco products they use. Different age ranges are surveyed, and the breadth of topics covered by the survey can vary. All this variety makes a global analysis of tobacco use as reported in national surveys challenging. The methods described below try to surmount these challenges. “Prevalence” is defined as the proportion of the population of interest who report that they use the product. “Current use” of a product is defined as using the product at the time of the survey on a daily or non-daily basis. “Any tobacco use” is defined in this report as use of any type of tobacco – smoked and/or smokeless tobacco. “Any tobacco use” does not include the use of products that do not contain tobacco, such as electronic nicotine delivery systems (ENDS), referred to in this report as e-cigarettes. Surveys can vary in how strict they are about supplying a definition of which products they are referring to when asking respondents about tobacco use. The survey report and questionnaire, when available, were consulted to determine which of the following categories best characterize the data reported: (i) any tobacco product; (ii) any smoked tobacco product; (iii) any cigarette (manufactured or hand-rolled); or (iv) any smokeless tobacco product. 3 The dataset used for the 2023 round of trend estimates contains data from a total of 1872 national surveys. Of these, 1643 were the same surveys used during the last round with no additional data points added, 51 were surveys present in the dataset in the last round, but which have since had one or more datapoints added, and 178 were completely new surveys added since the last round. All data years from 1996 to 2022 received new data since the last round, thereby strengthening the existing data and allowing retrospective corrections to the trends in all years dating back to 1990 (see Fig. 1). The data year with the greatest number of eligible surveys undertaken is 2017 (110 surveys) followed by 2014 (109 surveys). When the dataset closed on 1 February 2023, only five surveys from 2022 were available. The surveys published since then will be included in the dataset for the next round of WHO estimates. Each round of estimates recalculates the trends from 2000 to 2030 using the updated dataset, therefore the results from one round cannot be directly compared with the results from any other round. Fig. 1: Surveys added to the dataset and surveys updated since the last round of WHO estimates in 2021 The dataset is run through a statistical model to estimate the underlying trends in tobacco use prevalence among the population aged 15+ in each country. This is done separately by sex, type of tobacco used and frequency of use (current and daily). The trends in prevalence are projected to 2025 and 2030. WHO used a statistical modelling tool called “DISMOD-MR” to calculate tobacco use trends among adults. DISMOD-MR is an open-source tool designed to run Bayesian mixed-effects meta-regression statistical analyses on epidemiological datasets. It was originally developed by academics at the University of Washington, USA, and is downloadable from Github (6). Details of how this tool was used by WHO for this analysis were published in a peer-reviewed journal in 2015 (7). The DISMOD- MR programmes and input file, as well as the list of surveys in the dataset, are available from the 0 20 40 60 80 100 120 140 160 180 1 9 9 0 1 9 9 1 1 9 9 2 1 9 9 3 1 9 9 4 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8 2 0 0 9 2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 9 2 0 2 0 2 0 2 1 2 0 2 2 N u m b er o f n at io n al s u rv ey s Year the survey was in the field Surveys added to the database since the last estimates round Surveys already in the database, updated since the last estimates round Surveys in the database since the last round with no updates 4 WHO tobacco repository on Github. The original model analysed only the “smoked tobacco use” and “cigarette use” indicators. In 2018, WHO modified the tool to process also the indicator “any tobacco use”. Originally the model paired “tobacco smoking” rates with “cigarette smoking” rates in the dataset and examined the relationship between the two to fill gaps where either rate was missing. The recent modification is to run this analysis end-to-end as the first step of the modelling, and then rerun end-to-end to pair “tobacco smoking” rates with “any tobacco use” rates, again examining the relationship between the two to fill gaps where either rate was missing. The results of the two runs are then combined by retaining results for “any tobacco use”, “cigarette smoking” and only one of the two sets of “tobacco smoking” results, selected based on the comparative strength of its relationship with either the “any tobacco use” indicator or the “cigarette smoking” indicator, and assessed separately by sex, on a country-by- country basis. Where a country had survey data about the “any tobacco use” indicator and the “cigarette smoking” indicator but not the “tobacco smoking” indicator, the estimates of “tobacco smoking” derived from the first step were included as input for the second step. The output of the model is a set of trend lines for each country summarizing prevalence between 2000 and the country’s most recent survey, then projecting to 2025 and 2030. The model is fitted separately for men and women and produces age-specific rates as well as summary rates for the population aged 15 years and older. Trends in six indicators are produced: (i) Current tobacco use (ii) Daily tobacco use (iii) Current tobacco smoking (iv) Daily tobacco smoking (v) Current cigarette smoking (vi) Daily cigarette smoking The model was run for countries that had at least two nationally representative surveys carried out in different years that report national prevalence rates for one or more tobacco use indicator(s), with at least one of these surveys reporting rates disaggregated by age and by sex, and at least one survey carried out since 2012. Countries who previously had results in earlier rounds of WHO estimates, but who have not run a survey since 2012, no longer have any results. For countries that have insufficient data to run the model, no trend estimates are calculated. All countries are nevertheless included in global and regional analyses by assuming that the rates of tobacco use – had they been measured – would resemble the average rates seen in the relevant analysis grouping of countries (see Annex 2.3). In this report, country trends are summarized at global level, at WHO regional level, and by World Bank income group, according to the World Bank classification in 2022 (8). Global and regional averages are weighted by population, according to the UN estimates published in World Population 5 Prospects, 2022 (9). To facilitate comparisons between countries, prevalence rates are standardized to the WHO Standard Population (10). Age-standardized rates are hypothetical numbers that can be quite different from the non-standardized rates for countries with population structures that are unlike the WHO Standard Population structure. The Sustainable Development Goal indicator calls on countries to report age-standardized rates. Each country’s trend category is reported in Table A1.7. Alongside this is an indication of reliability of the assessment, based on the quantity of the underlying data. Each trend result is classified as either “more reliable” or “less reliable”. The assessment for a country with (i) at least three surveys since 1990, and (ii) at least one survey since 2012, and (iii) at least two surveys with prevalence rates disaggregated by age and by sex, is categorized as “more reliable”. All others are classified as “less reliable”. To assess whether countries are on track to meet the tobacco use reduction targets under the NCD GAP, the trend results are categorized into one of five categories: on track to achieve a 30% relative reduction between 2010 and 2025; likely to achieve a decrease in prevalence but less than 30% by 2025; unlikely to experience a significant change in prevalence; likely to experience an increase in prevalence; and having insufficient data to calculate a trend. For countries close to the 30% cut-off, an uncertainty analysis was undertaken so that only countries with a statistically significant chance of meeting the target are reported as on track to meet it. 2.2 Global estimates of indicators without trend analysis Global estimates in this report other than those mentioned above, such as global prevalence of smokeless tobacco use among adults, prevalence of use of any tobacco, cigarettes, smokeless tobacco and e-cigarettes among adolescents, and global prevalences of e-cigarette use among adults and adolescents have been calculated by collating the most recent national survey in each country that reports these indicators for adults (in a population-based survey) and for adolescents (in a school-based survey). There is not yet a critical mass of survey data on any of these indicators to allow a trend analysis. Instead, all these estimates centre around a single point in time. The pertinent methods and datasets used are described in Annex 2 of this report. 6 3. Results 3.1 Trends in prevalence of tobacco use 3.1.1 Characteristics of data used to calculate WHO trends in tobacco use, tobacco smoking and cigarette use among adults Trend results were produced for 165 countries with sufficient data as described in the Methods chapter. These 165 countries represent 85% of WHO Member States and 97% of the global population. Each WHO Region has results for at least 76% of its Member States and 88% of its population, and each World Bank income group is represented by at least 69% of its countries and 78% of its population (see Table 1). Table 1: 2022 global dataset, levels of Member State and population coverage with nationally representative population-based surveys African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region % of countries 39 / 47 26 / 35 11 / 11 49 / 53 16 / 21 24 / 27 % of population covered 91% 96% 100% 99% 88% 100% High-income countries Upper middle- income countries Lower middle- income countries Low-income countries Global % of countries 55 / 60 46 / 56 44 / 49 20 / 29 165 / 194 % of population covered 100% 99% 99% 78% 97% The South-East Asia Region is the only WHO Region with all its Member States having sufficient survey data to allow measurement and projection of tobacco use trends over the period 2000–2030. The Western Pacific Region has survey data covering close to 100% of the adult population, with only three countries having insufficient survey data to calculate a trend for this report. The European Region has regular national surveys covering 99% of its population. The Region of the Americas has coverage for 96% of its population, although the proportion of countries covered is the lowest of all regions at 74% due to 9 countries having no data or insufficient data. The African Region has 91% of its population covered by sufficient surveys in 39 countries. The lowest population coverage is in the Eastern Mediterranean Region, where only 88% of the population living in three quarters of the Region’s countries have sufficient survey data available to calculate tobacco use trends for this report (see Table 1). 7 Monitoring rates vary by World Bank country income group, with better survey coverage achieved in the best-resourced nations. In high-income Member States, close to 100% of the aggregated adult population are covered by surveys. In both the upper middle-income and lower middle-income Member States groups, the coverage is 99% of the aggregated populations. Low-income countries have the lowest level of sufficient survey coverage at 69% of countries and 78% of combined populations (see Table 1). 3.1.2 Estimates of global trends in prevalence of tobacco use among people aged 15 years and older, by sex, 2000–2030 Table 2: Global trends in prevalence of tobacco use among people aged 15 years and older, by year Overall, the global target for the total population will fall short of meeting the overall global target of 18.4% by an absolute 1.3%. Instead of achieving the 30% relative reduction called for in the NCD GAP by 2025, current efforts are likely to yield a global prevalence of around 19.8% in 2025, which equates to a 25% relative reduction since 2010 (21% reduction among males and 40% reduction among females). At the current annual absolute decline rate of 0.3%–0.4% per annum, it will take an extra four years, or until 2029, to achieve a 30% relative reduction from the prevalence of 2010 (see Table 2). In 2000, around half of men (49.1%) aged 15 years and older were current users of some form of tobacco. If the level of intensity of tobacco control measures is maintained over time, then the prevalence rate is projected to decline to 32.9% in 2025 and to 30.6% by 2030. Although these Year 2000 2005 2010 2015 2020 2025 2030 Relative reduction % 2010-2025 30% reduction target* Prevalence (%) 32.7 29.3 26.4 23.9 21.7 19.8 18.1 18.4 1.3 Average change over previous 5 years (%/year) -- -0.68 -0.59 -0.50 -0.43 -0.38 -0.33 -0.65 -0.65 Prevalence (%) 49.1 45.1 41.6 38.4 35.5 32.9 30.6 29.1 3.8 Average change over previous 5 years (%/year) -- -0.79 -0.71 -0.63 -0.58 -0.53 -0.47 -1.28 -1.28 Prevalence (%) 16.3 13.5 11.1 9.3 7.9 6.7 5.7 7.8 -1.1 Average change over previous 5 years (%/year) -- -0.57 -0.46 -0.36 -0.29 -0.24 -0.19 -0.01 -0.01 * The average annual change required to achieve the 2025 target from 2020 onwards. Reduction target Males Both sexes Females Projected prevalenceEstimated prevalence 8 decreases are encouraging, they would not meet the target of a 30% relative reduction by 2025 using 2010 as the baseline. In 2010, the male rate of 41.6% means a target rate of 29.1% needs to be reached by 2025. The projected prevalence based on current trends suggests that males will miss that target by 3.8%. Fig. 2: Global trends in prevalence of tobacco use among people aged 15 years and older, by sex, 2000–2030 (estimates to 2020, projections to 2030) In 2000, around one in six women (16.3%) aged 15 years and older were current users of some form of tobacco. By 2025, the rate is projected to decline to 6.7% and further to 5.7% by 2030. The projected 2025 prevalence (6.7%) exceeds the 30% reduction target (7.8%) by an absolute 1.1%. Based on existing data, a 30% reduction was already achieved among women in 2021. In 2000, the proportion of males using any form of tobacco was three times the proportion of women users. By 2022 the rate for males was more than four times the rate for females. This reflects the faster decline in prevalence among females. This gap is expected to increase further and reach just over five times by 2030 (see Fig. 2). 49.1 45.1 41.6 38.4 35.5 32.9 30.6 32.7 29.3 26.4 23.9 21.7 19.8 18.116.3 13.5 11.1 9.3 7.9 6.7 5.7 0.0 20.0 40.0 60.0 80.0 100.0 2000 2005 2010 2015 2020 2025 2030 P re va le n ce o f cu rr en t to b ac co u se (% ) Males Both sexes Females 9 3.1.3 Trends in prevalence of tobacco use by age Table 3: Global trends in prevalence of tobacco use by age, 2000–2030 Globally, the average rate of tobacco use among young people aged 15–24 years has declined from just over 20% in 2000 to about 13% in 2022, and is projected to reach 12% in 2030 (see Table 3). Among males in the age group 15–24 years, tobacco use has declined from 32.3% in 2000 to 21.8% in 2022. The rate in 2030 is projected to be 19.6%. Among women in this age group, the 2000 rate of 8.3% reduced to 4.3% by 2022, and this is projected to continue downwards to 3.5% by 2030. There has been a steady decline in tobacco use for both males and females in each age group over the observed period 2000–2022. The age-specific rates are projected to continue declining to 2030 for both males and females. The age-specific rates peak at age group 45–54 for men (see Fig.3), and Age (years) 2000 2005 2010 2015 2020 2022 2025 2030 15–24 20.5 18.5 16.8 15.3 13.8 13.3 12.7 11.8 25–34 31.0 28.2 25.4 23.1 21.2 20.4 19.2 17.5 35–44 38.3 34.2 31.1 28.3 25.6 24.7 23.5 21.6 45–54 41.2 37.0 33.2 30.1 27.5 26.4 25.0 22.9 55–64 40.0 35.4 31.5 28.4 25.8 24.8 23.6 21.8 65–74 34.2 30.5 27.1 24.2 21.9 21.1 19.9 18.4 75–84 27.7 24.5 21.9 19.6 17.7 16.9 16.0 14.9 ≥ 85 21.0 19.8 16.6 14.8 13.5 12.9 12.0 11.1 15–24 32.3 29.5 27.2 24.8 22.6 21.8 20.9 19.6 25–34 49.1 45.1 41.0 38.0 35.1 33.8 31.9 29.2 35–44 58.6 53.9 49.9 45.8 42.0 40.8 39.2 36.3 45–54 60.6 56.0 51.7 48.1 44.9 43.4 41.2 38.1 55–64 56.1 51.6 47.9 44.6 41.6 40.5 39.2 36.8 65–74 47.3 43.8 40.3 37.3 35.4 34.5 33.1 31.3 75–84 39.8 36.3 33.6 31.3 29.1 28.1 27.2 26.3 ≥ 85 33.5 31.6 28.3 26.0 24.4 23.8 22.5 21.1 15–24 8.3 6.9 5.9 5.2 4.5 4.3 3.9 3.5 25–34 12.4 10.7 9.1 7.6 6.6 6.2 5.7 5.0 35–44 17.6 14.2 11.8 10.2 8.8 8.2 7.4 6.4 45–54 21.9 18.0 14.8 12.0 10.0 9.5 8.7 7.5 55–64 24.7 19.9 15.8 13.1 10.7 9.9 8.7 7.3 65–74 23.1 19.1 15.7 12.7 10.2 9.5 8.5 7.0 75–84 19.6 16.4 13.5 11.2 9.3 8.6 7.6 6.3 ≥ 85 15.5 14.3 11.0 9.1 7.8 7.3 6.5 5.6 Estimated prevalence (%) Projected prevalence (%) Females Males Both sexes 10 for women peak at age group 55–64 (see Fig.4). The absolute prevalence levels in each age group have been consistently higher for males than for females. Fig. 3: Global trends in age pattern of tobacco use among males, 2000–2030 (estimates to 2020, projections to 2030) Fig. 4: Global trends in age pattern of tobacco use among females, 2000–2030 (estimates to 2020, projections to 2030) 0 10 20 30 40 50 60 70 80 90 100 15–24 25–34 35–44 45–54 55–64 65–74 75–84 ≥ 85 P re va le n ce o f cu rr en t to b ac co u se ( % ) 2000 2005 2010 2015 2020 2025 2030 0 10 20 30 40 50 60 70 80 90 100 15–24 25–34 35–44 45–54 55–64 65–74 75–84 ≥ 85 P re va le n ce o f cu rr en t to b ac co u se ( % ) 2000 2005 2010 2015 2020 2025 2030 11 3.1.4 Trends in prevalence of tobacco use by WHO region Table 4: Trends in prevalence of tobacco use among people aged 15 years and over, by WHO region, estimated and projected Estimated prevalence (%) Projected prevalence(%) Reduction target WHO region 2000 2005 2010 2015 2020 2022 2025 2030 Relative reduction % 2010-2025 30% reduction target Both sexes African Region 17.8 15.3 13.2 11.5 10.1 9.5 8.9 8.0 32% 9.3 Region of the Americas 26.8 23.9 21.3 19.2 17.3 16.6 15.6 14.2 27% 14.9 South-East Asia Region 51.2 43.6 37.2 32.2 28.0 26.5 24.6 22.0 34% 26.1 European Region 34.4 31.7 29.5 27.6 25.9 25.3 24.4 23.1 17% 20.6 Eastern Mediterranean Region 26.9 24.3 22.0 20.1 18.7 17.9 17.5 16.6 20% 15.4 Western Pacific Region 28.0 26.4 25.1 24.0 22.9 22.5 21.8 20.8 13% 17.6 Global 32.7 29.3 26.4 23.9 21.7 20.9 19.8 18.1 25% 18.4 Males African Region 28.7 25.1 22.2 19.7 17.6 16.6 15.8 14.3 29% 15.5 Region of the Americas 33.9 30.4 27.4 24.8 22.6 21.7 20.6 18.8 25% 19.2 South-East Asia Region 68.9 61.7 55.5 50.2 45.3 43.7 41.3 38.0 26% 38.9 European Region 46.4 42.5 39.0 35.9 33.1 32.0 30.6 28.3 22% 27.3 Eastern Mediterranean Region 43.7 40.4 37.4 34.9 33.2 31.9 31.6 30.4 16% 26.2 Western Pacific Region 50.8 48.5 46.5 44.7 43.0 42.4 41.2 39.6 11% 32.6 Global 49.1 45.1 41.6 38.4 35.5 34.4 32.9 30.6 21% 29.1 Females African Region 7.0 5.5 4.3 3.4 2.7 2.4 2.1 1.7 50% 3.0 Region of the Americas 19.7 17.4 15.3 13.5 12.0 11.4 10.6 9.5 30% 10.7 South-East Asia Region 33.5 25.4 18.9 14.2 10.6 9.4 7.9 6.0 58% 13.2 European Region 22.3 21.0 20.0 19.2 18.7 18.5 18.2 17.9 9% 14.0 Eastern Mediterranean Region 10.2 8.2 6.6 5.3 4.3 4.0 3.5 2.9 46% 4.6 Western Pacific Region 5.2 4.3 3.7 3.2 2.8 2.6 2.4 2.1 35% 2.6 Global 16.3 13.5 11.1 9.3 7.9 7.4 6.7 5.7 40% 7.8 Age-standardized tobacco use prevalence rates are declining on average in all WHO regions. The existing data suggest that the NCD 2025 target of a 30% reduction in tobacco use prevalence is on track to be achieved in just two WHO Regions: the African Region and the South-East Asia Region. The Region of the Americas appeared to be on track in the last round of WHO estimates two years ago but is now tracking towards a 27% relative reduction by 2025. The Eastern Mediterranean Region is projecting a 20% relative reduction (however as noted in Table 1 above, data are the least robust in this region), while the European Region is projecting at 17% relative reduction and the Western Pacific Region at 13%. 12 Looking at trends in tobacco use among men and region averages, none of the WHO Regions are projecting a 30% relative reduction. The best reduction in region average among men is in the African Region, at 29%, followed by the South-East Asia Region and Region of the Americas, at 26% and 25% respectively. Despite the good rate of reduction in the South-East Asia Region, the prevalence will be above 40% in 2025, which is as high as the prevalence among men in the Western Pacific Region, where reductions are the slowest (see Fig. 5.1). All WHO Regions are projecting an average relative reduction among women above 30% except the European Region. This Region is very different from the other five Regions in terms of women’s tobacco use. Prevalence is projected to reduce very little, from an average of 20.0% in 2010 to 18.2% in 2025 (see Fig. 5.2). Fig. 5: Trends in current tobacco use among both sexes combined aged 15 years and older, WHO region averages, 2000–2030 (estimates to 2020; projections to 2030) 0 10 20 30 40 50 60 70 80 90 100 2000 2005 2010 2015 2020 2025 2030 C u rr en t to b ac co u se p re va le n ce , b o th s ex es ( % ) African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region 13 Fig. 5.1: Trends in current tobacco use among males aged 15 years and older, WHO region averages, 2000–2030 (estimates to 2020; projections to 2030) Looking at tobacco use among males only, in 2000 the highest average prevalence rates were in the South-East Asia Region (69%), followed by the Western Pacific Region (51%). These two regions still had the highest rates in 2022, both over 40%. The Western Pacific Region has the flattest trend among all regions for men. Fig. 5.2: Trends in current tobacco use among females aged 15 years and older, WHO region averages, 2000–2030 (estimates to 2020; projections to 2030) 0 10 20 30 40 50 60 70 80 90 100 2000 2005 2010 2015 2020 2025 2030 African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region Males Current tobacco use prevalence (%) 0 10 20 30 40 50 60 70 80 90 100 2000 2005 2010 2015 2020 2025 2030 African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region Females Current tobacco use prevalence (%) 14 In 2000, the highest tobacco use prevalence among females by WHO region was 33% in the South-East Asia Region, but rapidly declining use rates have brought this below 10% in 2022. In 2022, the highest prevalence among females is seen in the European Region (18%). South-East Asia and the Americas regions have similar prevalence levels at around 10–11%. The lowest average rates among females continue to be seen in the African Region, Eastern Mediterranean Region, and Western Pacific Region, with rates of 2–4%. 15 3.1.5 Trends in prevalence of tobacco use by World Bank income group Table 5. Global trends in prevalence of tobacco use among people aged 15 years and older, by World Bank income group, estimated and projected Estimated prevalence (%) Projected prevalence (%) WB country income group 2000 2005 2010 2015 2020 2022 2025 2030 Both sexes High-income 33.0 30.0 27.2 24.9 22.9 22.2 21.2 19.6 Upper middle-income 27.2 25.6 24.3 23.1 22.0 21.6 20.9 19.9 Lower middle-income 43.1 37.0 31.7 27.5 24.0 22.7 21.1 18.8 Low-income 21.0 18.4 16.3 14.4 12.9 12.0 11.7 10.6 Global 32.7 29.3 26.4 23.9 21.7 20.9 19.8 18.1 Males High-income 41.4 37.4 33.8 30.7 28.1 27.2 25.9 23.8 Upper middle-income 47.0 44.7 42.7 40.7 38.8 38.1 37.0 35.2 Lower middle-income 60.6 54.3 48.7 43.8 39.6 38.0 35.9 32.8 Low-income 33.4 30.1 27.2 24.5 22.4 20.9 20.6 19.0 Global 49.1 45.1 41.6 38.4 35.5 34.4 32.9 30.6 Females High-income 24.6 22.5 20.6 19.0 17.7 17.2 16.4 15.4 Upper middle-income 7.3 6.5 6.0 5.5 5.2 5.1 4.9 4.6 Lower middle-income 25.6 19.6 14.8 11.2 8.4 7.5 6.4 4.8 Low-income 8.7 6.8 5.3 4.2 3.4 3.1 2.7 2.2 Global 16.3 13.5 11.1 9.3 7.9 7.4 6.7 5.7 Tobacco use prevalence is continuing to trend downwards over time in all World Bank country income groups. In 2000, the highest average rate was found among lower middle-income countries, but by 2022 their rate was essentially similar to those for high and upper middle-income countries at around 21–22%. Low-income countries have experienced the lowest average prevalence throughout the period 2000–2022, with rates declining from 21% in 2000 to 12% in 2022. These countries are projected to reach a prevalence rate of 11% in 2030 (see Table 5). Among men, upper and lower middle-income countries are expected to have the highest average prevalences in 2030 at 35% and 33% respectively. Their prevalences will be substantially higher than the rates for high-income countries as a group (24%) and low-income countries (19%). Among women, the average prevalence in all income groups except the high-income group is projected to reduce to under 5% by 2030. Average prevalence was highest in high-income countries in 2010, at 21%, and this group is projected to still rank the highest at 15% in 2030. The biggest reduction in prevalence among women is seen in the lower middle-income group, where the average halved from 15% in 2010 to 7.5% in 2022. 16 3.1.6 Trends in the number of tobacco users Table 6: Trends in the global number of tobacco users (millions) aged 15 years and older Number of tobacco users (millions) WHO region 2000 2005 2010 2015 2020 2022 2025 2030 Both sexes African Region 59 59 59 60 61 60 62 64 Region of the Americas 159 154 148 142 136 133 129 121 South-East Asia Region 488 471 452 436 420 411 402 387 European Region 229 218 207 195 184 179 173 164 Eastern Mediterranean Region 74 79 85 88 92 92 97 103 Western Pacific Region 353 365 371 374 372 370 365 357 Global 1,362 1,345 1,322 1,296 1,264 1,245 1,227 1,197 Males African Region 48 49 50 51 53 53 55 58 Region of the Americas 99 97 94 91 88 86 84 80 South-East Asia Region 342 345 345 345 343 340 338 334 European Region 153 144 135 127 118 114 109 101 Eastern Mediterranean Region 61 67 73 78 82 83 88 94 Western Pacific Region 321 335 344 348 348 347 343 337 Global 1,024 1,036 1,040 1,039 1,031 1,022 1,016 1,004 Females African Region 11 10 9 8 8 8 7 7 Region of the Americas 60 57 55 51 48 47 45 42 South-East Asia Region 146 127 107 91 77 71 64 54 European Region 76 74 71 69 66 65 64 62 Eastern Mediterranean Region 13 12 11 11 10 9 9 8 Western Pacific Region 32 30 28 26 24 23 22 20 Global 338 309 281 256 233 224 211 193 The total number of tobacco users for both sexes combined has declined steadily over the period 2000–2022. In 2000, an estimated 1.362 billion people aged 15 years and over were current users of one or more tobacco products. That number has declined steadily over time to reach 1.245 billion in 2022 and is projected to further decline to 1.20 billion by 2025 (see Table 6) In 2022, 82% of current tobacco users aged 15 years or above in the world were male. From 2000 to 2010, the number of male tobacco users globally aged 15 years and older increased each year, even as prevalence rates fell. The number of male tobacco users is estimated to have peaked in 2010 at 1.040 billion. This number is projected to keep reducing in future, and by 2030 should be down to 1.004 billion. However, in four out of six WHO regions, the number of male tobacco users rose between 2000 and 17 2015. The numbers of male tobacco users in South-East Asia and Western Pacific regions peaked in 2015 and started to decrease from then onwards, while the African and Eastern Mediterranean regions are expected to keep increasing until at least 2030 on current trends. The two regions with declining numbers of male tobacco users between 2000 and 2030 are the Region of the Americas and the European Region, where prevalence rates are reducing fast enough to keep ahead of population growth. The number of female current tobacco users aged 15 years or older has been declining in all WHO regions over the period 2000–2022, and this is expected to continue to 2030. There are already an estimated 115 million fewer female tobacco users in 2022 (224 million) than there were in 2000 (338 million). The total number of tobacco users among females is projected to decline to around 193 million by 2030. 18 3.1.7 Levels of tobacco use, smoking and cigarette use among adults in 2022 Although there is a wide diversity of products available in countries, the type of tobacco used in countries could be classified into three nested categories: (i) any tobacco use (smoked and/or smokeless); (ii) tobacco smoking (all forms including for example manufactured cigarettes, roll-your- own, shisha, bidis, kreteks and others; and (iii) cigarette smoking. Someone who reports using cigarettes is counted as a user for all three categories. Someone who uses only waterpipe is counted for both “the tobacco smoking” and the “any tobacco use” indicators. Someone who only uses nasal tobacco is counted for the “any tobacco use” indicator only. Every specific tobacco product fits into one, two or all three of these categories. The global dataset indicates that 20.9% of all persons aged 15 years and over used some form of tobacco on a current basis in 2022. Of all these tobacco users, 80% were current smokers with a prevalence of current tobacco smoking of 16.7%. Among tobacco smokers, 89% were cigarette smokers with a current cigarette smoking prevalence of 15.0% among all persons aged 15 years and over (see Fig. 6). Fig 6: Age standardized global prevalence of tobacco use by type, 2022 In 2022, the prevalence of current tobacco use among males aged 15 years and over was 34.4%. Of these, 83% consumed smoked tobacco products (global prevalence of 28.4%); see Fig. 6. These male smokers mostly used cigarettes (90%) with a prevalence level of 25.5%. In the same year, 7.4% of females of the same age were current users of any form of tobacco. Compared with males, a somewhat lower proportion used any smoking tobacco (69% at a prevalence of 5.1%.). However, of those who smoked, 86% smoked cigarettes (prevalence of 4.4%); see Fig. 7. 20.9 34.4 7.4 16.7 28.4 5.1 15.0 25.5 4.4 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Both sexes Men Women P re va le n ce ( % ) Any tobacco Smoked tobacco Cigarettes 19 Fig 7: Global number of tobacco users (millions) by type of tobacco, 2022 In terms of numbers of adult users, in 2022, there were an estimated 1.245 billion current tobacco users in the world, among whom 995 million were current tobacco smokers. Among smokers, around 890 million were currently smoking cigarettes; see Fig. 7. Of the estimated 1.245 billion current tobacco users globally, around 1.022 billion were men and 224 million were women. These numbers do not include adolescents aged under 15. Table 7: Age-standardised prevalence of tobacco use by type among the population aged 15 years and over, 2022 Males Females Both sexes Any tobacco Smoked tobacco Cigar- ettes Any tobacco Smoked tobacco Cigar- ettes Any tobacco Smoked tobacco Cigar- ettes WHO region African Region 16.6 14.3 12.9 2.4 1.5 0.8 9.5 7.9 6.9 Region of the Americas 21.7 19.8 16.8 11.4 10.8 9.5 16.6 15.3 13.2 South-East Asia Region 43.7 24.1 19.3 9.4 1.3 0.8 26.5 12.7 10.0 European Region 32.0 31.3 29.0 18.5 18.3 17.0 25.3 24.8 23.0 Eastern Mediterranean Region 31.9 28.1 22.6 4.0 2.3 1.3 17.9 15.2 12.0 Western Pacific Region 42.4 42.3 41.3 2.6 2.5 2.3 22.5 22.4 21.8 World Bank country income group High-income 27.2 25.2 21.9 17.2 16.5 14.9 22.2 20.9 18.4 Upper middle-income 38.1 38.1 37.0 5.1 5.0 4.6 21.6 21.5 20.8 Lower middle-income 38.0 24.0 19.6 7.5 1.7 1.1 22.7 12.9 10.4 Low-income 20.9 17.7 15.4 3.1 1.6 0.7 12.0 9.7 8.0 Global 34.4 28.4 25.5 7.4 5.1 4.4 20.9 16.7 15.0 1,245 1,022 224 995 843 152 890 759 131 0 200 400 600 800 1,000 1,200 1,400 Both sexes Men Women N o . o f u se rs ( m ill io n s) Any tobacco Smoked tobacco Cigarettes 20 In the European Region, 25.3% of all people aged 15 years and over were current users of tobacco; with almost all (98% among males and 99% among females) using a smoking product and again almost all using cigarettes; see Table 7. The lowest proportion of smokers among tobacco users is seen in the South-East Asia Region where 26.5% of people were current users of tobacco with less than half of these using a smoked tobacco product. There was a marked difference by sex with 55% of males using a smoked product compared with 14% of female tobacco users who were smokers (see Table 7). The largest proportion of smokers among tobacco users is found in the high-income country group, where 22.2% of adults were current tobacco users (27.2% of males and 17.2% of females). Of these, the large majority were current smokers (25.2% of males and 16.5% of females). This translates to 94% of current tobacco users being smokers (93% of male tobacco users and 96% of female tobacco users). The smallest proportion of smokers among tobacco users is found in the lower middle-income country group, where on average 22.7% of adults were current tobacco users in 2022, with only 12.9% using a smoked product. Among tobacco smokers globally, just under 90% smoked cigarettes. The proportion was highest in the Western Pacific Region, where almost all smokers smoke cigarettes, and lowest in the South-East Asia Region, where almost 80% of smokers used cigarettes. Table 8: Global number of tobacco users (millions) by type of tobacco used, 2022 Males Females Both sexes Any tobacco Smoked tobacco Cigar- ettes Any tobacco Smoked tobacco Cigar- ettes Any tobacco Smoked tobacco Cigar- ettes WHO region African Region 52.8 46.0 41.1 7.5 4.6 2.5 60.3 50.6 43.6 Region of the Americas 85.7 78.0 66.3 46.9 44.5 39.1 132.7 122.5 105.4 South-East Asia Region 340.0 189.0 151.3 71.3 10.0 5.8 411.3 199.0 157.1 European Region 113.8 111.2 103.0 65.5 64.9 60.1 179.3 176.1 163.0 Eastern Mediterranean Region 82.6 72.8 59.0 9.4 5.5 3.2 92.0 78.4 62.2 Western Pacific Region 346.8 346.1 338.3 23.1 22.2 20.1 369.8 368.4 358.4 World Bank country income group High-income 129.9 120.9 105.3 79.0 76.1 68.4 208.9 197.0 173.7 Upper middle-income 399.6 398.9 388.3 52.8 52.5 47.9 452.4 451.3 436.2 Lower middle-income 451.5 288.8 235.3 85.9 19.9 13.1 537.3 308.7 248.3 Low-income 40.7 34.6 30.0 6.1 3.2 1.4 46.8 37.8 31.4 Global 1021.7 843.2 758.9 223.7 151.7 130.7 1245.4 994.9 889.7 21 The WHO Region with the largest number of smokers was the Western Pacific Region, with 368 million smokers in 2022. The upper middle-income group of countries had the largest number of smokers, with 451 million smokers, or 45% of the global number (see Table 8). The largest number of female smokers per WHO Region are the 65 million living in the European Region, representing over 40% of all female smokers in the world. Around 10 million women smoke in the South-East Asia Region, while a total of 71 million use tobacco (smoked or smokeless tobacco) in this Region. The high-income countries have the largest proportion of female smokers at 50% of all women smokers, or 76 million smokers. 22 3.2 Progress towards meeting tobacco use reduction targets The NCD GAP includes a target for reducing the global prevalence of tobacco use (smoked and smokeless tobacco) among people aged 15 years and older by 30% by the year 2025, relative to 2010. The likelihood of achieving the tobacco use reduction target was assessed for 194 WHO Member States. In total, 165 countries have results from the analysis of tobacco use trends for this report. Collectively they cover 97% of the world’s population. Countries were grouped into the following categories: likely to achieve a 30% relative reduction; likely to achieve a decrease in prevalence but less than 30%; unlikely to experience a significant change in prevalence; likely to experience an increase in prevalence; or did not have enough data for calculating a trend. The results are summarised in Table 9. Table 9: Global status of tobacco use prevalence reduction target, 2022 Number of countries that… WHO Region are likely to achieve a 30% relative reduction are likely to achieve a decrease in prevalence but less than 30% are unlikely to experience a significant change in prevalence are likely to experience an increase in prevalence did not have enough data for calculating a trend were assessed in total Global 56 94 9 6 29 194 African Region 22 15 1 1 8 47 Region of the Americas 13 13 0 0 9 35 South-East Asia Region 2 8 0 1 0 11 European Region 11 34 3 1 4 53 Eastern Mediterranean Region 2 8 3 3 5 21 Western Pacific Region 6 16 2 0 3 27 On current trends, 56 countries are likely to achieve at least a 30% relative reduction in tobacco use by 2025, assuming they can continue implementing tobacco control measures at the current pace or faster. Another 94 countries are experiencing a statistically significant downward trend but are unlikely to achieve the target by 2025 without accelerating efforts. Within this group of 94 countries are 11 with a relative reduction that calculates to 30% or above but who are not classified as on track because of statistical uncertainty around their estimates. Nine countries are neither increasing nor decreasing their rates of tobacco use over time. Six countries are experiencing an increase in tobacco use rates. The remaining 29 countries have no trend estimates in this report due to absence of, or insufficiencies in, the available survey data. The countries are listed by category in Annex Table A1.7. Compared to the last assessment of countries on track to achieve the NCD GAP target two years ago, there is a net loss of four countries from the group expected to achieve the target. One country has accelerated its reduction rate and is now on track (Cambodia), one country previously had 23 insufficient data and are now evidently on track (United Arab Emirates), four countries fell back from being on track into a slower rate of reduction (Belize, Cook Islands, Mexico and Rwanda), and two countries previously on track have no new survey since 2012 and so their current trajectories are unknown (Eritrea and Mozambique). The other 54 countries in the group on track for the target were already on track two years ago. Fig. 8: Status of tobacco use prevalence reduction target by WHO region, 2022 The 56 countries currently on track to meet the reduction target represent 29% of the world’s countries and 40% of the world’s population. They are spread across all six WHO regions, but the African Region has the largest proportion of its Member States on track, with 22 countries or almost half of its countries, followed by the Region of the Americas with over one third of its countries on track (see Fig. 8). The South-East Asia Region has the highest proportion of its population living in countries on track – 70% of the total population of the Region. The lowest proportion is in the Western Pacific Region, where 12% of the population lives in countries on track. The Western Pacific is also the only region where almost 100% of the population live in countries where tobacco use prevalence is in decline. The European Region has 97% of its population in countries experiencing an overall decline in tobacco use (see Table 10). 56 22 13 2 11 2 6 94 15 13 8 34 8 16 9 1 3 3 26 1 1 1 3 29 8 9 4 5 3 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Global African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region % o f co u n tr ie s in t h e re gi o n ( n u m b er o f co u n tr ie s in b ar s) WHO Member States by category of trend in tobacco use prevalence, including NCD GAP target assessment 2010-2025 Data insufficient or not available Increasing No change Decreasing but not on track for a 30% reduction Decreasing and on track for a 30% reduction 24 Table 10: Status of tobacco use prevalence reduction target by WHO region, 2022 WHO Region are l ikely to achieve a 30% relative reduction are l ikely to achieve a decrease in prevalence but less than 30% are unl ikely to experience a s igni ficant change in prevalence are l ikely to experience an increase in prevalence did not have enough data for ca lculating a trend were assessed in tota l African Region 53% 37% 0% 1% 9% 100% Region of the Americas 38% 58% – – 4% 100% South-East Asia Region 70% 17% – 13% – 100% European Region 22% 75% 1% 0% 1% 100% Eastern Mediterranean Region 32% 29% 11% 16% 12% 100% Western Pacific Region 12% 88% 0% – 0% 100% Global 40% 51% 1% 5% 3% 100% a Population figures are for all ages in 2022 Proportion (%) of region's populationa l iving in countries that… 25 3.3 Smokeless tobacco use among people aged 15 years and older Data on smokeless tobacco use among persons aged 15 years and older were available from 89 countries (46% of WHO Member States) between 2012 and 2022, representing 78% of the global population aged 15 years and above. These estimates cover both exclusive use of smokeless tobacco products and dual use of such products along with smoked tobacco products. However, the data allow only a combined estimate of “any smokeless tobacco use”, with no distinction between exclusive and dual use. For this analysis, for countries where no data were available, it was assumed that use of smokeless tobacco was negligible, and the prevalence is set to zero. This assumption may result in an underestimate of smokeless tobacco use at global and regional levels. Table 11: Prevalence of smokeless tobacco use and number of users aged 15 years and older, by sex, by WHO region and by World Bank country income group Based on the available data, the average prevalence of current smokeless tobacco use among adults in the world is estimated at 6.3% – 9.0% among males and 3.5% among females (see Table 11). The highest use rates are in the South-East Asia Region, where 24.9% of males and 11.8% of females, on average, use smokeless tobacco. The lowest average rates are seen in the Region of the Americas, where 1.2% of adults are current users of smokeless tobacco – 2.2% of males and 0.3% of females. Smokeless tobacco use is moderately high among men in the Eastern Mediterranean Region, where an estimated 5.4% of adults are current users (see Fig. 9). Males Females Both sexes Males Females Both sexes African Region 2.9 1.4 2.2 9 5 14 Region of the Americas 2.2 0.3 1.2 9 1 10 South-East As ia Region 24.9 11.8 18.4 191 88 280 European Region 2.6 0.3 1.4 9 1 10 Eastern Mediterranean Region 8.9 1.8 5.4 22 4 27 Western Paci fic Region 2.3 0.4 1.3 18 3 21 High-income 3.1 0.4 1.7 15 2 17 Upper middle-income 1.7 0.3 1.0 17 3 20 Lower middle-income 18.1 8.0 13.0 216 94 310 Low-income 5.3 2.0 3.6 11 4 15 Global 9.0 3.5 6.3 259 103 362 The average estimates were constructed from surveys conducted in countries in the period 2012–2022 and applied to each country’s United Nations estimated population in 2021. WHO region World Bank country income group Average prevalence rate (%) Estimated no. of smokeless tobacco users (mi l l ions) 26 Fig. 9: Prevalence of smokeless tobacco use, people aged 15 years and older Note: The average estimates were constructed from surveys conducted in countries in the period 2012–2022 and applied to each country’s population in 2021. See Annex 2.1 for more information. These prevalence estimates translate to at least 362 million adult users of smokeless tobacco globally – 259 million men and 103 million women. Over 280 million smokeless tobacco users, or 77% of the global total, live in the South-East Asia Region. The region with the second highest burden of smokeless tobacco use is the Eastern Mediterranean Region where at least 27 million adult smokeless tobacco users live; at least 21 million users live in the Western Pacific Region. Each WHO region is estimated to have at least 10 million adult smokeless tobacco users. Of the World Bank country income groups, the heaviest burden of smokeless tobacco use is carried by the lower middle-income group of countries where prevalence is around 13%, totalling 310 million current users (86% of total users globally). The second highest average prevalence is among low- income countries where an estimated 3.6% of adults are currently using smokeless tobacco products. 6 2 1 18 1 5 1 9 3 2 25 3 9 2 4 1 0 12 0 2 0 0 5 10 15 20 25 30 Global African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region Prevalence of current smokeless tobacco use (%) Both sexes Males Females 27 3.4 Smokeless tobacco use among adolescents aged 13–15 years Data on smokeless tobacco use among adolescents aged 13–15 years are available from 123 countries (63% of WHO Member States and 73% of the global population aged 13–15 years) who asked questions about smokeless tobacco use in a school-based survey between 2012 and 2022 among children aged 13–15 years or in equivalent grades. While prevalence is unknown in countries who are not monitoring smokeless tobacco use among adolescents aged 13–15 years, for this analysis it is assumed that use rates are negligible in countries with no data. On average globally, around 3.1% of adolescents aged 13–15 years report current use of smokeless tobacco products: 3.7% of boys and 2.5% of girls. Use rates are highest in the Eastern Mediterranean and South-East Asia regions where respectively 4.2% and 3.6% of adolescents aged 13–15 years use smokeless tobacco. These two regions, along with the Western Pacific Region, are also those with the best survey coverage – with at least 77% of the population aged 13–15 years in all three regions asked about their use of smokeless tobacco products. The lowest data coverage rate was in the African Region (35% of the population aged 13–15), followed by the European Region (51%). Table 12: Prevalence of smokeless tobacco use and number of users aged 13–15 years, by sex, by WHO region, and by World Bank country income group At least 7 million boys and 5 million girls globally are current smokeless tobacco users, totalling 12 million adolescents aged 13–15 years who use smokeless tobacco products. These numbers are un underestimate as there are 71 countries with no data on this indicator. Boys Girls Both sexes Boys Girls Both sexes African Region 4.5 3.6 4.1 2 1 3 Region of the Americas 2.4 1.6 2.0 1 0 1 South-East As ia Region 4.4 2.8 3.6 3 1 4 European Region 2.5 1.4 2.0 0 0 1 Eastern Mediterranean Region 5.0 3.4 4.2 1 1 2 Western Paci fic Region 2.1 1.0 1.6 1 0 1 High-income 2.0 1.1 1.6 0 0 1 Upper middle-income 2.4 1.4 1.9 1 1 2 Lower middle-income 4.3 2.9 3.7 4 3 7 Low-income 5.1 3.8 4.4 1 1 2 Global 3.7 2.5 3.1 7 5 12 WHO region World Bank country income group Average prevalence rate among people aged 13-15 (%) Estimated no. of smokeless tobacco users aged 13-15 (mi l l ion) The average estimates were constructed from surveys conducted in countries in the period 2012–2022 and applied to each country’s United Nations estimated population in 2021. 28 Table 12 shows that rates of smokeless tobacco use among adolescents aged 13–15 years are highest on average in the Eastern Mediterranean Region and African Regions, at just over 4%. The data in both these regions are incomplete, at 77% and 35% population coverage of surveys respectively. Average prevalence is lowest in the Western Pacific Region at 1.6%, however this aggregate masks the fact that the prevalence is remarkably high in some of the Pacific Island nations, for example, above 10% in Kiribati, Marshall Islands, Micronesia (Federated States of) and Papua New Guinea (5). Fig. 10: Prevalence of smokeless tobacco use, adolescents aged 13–15 years, 2012–2022 Note: The average estimates were constructed from surveys conducted in countries in the period 2012–2022 and applied to each country’s population in 2021. See Annex 2.2 for more information. Use of smokeless tobacco among adolescents aged 13–15 years is highest on average in low-income countries, at 4.4% (see Fig. 10). This group has the lowest coverage of surveys that ask specifically about smokeless tobacco use – only 31% of the group’s population has been surveyed in the period – therefore this income group’s estimate is the least reliable of all income groups. 2% 5% 2% 4% 2% 4% 4% 1% 3% 1% 3% 2% 4% 2% 2% 4% 2% 4% 2% 4% 3% 0% 5% 10% 15% Western Pacific Region Eastern Mediterranean Region European Region South-East Asia Region Region of the Americas African Region Global Prevalence of current smokeless tobacco use (%) Both sexes Girls Boys 29 3.5 Any tobacco use among adolescents aged 13–15 years In the decade 2012–2022, 148 countries ran at least one school-based survey of children aged 13–15 years asking about tobacco use. Collectively, these surveys are representative of 80% of the world’s school-going adolescents aged 13–15 years, which makes it possible to derive global and regional average rates of tobacco use for this age group. The term “any tobacco use” is defined as use of any type of tobacco – smoked and/or smokeless. This excludes use of products that do not contain tobacco, such as electronic nicotine delivery systems (ENDS). Note that many of the European Region countries monitor using the Health Behaviour in School-Aged Children Survey (HBSC), which asks about cigarette smoking instead of all tobacco use. To make a global estimate possible despite the data gaps in the European Region, this analysis assumes that cigarette smoking rates in this region closely approximate and can stand in for tobacco use rates in the countries with no data. The global dataset indicates that at least 37 million adolescents aged 13–15 years are current users of some form of tobacco – 25 million boys and 12 million girls. On average, around 10% of adolescents aged 13–15 years globally report using one or more types of tobacco product: 13% of boys and 7% of girls; see Table 13. Table 13: Prevalence of tobacco use and number of adolescents aged 13–15 years using tobacco, by sex, by WHO region and by World Bank country income group Average prevalence rate among people aged 13-15 (%) Estimated number of tobacco users aged 13-15 (millions) Boys Girls Both sexes Boys Girls Both sexes WHO region African Region 11.1 7.2 9.2 5 3 7 Region of the Americas 10.3 9.4 9.9 2 2 5 South-East Asia Region 14.0 6.2 10.3 8 3 11 European Region 11.5 10.1 10.8 2 2 4 Eastern Mediterranean Region 15.0 7.7 11.4 4 2 5 Western Pacific Region 12.0 3.1 7.8 5 1 6 World Bank country income group High-income 9.4 8.7 9.0 2 2 4 Upper middle-income 12.8 6.2 9.7 7 3 10 Lower middle-income 13.1 6.4 9.9 13 6 19 Low-income 12.0 7.5 9.8 3 2 5 Global 12.5 6.8 9.7 25 12 37 The average estimates were constructed from surveys conducted in countries in the period 2012–2022 and applied to each country’s United Nations estimated population in 2021. 30 Of all WHO Regions, the South-East Asia Region has the largest number of adolescent tobacco users aged 13–15 years (11 million, or 30% of the global total). All WHO Regions have remarkably similar average prevalences of current tobacco use, in the range 9–11%, except the Western Pacific Region which has the lowest average rate at 8% (see Fig. 11). Considering that the Western Pacific Region average is heavily weighted by the prevalence in China (7%), the average for the remainder of this Region’s countries is similar to the other WHO Regions at 9%. Among boys, the highest average prevalence of tobacco use is in the Eastern Mediterranean Region, where 15% of boys aged 13–15 years are currently using tobacco, followed by the South-East Asia Region at 14%. Average prevalence is lowest in the Region of the Americas, where 10% of boys use any form of tobacco. The other WHO Regions range between 11% and 12% prevalence. Fig. 11: Prevalence of current tobacco use, adolescents aged 13–15 years, by WHO region Note: The average estimates were constructed from surveys conducted in countries in the period 2012-2022 and applied to each country’s population in 2021. See Annex 2.3 for more information. Among girls, the Region of the Americas and the European Region have the highest average rates at 9–10%. The lowest average prevalence rate among girls is in the Western Pacific Region (3%), again heavily weighted by prevalence among girls in China (2%). 12% 15% 11% 14% 10% 11% 12% 3% 8% 10% 6% 9% 7% 7% 8% 11% 11% 10% 10% 9% 10% 0% 5% 10% 15% Western Pacific Region Eastern Mediterranean Region European Region South-East Asia Region Region of the Americas African Region Global Prevalence of current tobacco use (%) Both sexes Girls Boys 31 The least differentiation between boys’ and girls’ tobacco use rates is seen in the Region of the Americas (girls 9% and boys 10%) and the European Region (girls 10% and boys 11%). Fig. 12: Prevalence of current tobacco use, adolescents aged 13–15 years, by World Bank income group Note: The average estimates were constructed from surveys conducted in countries in the period 2012-2022 and applied to each country’s population in 2021. See Annex 2.3 for more information. Over 19 million adolescent tobacco users – or 51% of the global number – live in lower middle- income countries. A further 10 million live in upper middle-income countries, 5 million in low-income countries, and 4 million in high-income countries. As for WHO Regions, all income groups of countries have very similar average prevalences of current tobacco use – all around 10%, with high-income countries slightly lower at 9%; see Fig. 12. The high- income countries also have the lowest prevalence among adolescent boys at 9%, while the average for boys in all other World Bank income groups is around 12–13%. Among adolescent girls, the opposite is the case; the average prevalence is highest in high-income countries at 9%, while the other groups have averages around 6-7%. It should be noted that the prevalences in high-income countries could be understated, since many countries’ data in this group are sourced from the HBSC, which – except in a few countries – asks only about cigarettes and no other forms of tobacco. 12% 13% 13% 9% 12% 7% 6% 6% 9% 7% 10% 10% 10% 9% 10% 0% 5% 10% 15% Low income Lower middle income Upper middle income High income Global Prevalence of current tobacco use (%) Both sexes Girls Boys 32 3.6 Cigarette smoking among adolescents aged 13–15 years In the decade 2012–2022, 149 countries ran at least one school-based survey of children aged 13–15 years asking about cigarette use. Collectively, these surveys are representative of 81% of the world’s school-going adolescents aged 13–15 years, which makes it possible to derive global and regional average rates of cigarette smoking for this age group. Table 14: Prevalence of current cigarette smoking and number of adolescents aged 13–15 years smoking cigarettes, by sex, by WHO region and by World Bank country income group Globally, an estimated 19 million adolescents aged 13–15 years (13 million boys and 6 million girls) are current cigarette smokers. Around 5 million adolescent cigarette smokers – or 26% of the global number – live in the South-East Asia Region, and 3 million live in each of the other Regions, except the Eastern Mediterranean where 2 million live (see Table 14.). Boys Girls Both sexes Boys Girls Both sexes African Region 5.5 2.5 4.0 2 1 3 Region of the Americas 6.0 6.1 6.0 1 1 3 South-East As ia Region 7.1 1.7 4.5 4 1 5 European Region 8.1 7.7 7.9 1 1 3 Eastern Mediterranean Region 6.7 1.9 4.3 2 0 2 Western Paci fic Region 6.1 2.2 4.3 2 1 3 High-income 5.6 6.1 5.8 1 1 2 Upper middle-income 6.7 4.1 5.4 3 2 5 Lower middle-income 6.8 1.9 4.4 7 2 9 Low-income 5.7 2.6 4.2 1 1 2 Global 6.5 3.0 4.8 13 6 19 Average prevalence rate among people aged 13-15 (%) Estimated number of cigarette smokers aged 13-15 (mi l l ions) WHO region World Bank country income group The average estimates were constructed from surveys conducted in countries in the period 2012–2022 and applied to each country’s United Nations estimated population in 2021. 33 Fig. 13: Average prevalence of current cigarette smoking, adolescents aged 13–15 years, by WHO region Note: The average estimates were constructed from surveys conducted in countries in the period 2012–2022 and applied to each country’s population in 2021. See Annex 2.3 for more information. Globally an average of around 5% of adolescents aged 13–15 years report smoking cigarettes (6% of boys and 3% of girls). The average prevalence of cigarette smoking is highest in the European Region and the Region of the Americas at 8% and 6% respectively. All other WHO Regions have remarkably similar averages at around 4% (see Fig. 13). Among boys, the highest average rate of cigarette smoking is just over 8% in the European Region. The other five WHO regions have average rates among boys of around 6–7%. Among girls, the European Region has the highest average rate of cigarette smoking at just under 8%, followed by the Region of the Americas at 6%. The other four WHO regions have distinctly lower average rates among girls at around 2%. 6% 7% 8% 7% 6% 6% 6% 2% 2% 8% 2% 6% 2% 3% 4% 4% 8% 4% 6% 4% 5% 0% 5% 10% 15% Western Pacific Region Eastern Mediterranean Region European Region South-East Asia Region Region of the Americas African Region Global Prevalence of current cigarette smoking (%) Both sexes Girls Boys 34 Fig. 14: Average prevalence of current cigarette smoking, adolescents aged 13–15 years, by country income group Note: The average estimates were constructed from surveys conducted in countries in the period 2012–2022 and applied to each country’s population in 2021. See Annex 2.3 for more information. Around 9 million adolescent cigarette smokers – or 46% of the global total – live in lower middle- income countries. The next largest group, 5 million, live in upper middle-income countries, while 2 million live in high-income countries and another 2 million live in low-income countries. There is little difference in average cigarette smoking prevalence among adolescents aged 13–15 years across the World Bank country income groups. They range from 4% to 6% around a global average of 5%; see Fig. 14. Among boys, cigarette smoking prevalence is similar across income groups of countries, ranging from 6–7%. In contrast, rates among girls vary, with the highest average at 6% for high-income countries and the lowest average at 2% for lower middle-income countries. The differential between boys and girls is most stark in lower middle-income countries, where on average 7% of boys and 2% of girls are currently using cigarettes. 6% 7% 7% 6% 6% 3% 2% 4% 6% 3% 4% 4% 5% 6% 5% 0% 5% 10% 15% Low–income Lower middle–income Upper middle–income High–income Global Prevalence of current cigarette smoking (%) Both sexes Girls Boys 35 3.7 Use of electronic nicotine devices including e-cigarettes ENDS, of which electronic cigarettes are a common type, are devices that heat a liquid to create an aerosol that is inhaled by the user. The liquid contains nicotine (but not tobacco) and other chemicals that may be toxic to people’s health (11). Despite sometimes appearing similar, heated tobacco products (HTPs) – products that heat tobacco to create an aerosol – are not ENDS (12). Data on HTP use instead falls under the categories “smoked tobacco use” and “any tobacco use”, while ENDS use is a separate category to be monitored alongside tobacco use. Monitoring the use of ENDS among both adults and adolescents is necessary to understand the level of use in the population and changes in this level of use over time. Countries began collecting data on current use of ENDS among adults in 2013. By 2022, 70 countries had nationally representative data available, and 69% of the global adult population has now been surveyed at least once. Among adolescents, national data are available from 102 countries since 2013, but these surveys cover only 38% of the global population aged 13-17. Three out of six WHO regions have sufficient survey coverage to produce relatively robust estimates of the prevalence of e-cigarette use among adults: the Region of the Americas, the European Region and the Western Pacific Region. The South-East Asia Region has a good population coverage level at 91%, but only 4 countries have a survey in the dataset for this analysis. The survey coverage in the African Region and Eastern Mediterranean Region are too low to yield representative region averages. Table 15: Availability of national population-based surveys reporting prevalences of current e-cigarette use among adults 2013–2022 Concerning current use of e-cigarettes among young people, data are increasingly available from school-based surveys such as the Global Youth Tobacco Survey (GYTS) since 2013, the HBSC since 2014, the European School Survey Project on Alcohol and other Drugs (ESPAD) since 2015, the Global School-Based Students Health Survey (GSHS) since 2019, and other surveys run by countries. Table 16: Global availability of national school-based surveys reporting prevalences of current e-cigarette use among adolescents 2013–2022 Global African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region No. of countries 70 / 194 2 / 47 14 / 35 4 / 11 37 / 53 3 / 21 10 / 27 % of population covered 69% 8% 66% 91% 79% 7% 92% Global African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region No. of countries 102 / 194 6 / 47 25 / 35 1 / 11 44 / 53 7 / 21 19 / 27 % of population covered 38% 4% 77% 2% 81% 21% 96% 36 In total, 102 countries now have at least one nationally representative school-based survey that monitors e-cigarettes prevalence among adolescents aged somewhere in the age range 13–17 years. While these 102 countries represent 53% of all countries, they have in aggregate surveyed only 38% of the world’s population aged 13–17. Of these, 65 countries are monitoring the age group 13–15 years. In contrast, the European Region surveys tend to be about school-going children aged 15–16. The WHO Region with the largest proportion of the adolescent population surveyed is the Western Pacific Region, where 70% of the countries had surveys covering 96% of the Region’s adolescents. The European Region had the second best representation, with 83% of countries and 81% of the adolescent population covered in the dataset. E-cigarette use among adolescents in the African, South-East Asia and Eastern Mediterranean Regions is particularly poorly covered by survey data. In the South-East Asia Region, only 2% of the population aged 13–17 were asked about current e-cigarette use in surveys (one country). In summary, it is not possible to calculate global estimates of e-cigarette use among adults or adolescents at the present time. To enable a robust estimate of global trends in e-cigarette use, more countries need to add the question to their population-based surveys. In the meantime, we may refer to the surveys of countries who have begun monitoring e-cigarette use, as listed in Annex 2.4 and Annex 2.5. 37 4. Discussion The estimates and trends in this report are recalculated each biennial round after adding new surveys to the previous dataset, leading to increasingly robust results. This means that the results in this report cannot be directly compared with earlier reports in the WHO global report on trends in prevalence of tobacco use 2000–2025 series, since the dataset is significantly improved each time, and all trend lines are recalculated for all countries. The downward trend in tobacco use currently seen at global level is encouraging and reflects the efforts being made in many countries to implement tobacco control measures. Already 151 countries have put in place at least one of the MPOWER demand-reduction measures of the WHO FCTC at best-practice level (5), and 150 countries are seeing their tobacco use rates declining. However, it is important to note that since the last round of WHO estimates two years ago, there is an overall reduction in the number of countries on track to reach the NCD GAP target from 60 down to 56 countries. Analysis for this report suggests that there are only six countries in the world where tobacco use is still rising: three are in the Eastern Mediterranean Region (Egypt, Jordan and Oman), one is in the African Region (Congo), one is in the European Region (Republic of Moldova) and one is in the South- East Asia Region (Indonesia). There may be other countries experiencing rising tobacco use rates among the 29 countries that have insufficient data to measure the trend, but even in the unlikely scenario that all 29 have increasing rates, the total would be 35 countries, with all together only 8% of the world’s population. Since 2020, the impact of the COVID-19 pandemic varied enormously across countries and likely had an impact on the trends in many of them. Hence the pathway towards the 2025 global voluntary tobacco reduction target of 30% using 2010 as a baseline appears to have altered in some countries during the pandemic. As well as individuals changing their tobacco use behaviour (13,14,15), it is possible the number of smokers in some countries could have been reduced by potentially higher COVID-19 related mortality among smokers (16). This question is worthy of further research. While tobacco use prevalence is declining in all WHO Regions, population growth is preventing the rate reductions from translating into reduced numbers of users in two of the six WHO Regions. The rate reductions need to be more dramatic to halt the continuing rise in the number of tobacco users in the African Region and the Eastern Mediterranean Region. While the slope of the decline in the Western Pacific Region in aggregate is the flattest slope among all regions, it should be noted that the average rates for all indicators of the Western Pacific Region largely reflect China’s data, since 75% of the region’s population aged 15 years or older lives in China. Smokeless tobacco estimates are a guide only. Their reliability is affected by data gaps. Even in regions where smokeless tobacco use rates seem to be low, true levels of use are unknown because many countries do not monitor smokeless tobacco use. While global targets to reduce tobacco use are measured using data on people aged 15 years and older, it is important to also monitor what is happening among adolescents in each country. Use 38 rates among adolescents are a harbinger of future levels of tobacco use among young adults, particularly because nicotine is an addictive substance, and many users find it difficult to quit after forming the habit at a young age (17). While derivation of information about trends in tobacco use and e-cigarette use in the adolescent population remains challenging, particularly at the global level, some countries are frequently monitoring knowledge, attitudes and practices in surveys among adolescents (18,19,20). The surveys consistently show that children aged 13–15 years in most countries with data can acquire tobacco and other nicotine products for their own use. While restrictive e-cigarette regulations do help reduce the chance that adolescents report current e-cigarette use (18), the minority have concerns for long-term addiction and health risks (19). Limitations The estimates are only as robust as the data allow. Countries have variable quantities and qualities of data, and this directly influences the quality of modelled results for each country. For example, the focus year of this report is 2022, but in fact only 6 national surveys from 2022 were available when WHO calculated the trend estimates in this report. Therefore, almost all 2022 estimates are modelled based on older data. Many factors can affect the quality of the information collected in population surveys, such as how the questions are framed, clarity on which types of tobacco are being asked about, how candid they can expect respondents to be because of the collection mode or privacy concerns, appropriate sampling and training and supervision of data collectors. The results of country efforts in tobacco control are only measured once the survey is done, after the policy changes are made. Not all countries run frequent surveys. To help readers understand how current the information is, Appendix Table A1.6 records the year of the most recent survey used in the trend estimate for each country. Some countries model their own trends and projections, especially those with their own tobacco use reduction targets. Each model uses different methods and different data from the methods and data used here, and therefore can produce different results and conclusions. WHO estimates are not intended to challenge countries’ own analyses, but rather to complement them by providing internationally comparable estimates for all WHO Member States. Estimates of prevalence of tobacco use among adolescents and smokeless use among adults are calculated for a single point in time, although it was necessary to use surveys that ran over a full decade to have sufficient countries represented to make the estimates globally representative. This creates comparability issues because prevalence can change significantly over a decade. 39 5. Conclusion While prevalence is decreasing in most countries, tobacco-related deaths can be expected to remain high until all the people who are still using tobacco in 2022, or formerly used tobacco over a long period in their life, have passed through the years when they are at greatest risk of dying from a tobacco-related illness. Countries implementing strong tobacco control measures can expect to wait about 30 years between turning the prevalence rate from increasing to decreasing and seeing an associated turnaround in the number of deaths due to tobacco (21). A rising number of deaths therefore is not a sign of failure of tobacco control efforts; rather, it is part of turning the tide for the next generation. The main influence on each country’s tobacco use trend is the effort the country invests in tobacco control. These efforts start with adopting a whole of government approach for multisectoral action to reduce tobacco use, guided by the WHO FCTC. The WHO MPOWER package of key demand- reduction measures, such as high tax and prices, smoke-free public places, large graphic health warnings on products and comprehensive bans on tobacco advertising, promotion and sponsorship are measures proven to reduce prevalence if implemented at the highest level. Coupled with offering support to tobacco users to quit, properly implemented tobacco control programs and firewalling of tobacco control policies from industry influence go a long way to ensure a sustained decline in tobacco use prevalence. Routine and timely monitoring of policy and prevalence, along with continual advocacy actions, are key enabling factors. Many countries are still not monitoring at a sufficient level to fully inform their tobacco control policy priorities going forward. At a minimum, countries need to carry out research and establish surveillance/monitoring systems as per Article 20 of the WHO FCTC. The monitoring should keep abreast of developments in use of newer tobacco products and other nicotine products, even when the country has banned the sale or believes that their use is negligible. Only data will reveal the reality on the ground. Smokeless tobacco use is still a concern in many countries where less attention has been paid to reducing the demand for it. Reducing rates of smokeless tobacco use is key to reducing rates of tobacco use in countries where smokeless tobacco products are popular or on the horizon as the next direction for the industry. In regions where smokeless tobacco use rates seem negligible, monitoring is key to capturing changes in trends in smokeless tobacco use. Use of tobacco and other nicotine products among adolescents is an important focus for both monitoring systems and policy response. This report shows that traditional tobacco products are well-covered globally in school-based surveys of health behaviour and tobacco and other drug use. However, data on uptake of the newer products is still relatively scant. Countries need these data to counter tobacco and associated industries’ claims that adolescents are not being targeted as new clients. This report shows that prevalence of tobacco use is remarkably standard all around the world. Despite the efforts of countries to raise awareness of the dangers and restrict legal access to 40 adults only, young people are still reporting regular use of the products, easy access to purchasing them, and low concerns about becoming addicted (19,20). Gathering data from adolescents on their knowledge, attitudes and practices is the most powerful way to combat the industry and shape effective policies that prevent initiation of tobacco use. 41 References 1. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2005 (http://apps.who.int/iris/bitstream/10665/42811/1/9241591013.pdf, accessed 10 Oct 2023). 2. United Nations General Assembly. Resolution adopted by the General Assembly on Work of the Statistical Commission pertaining to the 2030 Agenda for Sustainable Development, 6 July 2017 (https://undocs.org/A/RES/71/313, accessed 7 Oct 2021). 3. WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Geneva: World Health Organization; 2013 (https://iris.who.int/handle/10665/94384, accessed 10 October 2023). 4. 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April 2023, University of Waterloo (https://profglantz.files.wordpress.com/2023/06/2023-itc-canengus-ecig-youth-report-hammond-et- al.pdf, accessed 22 October 2023). 21. Thun M, Peto R, Boreham J and Lopez A. “Stages of the cigarette epidemic on entering its second century”, Tobacco Control 2012;21:96-101 (https://tobaccocontrol.bmj.com/content/tobaccocontrol/21/2/96.full.pdf, accessed 10 October 2023). 43 Annex 1: Tables The following tables appear in this annex and are also provided in table format in the WHO Global Health Observatory at https://www.who.int/data/gho/data/themes/theme-details/GHO/tobacco- control. Table A1.1. Current tobacco use rates among people aged 15 years and older, 2022 estimates Table A1.2. Current tobacco smoking rates among people aged 15 years and older, 2022 estimates Table A1.3. Current cigarette smoking rates among people aged 15 years and older, 2022 estimates Table A1.4. Number of tobacco users and tobacco smokers aged 15 years and older, 2022 estimates Table A1.5. Current tobacco use prevalence trends among people aged 15 years and older, 2000–2030, not age-standardized Table A1.6. Characteristics of the most recent survey in the survey set used to produce the estimates Table A1.7. Current tobacco use relative reduction category, 2022 44 Table A1.1. Current tobacco use rates among people aged 15 years and older, 2022 estimates Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate GLOBAL — — — — — — — — — 20.9 34.4 7.4 AFRICAN REGION — — — — — — — — — 9.5 16.6 2.4 Algeria DZA 16.3 21.6 27.0 31.6 41.9 52.3 0.4 0.7 0.9 21.2 41.8 0.7 Angola AGO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Benin BEN 3.9 5.5 7.2 6.7 9.5 12.2 1.0 1.7 2.3 6.3 10.7 1.9 Botswana BWA 13.3 18.1 22.9 22.1 30.2 38.3 4.8 6.5 8.1 18.7 30.2 7.2 Burkina Faso BFA 8.3 13.5 18.7 14.3 21.7 29.1 2.4 5.5 8.5 14.3 22.5 6.0 Burundi BDI 6.2 10.0 13.9 10.0 15.2 20.5 2.4 5.0 7.6 11.2 17.1 5.3 Cabo Verde CPV 7.8 10.5 13.3 12.3 16.2 20.1 3.4 5.0 6.7 11.0 16.7 5.2 Cameroon CMR 3.9 5.6 7.3 7.2 10.2 13.2 0.6 1.1 1.6 6.5 11.7 1.3 Central African Republic CAF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chad TCD a 4.7 6.8 9.0 8.5 12.3 16.1 0.9 1.4 1.9 7.4 13.2 1.6 Comoros COM 10.4 16.2 22.0 17.7 26.2 34.7 3.1 6.2 9.3 17.2 27.7 6.7 Congo COG 7.9 15.0 22.0 15.0 28.2 41.4 1.0 2.0 2.9 15.4 28.8 2.1 Côte d'Ivoire CIV 5.3 8.6 12.0 10.0 16.4 22.8 0.4 0.7 1.1 8.8 16.9 0.8 Democratic Republic of the Congo COD 7.0 11.1 15.2 12.8 19.9 26.9 1.4 2.6 3.8 12.2 21.6 2.8 Equatorial Guinea GNQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eritrea ERI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eswatini SWZ 5.4 8.6 11.8 10.3 16.2 22.1 0.8 1.4 2.0 9.5 17.4 1.5 Ethiopia ETH 3.3 4.6 5.8 5.7 7.8 9.8 0.9 1.4 1.9 5.2 9.0 1.5 Gabon GAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gambia GMB 6.7 9.6 12.5 13.2 18.7 24.3 0.4 0.6 0.9 10.5 20.3 0.7 45 Table A1.1. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate AFRICAN REGION (continued) — — — — — — — — — 9.5 16.6 2.4 Ghana GHA 2.1 3.1 4.0 4.1 5.9 7.7 0.2 0.3 0.4 3.4 6.5 0.3 Guinea GIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guinea-Bissau GNB 4.7 7.5 10.4 9.2 14.8 20.4 0.3 0.6 0.9 8.2 15.9 0.6 Kenya KEN 6.6 9.2 11.8 11.9 16.6 21.2 1.5 2.1 2.7 10.7 18.7 2.7 Lesotho LSO 17.2 22.9 28.6 32.4 42.0 51.6 2.7 4.8 6.8 24.3 43.6 5.1 Liberia LBR 4.3 7.1 9.9 7.7 12.5 17.4 1.0 1.7 2.5 7.7 13.6 1.9 Madagascar MDG 19.5 25.7 31.9 32.2 41.7 51.3 7.0 9.9 12.7 26.8 43.0 10.7 Malawi MWI 5.6 7.1 8.6 10.5 13.0 15.6 1.2 1.7 2.3 9.7 16.4 3.0 Mali MLI 5.8 7.6 9.5 11.0 14.4 17.8 0.4 0.7 1.0 8.0 15.1 0.9 Mauritania MRT 7.0 9.4 11.7 13.1 17.2 21.4 1.4 2.0 2.7 9.5 16.9 2.0 Mauritius MUS a 13.8 20.0 26.2 26.5 38.1 49.6 1.8 2.8 3.9 20.9 38.8 3.0 Mozambique MOZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Namibia NAM 8.2 12.5 16.8 14.2 21.3 28.4 2.9 4.7 6.4 14.1 23.0 5.2 Niger NER 4.4 7.7 11.0 8.2 14.0 19.8 0.6 1.3 2.0 7.7 14.0 1.4 Nigeria NGA 2.0 2.9 3.9 3.7 5.4 7.2 0.2 0.4 0.6 3.3 6.1 0.5 Rwanda RWA 6.3 12.0 17.8 9.7 17.7 25.8 3.1 6.7 10.3 14.3 21.0 7.6 Sao Tome and Principe STP 4.9 7.1 9.3 8.8 12.6 16.4 1.1 1.8 2.5 7.8 13.7 2.0 Senegal SEN 4.3 6.0 7.7 8.5 11.7 15.0 0.4 0.6 0.8 6.5 12.3 0.7 Seychelles SYC 13.4 20.8 28.2 22.8 34.6 46.5 3.2 5.7 8.3 20.2 34.7 5.8 Sierra Leone SLE 8.1 11.4 14.7 12.7 17.3 21.8 3.5 5.5 7.6 12.9 19.8 5.9 46 Table A1.1. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate AFRICAN REGION (continued) — — — — — — — — — 9.5 16.6 2.4 South Africa ZAF a 14.9 20.3 25.8 25.8 35.1 44.4 4.7 6.5 8.3 20.7 34.9 6.5 South Sudan SSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Togo TGO 3.5 5.6 7.7 6.5 10.2 14.0 0.5 0.9 1.3 5.3 10.0 0.5 Uganda UGA 3.9 5.3 6.7 6.5 9.0 11.4 1.3 1.8 2.3 6.4 10.8 2.0 United Republic of Tanzania TZA 5.4 7.5 9.6 9.5 13.1 16.8 1.5 2.2 2.9 7.0 12.6 1.3 Zambia ZMB 8.8 12.0 15.2 16.3 21.8 27.4 1.7 2.7 3.6 12.9 23.2 2.7 Zimbabwe ZWE 6.1 9.2 12.3 12.7 19.0 25.3 0.4 0.8 1.1 10.5 20.2 0.8 REGION OF THE AMERICAS — — — — — — — — — 21.7 11.4 Antigua and Barbuda ATG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Argentina ARG 17.6 23.1 28.6 21.6 28.2 34.9 13.7 18.1 22.5 23.8 28.5 19.1 Bahamas BHS 7.7 10.7 13.7 15.0 20.6 26.1 1.4 2.1 2.8 11.3 20.5 2.1 Barbados BRB 3.8 6.5 9.1 6.8 11.7 16.6 1.1 1.7 2.3 7.0 12.2 1.7 Belize BLZ a 5.7 8.7 11.7 10.3 15.5 20.8 1.1 1.9 2.6 8.8 15.6 1.9 Bolivia BOL 6.1 12.2 18.4 10.1 20.4 30.8 2.1 4.1 6.2 12.4 20.6 4.2 Brazil BRA 9.0 12.3 15.6 11.5 15.7 19.8 6.6 9.1 11.6 12.2 15.4 8.9 Canada CAN 9.4 11.4 13.4 11.3 13.7 16.2 7.6 9.2 10.7 12.0 14.3 9.7 Chile CHL a 22.5 28.2 33.9 24.8 30.6 36.5 20.2 25.8 31.4 28.7 30.8 26.7 Colombia COL 6.2 8.2 10.2 9.0 12.1 15.1 3.5 4.5 5.5 8.2 12.0 4.4 Costa Rica CRI 6.3 8.8 11.3 9.4 13.2 17.0 3.3 4.5 5.8 8.9 13.2 4.5 Cuba CUB 13.3 18.5 23.7 19.2 26.9 34.6 7.6 10.4 13.2 17.4 25.3 9.5 Dominica DMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dominican Republic DOM 6.7 10.2 13.8 9.2 14.0 18.7 4.2 6.5 8.9 10.5 14.4 6.6 47 Table A1.1. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate REGION OF THE AMERICAS (continued) — — — — — — — — — 16.6 21.7 11.4 Ecuador ECU 6.3 10.1 13.8 11.1 17.6 24.1 1.6 2.6 3.6 10.2 17.8 2.6 El Salvador SLV a 5.1 8.3 11.4 9.7 15.6 21.4 1.1 1.9 2.6 8.9 15.9 1.9 Grenada GRD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guatemala GTM 7.2 12.0 16.8 13.6 22.7 31.8 1.0 1.7 2.4 11.9 22.2 1.7 Guyana GUY 7.1 10.5 13.9 13.0 19.3 25.5 1.5 2.2 2.9 6.5 10.7 2.2 Haiti HTI 5.2 7.3 9.5 8.9 12.6 16.3 1.6 2.3 3.0 8.4 13.4 3.4 Honduras HND a 9.5 12.2 15.0 17.6 22.7 27.8 1.3 1.7 2.1 12.3 22.9 1.7 Jamaica JAM a 5.7 9.5 13.4 9.5 15.8 22.1 2.1 3.5 4.9 9.7 15.9 3.5 Mexico MEX 12.1 14.6 17.2 19.0 23.1 27.1 5.7 6.9 8.0 14.9 23.0 6.9 Nicaragua NIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Panama PAN 3.8 5.1 6.5 6.3 8.4 10.5 1.3 1.9 2.5 5.0 8.0 1.9 Paraguay PRY a 6.7 10.6 14.4 11.2 17.4 23.5 2.3 3.8 5.3 10.7 17.6 3.9 Peru PER a 4.8 7.0 9.3 7.7 11.6 15.5 1.9 2.6 3.4 7.1 11.6 2.6 Saint Kitts and Nevis KNA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Saint Lucia LCA 10.1 13.6 17.2 18.3 24.8 31.2 2.2 3.0 3.7 13.8 24.7 3.0 Saint Vincent and the Grenadines VCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Suriname SUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Trinidad and Tobago TTO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States of America USA 18.1 23.0 27.9 22.6 28.6 34.7 13.7 17.5 21.3 20.4 24.0 16.8 Uruguay URY 15.8 19.3 22.9 18.7 23.0 27.2 13.1 16.0 18.8 20.5 23.4 17.5 Venezuela (Bolivarian Republic of) VEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table A1.1. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate SOUTH-EAST ASIA REGION — — — — — — — — — 26.5 43.7 9.4 Bangladesh BGD 24.9 31.1 37.4 39.9 48.9 57.9 10.6 14.2 17.9 17.6 34.7 0.5 Bhutan BTN 14.1 19.6 25.0 19.3 27.2 35.0 8.3 11.0 13.7 6.4 10.1 2.6 Democratic People's Republic of Korea PRK a 12.5 17.1 21.8 25.3 34.7 44.2 0.0 0.0 0.0 16.5 33.0 0.0 India IND 18.9 23.9 28.9 29.0 36.8 44.5 8.3 10.4 12.5 7.1 13.1 1.2 Indonesia IDN 30.8 38.5 46.1 59.1 73.6 88.0 2.6 3.4 4.2 36.5 70.8 2.1 Maldives MDV 22.0 29.3 36.6 33.8 43.6 53.4 6.1 10.1 14.1 23.0 42.2 3.8 Myanmar MMR 31.9 43.9 55.8 52.0 69.4 86.8 12.6 19.2 25.8 19.8 36.6 3.1 Nepal NPL 20.0 24.9 29.8 34.3 42.7 51.0 7.5 9.4 11.3 16.4 27.4 5.4 Sri Lanka LKA 14.3 19.1 24.0 28.6 37.8 46.9 1.5 2.4 3.4 8.7 17.3 0.2 Thailand THA a 15.1 18.9 22.8 30.1 37.7 45.3 1.4 1.8 2.2 19.2 36.9 1.5 Timor-Leste TLS 27.1 37.6 48.0 47.9 64.5 81.1 5.6 9.8 13.9 31.8 58.6 4.9 EUROPEAN REGION — — — — — — — — — — 32.0 18.5 Albania ALB a 16.5 22.4 28.3 29.3 38.7 48.1 4.1 6.6 9.0 21.9 37.8 6.0 Andorra AND a 22.2 33.6 44.9 22.1 33.3 44.5 22.3 33.8 45.4 36.3 34.8 37.9 Armenia ARM 17.0 22.5 28.0 37.3 49.3 61.2 1.2 1.7 2.2 24.9 48.2 1.5 Austria AUT a 16.9 22.0 27.2 17.8 23.7 29.6 15.9 20.5 25.0 24.9 25.8 24.0 Azerbaijan AZE 12.2 19.3 26.4 25.0 39.6 54.2 0.1 0.1 0.2 19.6 39.0 0.1 Belarus BLR 21.3 27.9 34.5 36.1 47.2 58.4 9.1 12.0 14.9 25.6 39.9 11.3 Belgium BEL 19.2 24.7 30.3 21.4 27.4 33.4 17.1 22.1 27.2 24.8 27.6 22.0 Bosnia and Herzegovina BIH a 17.2 35.1 53.1 20.0 41.0 62.0 14.5 29.5 44.5 36.2 41.6 30.9 Bulgaria BGR a 24.4 34.0 43.6 27.7 38.1 48.4 21.3 30.2 39.1 39.5 40.3 38.7 49 Table A1.1. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate EUROPEAN REGION (continued) — — — — — — — — — 25.3 32.0 18.5 Croatia HRV a 24.2 32.6 41.0 26.1 34.2 42.4 22.5 31.1 39.6 37.0 36.7 37.3 Cyprus CYP a 25.4 34.0 42.6 34.9 46.0 57.1 16.0 22.1 28.2 35.6 47.2 23.9 Czechia CZE a 22.4 27.5 32.6 25.5 31.7 37.9 19.2 23.3 27.4 29.9 33.4 26.5 Denmark DNK a 13.2 16.2 19.2 13.4 16.4 19.5 13.0 16.0 18.9 16.2 16.4 16.1 Estonia EST 20.8 25.6 30.5 26.8 32.9 39.1 15.4 19.1 22.7 25.9 30.3 21.5 Finland FIN 16.0 19.6 23.1 19.4 23.9 28.5 12.8 15.4 17.9 17.1 18.4 15.9 France FRA a 22.5 29.2 35.9 23.8 31.3 38.8 21.2 27.3 33.3 34.6 35.5 33.7 Georgia GEO 22.7 29.0 35.2 42.9 54.7 66.4 5.6 7.1 8.7 31.8 55.9 7.6 Germany DEU a 15.4 18.8 22.2 17.4 21.3 25.2 13.4 16.4 19.3 21.3 23.2 19.3 Greece GRC 21.3 29.6 37.9 24.1 33.1 42.1 18.7 26.3 34.0 32.8 35.0 30.6 Hungary HUN a 22.2 29.4 36.5 27.1 34.7 42.4 17.7 24.5 31.2 32.2 36.3 28.1 Iceland ISL a 7.6 9.4 11.3 7.6 9.4 11.2 7.5 9.4 11.4 9.4 9.3 9.4 Ireland IRL a 14.3 18.2 22.2 15.9 20.5 25.1 12.8 16.1 19.3 19.3 21.5 17.0 Israel ISR a 15.8 19.8 23.8 21.1 26.4 31.6 10.5 13.3 16.1 20.4 27.0 13.8 Italy ITA a 17.0 20.4 23.7 20.0 24.1 28.2 14.2 16.8 19.4 22.4 25.7 19.1 Kazakhstan KAZ 17.7 21.7 25.7 31.3 38.2 45.1 5.5 6.9 8.2 21.9 37.4 6.4 Kyrgyzstan KGZ 18.2 26.4 34.6 35.5 51.3 67.0 2.1 3.3 4.4 26.6 50.1 3.2 Latvia LVA 24.4 30.3 36.1 36.4 45.6 54.8 14.2 17.2 20.3 30.4 41.2 19.5 Lithuania LTU 21.0 27.9 34.7 30.4 40.1 49.7 12.9 17.3 21.7 29.1 38.5 19.7 Luxembourg LUX a 17.2 21.8 26.5 18.7 23.3 28.0 15.7 20.3 25.0 23.0 24.4 21.6 Malta MLT a 17.1 23.2 29.2 19.4 25.5 31.6 14.5 20.6 26.6 24.7 26.3 23.2 Monaco MCO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table A1.1. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate EUROPEAN REGION (continued) — — — — — — — — — 25.3 32.0 18.5 Montenegro MNE 18.9 32.1 45.3 18.7 30.9 43.1 19.1 33.2 47.2 32.0 30.9 33.2 Netherlands (Kingdom of the) NLD a 16.1 20.1 24.0 18.4 22.5 26.7 13.9 17.7 21.4 21.3 23.5 19.0 North Macedonia MKD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Norway NOR a 11.6 14.0 16.4 12.0 14.8 17.5 11.2 13.2 15.3 14.2 14.9 13.5 Poland POL 18.2 23.2 28.1 21.9 27.6 33.4 14.9 19.1 23.2 23.6 27.1 20.1 Portugal PRT a 15.8 20.9 26.0 20.5 27.1 33.7 11.8 15.5 19.3 25.6 30.5 20.7 Republic of Moldova MDA 21.5 27.8 34.1 40.9 52.7 64.5 4.8 6.3 7.8 28.2 49.6 6.7 Romania ROU 21.4 27.5 33.6 28.8 37.4 45.9 14.7 18.5 22.4 29.4 38.6 20.3 Russian Federation RUS 22.4 27.2 32.0 34.9 42.0 49.1 11.8 14.8 17.7 29.2 41.1 17.4 San Marino SMR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serbia SRB a 29.5 36.6 43.7 31.1 38.8 46.5 28.0 34.6 41.2 39.5 39.9 39.1 Slovakia SVK a 18.8 30.2 41.7 23.2 35.4 47.5 14.7 25.4 36.2 32.4 36.3 28.5 Slovenia SVN a 14.6 18.1 21.5 16.3 20.2 24.1 13.0 15.9 18.9 20.1 21.8 18.5 Spain ESP a 20.2 24.9 29.7 22.6 27.5 32.4 17.9 22.5 27.1 28.4 29.4 27.5 Sweden SWE 18.4 22.1 25.8 23.5 28.3 33.0 13.2 15.9 18.5 12.6 13.3 11.9 Switzerland CHE a 18.5 23.3 28.1 20.9 26.3 31.8 16.2 20.4 24.6 25.5 28.2 22.9 Tajikistan TJK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Türkiye TUR 24.6 30.7 36.8 33.9 41.9 50.0 15.5 19.6 23.8 30.5 41.2 19.8 Turkmenistan TKM 3.4 5.4 7.4 6.6 10.6 14.5 0.3 0.5 0.7 5.4 10.4 0.5 Ukraine UKR 18.2 22.0 25.7 31.9 38.3 44.7 6.8 8.5 10.1 24.9 38.4 11.5 United Kingdom GBR a 10.8 13.1 15.4 12.5 15.0 17.4 9.2 11.4 13.5 14.2 16.1 12.4 Uzbekistan UZB 11.7 16.2 20.7 23.0 31.8 40.6 0.7 1.0 1.4 10.7 20.5 1.0 51 Table A1.1. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate EASTERN MEDITERRANEAN REGION — — — — — — — — — 17.9 31.9 4.0 Afghanistan AFG 16.0 22.1 28.2 28.2 38.3 48.5 3.8 5.9 8.0 9.0 16.1 2.0 Bahrain BHR a 11.8 18.1 24.3 17.6 25.7 33.8 1.8 4.9 8.1 15.0 25.0 5.1 Djibouti DJI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Egypt EGY a 18.7 24.7 30.7 37.0 48.9 60.7 0.2 0.3 0.5 24.7 49.1 0.4 Iran (Islamic Republic of) IRN 10.1 13.9 17.8 18.0 24.8 31.6 2.1 3.1 4.0 9.1 17.0 1.1 Iraq IRQ 10.4 18.7 27.0 19.9 36.0 52.1 1.0 1.6 2.2 19.2 36.7 1.7 Jordan JOR a 28.3 36.3 44.3 45.5 57.8 70.0 9.9 13.4 16.8 35.6 57.6 13.6 Kuwait KWT a 14.5 22.7 30.8 22.8 35.6 48.3 1.2 2.1 3.1 19.9 37.7 2.1 Lebanon LBN a 24.1 34.0 43.8 31.4 43.1 54.9 17.6 25.7 33.8 34.3 42.9 25.7 Libya LBY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Morocco MAR a 9.5 13.1 16.7 18.7 25.3 31.9 0.4 1.0 1.6 13.0 25.0 1.0 Oman OMN 8.2 11.0 13.9 12.9 17.4 21.9 0.2 0.4 0.6 7.6 14.9 0.4 Pakistan PAK 12.7 16.9 21.1 21.3 27.7 34.2 4.2 6.2 8.1 16.7 30.7 2.7 Qatar QAT 12.7 18.8 25.0 16.5 24.6 32.6 1.5 2.3 3.2 10.8 19.7 1.9 Saudi Arabia SAU 12.8 17.4 22.0 20.9 28.4 35.8 1.4 2.1 2.7 13.9 25.9 2.0 Somalia SOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sudan SDN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Syrian Arab Republic SYR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tunisia TUN a 15.4 20.1 24.8 30.5 39.7 48.8 1.1 1.6 2.1 20.5 39.5 1.6 United Arab Emirates ARE a 7.4 11.7 16.0 9.9 15.5 21.1 1.5 2.5 3.6 9.0 15.4 2.6 Yemen YEM 9.8 20.8 31.8 15.5 33.7 51.8 4.1 7.9 11.8 17.2 27.8 6.5 52 Table A1.1. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate WESTERN PACIFIC REGION — — — — — — — — — 22.5 42.4 2.6 Australia AUS a 10.1 12.5 14.9 11.9 14.8 17.6 8.4 10.3 12.2 13.1 15.2 10.9 Brunei Darussalam BRN a 12.1 17.1 22.2 22.3 31.3 40.3 1.3 2.2 3.0 16.4 30.7 2.2 Cambodia KHM 12.8 16.1 19.4 21.8 27.3 32.7 4.2 5.5 6.8 15.1 28.7 1.6 China CHN a 20.1 24.9 29.7 38.2 47.3 56.5 1.6 2.0 2.4 23.4 45.1 1.6 Cook Islands COK a 20.5 25.5 30.4 24.6 30.3 35.9 16.9 21.4 25.8 27.0 31.8 22.2 Fiji FJI a 20.0 27.3 34.6 30.8 41.7 52.5 9.3 13.1 16.9 27.6 42.0 13.2 Japan JPN a 13.7 16.8 19.8 21.7 26.5 31.4 6.3 7.7 9.0 19.2 28.7 9.6 Kiribati KIR a 28.0 38.2 48.3 39.0 51.6 64.2 17.8 25.7 33.6 39.7 52.5 26.8 Lao People's Democratic Republic LAO 19.6 25.8 32.0 33.0 43.2 53.3 6.1 8.4 10.6 25.0 45.4 4.7 Malaysia MYS 17.0 22.6 28.1 33.1 43.8 54.5 0.5 0.7 1.0 20.4 40.3 0.5 Marshall Islands MHL 22.3 30.4 38.5 38.2 51.8 65.5 6.1 8.6 11.2 23.6 43.3 4.0 Micronesia (Federated States of) FSM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mongolia MNG 23.5 29.3 35.2 42.1 52.6 63.1 5.8 7.3 8.9 28.4 50.2 6.6 Nauru NRU 33.7 49.5 65.3 34.3 50.3 66.3 33.2 48.7 64.3 45.2 45.9 44.6 New Zealand NZL a 9.5 11.4 13.4 10.5 12.7 14.8 8.4 10.2 12.0 12.2 13.4 11.1 Niue NIU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Palau PLW a 11.7 17.0 22.3 18.3 26.3 34.3 4.9 7.3 9.8 17.3 27.1 7.6 Papua New Guinea PNG a 29.4 40.4 51.5 41.4 55.4 69.4 16.9 24.9 32.8 39.6 54.3 24.9 Philippines PHL a 16.3 20.4 24.5 28.9 36.2 43.5 3.4 4.3 5.1 20.4 36.2 4.5 53 Table A1.1. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate WESTERN PACIFIC REGION (continued) — — — — — — — — — 22.5 42.4 2.6 Republic of Korea KOR a 15.5 18.9 22.4 26.9 32.7 38.5 4.2 5.4 6.6 20.0 34.1 5.8 Samoa WSM 14.2 22.2 30.1 20.0 31.0 42.0 8.3 13.2 18.0 22.5 31.6 13.3 Singapore SGP a 10.8 16.4 21.9 18.6 27.9 37.1 2.4 4.0 5.5 16.5 28.2 4.9 Solomon Islands SLB a 24.7 37.6 50.5 37.0 55.3 73.6 12.2 19.6 27.0 36.9 54.4 19.4 Tonga TON a 23.3 30.7 38.1 35.8 46.8 57.8 11.5 15.5 19.4 31.3 47.0 15.5 Tuvalu TUV a 24.7 33.8 42.9 36.2 48.3 60.4 12.9 19.0 25.1 33.7 48.2 19.1 Vanuatu VUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Viet Nam VNM 17.9 22.8 27.6 35.1 44.3 53.6 1.6 2.2 2.9 22.5 43.0 2.0 a Tobacco use estimates are not available. Tobacco smoking estimates are substituted for missing tobacco use estimates on the assumption that there is little difference between the two measures in the country. 54 Table A1.2. Current tobacco smoking rates among people aged 15 years and older, 2022 estimates Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate GLOBAL — — — — — — — — — 16.7 28.4 5.1 AFRICAN REGION — — — — — — — — — 7.9 14.3 1.5 Algeria DZA 10.9 15.6 20.4 21.1 30.2 39.3 0.3 0.6 0.8 15.3 30.1 0.6 Angola AGO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Benin BEN 2.9 4.0 5.1 5.2 6.9 8.6 0.7 1.2 1.7 4.5 7.7 1.2 Botswana BWA 10.9 14.7 18.5 19.7 26.4 33.1 2.4 3.4 4.4 15.0 26.4 3.5 Burkina Faso BFA 6.5 10.0 13.6 12.2 18.0 23.9 0.9 2.2 3.5 10.1 17.8 2.5 Burundi BDI 4.4 7.5 10.7 8.0 13.6 19.2 1.0 1.7 2.4 8.5 15.1 1.8 Cabo Verde CPV 5.5 7.4 9.2 9.2 12.2 15.1 1.8 2.7 3.5 7.6 12.4 2.7 Cameroon CMR 3.0 4.3 5.6 5.9 8.4 10.9 0.2 0.3 0.4 4.9 9.5 0.3 Central African Republic CAF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chad TCD 4.7 6.8 9.0 8.5 12.3 16.1 0.9 1.4 1.9 7.4 13.2 1.6 Comoros COM 7.3 11.9 16.4 13.6 21.7 29.7 0.9 2.0 3.1 12.1 22.2 2.1 Congo COG 7.6 14.4 21.2 15.0 28.2 41.4 0.4 0.8 1.3 14.8 28.8 0.9 Côte d'Ivoire CIV 5.2 8.5 11.9 10.0 16.4 22.8 0.2 0.5 0.8 8.7 16.9 0.5 Democratic Republic of the Congo COD 5.0 8.3 11.7 9.9 16.4 22.8 0.2 0.6 0.9 9.1 17.6 0.6 Equatorial Guinea GNQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eritrea ERI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eswatini SWZ 5.0 7.6 10.3 9.7 14.6 19.6 0.5 1.0 1.4 8.2 15.4 1.0 Ethiopia ETH 2.4 3.1 3.9 4.3 5.5 6.6 0.5 0.9 1.2 3.6 6.3 0.9 Gabon GAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gambia GMB 6.6 9.1 11.6 13.2 18.1 22.9 0.2 0.4 0.7 12.8 24.9 0.6 55 Table A1.2. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate AFRICAN REGION (continued) — — — — — — — — — 7.9 14.3 1.5 Ghana GHA 1.4 2.1 2.8 2.8 4.0 5.3 0.1 0.3 0.4 2.4 4.5 0.3 Guinea GIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guinea-Bissau GNB 4.8 7.3 9.9 9.6 14.5 19.4 0.2 0.4 0.7 8.0 15.5 0.5 Kenya KEN 5.7 7.6 9.4 11.3 14.7 18.2 0.4 0.7 0.9 8.4 16.1 0.8 Lesotho LSO 15.2 19.3 23.4 31.0 39.2 47.4 0.3 0.4 0.6 26.5 52.3 0.6 Liberia LBR 3.3 5.9 8.5 6.0 10.7 15.4 0.7 1.2 1.8 7.3 13.6 1.0 Madagascar MDG 12.8 16.1 19.4 24.8 31.2 37.5 0.9 1.2 1.5 16.3 31.4 1.3 Malawi MWI 4.9 6.3 7.7 9.8 12.2 14.7 0.5 0.9 1.3 8.3 15.3 1.3 Mali MLI 4.8 6.3 7.8 9.1 11.9 14.8 0.4 0.6 0.8 6.4 12.2 0.7 Mauritania MRT 5.7 7.9 10.0 11.0 14.8 18.6 0.8 1.4 2.0 7.7 14.1 1.4 Mauritius MUS 13.8 20.0 26.2 26.5 38.1 49.6 1.8 2.8 3.9 20.9 38.8 3.0 Mozambique MOZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Namibia NAM 7.7 11.2 14.7 13.4 19.2 25.0 2.6 4.0 5.5 17.2 28.2 6.1 Niger NER 3.9 6.4 8.9 7.4 12.1 16.7 0.3 0.5 0.8 6.3 12.0 0.6 Nigeria NGA 2.0 2.9 3.8 3.7 5.4 7.0 0.2 0.4 0.5 3.1 5.7 0.4 Rwanda RWA 5.1 8.6 12.1 8.8 14.4 20.1 1.6 3.1 4.7 10.1 16.6 3.5 Sao Tome and Principe STP 3.2 5.1 7.0 6.0 9.5 13.0 0.5 0.8 1.1 5.5 10.2 0.9 Senegal SEN 4.5 6.0 7.4 9.0 11.7 14.4 0.4 0.6 0.8 6.3 12.0 0.6 Seychelles SYC 13.6 20.7 27.9 22.8 34.6 46.5 3.6 5.6 7.6 20.1 34.7 5.6 Sierra Leone SLE 7.6 10.0 12.3 13.0 16.4 19.7 2.3 3.6 4.9 11.3 18.7 3.9 56 Table A1.2. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate AFRICAN REGION (continued) — — — — — — — — — 7.9 14.3 1.5 South Africa ZAF 14.9 20.3 25.8 25.8 35.1 44.4 4.7 6.5 8.3 20.7 34.9 6.5 South Sudan SSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Togo TGO 3.1 4.7 6.4 5.9 8.9 12.0 0.3 0.5 0.7 5.3 10.0 0.5 Uganda UGA 3.0 4.1 5.1 5.3 7.1 8.8 0.8 1.1 1.5 6.4 10.8 2.0 United Republic of Tanzania TZA 4.2 5.9 7.6 7.9 10.9 13.9 0.7 1.1 1.6 7.0 12.6 1.3 Zambia ZMB 8.4 10.7 12.9 16.0 20.2 24.3 1.1 1.6 2.1 12.9 23.2 2.7 Zimbabwe ZWE 5.5 8.7 11.8 11.6 18.0 24.3 0.3 0.7 1.1 10.5 20.2 0.8 REGION OF THE AMERICAS — — — — — — — — — 19.8 10.8 Antigua and Barbuda ATG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Argentina ARG 17.6 23.1 28.6 21.6 28.2 34.9 13.7 18.1 22.5 23.8 28.5 19.1 Bahamas BHS 7.7 10.7 13.7 15.0 20.6 26.1 1.4 2.1 2.8 11.3 20.5 2.1 Barbados BRB 3.8 6.5 9.1 6.8 11.7 16.6 1.1 1.7 2.3 7.0 12.2 1.7 Belize BLZ 5.7 8.7 11.7 10.3 15.5 20.8 1.1 1.9 2.6 8.8 15.6 1.9 Bolivia BOL 6.1 12.2 18.4 10.1 20.4 30.8 2.1 4.1 6.2 12.4 20.6 4.2 Brazil BRA 9.0 12.3 15.6 11.5 15.7 19.8 6.6 9.1 11.6 12.2 15.4 8.9 Canada CAN 9.4 11.4 13.4 11.3 13.7 16.2 7.6 9.2 10.7 12.0 14.3 9.7 Chile CHL 22.5 28.2 33.9 24.8 30.6 36.5 20.2 25.8 31.4 28.7 30.8 26.7 Colombia COL 6.2 8.2 10.2 9.0 12.1 15.1 3.5 4.5 5.5 8.2 12.0 4.4 Costa Rica CRI 6.3 8.8 11.3 9.4 13.2 17.0 3.3 4.5 5.8 8.9 13.2 4.5 Cuba CUB 13.3 18.5 23.7 19.2 26.9 34.6 7.6 10.4 13.2 17.4 25.3 9.5 Dominica DMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table A1.2. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate REGION OF THE AMERICAS (continued) — — — — — — — — — 15.3 19.8 10.8 Dominican Republic DOM 6.5 9.1 11.7 9.0 12.5 16.1 4.1 5.7 7.4 9.7 11.6 7.8 Ecuador ECU 6.3 10.1 13.8 11.1 17.6 24.1 1.6 2.6 3.6 10.2 17.8 2.6 El Salvador SLV 5.1 8.3 11.4 9.7 15.6 21.4 1.1 1.9 2.6 8.9 15.9 1.9 Grenada GRD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guatemala GTM 7.2 12.0 16.8 13.6 22.7 31.8 1.0 1.7 2.4 11.9 22.2 1.7 Guyana GUY 7.1 10.5 13.9 13.0 19.3 25.5 1.5 2.2 2.9 6.5 10.7 2.2 Haiti HTI 5.2 7.3 9.5 8.9 12.6 16.3 1.6 2.3 3.0 8.4 13.4 3.4 Honduras HND 9.5 12.2 15.0 17.6 22.7 27.8 1.3 1.7 2.1 12.3 22.9 1.7 Jamaica JAM 5.7 9.5 13.4 9.5 15.8 22.1 2.1 3.5 4.9 9.7 15.9 3.5 Mexico MEX 12.1 14.6 17.2 19.0 23.1 27.1 5.7 6.9 8.0 14.9 23.0 6.9 Nicaragua NIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Panama PAN 3.5 4.9 6.4 5.7 8.0 10.3 1.3 1.9 2.5 5.0 8.0 1.9 Paraguay PRY 6.7 10.6 14.4 11.2 17.4 23.5 2.3 3.8 5.3 10.7 17.6 3.9 Peru PER 4.8 7.0 9.3 7.7 11.6 15.5 1.9 2.6 3.4 7.1 11.6 2.6 Saint Kitts and Nevis KNA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Saint Lucia LCA 10.1 13.6 17.2 18.3 24.8 31.2 2.2 3.0 3.7 13.8 24.7 3.0 Saint Vincent and the Grenadines VCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Suriname SUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Trinidad and Tobago TTO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States of America USA 15.6 19.3 22.9 18.7 22.9 27.2 12.7 15.8 18.8 20.4 24.0 16.8 Uruguay URY 15.8 19.3 22.9 18.7 23.0 27.2 13.1 16.0 18.8 20.5 23.4 17.5 Venezuela (Bolivarian Republic of) VEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table A1.2. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate SOUTH-EAST ASIA REGION — — — — — — — — — 12.7 24.1 1.3 Bangladesh BGD 13.6 16.8 20.1 27.5 34.1 40.7 0.3 0.4 0.6 17.6 34.7 0.5 Bhutan BTN 4.8 6.9 8.9 7.5 10.6 13.8 1.9 2.7 3.5 6.4 10.1 2.6 Democratic People's Republic of Korea PRK 12.5 17.1 21.8 25.3 34.7 44.2 0.0 0.0 0.0 16.5 33.0 0.0 India IND 5.5 7.1 8.8 10.0 12.8 15.7 0.8 1.1 1.5 7.1 13.1 1.2 Indonesia IDN 29.3 36.7 44.0 57.1 71.2 85.4 1.6 2.2 2.7 36.5 70.8 2.1 Maldives MDV 20.4 26.6 32.7 33.8 43.6 53.4 2.4 3.7 5.0 23.0 42.2 3.8 Myanmar MMR 13.9 19.5 25.1 26.2 36.5 46.8 2.0 3.1 4.2 19.8 36.6 3.1 Nepal NPL 11.5 14.5 17.5 20.5 25.6 30.8 3.6 4.7 5.8 16.4 27.4 5.4 Sri Lanka LKA 6.4 8.5 10.5 13.4 17.7 22.0 0.1 0.2 0.3 8.7 17.3 0.2 Thailand THA 15.1 18.9 22.8 30.1 37.7 45.3 1.4 1.8 2.2 19.2 36.9 1.5 Timor-Leste TLS 22.0 30.9 39.7 40.7 56.3 72.0 2.8 4.6 6.4 31.8 58.6 4.9 EUROPEAN REGION — — — — — — — — — 31.3 18.3 Albania ALB 16.5 22.4 28.3 29.3 38.7 48.1 4.1 6.6 9.0 21.9 37.8 6.0 Andorra AND 22.2 33.6 44.9 22.1 33.3 44.5 22.3 33.8 45.4 36.3 34.8 37.9 Armenia ARM 17.0 22.5 28.0 37.3 49.3 61.2 1.2 1.7 2.2 24.9 48.2 1.5 Austria AUT 16.9 22.0 27.2 17.8 23.7 29.6 15.9 20.5 25.0 24.9 25.8 24.0 Azerbaijan AZE 12.2 19.3 26.4 25.0 39.6 54.2 0.1 0.1 0.2 19.6 39.0 0.1 Belarus BLR 19.0 23.6 28.2 32.7 40.7 48.6 7.7 9.6 11.5 25.6 39.9 11.3 Belgium BEL 18.5 22.9 27.3 20.9 26.0 31.1 16.2 19.9 23.6 24.8 27.6 22.0 Bosnia and Herzegovina BIH 17.2 35.1 53.1 20.0 41.0 62.0 14.5 29.5 44.5 36.2 41.6 30.9 Bulgaria BGR 24.4 34.0 43.6 27.7 38.1 48.4 21.3 30.2 39.1 39.5 40.3 38.7 59 Table A1.2. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate EUROPEAN REGION (continued) — — — — — — — — — 24.8 31.3 18.3 Croatia HRV 24.2 32.6 41.0 26.1 34.2 42.4 22.5 31.1 39.6 37.0 36.7 37.3 Cyprus CYP 25.4 34.0 42.6 34.9 46.0 57.1 16.0 22.1 28.2 35.6 47.2 23.9 Czechia CZE 22.4 27.5 32.6 25.5 31.7 37.9 19.2 23.3 27.4 29.9 33.4 26.5 Denmark DNK 13.2 16.2 19.2 13.4 16.4 19.5 13.0 16.0 18.9 16.2 16.4 16.1 Estonia EST 18.7 23.4 28.0 23.8 29.6 35.3 14.2 17.8 21.4 25.9 30.3 21.5 Finland FIN 12.4 15.0 17.6 14.0 16.8 19.7 10.9 13.2 15.5 17.1 18.4 15.9 France FRA 22.5 29.2 35.9 23.8 31.3 38.8 21.2 27.3 33.3 34.6 35.5 33.7 Georgia GEO 22.7 29.0 35.2 42.9 54.7 66.4 5.6 7.1 8.7 31.8 55.9 7.6 Germany DEU 15.4 18.8 22.2 17.4 21.3 25.2 13.4 16.4 19.3 21.3 23.2 19.3 Greece GRC 21.3 29.6 37.9 24.1 33.1 42.1 18.7 26.3 34.0 32.8 35.0 30.6 Hungary HUN 22.2 29.4 36.5 27.1 34.7 42.4 17.7 24.5 31.2 32.2 36.3 28.1 Iceland ISL 7.6 9.4 11.3 7.6 9.4 11.2 7.5 9.4 11.4 9.4 9.3 9.4 Ireland IRL 14.3 18.2 22.2 15.9 20.5 25.1 12.8 16.1 19.3 19.3 21.5 17.0 Israel ISR 15.8 19.8 23.8 21.1 26.4 31.6 10.5 13.3 16.1 20.4 27.0 13.8 Italy ITA 17.0 20.4 23.7 20.0 24.1 28.2 14.2 16.8 19.4 22.4 25.7 19.1 Kazakhstan KAZ 17.5 21.4 25.4 31.3 38.3 45.3 5.1 6.3 7.5 21.9 37.4 6.4 Kyrgyzstan KGZ 17.6 25.8 34.0 34.5 50.1 65.6 1.9 3.2 4.6 26.6 50.1 3.2 Latvia LVA 22.1 27.0 32.0 32.4 40.2 48.0 13.2 15.8 18.4 30.4 41.2 19.5 Lithuania LTU 20.1 25.1 30.1 30.1 37.0 44.0 11.5 14.8 18.0 29.1 38.5 19.7 Luxembourg LUX 17.2 21.8 26.5 18.7 23.3 28.0 15.7 20.3 25.0 23.0 24.4 21.6 Malta MLT 17.1 23.2 29.2 19.4 25.5 31.6 14.5 20.6 26.6 24.7 26.3 23.2 Monaco MCO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table A1.2. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate EUROPEAN REGION (continued) — — — — — — — — — 24.8 31.3 18.3 Montenegro MNE 18.9 32.1 45.3 18.7 30.9 43.1 19.1 33.2 47.2 32.0 30.9 33.2 Netherlands (Kingdom of the) NLD 16.1 20.1 24.0 18.4 22.5 26.7 13.9 17.7 21.4 21.3 23.5 19.0 North Macedonia MKD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Norway NOR 11.6 14.0 16.4 12.0 14.8 17.5 11.2 13.2 15.3 14.2 14.9 13.5 Poland POL 18.2 23.2 28.1 21.9 27.6 33.4 14.9 19.1 23.2 23.6 27.1 20.1 Portugal PRT 15.8 20.9 26.0 20.5 27.1 33.7 11.8 15.5 19.3 25.6 30.5 20.7 Republic of Moldova MDA 20.9 26.4 31.8 39.6 49.8 60.0 4.7 6.0 7.3 28.2 49.6 6.7 Romania ROU 21.0 27.0 33.0 28.8 37.4 45.9 13.9 17.5 21.2 29.4 38.6 20.3 Russian Federation RUS 22.4 27.2 32.0 34.9 42.0 49.1 11.8 14.8 17.7 29.2 41.1 17.4 San Marino SMR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serbia SRB 29.5 36.6 43.7 31.1 38.8 46.5 28.0 34.6 41.2 39.5 39.9 39.1 Slovakia SVK 18.8 30.2 41.7 23.2 35.4 47.5 14.7 25.4 36.2 32.4 36.3 28.5 Slovenia SVN 14.6 18.1 21.5 16.3 20.2 24.1 13.0 15.9 18.9 20.1 21.8 18.5 Spain ESP 20.2 24.9 29.7 22.6 27.5 32.4 17.9 22.5 27.1 28.4 29.4 27.5 Sweden SWE 10.1 12.3 14.6 10.8 13.1 15.4 9.3 11.6 13.9 12.6 13.3 11.9 Switzerland CHE 18.5 23.3 28.1 20.9 26.3 31.8 16.2 20.4 24.6 25.5 28.2 22.9 Tajikistan TJK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Türkiye TUR 24.6 30.7 36.8 33.9 41.9 50.0 15.5 19.6 23.8 30.5 41.2 19.8 Turkmenistan TKM 3.5 5.3 7.1 6.8 10.3 13.8 0.3 0.5 0.7 5.4 10.4 0.5 Ukraine UKR 18.2 22.0 25.7 31.9 38.3 44.7 6.8 8.5 10.1 24.9 38.4 11.5 United Kingdom GBR 10.8 13.1 15.4 12.5 15.0 17.4 9.2 11.4 13.5 14.2 16.1 12.4 Uzbekistan UZB 6.8 10.6 14.3 13.2 20.4 27.6 0.6 1.0 1.4 10.7 20.5 1.0 61 Table A1.2. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate EASTERN MEDITERRANEAN REGION — — — — — — — — — 15.2 28.1 2.3 Afghanistan AFG 5.9 9.2 12.4 10.8 16.6 22.4 1.1 1.8 2.5 9.0 16.1 2.0 Bahrain BHR 11.8 18.1 24.3 17.6 25.7 33.8 1.8 4.9 8.1 15.0 25.0 5.1 Djibouti DJI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Egypt EGY 18.7 24.7 30.7 37.0 48.9 60.7 0.2 0.3 0.5 24.7 49.1 0.4 Iran (Islamic Republic of) IRN 6.8 9.5 12.2 12.9 17.8 22.8 0.7 1.1 1.5 9.1 17.0 1.1 Iraq IRQ 10.4 18.7 27.0 19.9 36.0 52.1 1.0 1.6 2.2 19.2 36.7 1.7 Jordan JOR 28.3 36.3 44.3 45.5 57.8 70.0 9.9 13.4 16.8 35.6 57.6 13.6 Kuwait KWT 14.5 22.7 30.8 22.8 35.6 48.3 1.2 2.1 3.1 19.9 37.7 2.1 Lebanon LBN 24.1 34.0 43.8 31.4 43.1 54.9 17.6 25.7 33.8 34.3 42.9 25.7 Libya LBY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Morocco MAR 9.5 13.1 16.7 18.7 25.3 31.9 0.4 1.0 1.6 13.0 25.0 1.0 Oman OMN 7.4 9.9 12.5 11.7 15.7 19.7 0.2 0.3 0.5 7.6 14.9 0.4 Pakistan PAK 9.2 12.0 14.8 16.7 21.3 26.0 1.8 2.7 3.6 16.7 30.7 2.7 Qatar QAT 11.2 16.4 21.5 14.7 21.4 28.1 1.2 2.0 2.7 10.8 19.7 1.9 Saudi Arabia SAU 11.1 16.2 21.2 18.2 26.3 34.4 1.3 1.9 2.6 13.9 25.9 2.0 Somalia SOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sudan SDN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Syrian Arab Republic SYR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tunisia TUN 15.4 20.1 24.8 30.5 39.7 48.8 1.1 1.6 2.1 20.5 39.5 1.6 United Arab Emirates ARE 7.4 11.7 16.0 9.9 15.5 21.1 1.5 2.5 3.6 9.0 15.4 2.6 Yemen YEM 7.7 16.7 25.6 12.0 27.0 42.1 3.5 6.3 9.1 17.2 27.8 6.5 62 Table A1.2. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate WESTERN PACIFIC REGION — — — — — — — — — 22.4 42.3 2.5 Australia AUS 10.1 12.5 14.9 11.9 14.8 17.6 8.4 10.3 12.2 13.1 15.2 10.9 Brunei Darussalam BRN 12.1 17.1 22.2 22.3 31.3 40.3 1.3 2.2 3.0 16.4 30.7 2.2 Cambodia KHM 11.3 14.1 17.0 21.8 27.3 32.7 1.2 1.6 1.9 15.1 28.7 1.6 China CHN 20.1 24.9 29.7 38.2 47.3 56.5 1.6 2.0 2.4 23.4 45.1 1.6 Cook Islands COK 20.5 25.5 30.4 24.6 30.3 35.9 16.9 21.4 25.8 27.0 31.8 22.2 Fiji FJI 20.0 27.3 34.6 30.8 41.7 52.5 9.3 13.1 16.9 27.6 42.0 13.2 Japan JPN 13.7 16.8 19.8 21.7 26.5 31.4 6.3 7.7 9.0 19.2 28.7 9.6 Kiribati KIR 28.0 38.2 48.3 39.0 51.6 64.2 17.8 25.7 33.6 39.7 52.5 26.8 Lao People's Democratic Republic LAO 18.1 23.8 29.5 33.0 43.2 53.3 3.2 4.4 5.7 25.0 45.4 4.7 Malaysia MYS 15.7 20.9 26.2 30.6 40.8 51.0 0.3 0.5 0.7 20.4 40.3 0.5 Marshall Islands MHL 17.7 24.1 30.5 32.3 43.8 55.3 2.8 4.0 5.3 23.6 43.3 4.0 Micronesia (Federated States of) FSM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mongolia MNG 21.9 28.3 34.6 39.5 51.0 62.6 5.3 6.7 8.2 28.4 50.2 6.6 Nauru NRU 27.1 46.3 65.5 27.4 47.3 67.3 26.8 45.3 63.7 45.2 45.9 44.6 New Zealand NZL 9.5 11.4 13.4 10.5 12.7 14.8 8.4 10.2 12.0 12.2 13.4 11.1 Niue NIU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Palau PLW 11.7 17.0 22.3 18.3 26.3 34.3 4.9 7.3 9.8 17.3 27.1 7.6 Papua New Guinea PNG 29.4 40.4 51.5 41.4 55.4 69.4 16.9 24.9 32.8 39.6 54.3 24.9 Philippines PHL 16.3 20.4 24.5 28.9 36.2 43.5 3.4 4.3 5.1 20.4 36.2 4.5 63 Table A1.2. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate WESTERN PACIFIC REGION (continued) — — — — — — — — — 22.4 42.3 2.5 Republic of Korea KOR 15.5 18.9 22.4 26.9 32.7 38.5 4.2 5.4 6.6 20.0 34.1 5.8 Samoa WSM 14.5 22.1 29.8 20.0 31.0 42.0 8.8 13.1 17.4 22.5 31.6 13.3 Singapore SGP 10.8 16.4 21.9 18.6 27.9 37.1 2.4 4.0 5.5 16.5 28.2 4.9 Solomon Islands SLB 24.7 37.6 50.5 37.0 55.3 73.6 12.2 19.6 27.0 36.9 54.4 19.4 Tonga TON 23.3 30.7 38.1 35.8 46.8 57.8 11.5 15.5 19.4 31.3 47.0 15.5 Tuvalu TUV 24.7 33.8 42.9 36.2 48.3 60.4 12.9 19.0 25.1 33.7 48.2 19.1 Vanuatu VUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Viet Nam VNM 16.6 21.8 27.0 33.3 43.6 53.9 0.8 1.1 1.5 23.4 45.9 1.0 64 Table A1.3. Current cigarette smoking rates among people aged 15 years and older, 2022 estimates Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate GLOBAL — — — — — — — — — 15.0 25.5 4.4 AFRICAN REGION — — — — — — — — — 6.9 12.9 0.8 Algeria DZA 11.2 15.3 19.5 21.8 29.9 37.9 0.2 0.3 0.5 15.0 29.8 0.3 Angola AGO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Benin BEN 2.3 3.0 3.7 4.4 5.6 6.9 0.3 0.4 0.6 3.4 6.3 0.4 Botswana BWA 9.4 13.2 17.1 17.7 24.7 31.8 1.4 2.1 2.9 13.4 24.5 2.2 Burkina Faso BFA 5.3 8.1 11.0 10.6 16.0 21.4 0.1 0.5 0.8 8.2 15.8 0.5 Burundi BDI 3.6 5.9 8.2 6.9 11.2 15.6 0.5 0.8 1.1 6.7 12.5 0.9 Cabo Verde CPV 3.9 5.5 7.1 7.1 10.0 12.9 0.7 1.1 1.5 5.7 10.2 1.2 Cameroon CMR 3.0 4.3 5.5 5.9 8.4 10.9 0.1 0.2 0.3 4.9 9.5 0.2 Central African Republic CAF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chad TCD 3.6 5.1 6.5 6.9 9.7 12.5 0.3 0.5 0.6 5.4 10.4 0.5 Comoros COM 5.5 9.6 13.7 10.5 17.9 25.3 0.6 1.3 2.0 9.8 18.3 1.4 Congo COG 6.7 10.9 15.1 13.2 21.6 29.9 0.2 0.4 0.6 11.2 22.0 0.4 Côte d'Ivoire CIV 5.6 8.3 11.1 11.0 16.4 21.8 0.1 0.2 0.3 8.5 16.8 0.2 Democratic Republic of the Congo COD 5.0 8.2 11.4 9.9 16.4 22.8 0.2 0.3 0.5 8.8 17.3 0.3 Equatorial Guinea GNQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eritrea ERI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eswatini SWZ 4.4 6.9 9.4 8.7 13.5 18.3 0.2 0.5 0.8 7.4 14.3 0.6 Ethiopia ETH 1.9 2.6 3.3 3.6 4.8 6.0 0.2 0.4 0.5 3.0 5.6 0.4 Gabon GAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gambia GMB 5.7 7.6 9.6 11.4 15.3 19.2 0.1 0.2 0.2 8.3 16.5 0.2 65 Table A1.3. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate AFRICAN REGION (continued) — — — — — — — — — 6.9 12.9 0.8 Ghana GHA 1.2 1.7 2.3 2.3 3.4 4.5 0.0 0.1 0.1 1.9 3.8 0.1 Guinea GIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guinea-Bissau GNB 3.9 6.0 8.1 7.9 12.0 16.1 0.2 0.3 0.5 6.6 12.8 0.3 Kenya KEN 4.7 6.5 8.2 9.5 12.9 16.2 0.2 0.3 0.4 7.2 14.1 0.3 Lesotho LSO 13.2 17.9 22.7 26.9 36.6 46.3 0.1 0.2 0.3 19.0 37.8 0.2 Liberia LBR 3.1 4.9 6.8 6.0 9.5 13.0 0.3 0.5 0.7 5.4 10.3 0.5 Madagascar MDG 10.7 13.8 16.8 21.0 26.8 32.6 0.7 0.9 1.2 14.0 27.0 1.0 Malawi MWI 4.0 5.2 6.5 8.3 10.7 13.1 0.1 0.3 0.4 6.9 13.4 0.4 Mali MLI 4.3 5.6 6.8 8.4 10.8 13.2 0.1 0.3 0.4 5.6 11.0 0.3 Mauritania MRT 4.5 7.2 9.9 8.3 13.4 18.4 1.0 1.5 2.0 7.3 13.1 1.4 Mauritius MUS 11.7 18.0 24.3 22.4 34.3 46.2 1.6 2.5 3.5 18.8 35.0 2.7 Mozambique MOZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Namibia NAM 7.4 10.8 14.2 13.4 19.2 25.0 2.1 3.3 4.6 12.3 20.9 3.7 Niger NER 3.4 5.4 7.4 6.7 10.6 14.6 0.0 0.0 0.0 5.2 10.4 0.0 Nigeria NGA 1.8 2.4 2.9 3.5 4.5 5.6 0.1 0.2 0.2 2.5 4.8 0.2 Rwanda RWA 3.0 5.0 7.1 5.8 9.6 13.4 0.3 0.7 1.1 5.9 11.1 0.8 Sao Tome and Principe STP 2.1 3.5 4.9 4.0 6.7 9.3 0.2 0.4 0.6 3.8 7.2 0.4 Senegal SEN 3.8 5.0 6.1 7.6 9.9 12.3 0.2 0.3 0.4 5.3 10.2 0.3 Seychelles SYC 11.6 17.9 24.2 19.9 30.3 40.7 2.6 4.5 6.3 17.4 30.4 4.5 Sierra Leone SLE 6.7 8.8 10.9 11.4 14.7 18.1 2.0 2.8 3.7 9.9 16.8 3.1 66 Table A1.3. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate AFRICAN REGION (continued) — — — — — — — — — 6.9 12.9 0.8 South Africa ZAF 11.5 16.5 21.5 19.9 28.7 37.5 3.7 5.1 6.6 16.8 28.5 5.2 South Sudan SSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Togo TGO 2.5 3.7 4.9 4.9 7.2 9.5 0.1 0.1 0.2 4.1 8.0 0.1 Uganda UGA 2.6 3.5 4.3 4.9 6.5 8.0 0.4 0.6 0.7 5.5 9.9 1.0 United Republic of Tanzania TZA 3.5 5.0 6.4 7.0 9.7 12.5 0.2 0.4 0.6 5.9 11.2 0.5 Zambia ZMB 7.4 9.4 11.3 14.7 18.4 22.1 0.5 0.8 1.0 11.2 21.2 1.3 Zimbabwe ZWE 4.8 7.2 9.6 10.3 15.4 20.4 0.1 0.2 0.3 8.8 17.3 0.2 REGION OF THE AMERICAS — — — — — — — — — 16.8 9.5 Antigua and Barbuda ATG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Argentina ARG 16.1 21.1 26.1 20.2 25.9 31.6 12.1 16.4 20.8 21.7 26.1 17.3 Bahamas BHS 4.9 8.6 12.2 9.6 16.5 23.4 0.9 1.6 2.4 9.0 16.5 1.6 Barbados BRB 2.6 5.3 7.9 4.6 9.5 14.5 0.8 1.4 2.0 5.7 10.0 1.4 Belize BLZ 5.0 7.4 9.8 9.1 13.4 17.6 1.0 1.5 2.1 7.5 13.4 1.5 Bolivia BOL 4.7 10.2 15.8 7.4 16.8 26.3 1.9 3.7 5.5 10.4 17.0 3.8 Brazil BRA 8.1 11.0 14.0 10.7 14.3 17.8 5.7 8.0 10.3 10.9 14.0 7.8 Canada CAN 9.0 10.8 12.7 10.8 13.0 15.2 7.2 8.7 10.2 11.4 13.5 9.2 Chile CHL 20.3 25.9 31.6 22.2 28.3 34.5 18.4 23.6 28.8 26.5 28.5 24.4 Colombia COL 4.6 7.1 9.7 6.5 10.5 14.5 2.7 3.9 5.1 7.1 10.4 3.8 Costa Rica CRI 5.5 7.9 10.2 8.1 11.8 15.4 2.9 4.0 5.1 7.9 11.7 4.0 Cuba CUB 12.0 16.1 20.3 17.8 23.6 29.4 6.5 9.0 11.4 15.2 22.2 8.2 Dominica DMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dominican Republic DOM 4.7 6.7 8.6 6.6 9.5 12.4 2.8 3.8 4.9 6.8 9.8 3.9 67 Table A1.3. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate REGION OF THE AMERICAS (continued) — — — — — — — — — 13.2 16.8 9.5 Ecuador ECU 5.6 8.6 11.6 10.2 15.2 20.3 1.2 2.2 3.2 8.8 15.4 2.2 El Salvador SLV 4.6 7.1 9.6 8.8 13.5 18.2 1.0 1.6 2.2 7.7 13.7 1.6 Grenada GRD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guatemala GTM 6.8 10.3 13.7 13.0 19.6 26.1 0.8 1.3 1.8 10.3 19.2 1.3 Guyana GUY 5.9 9.0 12.1 10.8 16.5 22.2 1.2 1.9 2.5 9.5 17.2 1.9 Haiti HTI 4.4 6.4 8.4 7.6 11.1 14.6 1.3 1.9 2.5 7.1 12.0 2.1 Honduras HND 7.9 10.8 13.8 14.7 20.2 25.6 1.0 1.5 1.9 10.9 20.3 1.5 Jamaica JAM 5.1 8.5 11.9 8.7 14.3 19.9 1.7 2.9 4.2 8.6 14.3 2.9 Mexico MEX 11.2 13.4 15.6 17.7 21.1 24.5 5.2 6.3 7.4 13.7 21.1 6.3 Nicaragua NIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Panama PAN 2.9 4.3 5.7 4.7 7.0 9.2 1.2 1.7 2.2 4.3 6.9 1.7 Paraguay PRY 4.3 8.6 12.9 6.6 14.2 21.8 2.1 3.1 4.1 8.8 14.4 3.2 Peru PER 4.5 6.4 8.3 7.3 10.7 14.0 1.7 2.3 2.9 6.5 10.7 2.3 Saint Kitts and Nevis KNA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Saint Lucia LCA 7.2 11.4 15.6 13.2 20.8 28.4 1.5 2.4 3.3 11.6 20.8 2.4 Saint Vincent and the Grenadines VCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Suriname SUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Trinidad and Tobago TTO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States of America USA 12.5 15.5 18.5 14.1 17.5 20.9 11.0 13.6 16.2 16.4 18.3 14.5 Uruguay URY 14.8 17.9 21.0 17.9 21.4 25.0 12.0 14.7 17.3 19.0 21.8 16.1 Venezuela (Bolivarian Republic of) VEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table A1.3. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate SOUTH-EAST ASIA REGION — — — — — — — — — 10.0 19.3 0.8 Bangladesh BGD 10.1 13.0 15.9 20.6 26.5 32.4 0.1 0.2 0.2 13.6 27.0 0.2 Bhutan BTN 2.9 4.9 7.0 4.7 8.1 11.5 0.7 1.4 2.0 4.5 7.7 1.3 Democratic People's Republic of Korea PRK 9.7 14.9 20.0 19.8 30.2 40.6 0.0 0.0 0.0 14.3 28.7 0.0 India IND 3.5 4.6 5.7 6.6 8.6 10.6 0.3 0.4 0.6 4.6 8.7 0.5 Indonesia IDN 25.2 33.4 41.5 48.8 64.7 80.6 1.6 2.0 2.5 33.2 64.3 2.0 Maldives MDV 16.5 21.9 27.2 28.1 37.1 46.1 0.9 1.4 1.9 18.7 36.0 1.4 Myanmar MMR 10.2 14.7 19.3 19.9 28.4 37.0 0.8 1.5 2.2 15.0 28.5 1.5 Nepal NPL 10.3 12.9 15.5 18.4 22.9 27.4 3.2 4.1 5.0 14.6 24.5 4.8 Sri Lanka LKA 3.9 5.7 7.5 8.2 11.9 15.7 0.0 0.1 0.2 5.9 11.7 0.1 Thailand THA 14.1 17.8 21.4 28.2 35.5 42.8 1.3 1.6 2.0 18.0 34.7 1.3 Timor-Leste TLS 21.9 30.6 39.3 40.7 56.3 72.0 2.5 4.0 5.5 31.5 58.6 4.5 EUROPEAN REGION — — — — — — — — — 29.0 17.0 Albania ALB 13.8 19.0 24.3 25.3 34.0 42.6 2.7 4.6 6.5 18.7 33.2 4.2 Andorra AND 14.9 27.4 39.8 15.1 27.4 39.6 14.7 27.4 40.0 29.6 28.6 30.6 Armenia ARM 17.0 22.1 27.2 37.7 48.9 60.2 1.0 1.3 1.6 24.5 47.9 1.2 Austria AUT 15.6 20.6 25.5 17.0 22.3 27.7 14.3 18.9 23.4 23.2 24.3 22.1 Azerbaijan AZE 10.3 15.2 20.1 21.2 31.1 41.1 0.1 0.1 0.2 15.4 30.7 0.1 Belarus BLR 17.7 22.4 27.1 30.3 38.4 46.4 7.3 9.3 11.3 24.3 37.6 10.9 Belgium BEL 16.7 21.4 26.1 19.2 24.2 29.3 14.4 18.7 23.1 23.2 25.7 20.7 Bosnia and Herzegovina BIH 15.8 28.2 40.7 18.6 33.0 47.5 13.1 23.6 34.1 29.1 33.5 24.7 Bulgaria BGR 21.6 31.1 40.7 24.5 35.3 46.1 19.0 27.3 35.7 36.2 37.4 34.9 69 Table A1.3. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate EUROPEAN REGION (continued) — — — — — — — — — 23.0 29.0 17.0 Croatia HRV 20.4 29.4 38.5 21.2 31.0 40.9 19.6 27.9 36.2 33.4 33.3 33.5 Cyprus CYP 17.3 27.9 38.4 23.2 38.3 53.4 11.5 17.5 23.5 29.1 39.3 19.0 Czechia CZE 18.1 23.5 28.8 20.9 27.1 33.4 15.5 19.9 24.3 25.6 28.5 22.6 Denmark DNK 11.5 14.4 17.4 11.0 14.1 17.1 11.9 14.8 17.7 14.5 14.0 14.9 Estonia EST 16.9 21.1 25.4 21.5 27.1 32.7 12.7 15.7 18.8 23.4 27.8 19.0 Finland FIN 10.3 13.3 16.2 11.8 15.1 18.5 8.9 11.5 14.1 15.2 16.5 13.8 France FRA 19.4 26.4 33.3 20.7 28.4 36.2 18.3 24.5 30.6 31.2 32.3 30.2 Georgia GEO 19.8 26.0 32.3 37.6 49.1 60.5 4.7 6.5 8.3 28.6 50.2 7.0 Germany DEU 13.5 16.9 20.2 14.8 18.8 22.7 12.3 15.1 17.9 19.1 20.5 17.8 Greece GRC 18.3 26.9 35.4 21.5 30.3 39.1 15.4 23.7 31.9 29.8 32.1 27.4 Hungary HUN 20.1 27.3 34.4 24.2 32.4 40.6 16.4 22.6 28.8 29.9 33.9 25.9 Iceland ISL 4.6 7.3 9.9 4.5 7.1 9.8 4.8 7.4 10.0 7.2 7.1 7.4 Ireland IRL 13.0 16.8 20.7 14.4 18.8 23.3 11.6 14.9 18.1 17.8 19.8 15.7 Israel ISR 13.5 17.7 21.9 17.8 23.2 28.5 9.2 12.3 15.5 18.2 23.7 12.8 Italy ITA 16.6 19.8 23.1 19.3 23.4 27.5 14.1 16.5 18.9 21.8 25.0 18.7 Kazakhstan KAZ 16.0 19.8 23.6 28.7 35.4 42.1 4.7 5.9 7.2 20.3 34.5 6.1 Kyrgyzstan KGZ 15.1 22.6 30.2 29.5 43.9 58.3 1.6 2.8 4.0 23.4 43.9 2.8 Latvia LVA 18.3 24.4 30.6 27.0 36.3 45.6 10.8 14.3 17.8 27.4 37.2 17.7 Lithuania LTU 18.3 22.9 27.6 27.2 34.4 41.5 10.5 13.0 15.5 26.5 35.7 17.4 Luxembourg LUX 15.4 19.3 23.2 17.0 21.2 25.3 13.7 17.4 21.1 20.3 22.1 18.5 Malta MLT 14.7 20.8 26.9 16.7 23.6 30.4 12.5 17.8 23.0 22.1 24.3 20.0 Monaco MCO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table A1.3. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate EUROPEAN REGION (continued) — — — — — — — — — 23.0 29.0 17.0 Montenegro MNE 18.0 30.3 42.6 17.4 30.1 42.7 18.6 30.6 42.6 29.4 29.1 29.6 Netherlands (Kingdom of the) NLD 12.5 17.1 21.7 13.9 18.8 23.7 11.2 15.4 19.7 18.1 19.6 16.6 North Macedonia MKD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Norway NOR 6.6 10.7 14.8 6.7 11.0 15.2 6.4 10.4 14.4 10.9 11.1 10.7 Poland POL 17.2 21.6 25.9 20.3 25.7 31.0 14.4 17.8 21.1 22.0 25.2 18.7 Portugal PRT 13.5 18.7 24.0 17.4 24.0 30.5 10.0 14.1 18.2 22.9 27.1 18.8 Republic of Moldova MDA 18.5 24.3 30.1 35.0 45.9 56.8 4.2 5.6 7.0 26.0 45.7 6.3 Romania ROU 19.2 24.4 29.7 26.9 34.0 41.1 12.1 15.6 19.2 26.6 35.1 18.1 Russian Federation RUS 21.5 26.7 31.9 33.3 41.3 49.2 11.6 14.5 17.3 28.7 40.4 17.1 San Marino SMR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serbia SRB 27.6 33.8 40.1 29.9 36.1 42.3 25.5 31.8 38.1 36.5 37.1 35.9 Slovakia SVK 15.3 25.2 35.1 18.3 30.2 42.2 12.5 20.5 28.5 27.0 31.0 23.0 Slovenia SVN 13.5 16.9 20.2 15.6 18.9 22.2 11.5 14.8 18.1 18.8 20.4 17.2 Spain ESP 17.9 23.3 28.6 20.4 25.8 31.2 15.6 20.9 26.3 26.6 27.5 25.6 Sweden SWE 6.2 9.0 11.8 5.4 8.3 11.3 7.0 9.7 12.4 9.2 8.5 10.0 Switzerland CHE 14.8 20.3 25.8 16.0 22.8 29.6 13.6 17.8 22.0 22.2 24.4 20.1 Tajikistan TJK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Türkiye TUR 23.1 29.1 35.1 31.6 39.5 47.5 14.7 18.8 22.8 28.9 38.9 18.9 Turkmenistan TKM 2.8 4.6 6.4 5.6 9.0 12.5 0.2 0.4 0.6 4.7 9.1 0.4 Ukraine UKR 17.0 20.8 24.5 29.8 36.2 42.5 6.5 8.1 9.7 23.6 36.2 11.0 United Kingdom GBR 9.0 11.4 13.8 10.1 13.1 16.0 7.9 9.8 11.6 12.3 14.0 10.6 Uzbekistan UZB 5.5 8.9 12.3 10.7 17.2 23.8 0.4 0.8 1.2 9.0 17.3 0.8 71 Table A1.3. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate EASTERN MEDITERRANEAN REGION — — — — — — — — — 12.0 22.6 1.3 Afghanistan AFG 5.4 7.6 9.9 10.3 14.6 18.9 0.5 0.7 1.0 7.5 14.1 0.8 Bahrain BHR 8.5 13.5 18.5 13.3 20.7 28.1 0.4 1.3 2.2 10.7 20.1 1.3 Djibouti DJI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Egypt EGY 13.1 19.2 25.4 26.0 38.2 50.4 0.1 0.1 0.2 19.3 38.4 0.1 Iran (Islamic Republic of) IRN 5.6 7.9 10.2 10.9 15.2 19.5 0.3 0.6 0.9 7.5 14.5 0.6 Iraq IRQ 6.4 14.1 21.8 12.4 27.5 42.6 0.4 0.8 1.1 14.4 28.0 0.8 Jordan JOR 21.4 28.1 34.9 35.3 45.9 56.5 6.5 9.2 11.9 27.5 45.7 9.4 Kuwait KWT 8.7 16.9 25.1 13.9 26.8 39.8 0.6 1.1 1.7 14.8 28.5 1.1 Lebanon LBN 15.2 26.1 37.0 19.6 33.5 47.3 11.3 19.5 27.6 26.8 33.2 20.5 Libya LBY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Morocco MAR 7.5 10.8 14.1 14.7 21.0 27.3 0.3 0.6 1.0 10.7 20.8 0.6 Oman OMN 6.1 8.4 10.7 9.8 13.4 17.0 0.0 0.1 0.1 6.3 12.5 0.1 Pakistan PAK 7.4 9.6 11.8 13.8 17.7 21.6 1.0 1.5 2.0 10.7 19.7 1.7 Qatar QAT 8.7 14.2 19.6 11.5 18.6 25.7 0.7 1.4 2.1 9.2 17.1 1.4 Saudi Arabia SAU 7.6 12.5 17.4 12.6 20.5 28.5 0.5 1.2 1.9 10.7 20.2 1.3 Somalia SOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sudan SDN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Syrian Arab Republic SYR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tunisia TUN 14.1 19.1 24.0 28.3 38.0 47.7 0.7 1.2 1.7 19.6 37.9 1.2 United Arab Emirates ARE 4.9 8.5 12.2 6.7 11.5 16.3 0.7 1.4 2.1 6.4 11.4 1.4 Yemen YEM 3.9 11.7 19.5 6.9 20.3 33.7 0.9 3.2 5.4 12.1 20.9 3.3 72 Table A1.3. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate WESTERN PACIFIC REGION — — — — — — — — — 21.8 41.3 2.3 Australia AUS 6.6 10.1 13.7 7.7 11.8 16.0 5.5 8.5 11.4 10.6 12.2 8.9 Brunei Darussalam BRN 8.5 14.3 20.2 15.7 26.3 37.0 0.9 1.7 2.5 13.7 25.8 1.7 Cambodia KHM 10.4 13.5 16.6 20.2 26.2 32.2 1.1 1.5 1.8 14.5 27.5 1.5 China CHN 20.0 24.8 29.6 38.2 47.3 56.5 1.4 1.8 2.2 23.3 45.1 1.4 Cook Islands COK 12.3 20.0 27.7 14.2 23.4 32.7 10.6 17.0 23.4 21.2 24.6 17.7 Fiji FJI 16.9 23.6 30.2 26.0 36.0 46.0 7.9 11.3 14.7 23.9 36.3 11.4 Japan JPN 13.3 16.2 19.1 21.1 25.6 30.2 5.9 7.3 8.7 18.5 27.7 9.2 Kiribati KIR 22.1 31.8 41.5 31.2 43.7 56.2 13.7 20.8 27.8 33.1 44.5 21.7 Lao People's Democratic Republic LAO 15.8 20.5 25.2 29.0 37.6 46.2 2.5 3.3 4.2 21.5 39.5 3.6 Malaysia MYS 12.6 18.1 23.5 24.6 35.2 45.8 0.2 0.4 0.6 17.6 34.8 0.4 Marshall Islands MHL 14.8 20.2 25.6 27.3 36.8 46.3 2.1 3.3 4.4 19.8 36.4 3.2 Micronesia (Federated States of) FSM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mongolia MNG 21.1 26.2 31.3 38.2 47.3 56.4 4.9 6.2 7.5 26.3 46.5 6.1 Nauru NRU 18.3 36.9 55.5 18.9 37.5 56.2 17.7 36.3 54.9 36.1 36.4 35.8 New Zealand NZL 8.7 10.9 13.1 9.5 12.0 14.5 8.0 9.8 11.7 11.7 12.7 10.6 Niue NIU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Palau PLW 8.1 13.8 19.5 12.6 21.4 30.2 3.5 5.9 8.3 14.1 22.1 6.1 Papua New Guinea PNG 20.6 29.9 39.2 25.7 38.6 51.6 15.2 20.8 26.3 29.4 37.9 20.8 Philippines PHL 15.1 19.0 22.8 26.9 33.7 40.6 3.2 3.9 4.6 18.9 33.7 4.1 73 Table A1.3. (continued) Crude adjusted prevalence (%) Age-standardised prevalence (%) Both sexes Male Female Both sexes Male Female WHO region and country Country code Notes Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Lower limit Point estimate Upper limit Point estimate Point estimate Point estimate WESTERN PACIFIC REGION (continued) — — — — — — — — — 21.8 41.3 2.3 Republic of Korea KOR 14.1 17.9 21.7 24.5 30.9 37.3 3.8 5.1 6.4 18.9 32.2 5.5 Samoa WSM 12.7 18.7 24.8 18.0 26.3 34.6 7.2 11.0 14.9 19.0 26.8 11.2 Singapore SGP 9.6 14.5 19.4 16.4 24.7 33.0 2.2 3.5 4.8 14.6 25.0 4.3 Solomon Islands SLB 21.5 30.8 40.1 32.2 46.0 59.7 10.6 15.4 20.1 30.2 45.2 15.2 Tonga TON 19.9 26.6 33.4 29.4 40.1 50.8 10.8 13.9 16.9 27.1 40.3 14.0 Tuvalu TUV 18.3 27.8 37.4 27.0 40.4 53.8 9.4 15.0 20.7 27.7 40.3 15.1 Vanuatu VUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Viet Nam VNM 13.1 16.5 19.9 26.5 33.2 39.9 0.5 0.7 0.9 18.5 36.3 0.7 74 Table A1.4. Number of tobacco users and tobacco smokers aged 15 years and older, 2022 estimates Estimated number of current tobacco users (thousands) Estimated number of current tobacco smokers (thousands) WHO region and country Country code Notes Both sexes Male Female Both sexes Male Female GLOBAL 1 245 400 1 021 684 223 717 994 893 843 198 151 695 AFRICAN REGION 60 290 52 766 7 524 50 601 46 024 4 577 Algeria DZA 6 666 6 568 98 4 804 4 720 84 Angola AGO 2 148 1 805 343 2 255 1 980 275 Benin BEN 420 357 62 302 259 43 Botswana BWA 315 258 58 255 227 28 Burkina Faso BFA 1 664 1 330 334 1 239 1 104 134 Burundi BDI 672 506 166 506 448 58 Cabo Verde CPV 45 34 11 32 26 6 Cameroon CMR 883 798 84 678 662 16 Central African Republic CAF a 307 259 48 323 285 38 Chad TCD b 621 558 63 621 558 63 Comoros COM 82 66 15 59 55 5 Congo COG 501 467 33 481 467 14 Côte d'Ivoire CIV 1 387 1 329 57 1 387 1 329 57 Democratic Republic of the Congo COD 5 713 5 051 662 4 445 4 091 354 Equatorial Guinea GNQ a 128 112 17 136 122 13 Eritrea ERI a 138 113 25 127 114 13 Eswatini SWZ 67 61 5 59 55 4 Ethiopia ETH 3 372 2 860 511 2 311 2 001 309 Gabon GAB a 181 155 26 190 169 21 Gambia GMB 144 139 5 138 135 3 Ghana GHA 630 599 31 438 411 27 Guinea GIN a 375 335 39 345 317 28 Guinea-Bissau GNB 91 88 4 91 85 5 Kenya KEN 3 066 2 709 357 2 513 2 404 108 Lesotho LSO 345 309 36 299 289 9 Liberia LBR 215 189 26 177 159 18 Madagascar MDG 4 585 3 703 882 2 874 2 769 105 Malawi MWI 827 723 104 730 678 52 Mali MLI 896 854 42 756 709 47 Mauritania MRT 254 225 29 214 193 21 Mauritius MUS b 214 198 15 214 198 15 Mozambique MOZ a 1 113 916 197 1 037 934 104 Namibia NAM 202 163 39 181 147 34 Niger NER 1 005 924 81 832 798 34 Nigeria NGA 3 534 3 293 241 3 517 3 297 220 Rwanda RWA 968 687 281 698 567 131 75 Table A1.4. (continued) Estimated number of current tobacco users (thousands) Estimated number of current tobacco smokers (thousands) WHO region and country Country code Notes Both sexes Male Female Both sexes Male Female AFRICAN REGION (continued) 60 290 52 766 7 524 50 601 46 024 4 577 Sao Tome and Principe STP 10 8 1 7 6 1 Senegal SEN 594 564 30 595 565 30 Seychelles SYC 17 15 2 17 15 2 Sierra Leone SLE 588 447 141 565 424 141 South Africa ZAF b 8 350 6 972 1 378 8 350 6 972 1 378 South Sudan SSD a 380 312 68 352 316 35 Togo TGO 289 266 23 246 234 13 Uganda UGA 1 347 1 093 254 1 047 895 151 United Republic of Tanzania TZA 2 726 2 320 406 2 137 1 934 203 Zambia ZMB 1 364 1 210 153 1 212 1 120 92 Zimbabwe ZWE 855 815 40 809 776 33 REGION OF THE AMERICAS 85 748 46 910 122 491 78 038 44 453 Antigua and Barbuda ATG a 9 6 3 9 6 3 Argentina ARG 8 023 4 814 3 209 8 023 4 814 3 209 Bahamas BHS 35 32 4 35 32 4 Barbados BRB 19 17 2 15 13 2 Belize BLZ b 25 22 3 25 22 3 Bolivia BOL 982 818 164 982 818 164 Brazil BRA 20 781 12 858 7 923 20 781 12 858 7 923 Canada CAN 3 698 2 194 1 504 3 698 2 194 1 504 Chile CHL b 4 475 2 401 2 074 4 475 2 401 2 074 Colombia COL 3 298 2 375 923 3 298 2 375 923 Costa Rica CRI 359 267 92 359 267 92 Cuba CUB 1 721 1 231 491 1 721 1 231 491 Dominica DMA a 7 5 2 7 5 2 Dominican Republic DOM 823 561 262 733 502 231 Ecuador ECU 1 313 1 145 168 1 126 988 138 El Salvador SLV b 377 331 46 377 331 46 Grenada GRD a 11 8 3 11 8 3 Guatemala GTM 1 394 1 297 97 1 394 1 297 97 Guyana GUY 59 52 6 59 52 6 Haiti HTI 568 477 91 568 477 91 Honduras HND b 879 819 60 879 819 60 Jamaica JAM b 209 170 38 209 170 38 Mexico MEX 14 040 10 637 3 404 14 040 10 637 3 404 Nicaragua NIC a 646 504 142 666 524 142 76 Table A1.4. (continued) Estimated number of current tobacco users (thousands) Estimated number of current tobacco smokers (thousands) WHO region and country Country code Notes Both sexes Male Female Both sexes Male Female REGION OF THE AMERICAS (continued) 132 658 85 748 46 910 122 491 78 038 44 453 Panama PAN 148 134 14 158 128 31 Paraguay PRY b 496 406 91 496 406 91 Peru PER b 1 729 1 394 334 1 729 1 394 334 Saint Kitts and Nevis KNA a 4 3 1 5 3 1 Saint Lucia LCA 20 18 2 20 18 2 Saint Vincent and the Grenadines VCT a 10 7 3 10 7 2 Suriname SUR a 57 36 21 59 38 21 Trinidad and Tobago TTO a 147 106 41 150 110 40 United States of America USA 63 207 38 713 24 494 53 193 31 108 22 085 Uruguay URY 531 301 230 531 301 230 Venezuela (Bolivarian Republic of) VEN a 2 558 1 589 969 2 651 1 684 967 SOUTH-EAST ASIA REGION 340 022 71 313 199 017 188 977 10 040 Bangladesh BGD 39 298 30 267 9 031 21 316 21 045 270 Bhutan BTN 118 87 31 41 34 7 Democratic People's Republic of Korea PRK b 3 557 3 557 0 3 557 3 557 0 India IND 251 436 198 426 53 010 74 897 69 090 5 807 Indonesia IDN 78 720 75 286 3 433 74 916 72 711 2 205 Maldives MDV 120 104 16 111 104 6 Myanmar MMR 17 689 13 776 3 913 7 849 7 228 621 Nepal NPL 5 359 4 284 1 075 3 123 2 586 537 Sri Lanka LKA 3 179 2 970 209 1 407 1 393 14 Thailand THA b 11 537 10 984 553 11 537 10 984 553 Timor-Leste TLS 321 280 41 264 245 19 EUROPEAN REGION 113 778 65 496 176 054 111 187 64 866 Albania ALB b 529 452 77 529 452 77 Andorra AND b 23 12 11 23 12 11 Armenia ARM 485 464 21 483 464 19 Austria AUT b 1 669 877 792 1 669 877 792 Azerbaijan AZE 1 471 1 466 5 1 471 1 466 5 Belarus BLR 2 187 1 670 517 1 858 1 442 416 Belgium BEL 2 383 1 300 1 084 2 211 1 232 979 Bosnia and Herzegovina BIH b 917 519 398 917 519 398 Bulgaria BGR b 1 949 1 052 897 1 949 1 052 897 Croatia HRV b 1 110 565 545 1 110 565 545 Cyprus CYP b 352 237 115 352 237 115 Czechia CZE b 2 403 1 360 1 043 2 403 1 360 1 043 77 Table A1.4. (continued) Estimated number of current tobacco users (thousands) Estimated number of current tobacco smokers (thousands) WHO region and country Country code Notes Both sexes Male Female Both sexes Male Female EUROPEAN REGION (continued) 179 274 113 778 65 496 176 054 111 187 64 866 Denmark DNK b 794 399 395 794 399 395 Estonia EST 281 169 112 256 152 104 Finland FIN 912 548 365 702 387 316 France FRA b 15 477 7 916 7 562 15 477 7 916 7 562 Georgia GEO 842 729 113 842 729 113 Germany DEU b 13 410 7 459 5 951 13 410 7 459 5 951 Greece GRC 2 597 1 412 1 185 2 597 1 412 1 185 Hungary HUN b 2 473 1 392 1 081 2 473 1 392 1 081 Iceland ISL b 28 15 14 28 15 14 Ireland IRL b 730 404 327 730 404 327 Israel ISR b 1 269 834 435 1 269 834 435 Italy ITA b 10 460 5 995 4 465 10 460 5 995 4 465 Kazakhstan KAZ 2 907 2 412 495 2 879 2 426 454 Kyrgyzstan KGZ 1 135 1 060 75 1 139 1 066 73 Latvia LVA 467 321 146 417 283 134 Lithuania LTU 639 426 214 578 395 183 Luxembourg LUX b 118 63 55 118 63 55 Malta MLT b 106 61 45 106 61 45 Monaco MCO a 6 3 3 6 3 3 Montenegro MNE 177 87 90 156 62 93 Netherlands (Kingdom of the) NLD b 2 962 1 642 1 320 2 962 1 642 1 320 North Macedonia MKD a 467 284 183 470 287 183 Norway NOR b 630 334 296 630 334 296 Poland POL 7 758 4 434 3 324 7 758 4 434 3 324 Portugal PRT b 1 849 1 115 734 1 849 1 115 734 Republic of Moldova MDA 732 645 87 693 609 84 Romania ROU 4 509 2 926 1 583 4 428 2 926 1 501 Russian Federation RUS 32 064 22 518 9 546 32 064 22 518 9 546 San Marino SMR a 7 4 3 7 4 3 Serbia SRB b 2 242 1 124 1 118 2 242 1 124 1 118 Slovakia SVK b 1 401 796 605 1 401 796 605 Slovenia SVN b 322 181 142 322 181 142 Spain ESP b 10 137 5 434 4 703 10 137 5 434 4 703 Sweden SWE 1 904 1 221 683 1 068 568 500 Switzerland CHE b 1 718 956 762 1 718 956 762 Tajikistan TJK a 1 631 1 142 489 1 615 1 133 482 78 Table A1.4. (continued) Estimated number of current tobacco users (thousands) Estimated number of current tobacco smokers (thousands) WHO region and country Country code Notes Both sexes Male Female Both sexes Male Female EUROPEAN REGION (continued) 179 274 113 778 65 496 176 054 111 187 64 866 Türkiye TUR 20 020 13 626 6 393 20 020 13 626 6 393 Turkmenistan TKM 234 223 11 228 218 10 Ukraine UKR 7 277 5 724 1 553 7 277 5 724 1 553 United Kingdom GBR b 7 265 4 057 3 207 7 265 4 057 3 207 Uzbekistan UZB 3 838 3 715 123 2 486 2 372 115 EASTERN MEDITERRANEAN REGION 91 998 9 422 78 351 72 827 5 523 Afghanistan AFG 5 077 4 405 672 2 095 1 892 204 Bahrain BHR b 211 192 19 211 192 19 Djibouti DJI a 52 43 9 48 44 5 Egypt EGY b 18 183 18 061 122 18 183 18 061 122 Iran (Islamic Republic of) IRN 9 314 8 304 1 011 6 359 5 990 368 Iraq IRQ 4 941 4 730 211 4 941 4 730 211 Jordan JOR b 2 774 2 291 483 2 774 2 291 483 Kuwait KWT b 763 736 26 763 736 26 Lebanon LBN b 1 334 796 538 1 334 796 538 Libya LBY a 854 840 14 975 961 14 Morocco MAR b 3 541 3 412 129 3 541 3 412 129 Oman OMN 373 368 5 338 334 4 Pakistan PAK 25 126 20 610 4 517 17 770 15 775 1 995 Qatar QAT 430 417 12 374 364 10 Saudi Arabia SAU 4 730 4 513 217 4 349 4 174 176 Somalia SOM a 563 468 94 526 477 50 Sudan SDN a 4 597 4 516 80 5 300 5 221 78 Syrian Arab Republic SYR a 2 413 2 028 385 2 533 2 178 355 Tunisia TUN b 1 849 1 775 74 1 849 1 775 74 United Arab Emirates ARE b 935 880 55 935 880 55 Yemen YEM 3 940 3 190 750 3 153 2 544 608 WESTERN PACIFIC REGION 369 847 346 795 23 052 368 379 346 145 22 234 Australia AUS b 2 663 1 549 1 114 2 663 1 549 1 114 Brunei Darussalam BRN b 59 56 4 59 56 4 Cambodia KHM 1 910 1 577 333 1 672 1 577 95 China CHN b 292 481 280 643 11 837 292 481 280 643 11 837 Cook Islands COK b 3 2 1 3 2 1 Fiji FJI b 178 136 43 178 136 43 Japan JPN b 18 306 13 997 4 309 18 306 13 997 4 309 Kiribati KIR b 31 20 11 31 20 11 79 Table A1.4. (continued) Estimated number of current tobacco users (thousands) Estimated number of current tobacco smokers (thousands) WHO region and country Country code Notes Both sexes Male Female Both sexes Male Female WESTERN PACIFIC REGION (continued) 369 847 346 795 23 052 368 379 346 145 22 234 Lao People's Democratic Republic LAO 1 330 1 115 214 1 228 1 115 113 Malaysia MYS 5 885 5 792 93 5 432 5 370 61 Marshall Islands MHL 8 7 1 7 6 1 Micronesia (Federated States of) FSM a 29 20 9 30 21 9 Mongolia MNG 669 584 85 643 565 78 Nauru NRU 4 2 2 3 2 2 New Zealand NZL b 479 261 219 479 261 219 Niue NIU a 0 0 0 1 0 0 Palau PLW b 2 2 0 2 2 0 Papua New Guinea PNG b 2 676 1 880 796 2 676 1 880 796 Philippines PHL b 16 303 14 600 1 703 16 303 14 600 1 703 Republic of Korea KOR b 8 626 7 392 1 233 8 626 7 392 1 233 Samoa WSM 30 21 9 31 22 9 Singapore SGP b 853 756 97 853 756 97 Solomon Islands SLB b 162 121 42 162 121 42 Tonga TON b 21 16 6 21 16 6 Tuvalu TUV b 3 2 1 3 2 1 Vanuatu VUT a 73 50 23 75 52 23 Viet Nam VNM 17 062 16 195 867 16 412 15 984 428 a No estimates are available. The number of users and smokers are guesstimates arrived at by applying the average prevalence of the UN subregion in which the country belongs to the country's population aged 15 years and above. b Tobacco use estimates are not available. Tobacco smoking estimates are substituted for missing tobacco use estimates on the assumption that there is little difference between the two measures in the country. 80 Table A1.5. Current tobacco use prevalence trends among people aged 15 years and older, 2000–2030, not age-standardized Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 GLOBAL — — — — — — — — — — — — — — — — — — — — — AFRICAN REGION — — — — — — — — — — — — — — — — — — — — — Algeria 45.5 44.5 43.4 42.4 42.0 41.6 41.2 1.8 1.4 1.1 0.9 0.7 0.6 0.5 24.0 23.3 22.7 22.0 21.7 21.4 21.1 Angola . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Benin 26.5 20.7 16.4 13.0 10.3 8.3 6.6 4.3 3.4 2.7 2.2 1.8 1.5 1.2 15.1 12.0 9.4 7.6 6.1 4.8 3.9 Botswana 39.1 36.5 34.6 32.7 30.9 29.2 27.4 24.5 17.6 13.0 9.6 7.3 5.5 4.1 31.4 26.9 23.4 21.0 18.9 17.1 15.5 Burkina Faso 35.4 31.5 28.0 25.1 22.6 20.4 18.4 22.5 16.1 11.5 8.4 6.2 4.6 3.4 28.7 23.7 19.5 16.6 14.3 12.4 10.8 Burundi 28.3 23.8 20.7 18.1 16.1 14.0 12.4 18.8 13.6 10.0 7.5 5.6 4.3 3.2 23.4 18.6 15.2 12.7 10.8 9.1 7.8 Cabo Verde 25.5 22.9 20.7 18.6 16.9 15.3 14.0 11.6 9.6 7.9 6.5 5.4 4.5 3.8 18.1 16.1 14.2 12.5 11.1 9.8 8.8 Cameroon 23.0 18.8 15.6 12.9 10.9 9.2 7.9 4.0 2.9 2.1 1.6 1.2 0.9 0.7 13.4 10.8 8.8 7.2 6.0 5.0 4.2 Central African Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chad a 17.3 16.0 14.7 13.7 12.8 11.8 11.1 2.9 2.5 2.1 1.7 1.5 1.3 1.1 10.0 9.2 8.3 7.7 7.1 6.5 6.1 Comoros 40.9 36.5 32.8 29.7 27.3 24.8 22.8 51.1 31.4 19.4 11.9 7.5 4.7 3.0 46.2 34.0 26.0 20.9 17.4 14.7 12.9 Congo 18.3 20.1 21.9 24.4 27.0 30.0 33.7 5.3 4.1 3.3 2.6 2.1 1.7 1.4 11.7 12.1 12.5 13.4 14.5 15.8 17.4 Côte d'Ivoire 37.2 30.3 25.1 21.0 17.5 14.9 12.7 2.8 2.0 1.5 1.1 0.8 0.6 0.5 20.2 16.3 13.5 11.1 9.2 7.8 6.6 Democratic Republic of the Congo 33.8 29.4 25.8 22.9 20.7 18.8 17.2 7.6 5.8 4.5 3.6 2.8 2.3 1.9 20.4 17.4 15.0 13.1 11.6 10.4 9.4 Equatorial Guinea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eritrea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eswatini 17.4 16.7 16.4 16.4 16.3 16.1 16.0 4.5 3.3 2.5 1.9 1.5 1.2 0.9 10.5 9.8 9.1 9.0 8.7 8.5 8.3 Ethiopia 9.5 9.0 8.5 8.2 7.9 7.7 7.6 1.5 1.5 1.4 1.4 1.4 1.4 1.4 5.5 5.2 5.0 4.8 4.6 4.5 4.5 Gabon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gambia 39.7 33.4 27.8 23.6 20.0 17.0 14.6 3.9 2.5 1.7 1.1 0.7 0.5 0.3 21.3 17.8 14.4 12.2 10.2 8.6 7.4 Ghana 11.2 9.6 8.2 7.2 6.2 5.4 4.7 1.0 0.8 0.6 0.4 0.3 0.3 0.2 6.0 5.1 4.3 3.8 3.2 2.8 2.4 81 Table A1.5. (continued) Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 AFRICAN REGION (continued) — — — — — — — — — — — — — — — — — — — — — Guinea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guinea-Bissau 36.5 29.1 23.6 19.3 16.0 13.2 11.1 2.5 1.7 1.3 0.9 0.7 0.5 0.4 18.6 15.1 12.0 9.9 8.2 6.7 5.6 Kenya 26.9 23.8 21.5 19.4 17.5 15.5 14.0 4.4 3.6 3.1 2.6 2.3 1.9 1.7 15.5 13.6 12.2 10.9 9.7 8.6 7.7 Lesotho 43.9 42.9 42.2 42.3 42.5 42.4 42.1 15.5 11.5 8.8 6.8 5.3 4.1 3.3 29.1 26.8 25.0 24.1 23.4 22.8 22.2 Liberia 24.7 20.9 18.0 15.4 13.3 11.5 10.1 5.9 4.4 3.3 2.5 1.9 1.5 1.1 15.0 12.6 10.5 8.9 7.6 6.4 5.6 Madagascar 55.8 51.9 48.2 45.3 42.7 40.2 37.9 44.0 31.2 22.1 15.8 11.4 8.2 6.0 49.9 41.5 35.2 30.5 26.9 24.1 21.8 Malawi 29.1 24.2 20.2 16.9 14.1 11.7 10.0 8.7 6.7 4.5 2.9 2.0 1.4 1.0 18.5 15.1 12.0 9.6 7.8 6.3 5.3 Mali 27.2 23.6 20.4 17.7 15.3 13.1 11.4 3.9 2.6 1.8 1.2 0.8 0.6 0.4 15.6 13.2 11.2 9.5 8.1 6.9 6.0 Mauritania 37.8 31.6 26.2 21.9 18.4 15.5 13.1 7.1 5.3 4.0 3.0 2.3 1.7 1.3 22.3 18.0 14.7 12.1 10.1 8.3 7.0 Mauritius a 47.0 44.3 42.4 40.5 38.9 37.4 35.7 4.9 4.3 3.8 3.3 3.0 2.6 2.4 25.8 23.8 22.9 21.5 20.5 19.6 18.6 Mozambique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Namibia 30.2 27.6 25.1 23.5 22.0 20.5 18.9 15.9 11.8 8.8 6.8 5.2 3.9 3.0 22.7 19.3 16.6 14.7 13.1 11.8 10.6 Niger 16.9 16.0 15.2 14.6 14.1 13.7 13.4 2.6 2.2 1.8 1.6 1.4 1.2 1.1 9.7 9.2 8.6 8.2 7.8 7.5 7.3 Nigeria 17.1 13.1 10.0 7.7 6.0 4.8 4.0 1.8 1.2 0.9 0.6 0.5 0.3 0.2 9.4 7.2 5.5 4.2 3.3 2.6 2.1 Rwanda 27.6 24.4 22.0 20.1 18.3 17.0 16.2 11.9 10.4 9.2 8.0 7.0 6.3 5.7 19.2 17.2 15.2 13.8 12.5 11.4 10.8 Sao Tome and Principe 9.4 9.8 10.5 11.3 12.3 13.1 14.0 3.5 2.9 2.5 2.2 1.9 1.7 1.5 6.4 6.3 6.5 6.7 7.0 7.3 7.7 Senegal 26.0 21.6 18.0 15.1 12.6 10.5 8.8 1.5 1.2 1.0 0.8 0.6 0.5 0.4 13.4 11.1 9.2 7.7 6.4 5.4 4.5 Seychelles 43.5 41.0 38.9 37.0 35.1 34.2 33.3 18.0 13.8 10.6 8.2 6.3 5.2 4.7 30.7 28.0 25.2 23.2 21.3 20.5 19.6 Sierra Leone 57.1 43.4 32.9 25.0 19.3 14.8 11.5 13.8 11.2 9.0 7.3 6.0 4.9 4.1 35.0 27.2 20.8 16.1 12.6 9.8 7.8 South Africa a 34.6 34.1 34.1 34.7 35.1 35.3 35.2 11.2 9.8 8.6 7.6 6.8 6.0 5.4 22.0 21.5 20.6 20.7 20.5 20.1 19.8 South Sudan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table A1.5. (continued) Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 AFRICAN REGION (continued) — — — — — — — — — — — — — — — — — — — — — Togo 18.0 15.3 13.0 11.2 9.5 8.2 7.1 1.1 0.9 0.8 0.6 0.5 0.5 0.4 9.5 8.1 6.9 5.9 5.1 4.3 3.7 Uganda 25.9 19.0 13.9 10.4 7.8 6.1 4.8 5.0 3.5 2.4 1.8 1.3 1.0 0.7 15.0 11.1 8.0 6.0 4.5 3.5 2.7 United Republic of Tanzania 40.7 30.3 22.9 16.8 12.4 9.2 6.9 2.5 2.1 1.7 1.4 1.2 1.0 0.9 21.2 15.8 12.0 8.9 6.6 5.0 3.8 Zambia 23.5 22.4 21.8 21.1 20.4 19.8 19.0 3.4 2.7 2.3 2.0 1.7 1.5 1.3 12.8 12.4 11.7 11.3 10.8 10.4 10.0 Zimbabwe 31.5 27.7 24.5 21.6 18.9 16.6 14.7 2.4 1.8 1.3 1.0 0.7 0.6 0.4 15.8 13.7 11.8 10.5 9.1 7.9 7.0 REGION OF THE AMERICAS — — — — — — — — — — — — — — — — — — — — — Antigua and Barbuda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Argentina 39.9 37.0 34.0 31.5 29.2 26.9 24.9 27.5 24.8 22.7 20.5 18.8 17.1 15.6 33.5 30.8 28.2 25.9 23.9 21.9 20.2 Bahamas 19.4 19.6 19.7 20.1 20.3 20.8 21.2 4.8 4.0 3.3 2.7 2.3 1.9 1.6 11.9 11.3 11.1 10.8 10.7 10.8 10.7 Barbados 15.3 14.3 13.4 12.6 11.9 11.4 10.8 3.6 3.0 2.5 2.1 1.8 1.5 1.3 9.1 8.4 7.6 7.1 6.6 6.2 5.8 Belize a 24.0 21.6 19.5 17.6 16.1 14.8 13.7 3.1 2.7 2.4 2.2 1.9 1.8 1.6 13.6 12.1 10.9 9.9 9.0 8.3 7.6 Bolivia 40.8 34.4 29.3 25.0 21.7 18.9 16.5 28.7 18.1 11.6 7.5 4.9 3.2 2.1 34.8 26.2 20.5 16.2 13.2 11.0 9.3 Brazil 28.8 25.0 21.6 18.8 16.5 14.4 12.5 17.9 15.2 13.1 11.3 9.6 8.3 7.1 23.2 19.9 17.2 14.9 13.0 11.2 9.7 Canada 30.6 25.5 21.2 17.7 14.8 12.3 10.2 26.1 20.6 16.4 12.9 10.1 8.0 6.3 28.3 23.0 18.8 15.3 12.4 10.1 8.2 Chile a 52.2 46.0 40.8 36.2 32.1 28.4 24.8 42.5 37.9 33.7 30.1 27.0 24.1 21.2 47.3 41.9 37.2 33.1 29.5 26.2 23.0 Colombia 22.4 19.2 16.6 14.5 12.7 11.2 9.9 8.1 7.0 6.1 5.4 4.7 4.1 3.7 15.1 13.0 11.3 9.8 8.6 7.6 6.7 Costa Rica 25.1 21.7 18.7 16.1 14.0 12.2 10.6 9.6 8.1 6.8 5.7 4.8 4.1 3.5 17.3 14.8 12.7 10.9 9.4 8.1 7.0 Cuba 50.1 43.3 37.9 32.8 28.5 24.7 21.5 30.5 23.9 18.8 14.7 11.5 9.0 7.0 40.3 33.4 28.3 23.6 19.8 16.7 14.1 Dominica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dominican Republic 18.1 16.5 15.1 13.9 12.9 11.9 11.1 13.1 10.7 8.8 7.4 6.1 5.1 4.2 15.6 13.6 12.0 10.6 9.5 8.5 7.6 Ecuador 22.3 21.0 19.9 18.9 17.9 17.2 16.6 6.0 4.9 4.1 3.4 2.8 2.4 2.0 14.1 12.9 11.9 11.1 10.3 9.7 9.2 El Salvador a 26.3 23.3 20.4 18.2 16.3 14.7 13.3 3.9 3.2 2.8 2.3 2.0 1.7 1.5 14.3 12.6 10.9 9.7 8.6 7.8 7.0 83 Table A1.5. (continued) Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 REGION OF THE AMERICAS (continued) — — — — — — — — — — — — — — — — — — — — — Grenada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guatemala 25.5 24.6 24.1 23.4 23.0 22.5 22.1 3.2 2.7 2.3 2.0 1.8 1.5 1.3 14.1 13.5 13.0 12.5 12.2 11.8 11.5 Guyana 53.0 42.1 33.5 26.4 21.2 16.9 13.7 5.2 4.2 3.4 2.8 2.3 1.9 1.6 28.8 22.7 18.2 14.3 11.5 9.2 7.5 Haiti 15.2 14.3 13.7 13.1 12.7 12.4 12.0 5.0 4.2 3.5 2.9 2.5 2.1 1.8 10.0 9.2 8.5 7.9 7.5 7.1 6.8 Honduras a 30.6 28.5 26.4 24.7 23.4 22.2 20.9 3.4 2.9 2.4 2.1 1.8 1.6 1.4 17.1 15.7 14.5 13.4 12.6 11.9 11.2 Jamaica a 24.5 21.9 19.8 18.0 16.4 15.1 13.8 8.6 6.9 5.6 4.6 3.8 3.1 2.6 16.3 14.3 12.6 11.2 10.0 9.0 8.1 Mexico 33.6 30.8 28.3 25.9 23.9 21.8 19.9 12.0 10.6 9.3 8.2 7.2 6.3 5.5 22.4 20.3 18.5 16.7 15.2 13.8 12.5 Nicaragua . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Panama 20.6 16.6 13.4 10.8 8.8 7.1 5.8 4.7 3.8 3.1 2.5 2.1 1.7 1.4 12.6 10.1 8.2 6.6 5.4 4.4 3.6 Paraguay a 43.1 34.7 28.2 22.9 18.7 15.5 12.7 13.7 10.2 7.6 5.7 4.3 3.3 2.5 28.5 22.4 17.9 14.2 11.4 9.3 7.6 Peru a 56.3 38.9 27.0 18.9 13.3 9.5 6.7 13.8 9.4 6.5 4.4 3.1 2.1 1.5 34.8 23.9 16.6 11.5 8.1 5.7 4.0 Saint Kitts and Nevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Saint Lucia 32.7 30.5 28.6 26.8 25.3 24.1 23.0 7.4 5.9 4.9 3.9 3.2 2.6 2.2 19.8 17.9 16.6 15.1 14.0 13.1 12.3 Saint Vincent and the Grenadines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Suriname . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Trinidad and Tobago . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States of America 35.1 32.0 29.2 26.3 23.9 21.6 19.6 24.5 22.4 20.3 18.2 16.5 14.8 13.4 29.7 27.1 24.6 22.2 20.2 18.2 16.4 Uruguay 40.7 35.7 31.2 27.5 24.2 21.3 18.7 27.4 24.2 21.4 18.9 16.8 14.9 13.2 33.7 29.7 26.0 23.0 20.3 18.0 15.9 Venezuela (Bolivarian Republic of) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table A1.5. (continued) Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 SOUTH-EAST ASIA REGION — — — — — — — — — — — — — — — — — — — — — Bangladesh 55.4 49.8 44.6 39.7 35.6 32.1 28.9 4.4 2.5 1.5 0.9 0.5 0.3 0.2 30.4 25.6 22.9 19.8 17.6 15.9 14.2 Bhutan 18.5 16.5 14.5 12.8 11.2 9.8 8.6 12.4 8.7 6.2 4.3 3.1 2.2 1.6 15.6 12.8 10.6 8.8 7.4 6.2 5.3 Democratic People's Republic of Korea a 57.7 51.6 45.9 40.8 36.3 32.6 29.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 27.6 25.4 22.1 20.1 17.9 16.0 14.5 India 46.0 34.2 25.5 19.1 14.3 10.8 8.2 8.2 5.1 3.3 2.1 1.4 0.9 0.6 27.6 20.0 14.7 10.8 8.0 6.0 4.5 Indonesia 58.4 61.2 63.8 67.3 70.4 73.2 75.8 5.2 4.2 3.5 2.8 2.3 1.9 1.6 31.7 32.7 33.6 35.1 36.3 37.5 38.7 Maldives 60.5 55.3 51.7 48.6 45.3 41.5 37.6 13.3 9.8 7.2 5.4 4.1 3.2 2.4 37.6 35.9 32.1 30.2 27.8 25.5 22.6 Myanmar 58.2 52.2 47.0 42.0 37.9 34.2 30.9 18.9 12.4 8.2 5.4 3.6 2.4 1.6 38.3 31.9 27.3 23.4 20.4 18.1 16.0 Nepal 43.8 38.7 34.3 30.6 26.8 24.0 21.5 33.3 21.2 13.4 8.6 5.6 3.7 2.5 38.6 29.4 23.4 18.9 15.5 13.2 11.4 Sri Lanka 33.3 29.3 25.4 21.9 18.9 16.1 13.9 1.7 1.0 0.6 0.3 0.2 0.1 0.1 17.3 14.4 12.5 10.5 9.0 7.7 6.6 Thailand a 49.9 46.9 43.9 41.0 38.6 36.1 33.8 3.1 2.7 2.4 2.1 1.9 1.6 1.4 25.9 23.9 22.5 20.7 19.4 18.1 16.9 Timor-Leste 73.8 69.7 64.8 60.6 57.7 54.5 51.8 9.4 7.9 6.7 5.7 4.9 4.2 3.6 42.4 39.3 36.2 33.6 31.7 29.7 28.1 EUROPEAN REGION — — — — — — — — — — — — — — — — — — — — Albania a 59.2 53.1 48.0 43.6 40.2 37.0 33.4 11.1 9.7 8.6 7.7 6.9 6.2 5.5 34.7 31.1 28.2 25.4 23.3 21.4 19.2 Andorra a 43.0 40.8 38.9 36.3 34.0 31.7 29.7 27.3 29.0 30.9 31.9 33.2 34.4 35.7 35.4 35.0 34.9 34.1 33.6 33.0 32.7 Armenia 62.5 58.2 54.4 52.5 50.7 47.6 44.5 2.6 2.3 2.1 1.9 1.7 1.6 1.4 30.0 26.7 25.4 24.0 23.1 21.5 20.2 Austria a 56.6 46.6 37.9 31.3 25.6 21.1 17.1 42.5 36.3 30.6 26.0 22.0 18.3 15.5 49.2 41.3 34.1 28.6 23.7 19.7 16.3 Azerbaijan 55.9 50.7 46.8 43.7 40.7 37.9 35.2 0.3 0.3 0.2 0.2 0.1 0.1 0.1 26.4 24.8 22.5 21.4 19.9 18.4 17.2 Belarus 62.2 56.2 51.6 47.1 42.5 38.1 34.1 10.7 10.4 10.2 10.1 9.7 9.4 9.0 34.2 31.0 29.0 26.7 24.5 22.3 20.3 Belgium 34.4 32.4 30.2 28.5 26.5 25.0 23.4 21.4 20.9 20.8 20.3 20.0 19.8 19.3 27.7 26.6 25.4 24.3 23.2 22.3 21.3 Bosnia and Herzegovina a 59.2 53.8 49.5 45.5 42.0 39.2 36.5 34.1 32.7 31.6 30.5 29.8 29.0 28.6 46.2 43.0 40.2 37.9 35.8 34.0 32.5 85 Table A1.5. (continued) Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 EUROPEAN REGION (continued) — — — — — — — — — — — — — — — — — — — — — Bulgaria a 56.9 51.6 47.4 43.2 39.5 36.2 33.0 31.0 30.7 30.4 30.2 29.9 30.3 30.1 43.4 40.8 38.6 36.5 34.5 33.1 31.5 Croatia a 41.2 39.4 37.8 36.4 35.0 33.6 32.2 24.8 26.2 27.7 29.0 30.3 32.1 34.1 32.6 32.6 32.5 32.6 32.6 32.8 33.2 Cyprus a 63.7 58.8 54.8 50.8 47.2 44.1 40.9 20.6 21.1 21.4 21.8 22.0 22.2 22.6 42.2 39.9 38.1 36.3 34.6 33.1 31.7 Czechia a 41.1 39.0 36.6 34.2 32.4 30.8 29.2 26.6 25.8 25.1 24.3 23.7 23.0 22.4 33.6 32.3 30.7 29.2 28.0 26.8 25.8 Denmark a 41.6 33.9 27.3 22.1 17.9 14.4 11.7 34.9 29.4 24.5 20.5 17.1 14.3 11.9 38.2 31.6 25.9 21.3 17.5 14.3 11.8 Estonia 56.8 48.9 42.2 36.2 31.4 26.9 23.1 24.4 22.8 21.2 19.6 18.2 17.1 16.0 39.2 35.1 30.8 27.4 24.4 21.7 19.4 Finland 33.8 29.0 24.7 20.9 17.9 15.3 13.1 21.4 19.3 17.3 15.5 13.8 12.4 11.2 27.4 24.1 20.9 18.2 15.8 13.8 12.1 France a 37.5 35.9 34.4 33.1 31.7 30.7 29.4 26.6 26.8 26.8 27.0 27.1 27.3 27.9 31.8 31.1 30.5 29.9 29.3 28.9 28.6 Georgia 60.7 59.0 57.5 56.0 55.0 53.9 52.8 5.2 5.6 6.0 6.5 6.9 7.5 8.0 30.3 30.1 29.6 29.2 29.0 28.7 28.5 Germany a 40.3 34.5 29.9 25.8 22.6 19.4 16.7 28.7 25.2 22.2 19.5 17.2 15.0 13.2 34.3 29.8 25.9 22.6 19.9 17.2 14.9 Greece 65.6 56.2 47.9 41.1 35.1 30.3 26.1 41.1 37.1 33.4 30.1 27.4 24.6 22.5 53.3 46.3 40.5 35.4 31.1 27.3 24.3 Hungary a 42.3 40.5 38.8 37.0 35.1 33.7 32.1 29.1 27.8 26.7 25.6 24.7 23.8 22.9 35.3 33.9 32.4 31.0 29.6 28.5 27.3 Iceland a 34.1 25.5 19.1 14.2 10.6 7.9 6.0 30.3 23.3 17.8 13.7 10.5 8.0 6.2 32.2 24.4 18.4 13.9 10.6 8.0 6.1 Ireland a 34.8 31.2 27.6 24.5 21.5 19.2 16.9 35.3 29.7 25.1 20.7 17.4 14.4 12.0 35.0 30.4 26.3 22.5 19.4 16.8 14.4 Israel a 39.2 35.8 32.8 29.7 27.3 24.9 22.6 22.7 20.0 17.8 15.8 14.0 12.4 11.0 30.7 27.8 25.1 22.7 20.6 18.6 16.8 Italy a 32.6 30.7 28.7 26.7 24.8 23.2 21.4 18.0 17.9 17.7 17.4 17.1 16.6 16.1 25.0 24.1 23.0 21.9 20.8 19.8 18.7 Kazakhstan 55.8 50.6 46.4 43.0 39.6 35.7 31.9 9.7 8.8 8.0 7.3 6.6 5.9 5.3 31.2 28.5 25.8 24.1 22.2 19.9 17.9 Kyrgyzstan 50.5 49.8 49.4 49.8 50.0 50.1 49.6 5.1 4.5 4.1 3.7 3.3 3.1 2.8 26.8 26.3 25.9 25.9 25.8 25.7 25.3 Latvia 59.7 54.3 49.8 45.7 41.9 38.0 34.5 23.0 21.3 19.7 17.9 16.3 15.1 14.0 39.3 36.4 33.1 30.6 28.1 25.5 23.4 Lithuania 47.6 44.8 41.9 40.1 37.6 35.5 33.1 17.9 17.3 16.5 15.7 14.9 14.4 14.0 31.4 30.1 28.0 27.0 25.4 24.2 22.9 86 Table A1.5. (continued) Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 EUROPEAN REGION (continued) — — — — — — — — — — — — — — — — — — — — — Luxembourg a 34.3 31.6 28.7 26.4 24.2 22.1 19.9 23.3 22.6 21.8 21.3 20.7 19.9 19.0 28.7 27.1 25.3 23.8 22.5 21.0 19.5 Malta a 41.1 36.5 32.6 29.2 26.6 23.9 21.3 22.9 22.1 21.3 20.7 20.7 20.2 19.5 31.9 29.6 26.9 25.2 23.8 22.1 20.5 Monaco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Montenegro 40.9 38.0 35.7 33.6 31.5 29.9 28.4 36.4 35.5 34.7 33.9 33.2 33.1 32.6 38.5 36.7 35.2 33.7 32.4 31.6 30.6 Netherlands (Kingdom of the) a 37.4 33.2 29.7 26.2 23.4 21.0 18.7 30.7 27.0 24.0 21.2 18.6 16.4 14.4 34.0 30.1 26.8 23.7 21.0 18.7 16.5 North Macedonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Norway a 46.1 35.7 27.6 21.2 16.4 12.6 9.7 42.8 33.0 25.2 19.3 14.8 11.3 8.6 44.4 34.3 26.4 20.3 15.6 12.0 9.2 Poland 46.4 41.0 36.6 32.6 28.8 25.6 22.5 30.6 27.4 24.7 22.2 19.8 17.8 15.8 38.2 33.9 30.4 27.2 24.1 21.6 19.0 Portugal a 35.0 33.3 31.3 29.4 27.6 26.1 24.6 13.2 13.8 14.3 14.8 15.4 15.9 16.6 23.6 22.9 22.3 21.6 21.1 20.7 20.4 Republic of Moldova 41.7 43.2 45.0 46.8 48.9 51.2 52.8 4.8 5.1 5.3 5.5 5.7 6.2 6.4 22.0 22.8 23.9 24.7 25.8 27.1 27.9 Romania 47.3 45.3 42.6 40.3 38.2 36.2 33.8 23.7 22.2 20.6 19.2 17.8 16.8 15.6 35.1 33.2 31.2 29.3 27.6 26.1 24.3 Russian Federation 54.0 50.6 48.2 45.8 43.0 40.2 37.1 10.8 11.7 12.6 13.5 14.3 15.1 15.9 30.5 29.4 28.8 28.2 27.4 26.5 25.6 San Marino . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Serbia a 50.2 47.5 44.6 42.0 39.8 37.8 35.6 36.9 36.1 35.7 35.0 34.7 34.5 33.7 43.3 41.5 39.9 38.3 37.1 36.0 34.6 Slovakia a 43.9 41.8 39.8 37.7 36.0 34.5 32.8 19.8 20.8 22.0 23.3 24.5 26.3 27.9 31.3 31.0 30.6 30.3 30.1 30.3 30.3 Slovenia a 28.1 26.1 24.3 22.5 20.9 19.3 17.8 21.5 20.2 18.9 17.6 16.4 15.3 14.3 24.7 23.1 21.6 20.1 18.7 17.3 16.0 Spain a 41.2 38.1 35.0 31.7 28.6 25.8 23.3 24.6 24.5 24.2 23.4 22.7 22.0 21.0 32.6 31.1 29.5 27.4 25.6 23.9 22.1 Sweden 30.9 25.4 21.0 17.2 14.2 11.6 9.5 34.9 27.2 21.3 16.6 12.8 9.9 7.7 32.9 26.3 21.1 16.9 13.5 10.8 8.6 Switzerland a 32.1 30.5 29.1 28.1 26.9 25.5 24.3 21.9 21.6 21.3 21.0 20.7 20.1 19.6 26.8 26.0 25.1 24.5 23.8 22.8 21.9 Tajikistan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table A1.5. (continued) Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 EUROPEAN REGION (continued) — — — — — — — — — — — — — — — — — — — — — Türkiye 54.2 51.3 48.5 45.8 43.0 40.1 37.6 15.0 16.0 17.1 18.1 19.2 20.1 20.9 34.5 33.5 32.7 31.8 31.0 30.1 29.2 Turkmenistan 22.5 18.5 15.3 12.9 11.0 9.4 8.0 0.7 0.6 0.6 0.5 0.5 0.4 0.4 11.2 9.4 7.7 6.5 5.6 4.8 4.1 Ukraine 62.1 55.7 49.7 45.0 40.2 35.5 31.3 11.9 11.3 10.7 9.9 9.1 8.0 7.5 34.6 31.4 28.3 25.8 23.2 20.4 18.3 United Kingdom a 37.1 30.1 24.6 19.9 16.3 13.3 10.8 34.4 26.7 20.9 16.2 12.6 9.8 7.6 35.7 28.4 22.7 18.0 14.4 11.5 9.2 Uzbekistan 28.2 25.8 23.7 22.2 20.9 19.6 18.2 1.4 1.3 1.2 1.1 1.0 0.9 0.9 14.6 13.4 12.3 11.5 10.8 10.2 9.4 EASTERN MEDITERRANEAN REGION — — — — — — — — — — — — — — — — — — — — — Afghanistan 35.4 29.6 24.8 20.9 17.6 15.1 12.9 9.6 6.5 4.4 3.0 2.1 1.5 1.0 22.3 18.0 14.6 12.0 9.9 8.3 7.0 Bahrain a 37.2 34.0 31.4 28.8 26.4 24.3 22.3 6.6 6.0 5.6 5.3 5.0 4.8 4.6 25.5 23.7 22.3 20.1 18.5 17.3 15.8 Djibouti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Egypt a 36.1 38.6 41.3 44.3 47.7 51.0 54.2 0.8 0.7 0.5 0.4 0.4 0.3 0.3 18.5 19.7 21.1 22.4 24.1 25.8 27.3 Iran (Islamic Republic of) 28.2 24.7 22.2 20.4 18.6 16.7 14.7 4.3 3.1 2.3 1.7 1.3 0.9 0.7 16.4 13.9 12.4 11.0 9.9 8.8 7.7 Iraq 36.3 35.7 35.5 35.5 35.7 36.2 37.0 6.2 4.5 3.2 2.4 1.8 1.3 1.0 20.8 20.0 19.0 18.9 18.6 18.6 18.9 Jordan a 52.6 53.6 54.3 55.9 57.2 58.6 60.2 9.7 10.4 11.2 12.0 12.9 13.9 15.0 32.2 32.7 33.5 34.6 35.8 37.1 38.3 Kuwait a 41.1 40.6 40.2 38.5 36.4 34.9 34.3 5.2 4.2 3.5 2.8 2.3 1.9 1.6 27.3 26.6 25.0 24.8 23.2 22.4 21.6 Lebanon a 39.9 41.1 41.6 42.0 42.8 43.8 44.5 30.3 28.7 27.7 26.7 25.9 25.4 25.0 35.0 34.6 34.5 34.0 33.9 34.1 34.3 Libya . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Morocco a 38.8 35.3 32.0 28.9 26.3 23.7 21.5 3.1 2.3 1.8 1.4 1.1 0.9 0.7 20.7 18.8 16.9 15.1 13.7 12.3 11.1 Oman 12.1 12.5 13.2 14.3 15.3 16.3 17.1 0.5 0.5 0.4 0.4 0.4 0.3 0.2 7.6 8.0 8.4 9.1 9.7 10.5 10.8 Pakistan 33.4 29.9 26.8 24.3 22.1 20.2 18.5 8.3 6.3 4.9 3.8 3.0 2.4 1.9 21.2 18.1 16.2 14.0 12.6 11.3 10.2 Qatar 21.7 21.2 20.8 20.7 21.0 21.5 21.7 2.6 2.4 2.2 2.1 2.0 1.9 1.8 16.4 16.4 17.0 15.9 16.1 16.7 16.6 88 Table A1.5. (continued) Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 EASTERN MEDITERRANEAN REGION (continued) — — — — — — — — — — — — — — — — — — — — — Saudi Arabia 22.6 23.7 24.6 25.2 26.2 27.0 27.8 3.4 3.0 2.6 2.3 2.0 1.8 1.6 15.1 15.1 15.7 15.7 16.2 16.7 16.9 Somalia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sudan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Syrian Arab Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tunisia a 55.1 50.8 47.5 44.0 40.9 37.6 35.0 4.2 3.4 2.7 2.2 1.7 1.4 1.1 29.4 26.4 24.7 22.5 20.8 19.0 17.6 United Arab Emirates a 34.8 28.9 24.2 19.9 16.6 13.9 11.9 3.7 3.3 2.9 2.8 2.6 2.4 2.3 26.4 21.4 19.0 14.9 12.5 10.7 9.1 Yemen 34.3 32.0 29.9 28.6 27.4 26.5 25.8 12.6 10.7 9.1 7.8 6.7 5.8 5.0 23.4 21.3 19.5 18.2 17.1 16.1 15.4 WESTERN PACIFIC REGION — — — — — — — — — — — — — — — — — — — — — Australia a 26.5 23.2 20.3 17.7 15.5 13.6 11.9 22.0 18.4 15.6 13.1 11.0 9.2 7.8 24.2 20.8 17.9 15.4 13.2 11.4 9.8 Brunei Darussalam a 30.6 30.7 30.9 31.2 31.2 31.2 31.5 4.9 4.0 3.3 2.8 2.3 1.9 1.6 18.6 17.7 17.7 17.4 17.2 17.0 17.0 Cambodia 49.1 41.9 36.4 32.6 28.8 24.9 21.4 6.9 4.8 3.4 2.5 1.8 1.3 0.9 27.1 22.9 19.5 17.2 15.0 12.8 10.9 China a 51.1 49.7 49.2 48.6 47.8 46.6 45.2 3.0 2.7 2.4 2.2 2.1 1.9 1.7 27.3 26.5 26.1 25.6 25.2 24.5 23.7 Cook Islands a 45.2 41.3 37.9 34.8 31.6 28.6 26.2 33.6 30.6 27.4 25.0 22.2 20.1 18.0 39.5 35.5 32.6 29.5 26.6 24.0 21.8 Fiji a 48.7 46.8 45.2 43.7 42.4 40.8 39.4 15.3 14.8 14.2 13.7 13.2 12.9 12.5 32.2 30.7 29.9 28.6 27.7 26.8 25.8 Japan a 51.3 44.1 38.0 32.6 28.2 24.4 21.0 13.1 11.5 10.1 9.0 8.0 7.2 6.4 31.7 27.2 23.6 20.4 17.7 15.5 13.4 Kiribati a 80.2 72.9 65.8 59.1 53.7 48.4 43.7 50.5 42.9 36.4 31.3 27.2 23.6 20.5 64.7 57.3 50.4 44.7 39.9 35.4 31.7 Lao People's Democratic Republic 64.4 58.3 53.0 48.4 44.8 41.0 37.9 17.8 12.8 9.2 6.7 5.0 3.7 2.7 41.0 35.5 31.1 27.6 24.9 22.4 20.4 Malaysia 56.0 51.8 48.3 44.9 42.0 38.9 36.2 3.1 2.0 1.3 0.9 0.6 0.4 0.3 29.7 27.2 25.5 23.2 21.6 20.0 18.5 Marshall Islands 40.9 41.8 42.6 43.5 43.8 44.7 46.4 6.0 5.4 5.0 4.5 4.2 3.8 3.4 23.8 23.8 24.1 24.2 24.2 24.5 25.1 Micronesia (Federated States of) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table A1.5. (continued) Male Female Both sexes WHO region and country Notes 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 2000 2005 2010 2015 2020 2025 2030 WESTERN PACIFIC REGION (continued) — — — — — — — — — — — — — — — — — — — — — Mongolia 51.0 50.5 50.6 50.8 50.9 50.2 49.0 7.4 7.1 7.0 6.9 6.8 6.5 6.3 28.8 28.2 28.5 28.3 28.2 27.8 27.1 Nauru 55.2 53.0 51.3 49.6 47.8 46.5 45.5 64.6 59.1 54.4 50.7 46.5 43.4 40.3 59.8 56.1 52.8 50.2 47.2 45.0 42.9 New Zealand a 30.7 25.0 20.3 16.6 13.8 11.2 9.1 28.5 22.7 18.0 14.2 11.3 8.9 7.0 29.6 23.9 19.1 15.4 12.5 10.0 8.0 Niue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Palau a 39.1 35.4 32.2 29.5 27.2 25.2 23.8 14.1 12.1 10.5 9.0 7.8 6.8 6.0 28.1 24.0 22.1 19.4 17.7 16.3 15.1 Papua New Guinea a 72.9 68.7 64.2 60.2 56.5 53.4 50.4 36.4 33.2 30.4 27.9 25.9 23.8 22.2 55.4 51.3 47.9 44.4 41.5 38.9 36.6 Philippines a 57.0 51.5 46.4 41.9 38.1 34.4 31.0 13.2 10.2 7.9 6.1 4.7 3.7 2.9 35.1 31.0 27.1 24.2 21.6 19.2 17.1 Republic of Korea a 65.0 56.0 47.7 40.8 34.9 29.7 25.3 7.2 6.7 6.2 5.9 5.5 5.2 5.0 35.9 31.1 26.7 23.2 20.0 17.4 15.1 Samoa 54.2 48.0 42.2 37.2 32.8 28.6 25.1 22.4 19.8 17.5 15.4 13.7 12.3 10.9 39.0 34.1 30.1 26.4 23.4 20.5 18.1 Singapore a 28.1 28.1 28.0 28.0 27.7 27.6 27.5 5.5 5.1 4.8 4.5 4.1 3.8 3.5 17.0 17.0 16.9 16.7 16.4 16.2 16.0 Solomon Islands a 61.8 59.9 58.3 56.5 55.6 54.5 54.0 27.0 25.0 23.2 21.5 20.1 18.8 17.7 45.0 42.6 41.0 39.1 38.0 36.8 36.0 Tonga a 52.7 51.1 49.9 48.4 47.4 46.1 45.2 13.6 14.1 14.4 14.9 15.3 15.8 16.3 33.1 32.1 31.9 31.2 30.9 30.5 30.3 Tuvalu a 69.3 63.7 58.4 54.0 50.1 46.2 42.8 27.6 25.4 23.1 21.2 19.5 18.1 16.7 47.5 44.8 41.0 37.8 34.9 32.4 29.9 Vanuatu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Viet Nam 54.0 51.9 49.3 47.6 45.5 43.1 40.6 4.3 3.6 3.1 2.7 2.4 2.1 1.8 28.1 27.2 25.5 24.6 23.4 22.0 20.7 a Tobacco use estimates are not available. Tobacco smoking estimates are substituted for missing tobacco use estimates on the assumption that there is little difference between the two measures in the country. 90 Table A1.6. Characteristics of the most recent survey in the survey set used to produce the estimates Year data were collected Ages surveyed Tobacco use indicator was reported Tobacco smoking indicator was reported Cigarette smoking indicator was reported WHO region and country Notes GLOBAL — — — — — AFRICAN REGION — — — — — Algeria 2016-17 18–69 Yes Yes No Angola a 2015-16 15–49 Yes Yes Yes Benin 2017-18 15–49 Yes Yes Yes Botswana 2017 15 + Yes Yes Yes Burkina Faso 2013 25–64 Yes Yes Yes Burundi 2016-17 15–49 Yes Yes Yes Cabo Verde 2020 18–69 Yes Yes Yes Cameroon 2018 15–49 No Yes Yes Central African Republic . . . . . . . . . . . . . . . Chad 2014-15 15 + Yes No Yes Comoros 2012 15–49 Yes No Yes Congo 2014-15 15–49 Yes No Yes Côte d'Ivoire 2016 15–49 Yes No Yes Democratic Republic of the Congo 2017-18 15–49 Yes No Yes Equatorial Guinea b 2011 15–49 Yes No Yes Eritrea b 2010 25–74 Yes Yes Yes Eswatini 2014 15–69 Yes Yes No Ethiopia 2016 15 + Yes Yes Yes Gabon a 2012 15–49 No No No Gambia 2018 15–49 Yes Yes Yes Ghana 2017-18 15–49 Yes Yes Yes Guinea a 2018 15–49 No Yes Yes Guinea-Bissau 2019 15–49 Yes No Yes Kenya 2015 18–69 Yes Yes No Lesotho 2018 15–49 Yes Yes Yes Liberia 2013 15–49 Yes No Yes Madagascar 2021 15–49 Yes Yes Yes Malawi 2019-20 15–49 Yes Yes Yes Mali 2018 15–49 Yes Yes Yes Mauritania 2019-21 15–49 Yes No Yes Mauritius 2021 25–74 No Yes No Mozambique b 2011 15–49 No No No Namibia 2013 15–49 Yes No Yes Niger 2012 15–49 Yes No Yes Nigeria 2018 15–49 Yes No Yes Rwanda 2014-15 15–49 Yes No Yes 91 Table A1.6. (continued) Year data were collected Ages surveyed Tobacco use indicator was reported Tobacco smoking indicator was reported Cigarette smoking indicator was reported WHO region and country Notes AFRICAN REGION (continued) — — — — — Sao Tome and Principe 2019 15–69 Yes Yes Yes Senegal 2017 15–49 Yes Yes Yes Seychelles 2013 25–64 Yes Yes Yes Sierra Leone 2019 15–49 Yes No No South Africa 2021 15 + Yes Yes Yes South Sudan . . . . . . . . . . . . . . . Togo 2017 15–49 Yes Yes Yes Uganda 2016 15–49 No Yes Yes United Republic of Tanzania 2018 15 + Yes Yes Yes Zambia 2018 15–49 Yes Yes Yes Zimbabwe 2015 15–49 No Yes Yes REGION OF THE AMERICAS — — — — — Antigua and Barbuda . . . . . . . . . . . . . . . Argentina 2018 18 + No No Yes Bahamas 2019 18–69 Yes Yes Yes Barbados 2011-12 25 + No Yes No Belize 2015 15–49 Yes No No Bolivia 2019 18–69 Yes Yes No Brazil 2019 18 + Yes Yes No Canada 2021 12 + No Yes No Chile 2022 15–64 No No Yes Colombia 2019 12–65 No Yes No Costa Rica 2015 15 + Yes Yes Yes Cuba 2019 15–49 Yes Yes Yes Dominica b 2007-08 15–64 Yes Yes No Dominican Republic 2019 15–49 Yes No Yes Ecuador 2018 18–69 Yes Yes Yes El Salvador 2014-15 20 + No Yes No Grenada b 2010-11 25–64 No Yes Yes Guatemala 2014-15 15–49 Yes No Yes Guyana 2016 18–69 No Yes Yes Haiti 2016-17 15–49 Yes Yes Yes Honduras 2019 15–49 Yes Yes Yes Jamaica 2016-17 15 + No Yes No Mexico 2021 20 + No Yes No Nicaragua b 2001 15–49 No Yes Yes 92 Table A1.6. (continued) Year data were collected Ages surveyed Tobacco use indicator was reported Tobacco smoking indicator was reported Cigarette smoking indicator was reported WHO region and country Notes REGION OF THE AMERICAS (continued) — — — — — Panama 2019 15 + Yes Yes No Paraguay 2016 15–49 Yes No Yes Peru 2019 15 + No No Yes Saint Kitts and Nevis b 2007-08 25–64 Yes Yes Yes Saint Lucia 2019 18 + Yes Yes Yes Saint Vincent and the Grenadines a 2013-14 18–69 No Yes No Suriname a 2013 25–65 No Yes Yes Trinidad and Tobago b 2011 15–64 Yes Yes Yes United States of America 2021 18 + Yes No Yes Uruguay 2021 15 + No Yes No Venezuela (Bolivarian Republic of) b 2011 18–65 Yes No Yes SOUTH-EAST ASIA REGION . . . . . . . . . . . . . . . Bangladesh 2018 18–69 Yes Yes No Bhutan 2019 15–69 Yes Yes Yes Democratic People's Republic of Korea 2017 15 + Yes Yes Yes India 2019-21 15 + Yes No No Indonesia 2021 15 + Yes Yes Yes Maldives 2020-21 15–69 Yes Yes No Myanmar 2015-16 15–49 No Yes Yes Nepal 2019 15–69 Yes Yes Yes Sri Lanka 2019-20 15 + Yes Yes Yes Thailand 2021 15 + Yes Yes Yes Timor-Leste 2016 15–49 Yes Yes Yes EUROPEAN REGION — — — — — Albania 2017-18 15–59 No Yes Yes Andorra 2017-18 12–75 No Yes No Armenia 2016 16 + No Yes No Austria 2020 15 + No No Yes Azerbaijan 2020 15 + No No Yes Belarus 2022 16 + No Yes No Belgium 2021 15 + No Yes No Bosnia and Herzegovina 2011-12 15–49 Yes No Yes Bulgaria 2020 15 + No Yes No Croatia 2020 15 + No Yes No Cyprus 2020 15 + No Yes No Czechia 2021 15 + Yes Yes Yes 93 Table A1.6. (continued) Year data were collected Ages surveyed Tobacco use indicator was reported Tobacco smoking indicator was reported Cigarette smoking indicator was reported WHO region and country Notes EUROPEAN REGION (continued) — — — — — Denmark 2020 15–79 No Yes No Estonia 2020 16–64 No Yes No Finland 2020-21 20 + No Yes No France 2021 18–75 No Yes No Georgia 2020 18 + No Yes No Germany 2021 14 + No Yes No Greece 2020 15 + No Yes No Hungary 2020 15 + No Yes No Iceland 2021 18–64 No Yes No Ireland 2020-21 15 + No Yes No Israel 2020 21 + No Yes No Italy 2022 15 + No No Yes Kazakhstan 2021 15 + Yes No Yes Kyrgyzstan 2013 25–64 Yes Yes Yes Latvia 2020 15–74 No Yes No Lithuania 2021 15–64 No No Yes Luxembourg 2021 16 + No Yes No Malta 2019-20 15 + No Yes No Monaco . . . . . . . . . . . . . . . Montenegro 2017 15–64 No Yes No Netherlands (Kingdom of the) 2021 18 + No Yes No North Macedonia a 2017 15–64 No Yes No Norway 2021 16–74 No Yes No Poland 2021 18 + No Yes Yes Portugal 2020 15 + No Yes No Republic of Moldova 2021 18–69 Yes Yes Yes Romania 2020 15 + No Yes No Russian Federation 2022 18 + No No Yes San Marino a 2013 15 + No Yes No Serbia 2019 15 + No Yes Yes Slovakia 2020 15 + No Yes No Slovenia 2021 18 + No Yes Yes Spain 2022 15–64 No Yes No Sweden 2021 16 + Yes Yes No Switzerland 2017 15 + No Yes No Tajikistan a 2016-17 18–69 Yes Yes Yes 94 Table A1.6. (continued) Year data were collected Ages surveyed Tobacco use indicator was reported Tobacco smoking indicator was reported Cigarette smoking indicator was reported WHO region and country Notes EUROPEAN REGION (continued) — — — — — Türkiye 2019 15 + No Yes No Turkmenistan 2018 18–69 Yes Yes Yes Ukraine 2020 18 + No Yes No United Kingdom 2021 18 + No Yes No Uzbekistan 2019 18–69 Yes Yes No EASTERN MEDITERRANEAN REGION — — — — — Afghanistan 2019 18–69 Yes Yes Yes Bahrain 2017-19 18 + No Yes No Djibouti a 2012 10 + Yes No No Egypt 2016-17 15–69 Yes Yes Yes Iran (Islamic Republic of) 2016 18 + No Yes Yes Iraq 2018 15–49 Yes Yes Yes Jordan 2019 18–69 No Yes No Kuwait 2014 18–69 Yes Yes Yes Lebanon 2016-17 18–69 Yes Yes No Libya b 2009 25–64 No Yes Yes Morocco 2018 15 + No Yes No Oman 2017 15 + Yes Yes No Pakistan 2017-18 15–49 Yes Yes Yes Qatar 2013 15 + Yes Yes Yes Saudi Arabia 2019 15 + Yes Yes No Somalia . . . . . . . . . . . . . . . Sudan a 2016 18–69 Yes Yes Yes Syrian Arab Republic b 2002-03 15–65 No Yes No Tunisia 2018 15–49 Yes No Yes United Arab Emirates 2017-18 18–69 No Yes Yes Yemen 2013 10 + No Yes No WESTERN PACIFIC REGION — — — — — Australia 2020-21 15 + No No Yes Brunei Darussalam 2016 18–69 Yes Yes No Cambodia 2021 15 + Yes Yes Yes China 2018 15 + Yes Yes Yes Cook Islands 2021 15 + No Yes No Fiji 2021 15–49 Yes Yes Yes Japan 2019 20 + No Yes No Kiribati 2018-19 15–49 Yes Yes Yes 95 Table A1.6. (continued) Year data were collected Ages surveyed Tobacco use indicator was reported Tobacco smoking indicator was reported Cigarette smoking indicator was reported WHO region and country Notes WESTERN PACIFIC REGION (continued) — — — — — Lao People's Democratic Republic 2017 15–49 Yes Yes Yes Malaysia 2019 15–75 No Yes Yes Marshall Islands 2017-18 18 + Yes No Yes Micronesia (Federated States of) a 2012 12–98 No No Yes Mongolia 2019 15–69 Yes Yes Yes Nauru 2015-16 18–69 Yes Yes No New Zealand 2020-21 15 + No Yes No Niue a 2017 15 + No No Yes Palau 2016 18–97 No Yes No Papua New Guinea 2016-18 15–49 No Yes Yes Philippines 2021 15 + Yes Yes Yes Republic of Korea 2019 19 + No No Yes Samoa 2019-20 15–49 Yes Yes No Singapore 2019 18–74 No No Yes Solomon Islands 2015 18–69 Yes Yes No Tonga 2019 15–49 Yes Yes Yes Tuvalu 2019-20 15–49 Yes Yes Yes Vanuatu b 2011 25–64 No Yes No Viet Nam 2020-21 15–49 Yes No Yes a Although at least one survey was completed, no trend estimates were produced for this report. See the Methods section for further details. b The most recent survey was too old to calculate a trend estimates for this report. See the Methods section for further details. 96 Table A1.7. Current tobacco use relative reduction category, 2022 WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa GLOBAL AFRICAN REGION Algeria DZA 21.7 21.1 2.9 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Angola AGO . . . . . . . . . Has insufficient data to calculate a trend. . . . Benin BEN 10.9 5.5 49.8 On track to achieve a 30% relative reduction. More reliable Botswana BWA c 25.4 17.6 30.7 Likely to achieve a decrease in prevalence but less than 30%. More reliable Burkina Faso BFA 20.9 13.1 37.3 On track to achieve a 30% relative reduction. Less reliable Burundi BDI 17.3 10.1 41.3 On track to achieve a 30% relative reduction. Less reliable Cabo Verde CPV 15.1 10.2 32.7 On track to achieve a 30% relative reduction. More reliable Cameroon CMR 10.4 5.8 44.2 On track to achieve a 30% relative reduction. More reliable Central African Republic CAF . . . . . . . . . Has insufficient data to calculate a trend. . . . Chad TCD b 9.0 7.0 22.0 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Comoros COM 28.3 15.5 45.0 On track to achieve a 30% relative reduction. Less reliable Congo COG 13.0 16.3 -25.3 Likely to experience an increase in prevalence. More reliable Côte d'Ivoire CIV 13.7 8.0 41.8 On track to achieve a 30% relative reduction. Less reliable Democratic Republic of the Congo COD c 16.4 11.5 30.0 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Equatorial Guinea GNQ . . . . . . . . . Has insufficient data to calculate a trend. . . . Eritrea ERI . . . . . . . . . Has insufficient data to calculate a trend. . . . Eswatini SWZ 10.8 9.3 13.9 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Ethiopia ETH 5.8 5.1 11.4 Likely to achieve a decrease in prevalence but less than 30%. More reliable Gabon GAB . . . . . . . . . Has insufficient data to calculate a trend. . . . Gambia GMB 16.0 9.5 40.7 On track to achieve a 30% relative reduction. More reliable Ghana GHA 5.1 3.1 38.5 On track to achieve a 30% relative reduction. More reliable 97 Table A1.7. (continued) WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa AFRICAN REGION (continued) Guinea GIN . . . . . . . . . Has insufficient data to calculate a trend. . . . Guinea-Bissau GNB 13.4 7.3 45.4 On track to achieve a 30% relative reduction. Less reliable Kenya KEN 14.7 9.9 32.7 On track to achieve a 30% relative reduction. More reliable Lesotho LSO 27.5 24.1 12.2 Likely to achieve a decrease in prevalence but less than 30%. More reliable Liberia LBR 12.3 7.5 39.0 On track to achieve a 30% relative reduction. Less reliable Madagascar MDG c 37.0 25.1 32.3 Likely to achieve a decrease in prevalence but less than 30%. More reliable Malawi MWI 15.8 8.6 45.4 On track to achieve a 30% relative reduction. More reliable Mali MLI 11.8 7.3 38.6 On track to achieve a 30% relative reduction. More reliable Mauritania MRT 14.8 8.4 43.0 On track to achieve a 30% relative reduction. Less reliable Mauritius MUS b 23.0 20.5 10.9 Likely to achieve a decrease in prevalence but less than 30%. More reliable Mozambique MOZ . . . . . . . . . Has insufficient data to calculate a trend. . . . Namibia NAM c 19.4 13.2 31.7 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Niger NER 8.6 7.5 12.7 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Nigeria NGA 6.1 2.8 54.0 On track to achieve a 30% relative reduction. More reliable Rwanda RWA 18.6 13.5 27.2 Likely to achieve a decrease in prevalence but less than 30%. More reliable Sao Tome and Principe STP 7.3 8.1 -10.0 Unlikely to experience a significant change in prevalence. More reliable Senegal SEN 10.2 5.8 43.1 On track to achieve a 30% relative reduction. More reliable Seychelles SYC 24.9 19.7 20.8 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Sierra Leone SLE 23.9 11.0 53.8 On track to achieve a 30% relative reduction. More reliable South Africa ZAF b 22.0 20.5 6.7 Likely to achieve a decrease in prevalence but less than 30%. More reliable South Sudan SSD . . . . . . . . . Has insufficient data to calculate a trend. . . . Togo TGO 10.2 5.7 43.9 On track to achieve a 30% relative reduction. More reliable 98 Table A1.7. (continued) WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa AFRICAN REGION (continued) Uganda UGA 14.6 6.4 56.1 On track to achieve a 30% relative reduction. More reliable United Republic of Tanzania TZA 16.8 8.1 52.0 On track to achieve a 30% relative reduction. More reliable Zambia ZMB 17.0 14.1 17.2 Likely to achieve a decrease in prevalence but less than 30%. More reliable Zimbabwe ZWE 15.7 10.4 33.5 On track to achieve a 30% relative reduction. More reliable REGION OF THE AMERICAS — — — — Antigua and Barbuda ATG . . . . . . . . . Has insufficient data to calculate a trend. . . . Argentina ARG 29.0 22.6 21.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Bahamas BHS 11.5 11.3 1.2 Likely to achieve a decrease in prevalence but less than 30%. More reliable Barbados BRB 8.1 6.7 17.1 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Belize BLZ b 11.0 8.3 24.8 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Bolivia (Plurinational State of) BOL 20.7 11.1 46.3 On track to achieve a 30% relative reduction. Less reliable Brazil BRA 17.4 11.1 36.3 On track to achieve a 30% relative reduction. More reliable Canada CAN 19.3 10.7 44.6 On track to achieve a 30% relative reduction. More reliable Chile CHL b 37.5 27.0 28.0 Likely to achieve a decrease in prevalence but less than 30%. More reliable Colombia COL 11.5 7.5 34.6 On track to achieve a 30% relative reduction. More reliable Costa Rica CRI 12.7 8.1 36.0 On track to achieve a 30% relative reduction. Less reliable Cuba CUB 27.1 15.7 42.3 On track to achieve a 30% relative reduction. Less reliable Dominica DMA . . . . . . . . . Has insufficient data to calculate a trend. . . . Dominican Republic DOM c 14.3 9.8 31.6 Likely to achieve a decrease in prevalence but less than 30%. More reliable Ecuador ECU 12.2 9.8 19.6 Likely to achieve a decrease in prevalence but less than 30%. More reliable El Salvador SLV b 11.9 8.3 30.0 On track to achieve a 30% relative reduction. Less reliable 99 Table A1.7. (continued) WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa REGION OF THE AMERICAS (continued) Grenada GRD . . . . . . . . . Has insufficient data to calculate a trend. . . . Guatemala GTM 13.0 11.8 9.2 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Guyana GUY 19.4 9.7 49.9 On track to achieve a 30% relative reduction. Less reliable Haiti HTI 9.6 7.8 19.0 Likely to achieve a decrease in prevalence but less than 30%. More reliable Honduras HND b 14.6 11.9 18.1 Likely to achieve a decrease in prevalence but less than 30%. More reliable Jamaica JAM b 13.0 9.0 30.8 On track to achieve a 30% relative reduction. More reliable Mexico MEX 18.7 14.1 24.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Nicaragua NIC . . . . . . . . . Has insufficient data to calculate a trend. . . . Panama PAN 8.8 4.5 48.9 On track to achieve a 30% relative reduction. More reliable Paraguay PRY b 18.4 9.4 48.7 On track to achieve a 30% relative reduction. Less reliable Peru PER b 16.7 5.8 65.3 On track to achieve a 30% relative reduction. More reliable Saint Kitts and Nevis KNA . . . . . . . . . Has insufficient data to calculate a trend. . . . Saint Lucia LCA 16.8 13.3 20.8 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Saint Vincent and the Grenadines VCT . . . . . . . . . Has insufficient data to calculate a trend. . . . Suriname SUR . . . . . . . . . Has insufficient data to calculate a trend. . . . Trinidad and Tobago TTO . . . . . . . . . Has insufficient data to calculate a trend. . . . United States of America USA 27.9 23.6 15.5 Likely to achieve a decrease in prevalence but less than 30%. More reliable Uruguay URY 27.6 19.1 30.8 On track to achieve a 30% relative reduction. More reliable Venezuela (Bolivarian Republic of) VEN . . . . . . . . . Has insufficient data to calculate a trend. . . . 100 Table A1.7. (continued) WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa SOUTH-EAST ASIA REGION Bangladesh BGD c 44.2 30.8 30.3 Likely to achieve a decrease in prevalence but less than 30%. More reliable Bhutan BTN 24.9 17.6 29.3 Likely to achieve a decrease in prevalence but less than 30%. More reliable Democratic People's Republic of Korea PRK b,c 22.7 15.4 32.3 Likely to achieve a decrease in prevalence but less than 30%. More reliable India IND 38.3 21.8 43.0 On track to achieve a 30% relative reduction. More reliable Indonesia IDN 36.2 38.7 -7.1 Likely to experience an increase in prevalence. More reliable Maldives MDV 33.7 24.9 26.1 Likely to achieve a decrease in prevalence but less than 30%. More reliable Myanmar MMR 54.8 42.3 22.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Nepal NPL 44.0 25.7 41.7 On track to achieve a 30% relative reduction. More reliable Sri Lanka LKA 24.3 18.5 23.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Thailand THA b 22.6 18.3 19.0 Likely to achieve a decrease in prevalence but less than 30%. More reliable Timor-Leste TLS 46.2 37.2 19.6 Likely to achieve a decrease in prevalence but less than 30%. More reliable EUROPEAN REGION — — — — — Albania ALB b 28.3 20.7 26.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Andorra AND b 35.7 36.4 -1.9 Unlikely to experience a significant change in prevalence. More reliable Armenia ARM 28.8 24.1 16.4 Likely to achieve a decrease in prevalence but less than 30%. More reliable Austria AUT b 37.2 22.5 39.6 On track to achieve a 30% relative reduction. More reliable Azerbaijan AZE 24.0 18.7 21.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Belarus BLR 36.4 28.9 20.6 Likely to achieve a decrease in prevalence but less than 30%. More reliable Belgium BEL 29.0 26.3 9.2 Likely to achieve a decrease in prevalence but less than 30%. More reliable Bosnia and Herzegovina BIH b 41.1 35.2 14.4 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Bulgaria BGR b 43.0 38.8 9.7 Likely to achieve a decrease in prevalence but less than 30%. More reliable 101 Table A1.7. (continued) WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa EUROPEAN REGION (continued) Croatia HRV b 35.5 37.6 -5.7 Unlikely to experience a significant change in prevalence. More reliable Cyprus CYP b 38.6 35.0 9.3 Likely to achieve a decrease in prevalence but less than 30%. More reliable Czechia CZE b 32.5 29.4 9.6 Likely to achieve a decrease in prevalence but less than 30%. More reliable Denmark DNK b 25.7 14.4 43.8 On track to achieve a 30% relative reduction. More reliable Estonia EST 37.3 26.4 29.4 Likely to achieve a decrease in prevalence but less than 30%. More reliable Finland FIN 22.8 15.9 30.1 On track to achieve a 30% relative reduction. More reliable France FRA b 34.6 34.4 0.5 Likely to achieve a decrease in prevalence but less than 30%. More reliable Georgia GEO 32.4 31.6 2.4 Likely to achieve a decrease in prevalence but less than 30%. More reliable Germany DEU b 28.5 19.7 30.9 On track to achieve a 30% relative reduction. More reliable Greece GRC 43.2 30.6 29.2 On track to achieve a 30% relative reduction. More reliable Hungary HUN b 34.9 31.5 9.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Iceland ISL b 18.3 7.9 56.7 On track to achieve a 30% relative reduction. More reliable Ireland IRL b 26.8 17.8 33.5 On track to achieve a 30% relative reduction. More reliable Israel ISR b 25.7 19.2 25.3 Likely to achieve a decrease in prevalence but less than 30%. More reliable Italy ITA b 24.4 22.1 9.4 Likely to achieve a decrease in prevalence but less than 30%. More reliable Kazakhstan KAZ 28.4 20.9 26.5 Likely to achieve a decrease in prevalence but less than 30%. More reliable Kyrgyzstan KGZ 28.7 26.9 6.3 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Latvia LVA 39.6 32.6 17.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Lithuania LTU 37.1 30.2 18.7 Likely to achieve a decrease in prevalence but less than 30%. More reliable Luxembourg LUX b 26.4 22.3 15.6 Likely to achieve a decrease in prevalence but less than 30%. More reliable Malta MLT b 28.8 23.9 17.0 Likely to achieve a decrease in prevalence but less than 30%. More reliable Monaco MCO . . . . . . . . . Has insufficient data to calculate a trend. . . . 102 Table A1.7. (continued) WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa EUROPEAN REGION (continued) Montenegro MNE 35.2 31.5 10.5 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Netherlands (Kingdom of the) NLD b 27.7 19.9 28.1 Likely to achieve a decrease in prevalence but less than 30%. More reliable North Macedonia MKD . . . . . . . . . Has insufficient data to calculate a trend. . . . Norway NOR b 26.6 12.2 54.1 On track to achieve a 30% relative reduction. More reliable Poland POL 30.9 22.1 28.5 Likely to achieve a decrease in prevalence but less than 30%. More reliable Portugal PRT b 25.8 25.5 1.0 Likely to achieve a decrease in prevalence but less than 30%. More reliable Republic of Moldova MDA 27.0 30.5 -13.1 Likely to experience an increase in prevalence. More reliable Romania ROU 33.6 29.3 12.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Russian Federation RUS 30.8 28.9 6.2 Likely to achieve a decrease in prevalence but less than 30%. More reliable San Marino SMR . . . . . . . . . Has insufficient data to calculate a trend. . . . Serbia SRB b 42.4 39.0 7.9 Likely to achieve a decrease in prevalence but less than 30%. More reliable Slovakia SVK b 31.8 32.8 -2.9 Unlikely to experience a significant change in prevalence. More reliable Slovenia SVN b 23.0 19.5 15.1 Likely to achieve a decrease in prevalence but less than 30%. More reliable Spain ESP b 31.7 27.8 12.6 Likely to achieve a decrease in prevalence but less than 30%. More reliable Sweden SWE 33.4 20.5 38.7 On track to achieve a 30% relative reduction. More reliable Switzerland CHE b 26.9 25.3 6.0 Likely to achieve a decrease in prevalence but less than 30%. More reliable Tajikistan TJK . . . . . . . . . Has insufficient data to calculate a trend. . . . Türkiye TUR 32.0 30.2 5.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Turkmenistan TKM 9.3 4.9 46.7 On track to achieve a 30% relative reduction. Less reliable Ukraine UKR 31.3 23.6 24.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable United Kingdom GBR b 24.1 12.5 48.0 On track to achieve a 30% relative reduction. More reliable Uzbekistan UZB 21.9 15.8 27.9 Likely to achieve a decrease in prevalence but less than 30%. More reliable 103 Table A1.7. (continued) WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa EASTERN MEDITERRANEAN REGION Afghanistan AFG 30.2 21.3 29.2 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Bahrain BHR b 18.3 14.3 21.6 Likely to achieve a decrease in prevalence but less than 30%. More reliable Djibouti DJI . . . . . . . . . Has insufficient data to calculate a trend. . . . Egypt EGY b 21.6 25.8 -19.2 Likely to experience an increase in prevalence. More reliable Iran (Islamic Republic of) IRN 17.3 12.5 28.0 Likely to achieve a decrease in prevalence but less than 30%. More reliable Iraq IRQ 20.1 19.2 4.5 Unlikely to experience a significant change in prevalence. More reliable Jordan JOR b 33.1 36.3 -9.6 Likely to experience an increase in prevalence. More reliable Kuwait KWT b 20.1 20.0 0.6 Unlikely to experience a significant change in prevalence. Less reliable Lebanon LBN b 35.1 34.1 2.9 Likely to achieve a decrease in prevalence but less than 30%. More reliable Libya LBY . . . . . . . . . Has insufficient data to calculate a trend. . . . Morocco MAR b 16.5 12.2 26.0 Likely to achieve a decrease in prevalence but less than 30%. More reliable Oman OMN 7.9 8.6 -9.3 Likely to experience an increase in prevalence. More reliable Pakistan PAK 28.0 17.2 38.5 On track to achieve a 30% relative reduction. More reliable Qatar QAT 12.5 12.5 0.3 Unlikely to experience a significant change in prevalence. Less reliable Saudi Arabia SAU 14.3 15.0 -5.0 Unlikely to experience a significant change in prevalence. More reliable Somalia SOM . . . . . . . . . Has insufficient data to calculate a trend. . . . Sudan SDN . . . . . . . . . Has insufficient data to calculate a trend. . . . Syrian Arab Republic SYR . . . . . . . . . Has insufficient data to calculate a trend. . . . Tunisia TUN b 25.0 19.5 22.1 Likely to achieve a decrease in prevalence but less than 30%. More reliable United Arab Emirates ARE b 13.3 8.2 38.3 On track to achieve a 30% relative reduction. Less reliable Yemen YEM 24.8 20.6 16.7 Likely to achieve a decrease in prevalence but less than 30%. Less reliable 104 Table A1.7. (continued) WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa WESTERN PACIFIC REGION Australia AUS b 18.4 12.0 34.9 On track to achieve a 30% relative reduction. More reliable Brunei Darussalam BRN b 16.5 16.4 0.3 Unlikely to experience a significant change in prevalence. More reliable Cambodia KHM 28.0 15.3 45.3 On track to achieve a 30% relative reduction. More reliable China CHN b 25.2 22.9 8.9 Likely to achieve a decrease in prevalence but less than 30%. More reliable Cook Islands COK b 32.9 25.8 21.6 Likely to achieve a decrease in prevalence but less than 30%. More reliable Fiji FJI b 30.4 27.0 11.1 Likely to achieve a decrease in prevalence but less than 30%. More reliable Japan JPN b 25.9 17.8 31.4 On track to achieve a 30% relative reduction. More reliable Kiribati KIR b 53.4 36.8 31.0 On track to achieve a 30% relative reduction. More reliable Lao People's Democratic Republic LAO c 38.0 25.1 33.9 Likely to achieve a decrease in prevalence but less than 30%. More reliable Malaysia MYS 26.0 21.0 19.3 Likely to achieve a decrease in prevalence but less than 30%. More reliable Marshall Islands MHL 28.5 30.4 -6.7 Unlikely to experience a significant change in prevalence. Less reliable Micronesia (Federated States of) FSM . . . . . . . . . Has insufficient data to calculate a trend. . . . Mongolia MNG 31.3 29.2 6.9 Likely to achieve a decrease in prevalence but less than 30%. More reliable Nauru NRU 55.6 46.7 16.1 Likely to achieve a decrease in prevalence but less than 30%. More reliable New Zealand NZL b 20.1 10.9 46.1 On track to achieve a 30% relative reduction. More reliable Niue NIU . . . . . . . . . Has insufficient data to calculate a trend. . . . Palau PLW b 21.5 16.6 22.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Papua New Guinea PNG b 46.6 38.1 18.2 Likely to achieve a decrease in prevalence but less than 30%. Less reliable Philippines PHL b,c 27.7 19.1 31.1 Likely to achieve a decrease in prevalence but less than 30%. More reliable Republic of Korea KOR b 27.0 18.5 31.5 On track to achieve a 30% relative reduction. More reliable 105 Table A1.7. (continued) WHO Region and country Country code Notes 2010 estimate, both sexes (%) 2025 projection, both sexes (%) Expected relative reduction 2010-2025 (%) Target assessment category Indication of the reliability of the assessment based on the quantity of the underlying dataa WESTERN PACIFIC REGION (continued) Samoa WSM c 31.2 20.8 33.3 Likely to achieve a decrease in prevalence but less than 30%. More reliable Singapore SGP b 16.6 16.2 2.7 Likely to achieve a decrease in prevalence but less than 30%. More reliable Solomon Islands SLB b 40.0 36.1 9.8 Likely to achieve a decrease in prevalence but less than 30%. More reliable Tonga TON b 32.3 31.1 3.5 Likely to achieve a decrease in prevalence but less than 30%. More reliable Tuvalu TUV b 40.7 32.2 20.9 Likely to achieve a decrease in prevalence but less than 30%. More reliable Vanuatu VUT . . . . . . . . . Has insufficient data to calculate a trend. . . . Viet Nam VNM 26.6 21.7 18.3 Likely to achieve a decrease in prevalence but less than 30%. More reliable a At least one survey since 2014 with prevalence disaggregated by age and by sex, and at least one more survey in a different year disaggregated by age and sex, and at least one more survey in a different year. b Tobacco use estimates are not available. Tobacco smoking estimates are substituted for missing tobacco use estimates on the assumption that there is little difference between the two measures in the country. c Reduction is at or higher than 30% but the estimate has a high degree of uncertainty. 106 Annex 2. Statistical Annex This annex provides data sources and explanations of the methods used to calculate the estimates in this report, including details of the various country groupings used: the World Bank grouping of countries by income; WHO regional grouping of countries; and the analysis grouping of countries. This Statistical Annex includes the following tables: Table A2.1 Most recent national population-based survey that reports rates of smokeless tobacco use among adults, 2012–2022. Table A2.2 Most recent national school-based survey that reports rates of smokeless tobacco among adolescents aged 13–15 years, 2012–2022. Table A2.3 Most recent national school-based survey that reports rates of tobacco use, smoking or cigarette smoking among adolescents aged 13–15 years, 2012– 2022. Table A2.4 Most recent national school-based survey that reports rates of e- cigarette use, among adolescents aged in the range 13–17 years, 2013–2022. Table A2.5 Most recent national population-based survey that reports rates of e- cigarette use among adults, 2013–2022. 107 2.1 Estimated prevalence rates and numbers of current smokeless tobacco users aged 15 years and above by WHO Region and country income group. Source of prevalence rates: the most recent national population-based survey undertaken by the country during the period 2012–2022 that reported rates of smokeless tobacco use. Surveys used are listed in Table A2.1 below. Reports and data sets of the Global Adult Tobacco Surveys and STEPS Surveys are available from the WHO microdata repository at https://extranet.who.int/ncdsmicrodata/index.php/home. Eurobarometer surveys are available from https://europa.eu/eurobarometer/screen/home. Demographic and Health Surveys are available from https://www.dhsprogram.com/. Country-specific surveys are generally available on the websites of the Ministry of Health in the country. Source of population numbers: World Population Prospects, 2022 revision, medium fertility variant, population estimates by sex and year for 2021. United Nations, Department of Economic and Social Affairs, Population Division, 2022. Available from: https://esa.un.org/unpd/wpp/Download/Standard/Population/. Method: For each country and for each sex, the number of current smokeless tobacco users aged 15 years or older was calculated using the prevalence rates from the appropriate survey and multiplying by the population aged 15 years or older for the appropriate sex. These numbers were then summed to calculate total smokeless tobacco users in each region by grouping Member States into their World Bank income group regions and their WHO Regions (groups specified below). To calculate average prevalence rates for each region, the total number of smokeless tobacco users was divided by the summed populations aged 15 years or older in each region. Some surveys published a rate of smokeless tobacco use for both sexes only, not sex disaggregated; in these countries, the both-sexes rate was assumed to apply to both males and females separately. Data coverage: A total of 89 countries (46% of countries) had surveyed smokeless tobacco use among their national adult populations in this period. The global population coverage of these surveys was 78%. The missing 22% of global population contributes to an undercount of smokeless tobacco users in this report which will be corrected in future as more countries survey smokeless use. Countries without a published survey reporting smokeless tobacco use in the period 2012–2022 were assumed to have no smokeless tobacco users. Countries with a survey reporting smokeless tobacco use among persons in an age range other than 15 years or older were included in the analysis by assuming the total age rate was not too dissimilar from the rate for persons aged 15 years or older. This assumption may result in some overstated or understated rates for some countries. 108 Table A2.1 Most recent national population-based survey that reports rates of smokeless tobacco use among adults, 2012–2022 COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Afghanistan STEPS Survey 2019 18-69 Algeria Enquête STEPS 2016-17 18-69 Angola Demographic and Health Survey 2015-16 15-49 Armenia STEPS Survey 2016 18-69 Austria Repräsentativerhebung zum Substanzgebrauch 2020 15+ Bahamas Bahamas STEPS 2019 18-69 Bangladesh STEPS Survey 2018 18-69 Benin Enquête Démographique et de Santé au Bénin 2017-18 15-49 Bhutan STEPS Survey 2019 15-69 Botswana Global Adult Tobacco Survey (GATS) 2017 15+ Brazil Pesquisa Nacional de Saúde (National Health Survey) 2013 18+ Brunei Darussalam STEPS Survey 2016 18-69 Burkina Faso Enquête STEPs sur les facteurs de risque des maladies non transmissibles, Burkina Faso 2021 18-29 Burundi Demographic and Health Survey 2016-17 15-59 (men) 15-49 (women) Cambodia National Adult Tobacco Survey of Cambodia 2021 15+ Cameroon Demographic and Health Survey 2018 15-64 China Global Adult Tobacco Survey (GATS) 2020 15+ Costa Rica Global Adult Tobacco Survey (GATS) 2015 15+ Czechia National Research on Tobacco and Alcohol Use in the Czech Republic (NAUTA) 2021 15+ Democratic People's Republic of Korea National Adult Tobacco Survey 2017 15+ Ecuador STEPS Survey 2018 18-69 Egypt STEPS Survey 2016-17 15-69 El Salvador Encuesta Nacional de Alcohol y Tabaco (ENAT) 2022 18+ Eswatini STEPS Survey 2014 15-69 Ethiopia Global Adult Tobacco Survey (GATS) 2016 15+ Finland National FinSote Survey 2020-21 20+ Georgia National tobacco survey 2019 18-69 Ghana Demographic and Health Survey 2014 15-49 Haiti Enquête Mortalité, Morbidité et Utilisation des Services en Haïti 2016-17 15-64 Iceland Tóbakskönnun by Gallup 2021 18+ India Global Adult Tobacco Survey (GATS) 2016-17 15+ Indonesia Global Adult Tobacco Survey (GATS) 2021 15+ Iraq STEPS Survey 2015 18+ Kazakhstan Global Adult Tobacco Survey (GATS) 2019 15+ Kenya Kenya STEPS survey 2015 18-69 Kiribati Kiribati STEPS survey 2015-16 18-69 Kuwait STEPS Survey 2014 18-69 Kyrgyzstan Kyrgyzstan STEPS 2013 25-64 Lao People's Democratic Republic National Adult Tobacco Survey 2015 15+ Lesotho Demographic and Health Survey 2014 15-59 (men) 15-49 (women) 109 Table A2.1 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Madagascar Demographic and Health Survey 2021 15-59 (men) 15-49 (women) Malawi STEPS Survey 2017 18-69 Maldives STEPS Survey 2020-21 15-69 Mali Demographic and Health Survey 2018 15-59 (men) 15-49 (women) Marshall Islands Hybrid Household Survey of NCD risk factors and substance use 2017-18 18+ Mongolia STEPS Survey 2019 15-69 Myanmar Demographic and Health Survey 2015-16 15-49 Nauru STEPS Survey 2015-16 18-69 Nepal STEPS Survey 2019 15-69 Nigeria Global Adult Tobacco Survey (GATS) 2012 15+ Norway Statistics Norway Smoking Habits Survey 2019 16-74 Oman STEPS Survey 2017 15+ Pakistan Demographic and Health Survey 2017-18 15-49 Palau Behavioral Risk Factor Surveillance Survey (BRFSS) 2012 18+ Panama Encuesta Nacional de Salud 2019 15+ Philippines Global Adult Tobacco Survey (GATS) 2021 15+ Republic of Moldova STEPS Survey 2021 18-69 Russian Federation осстат. Состояние здоровья населения Selective monitoring of the health of the population survey (Rosstat) 2022 15+ Rwanda Rwanda STEPS 2021 18-69 Saint Lucia STEPS Survey 2019 18+ Saint Vincent and the Grenadines National Health and Nutrition Survey 2013-14 18-69 Samoa Samoa STEPS 2013 18-64 Sao Tome and Principe Sao Tomé et Principe Enquête STEPS 2019 15-69 Saudi Arabia Global Adult Tobacco Survey (GATS) 2019 15+ Senegal Enquête Démographique et de Santé à Indicateurs Multiples (EDS-MICS) 2017 15-59 (men) 15-49 (women) Seychelles The Seychelles Heart Study IV 2013 25-64 Sierra Leone Demographic and Health Survey 2019 15-49 Slovenia National Survey on the Impact of the Pandemic of Life 2021 18+ Solomon Islands STEPS Survey 2015 18-69 South Africa Global Adult Tobacco Survey (GATS) 2021 15+ Spain European Health Interview Survey (EHIS) 2019-20 15+ Sri Lanka Global Adult Tobacco Survey (GATS) 2019-20 15+ Sudan STEPS Survey 2016 18-69 Sweden National Survey on Public Health 2022 16-84 Switzerland Enquête Santé et Lifestyle 2022 15+ Tajikistan STEPS Survey 2016-17 18-69 Thailand The Smoking and Drinking Behaviour Survey 2017 15+ Timor-Leste Demographic and Health Survey 2016 15-49 Turkmenistan Turkmenistan STEPS 2018 18-69 Uganda Uganda NCD Risk Factors Survey 2014 18-69 Ukraine Global Adult Tobacco Survey (GATS) 2017 15+ 110 Table A2.1 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) United Arab Emirates National Health Survey (STEPS) 2017-18 18-69 United Republic of Tanzania Global Adult Tobacco Survey (GATS) 2018 15+ United States of America National Health Interview Survey (NHIS) 2020 18+ Uruguay Global Adult Tobacco Survey (GATS) 2016-17 15+ Uzbekistan Uzbekistan STEPS Survey 2019 18-69 Viet Nam Provincial Global Adult Tobacco Survey 2020 15+ Yemen Demographic and Health Survey 2013 15+ Zambia Demographic and Health Survey 2018 15-59 (men) 15-49 (women) 111 2.2 Estimated prevalence rates and numbers of adolescents aged 13–15 years who use smokeless tobacco. Source of prevalence rates: the most recent nationally-representative school-based survey covering the age range 13-15 completed in each country in the period 2012–2022, if any. Specific surveys used are listed in Table A2.2. Reports and data sets of the Global Youth Tobacco Survey and the Global School-Based Students Health Survey are available from the WHO microdata repository at https://extranet.who.int/ncdsmicrodata/index.php/home. Reports and data sets of the HBSC survey are available from http://www.hbsc.org/. Canada: Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS), available from https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs- survey.html. Colombia: Encuesta Nacional de Tabaquismo en Jóvenes, report available on request. Malaysia: Tobacco and E-Cigarette Survey Among Malaysian Adolescents (TECMA), available from https://iku.moh.gov.my/images/IKU/Document/REPORT/TECMA2016/TabaccoandECigarette. pdf. USA: National Youth Tobacco Survey, available from http://www.cdc.gov/tobacco/data_statistics/surveys/nyts. Source of population numbers: World population prospects, 2022 revision, medium fertility variant, population estimates by sex and year for 2021. United Nations, Department of Economic and Social Affairs, Population Division, 2022. Available from https://esa.un.org/unpd/wpp/Download/Standard/Population/. Method: For each country and for each sex, the number of current smokeless tobacco users aged 13–15 years was calculated using smokeless tobacco use prevalence rates published in the country’s latest survey and multiplying by the population aged 13–15 years for the appropriate sex. Countries without a survey reporting smokeless tobacco use in the period 2012–2022 were assumed to have no smokeless tobacco users. In total, 73% of the world’s population aged 13–15 years was represented by a survey in this analysis. The number of smokeless tobacco users aged 13–15 years was summarized by World Bank country income group regions, by WHO regions (specified below) and globally by dividing the number of smokeless tobacco users in each region by the population of the region aged 13–15 years. The method results in a global underestimate of smokeless tobacco users aged 13–15 years which would be improved if more countries survey smokeless tobacco use. 112 Table A2.2 Most recent national school-based survey that reports rates of smokeless tobacco among adolescents aged 13–15 years, 2012–2022 COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Albania Global Youth Tobacco Survey 2020 13-15 Algeria Global Youth Tobacco Survey 2013 13-15 Antigua and Barbuda Global Youth Tobacco Survey 2017 13-15 Argentina Global Youth Tobacco Survey 2018 13-15 Armenia Global Youth Tobacco Survey 2009 13-15 Azerbaijan Global Youth Tobacco Survey 2016 13-15 Bahamas Global Youth Tobacco Survey 2013 13-15 Bahrain Global Youth Tobacco Survey 2015 13-15 Bangladesh Global Youth Tobacco Survey 2013 13-15 Barbados Global Youth Tobacco Survey 2013 13-15 Belarus Global Youth Tobacco Survey 2021 13-15 Belize Global Youth Tobacco Survey 2014 13-15 Bhutan Global Youth Tobacco Survey 2019 13-15 Bolivia (Plurinational State of) Global Youth Tobacco Survey 2018 13-15 Bosnia and Herzegovina Global Youth Tobacco Survey 2018-19 13-15 Botswana Global Youth Tobacco Survey 2008 13-15 Brunei Darussalam Global Youth Tobacco Survey 2019 13-15 Bulgaria Global Youth Tobacco Survey 2015 13-15 Cambodia Global Youth Tobacco Survey 2022 13-15 Cameroon Global Youth Tobacco Survey 2014 13-15 Canada Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS) 2018-19 Grades 7-9 Chad Global Youth Tobacco Survey 2019 13-15 China Global Youth Tobacco Survey 2014 13-15 Colombia Encuesta Nacional de Tabaquismo en Jóvenes 2017 13-15 Comoros Global Youth Tobacco Survey 2015 13-15 Congo Global Youth Tobacco Survey 2019 13-15 Cook Islands Global Youth Tobacco Survey 2016 13-15 Costa Rica Global Youth Tobacco Survey 2013 13-15 Cote d'Ivoire Global Youth Tobacco Survey 2009 13-15 Croatia Global Youth Tobacco Survey 2016 13-15 Cuba Global Youth Tobacco Survey 2018 13-15 Czechia Global Youth Tobacco Survey 2016 13-15 Djibouti Global Youth Tobacco Survey 2009 13-15 Dominica Global Youth Tobacco Survey 2009 13-15 113 Table A2.2 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Dominican Republic Global Youth Tobacco Survey 2016 13-15 Ecuador Global Youth Tobacco Survey 2016 13-15 Egypt Global Youth Tobacco Survey 2014 13-15 El Salvador Global Youth Tobacco Survey 2021 13-15 Estonia Global Youth Tobacco Survey 2007 13-15 Eswatini Global Youth Tobacco Survey 2009 13-15 Fiji Global Youth Tobacco Survey 2016 13-15 Finland Global Youth Tobacco Survey 2012 13-15 Gabon Global Youth Tobacco Survey 2014 13-15 Gambia Global Youth Tobacco Survey 2017 13-15 Georgia Global Youth Tobacco Survey 2017 13-15 Ghana Global Youth Tobacco Survey 2017 13-15 Greece Global Youth Tobacco Survey 2003 13-15 Grenada Global Youth Tobacco Survey 2016 13-15 Guatemala Global Youth Tobacco Survey 2015 13-15 Guyana Global Youth Tobacco Survey 2015 13-15 Honduras Global Youth Tobacco Survey 2016 13-15 Hungary Global Youth Tobacco Survey 2016 13-15 India Global Youth Tobacco Survey 2019 13-15 Indonesia Global Youth Tobacco Survey 2019 13-15 Iran (Islamic Republic of) Global Youth Tobacco Survey 2016 13-15 Iraq Global Youth Tobacco Survey 2019 13-15 Italy Global Youth Tobacco Survey 2018 13-15 Jamaica Global Youth Tobacco Survey 2017 13-15 Jordan Global Youth Tobacco Survey 2014 13-15 Kazakhstan Global Youth Tobacco Survey 2014 13-15 Kenya Global Youth Tobacco Survey 2013 13-15 Kiribati Global Youth Tobacco Survey 2018 13-15 Kuwait Global Youth Tobacco Survey 2016 13-15 Kyrgyzstan Global Youth Tobacco Survey 2019 13-15 Lao People's Democratic Republic Global Youth Tobacco Survey 2016 13-15 Latvia Global Youth Tobacco Survey 2019 13-15 Lesotho Global Youth Tobacco Survey 2008 13-15 Libya Global Youth Tobacco Survey 2010 13-15 Lithuania Global Youth Tobacco Survey 2001 13-15 114 Table A2.2 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Madagascar Global Youth Tobacco Survey 2018 13-15 Malawi Global Youth Tobacco Survey 2009 13-15 Malaysia Tobacco and E-Cigarette Survey Among Malaysian Adolescents (TECMA) 2016 13-15 Maldives Global Youth Tobacco Survey 2019 13-15 Marshall Islands Global Youth Tobacco Survey 2016 13-15 Mauritania Global Youth Tobacco Survey 2018 13-15 Mauritius Global Youth Tobacco Survey 2016 13-15 Mexico Global Youth Tobacco Survey 2011 13-15 Micronesia (Federated States of) Global Youth Tobacco Survey 2019 13-15 Mongolia Global Youth Tobacco Survey 2019 13-15 Montenegro Global Youth Tobacco Survey 2018 13-15 Morocco Global Youth Tobacco Survey 2016 13-15 Mozambique Global Youth Tobacco Survey 2013 13-15 Myanmar Global Youth Tobacco Survey 2016 13-15 Namibia Global Youth Tobacco Survey 2008 13-15 Nepal Global Youth Tobacco Survey 2011 13-15 Nicaragua Global Youth Tobacco Survey 2019 13-15 Niue Global Youth Tobacco Survey 2019 13-15 Norway Health Behaviour in School-aged Children 2014 13-15 Oman Global Youth Tobacco Survey 2016 13-15 Pakistan Global Youth Tobacco Survey 2013 13-15 Palau Global Youth Tobacco Survey 2022 13-15 Panama Global Youth Tobacco Survey 2017 13-15 Papua New Guinea Global Youth Tobacco Survey 2016 13-15 Paraguay Global Youth Tobacco Survey 2019 13-15 Peru Global Youth Tobacco Survey 2014 13-15 Philippines Global Youth Tobacco Survey 2019 13-15 Poland Global Youth Tobacco Survey 2016 13-15 Portugal Global Youth Tobacco Survey 2013 13-15 Qatar Global Youth Tobacco Survey 2018 13-15 Republic of Korea Global Youth Tobacco Survey 2013 13-15 Republic of Moldova Global Youth Tobacco Survey 2019 13-15 Russian Federation Global Youth Tobacco Survey 2021 13-15 Rwanda Global Youth Tobacco Survey 2008 13-15 Saint Lucia Global Youth Tobacco Survey 2017 13-15 115 Table A2.2 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Saint Vincent and the Grenadines Global Youth Tobacco Survey 2018 13-15 Samoa Global Youth Tobacco Survey 2017 13-15 San Marino Global Youth Tobacco Survey 2018 13-15 Saudi Arabia Global Youth Tobacco Survey 2022 13-15 Senegal Global Youth Tobacco Survey 2020 13-15 Serbia Global Youth Tobacco Survey 2013 13-15 Seychelles Global Youth Tobacco Survey 2015 13-15 Sierra Leone Global Youth Tobacco Survey 2017 13-15 Slovakia Global Youth Tobacco Survey 2016 13-15 Slovenia Global Youth Tobacco Survey 2017 13-15 Sri Lanka Global Youth Tobacco Survey 2015 13-15 Sudan Global Youth Tobacco Survey 2014 13-15 Suriname Global Youth Tobacco Survey 2016 13-15 Syrian Arab Republic Global Youth Tobacco Survey 2010 13-15 Tajikistan Global Youth Tobacco Survey 2019 13-15 Thailand Global Youth Tobacco Survey 2015 13-15 North Macedonia Global Youth Tobacco Survey 2016 13-15 Timor-Leste Global Youth Tobacco Survey 2019 13-15 Togo Global Youth Tobacco Survey 2019 13-15 Trinidad and Tobago Global Youth Tobacco Survey 2017 13-15 Tunisia Global Youth Tobacco Survey 2017 13-15 Turkmenistan Global Youth Tobacco Survey 2015 13-15 Tuvalu Global Youth Tobacco Survey 2018 13-15 Uganda Global Youth Tobacco Survey 2018 13-15 Ukraine Global Youth Tobacco Survey 2017 13-15 United Arab Emirates Global Youth Tobacco Survey 2013 13-15 United Republic of Tanzania Global Youth Tobacco Survey 2016 13-15 United States of America National Youth Tobacco Survey 2020 Middle-school Uruguay Global Youth Tobacco Survey 2019 13-15 Uzbekistan Global Youth Tobacco Survey 2021 13-15 Vanuatu Global Youth Tobacco Survey 2017 13-15 Venezuela Global Youth Tobacco Survey 2019 13-15 Viet Nam Global Youth Tobacco Survey 2014 13-15 Yemen Global Youth Tobacco Survey 2014 13-15 Zimbabwe Global Youth Tobacco Survey 2014 13-15 116 2.3 Estimated prevalence rates and numbers of adolescents aged 13–15 years who use tobacco and estimated prevalence rates and numbers of adolescents aged 13–15 years who smoke cigarettes. Source of prevalence rates: the most recent nationally-representative school-based survey completed in each country in the period 2012–2022 that reported rates for the age group 13–15 years, if any. For most countries, this was the Global youth tobacco survey (GYTS), Global school- based students health survey (GSHS) or Health behaviour in school-aged children survey (HBSC). For three countries where the age group 13–15 years was not reported, equivalent age ranges were surveyed: Canada (grades 7-9), Japan (junior high) and USA (middle school). The specific surveys used in the analysis are named in the table below. Reports and data sets of specific GYTS and GSHS surveys are available from the WHO microdata repository at https://extranet.who.int/ncdsmicrodata/index.php/home; reports and data sets of the HBSC survey are available from http://www.hbsc.org/. Brazil: Pesquisa nacional de saúde do escolar (PENSE), available from https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/p/pesquisa-nacional-de-saude-do- escolar-pense Colombia: Encuesta nacional de tabaquismo en jóvenes, report available on request Japan: National survey on underage smoking and drinking, report available on request Malaysia: Tobacco and E-Cigarette Survey Among Malaysian Adolescents (TECMA), available from https://iku.moh.gov.my/images/IKU/Document/REPORT/TECMA2016/TabaccoandECigarette. pdf. USA: National youth tobacco survey, available from: http://www.cdc.gov/tobacco/data_statistics/surveys/nyts. Source of population numbers: World Population Prospects, 2022 revision, medium fertility variant, population estimates by sex and year for 2021. United Nations, Department of Economic and Social Affairs, Population Division, 2022. Available from: https://esa.un.org/unpd/wpp/Download/Standard/Population/. Method: For each country and for each sex, the number of current cigarette smokers and current tobacco users aged 13–15 years was calculated using the prevalence rates published in the appropriate survey and multiplying by the population aged 13–15 years for the appropriate sex. Countries without a survey were included in region and global averages by having the average prevalence rate for the analysis group (see Section 3.7) in which the country is located stand in as the country’s own rate. The resulting numbers of tobacco users and cigarette smokers aged 13–15 years were summarized by World Bank income group regions and by WHO regions by summing the total users and dividing by the total population aged 13–15 years in each region. 117 In the period 2012–2022, 149 countries ran one a survey that met these criteria. While the GYTS, NYTS and GSHS routinely report both tobacco use rates and cigarette smoking rates, the HBSC 2017—18 reports cigarette smoking rates only. For this analysis, the cigarette smoking rates were used to stand in also as tobacco use rates in countries that ran the HBSC, on the assumption that almost all tobacco use among adolescents in these countries is cigarette use. The HBSC survey publishes rates separately for persons aged 13 and persons aged 15, so the number of tobacco user and cigarette smokers aged 13–15 years was calculated for this report using the mean of the two prevalence rates and multiplying by the population aged 13–15 years, separately for each sex. 118 Table A2.3 Most recent national school-based survey that reports rates of tobacco use or cigarette smoking among adolescents aged 13–15 years, 2012–2022 COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Afghanistan Global School-Based Student Health Survey 2014 13-15 Albania Global Youth Tobacco Survey 2020 13-15 Algeria Global Youth Tobacco Survey 2013 13-15 Antigua and Barbuda Global Youth Tobacco Survey 2017 13-15 Argentina Global Youth Tobacco Survey 2018 13-15 Armenia Health Behaviour in School-aged Children 2017-18 13-15 Austria Health Behaviour in School-aged Children 2017-18 13-15 Azerbaijan Health Behaviour in School-aged Children 2017-18 13-15 Bahamas Global Youth Tobacco Survey 2013 13-15 Bahrain Global School-Based Student Health Survey 2016 13-15 Bangladesh Global School-Based Student Health Survey 2014 13-15 Barbados Global Youth Tobacco Survey 2013 13-15 Belarus Global Youth Tobacco Survey 2021 13-15 Belize Global Youth Tobacco Survey 2014 13-15 Benin Global School-Based Student Health Survey 2016 13-15 Bhutan Global Youth Tobacco Survey 2019 13-15 Bolivia (Plurinational State of) Global Youth Tobacco Survey 2018 13-15 Bosnia and Herzegovina Global Youth Tobacco Survey 2018-19 13-15 Brazil 1 Pesquisa Nacional de Saúde do Escolar (PENSE) 2019 13-15 Brunei Darussalam Global Youth Tobacco Survey 2019 13-15 Bulgaria Health Behaviour in School-aged Children 2017-18 13-15 Cambodia Global Youth Tobacco Survey 2022 13-15 Cameroon Global Youth Tobacco Survey 2014 13-15 Canada Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS) 2018-19 Grades 7-9 Chad Global Youth Tobacco Survey 2019 13-15 Chile Global School-Based Student Health Survey 2013 13-15 China 2 Global Youth Tobacco Survey 2021 13-15 Colombia Encuesta Nacional de Tabaquismo en Jóvenes 2017 13-15 Comoros Global Youth Tobacco Survey 2015 13-15 Congo Global Youth Tobacco Survey 2019 13-15 Cook Islands Global Youth Tobacco Survey 2016 13-15 Costa Rica Global Youth Tobacco Survey 2013 13-15 Croatia Health Behaviour in School-aged Children 2017-18 13-15 Cuba Global Youth Tobacco Survey 2018 13-15 1 Any tobacco use was not reported in the 2019 round of this survey. Data were instead obtained from the 2015 round. 2 Any tobacco use was not reported in the 2021 round of this survey. Data were instead obtained from the 2014 round. 119 Table A2.3 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Czechia Health Behaviour in School-aged Children 2017-18 13-15 Denmark Health Behaviour in School-aged Children 2017-18 13-15 Dominican Republic Global Youth Tobacco Survey 2016 13-15 Ecuador Global Youth Tobacco Survey 2016 13-15 Egypt Global Youth Tobacco Survey 2014 13-15 El Salvador Global Youth Tobacco Survey 2021 13-15 Estonia Health Behaviour in School-aged Children 2017-18 13-15 Fiji Global Youth Tobacco Survey 2016 13-15 Finland Health Behaviour in School-aged Children 2017-18 13-15 France Health Behaviour in School-aged Children 2017-18 13-15 Gabon Global Youth Tobacco Survey 2014 13-15 Gambia Global Youth Tobacco Survey 2017 13-15 Georgia Health Behaviour in School-aged Children 2017-18 13-15 Germany Health Behaviour in School-aged Children 2017-18 13-15 Ghana Global Youth Tobacco Survey 2017 13-15 Greece Health Behaviour in School-aged Children 2017-18 13-15 Grenada Global Youth Tobacco Survey 2016 13-15 Guatemala Global Youth Tobacco Survey 2015 13-15 Guyana Global Youth Tobacco Survey 2015 13-15 Honduras Global Youth Tobacco Survey 2016 13-15 Hungary Global Youth Tobacco Survey 2019-20 13-15 Iceland Health Behaviour in School-aged Children 2017-18 13-15 India Global Youth Tobacco Survey 2019 13-15 Indonesia Global Youth Tobacco Survey 2019 13-15 Iran (Islamic Republic of) Global Youth Tobacco Survey 2016 13-15 Iraq Global Youth Tobacco Survey 2019 13-15 Ireland Health Behaviour in School-aged Children 2017-18 13-15 Italy Health Behaviour in School-aged Children 2017-18 13-15 Jamaica Global Youth Tobacco Survey 2017 13-15 Japan 1 National survey on underage smoking and drinking 2017 Junior-High Jordan Global Youth Tobacco Survey 2014 13-15 Kazakhstan Health Behaviour in School-aged Children 2018 11-15 Kenya Global Youth Tobacco Survey 2013 13-15 Kiribati Global Youth Tobacco Survey 2018 13-15 Kuwait Global Youth Tobacco Survey 2016 13-15 1 The survey addresses only smoking, not other forms of tobacco use. 120 Table A2.3 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Kyrgyzstan Global Youth Tobacco Survey 2019 13-15 Lao People's Democratic Republic Global Youth Tobacco Survey 2016 13-15 Latvia Global Youth Tobacco Survey 2019 13-15 Lebanon Global School-Based Student Health Survey 2017 13-15 Liberia Global School-Based Student Health Survey 2017 13-15 Lithuania Health Behaviour in School-aged Children 2017-18 13-15 Luxembourg Health Behaviour in School-aged Children 2017-18 13-15 Madagascar Global Youth Tobacco Survey 2018 13-15 Malaysia Tobacco and E-Cigarette Survey Among Malaysian Adolescents (TECMA) 2016 13-15 Maldives Global Youth Tobacco Survey 2019 13-15 Malta Health Behaviour in School-aged Children 2017-18 13-15 Marshall Islands Global Youth Tobacco Survey 2016 13-15 Mauritania Global Youth Tobacco Survey 2018 13-15 Mauritius Global School-Based Student Health Survey 2017 13-15 Micronesia (Federated States of) Global Youth Tobacco Survey 2019 13-15 Mongolia Global Youth Tobacco Survey 2019 13-15 Montenegro Global Youth Tobacco Survey 2018 13-15 Morocco Global Youth Tobacco Survey 2016 13-15 Mozambique Global School-Based Student Health Survey 2015 13-15 Myanmar Global Youth Tobacco Survey 2016 13-15 Namibia Global School-Based Student Health Survey 2013 13-15 Nepal Global School-Based Student Health Survey 2015 13-15 Netherlands (Kingdom of the) Health Behaviour in School-aged Children 2017-18 13-15 Nicaragua Global Youth Tobacco Survey 2019 13-15 Niue Global Youth Tobacco Survey 2019 13-15 Norway Health Behaviour in School-aged Children 2017-18 13-15 Oman Global Youth Tobacco Survey 2016 13-15 Pakistan Global Youth Tobacco Survey 2013 13-15 Palau Global Youth Tobacco Survey 2022 13-15 Panama Global School-Based Student Health Survey 2018 13-15 Papua New Guinea Global Youth Tobacco Survey 2016 13-15 Paraguay Global Youth Tobacco Survey 2019 13-15 Peru Global Youth Tobacco Survey 2014 13-15 Philippines Global Youth Tobacco Survey 2019 13-15 Poland Health Behaviour in School-aged Children 2017-18 13-15 121 Table A2.3 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Portugal Health Behaviour in School-aged Children 2017-18 13-15 Qatar Global Youth Tobacco Survey 2018 13-15 Republic of Korea Global Youth Tobacco Survey 2013 13-15 Republic of Moldova Global Youth Tobacco Survey 2019 13-15 Romania Health Behaviour in School-aged Children 2017-18 13-15 Russian Federation Global Youth Tobacco Survey 2021 13-15 Saint Lucia Global School-Based Student Health Survey 2018 13-15 Saint Vincent and the Grenadines Global Youth Tobacco Survey 2018 13-15 Samoa Global Youth Tobacco Survey 2017 13-15 San Marino Global Youth Tobacco Survey 2018 13-15 Saudi Arabia Global Youth Tobacco Survey 2022 13-15 Senegal Global Youth Tobacco Survey 2020 13-15 Serbia Health Behaviour in School-aged Children 2017-18 13-15 Seychelles Global Youth Tobacco Survey 2015 13-15 Sierra Leone Global Youth Tobacco Survey 2017 13-15 Slovakia Health Behaviour in School-aged Children 2017-18 13-15 Slovenia Health Behaviour in School-aged Children 2017-18 13-15 Spain Health Behaviour in School-aged Children 2017-18 13-15 Sri Lanka Global School-Based Student Health Survey 2016 13-15 Sudan Global Youth Tobacco Survey 2014 13-15 Suriname Global Youth Tobacco Survey 2016 13-15 Sweden Health Behaviour in School-aged Children 2017-18 15-15 Switzerland Health Behaviour in School-aged Children 2017-18 15-15 Tajikistan Global Youth Tobacco Survey 2019 13-15 Thailand Global Youth Tobacco Survey 2015 13-15 North Macedonia Health Behaviour in School-aged Children 2017-18 13-15 Timor-Leste Global Youth Tobacco Survey 2019 13-15 Togo Global Youth Tobacco Survey 2019 13-15 Tonga Global School-Based Student Health Survey 2017 13-15 Trinidad and Tobago Global Youth Tobacco Survey 2017 13-15 Tunisia Global Youth Tobacco Survey 2017 13-15 Türkiye Global Youth Tobacco Survey 2017 13-15 Turkmenistan Global Youth Tobacco Survey 2015 13-15 Tuvalu Global Youth Tobacco Survey 2018 13-15 Uganda Global Youth Tobacco Survey 2018 13-15 122 Table A2.3 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Ukraine Health Behaviour in School-aged Children 2017-18 13-15 United Arab Emirates Global School-Based Student Health Survey 2016 13-15 United Republic of Tanzania Global Youth Tobacco Survey 2016 13-15 United States of America National Youth Tobacco Survey 2020 Middle-school Uruguay Global Youth Tobacco Survey 2019 13-15 Uzbekistan Global Youth Tobacco Survey 2021 13-15 Vanuatu Global Youth Tobacco Survey 2017 13-15 Venezuela (Bolivarian Republic of) Global Youth Tobacco Survey 2019 13-15 Viet Nam Viet Nam Youth Tobacco Survey 2022 13-15 Yemen Global Youth Tobacco Survey 2014 13-15 Zimbabwe Global Youth Tobacco Survey 2014 13-15 123 2.4 Estimated prevalence rates and numbers of adolescents aged 13–17 years who use e-cigarettes. Source of prevalence rates: the most recent nationally-representative school-based survey covering the age range 13-15, 15-16 or 15-17 completed in each country in the period 2013– 2022, if any. Specific surveys used are listed in Table A2.4. Reports and data sets of the Global Youth Tobacco Survey and the Global School-Based Students Health Survey are available from the WHO microdata repository at https://extranet.who.int/ncdsmicrodata/index.php/home. The European School Survey Project on Alcohol and Other Drugs (ESPAD) surveys are available at http://espad.org/. Brazil: Pesquisa nacional de saúde do escolar (PENSE), available from https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/p/pesquisa-nacional-de-saude-do- escolar-pense Canada: Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS), available from https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs- survey.html. Colombia: Encuesta nacional de tabaquismo en jóvenes, report available on request France: enClass survey, data available at http://enclass.fr/ Japan: National survey on underage smoking and drinking, report available on request Malaysia: Tobacco and E-Cigarette Survey Among Malaysian Adolescents (TECMA), available from https://iku.moh.gov.my/images/IKU/Document/REPORT/TECMA2016/TabaccoandECigarette. pdf. New Zealand: ASH Year 10 survey, 2022 factsheet available at https://assets.nationbuilder.com/ashnz/pages/357/attachments/original/1670892009/2022_ ASH_Y10_Snapshot_Topline_smoking_and_vaping_FINAL.pdf?1670892009 Sweden: The Swedish Council for Information on Alcohol and Other Drugs data are available from https://www.can.se/In-English/ United Kingdom: Smoking, Drinking and Drug Use Among Young People in England, the 2018 report is available at https://digital.nhs.uk/data-and- information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in- england/2018 USA: National youth tobacco survey, available from: http://www.cdc.gov/tobacco/data_statistics/surveys/nyts. Source of population numbers: World population prospects, 2022 revision, medium fertility variant, population estimates by sex and year for 2021. United Nations, Department of Economic and Social Affairs, Population Division, 2022. Available from 124 https://esa.un.org/unpd/wpp/Download/Standard/Population/. Method: For each country and for each sex, the number of current e-cigarette users aged 13–17 years was calculated using current e-cigarette use prevalence rates published in the country’s most recent survey (age ranges vary) and multiplying by the population aged 13–17 years for the appropriate sex. In the period 2013-2022, 102 countries were covered by a survey. Countries without a survey reporting e-cigarette use in the period were assumed to have no e-cigarette users. The number of e-cigarette users aged 13–17 years was summarized by World Bank country income group regions, by WHO regions (specified below) and globally by dividing the number of e-cigarette users in each region by the population of the region aged 13–17 years. The method results in a global underestimate of e-cigarette users aged 13–17 years which would improve if more countries survey e-cigarette use in future. 125 Table A2.4 Most recent national school-based survey that reports rates of e-cigarette use among adolescents aged 13–17 years, 2013–2022 COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Albania Global Youth Tobacco Survey 2020 13-15 Antigua and Barbuda Global Youth Tobacco Survey 2017 13-15 Argentina Global Youth Tobacco Survey 2018 13-15 Austria European School Survey Project on Alcohol and Other Drugs (ESPAD) 2019 14-17 Belarus Global Youth Tobacco Survey 2021 13-15 Belize Global Youth Tobacco Survey 2014 13-15 Bolivia (Plurinational State of) Global Youth Tobacco Survey 2018 13-15 Bosnia and Herzegovina Global Youth Tobacco Survey 2018-19 13-15 Brazil Pesquisa Nacional de Saúde do Escolar (PENSE) 2019 13-15 Brunei Darussalam Global Youth Tobacco Survey 2019 13-15 Bulgaria European School Survey Project on Alcohol and Other Drugs 2019 15-16 Cambodia Global Youth Tobacco Survey 2022 13-15 Canada Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS) 2018-19 Grades 7-9 China Global Youth Tobacco Survey 2021 13-15 Colombia Encuesta Nacional de Tabaquismo en Jóvenes 2017 13-15 Congo Global Youth Tobacco Survey 2019 13-15 Cook Islands Global Youth Tobacco Survey 2016 13-15 Croatia European School Survey Project on Alcohol and Other Drugs 2019 15-16 Cuba Global Youth Tobacco Survey 2018 13-15 Cyprus European School Survey Project on Alcohol and Other Drugs 2019 15-16 Czechia European School Survey Project on Alcohol and Other Drugs 2019 15-16 Denmark European School Survey Project on Alcohol and Other Drugs 2019 15-16 Dominican Republic Global Youth Tobacco Survey 2016 13-15 Ecuador Global Youth Tobacco Survey 2016 13-15 El Salvador Global Youth Tobacco Survey 2021 13-15 Estonia European School Survey Project on Alcohol and Other Drugs 2019 15-16 Fiji Global Youth Tobacco Survey 2016 13-15 Finland European School Survey Project on Alcohol and Other Drugs 2019 15-16 France enCLASS 2021 9th-grade Georgia European School Survey Project on Alcohol and Other Drugs 2019 15-16 Germany European School Survey Project on Alcohol and Other Drugs 2019 15-16 Ghana Global Youth Tobacco Survey 2017 13-15 Greece European School Survey Project on Alcohol and Other Drugs 2019 15-16 126 Table A2.4 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Grenada Global Youth Tobacco Survey 2016 13-15 Guatemala Global Youth Tobacco Survey 2015 13-15 Guyana Global Youth Tobacco Survey 2015 13-15 Hungary Global Youth Tobacco Survey 2019-20 13-15 Iceland European School Survey Project on Alcohol and Other Drugs 2019 15-16 Iraq Global Youth Tobacco Survey 2019 13-15 Ireland European School Survey Project on Alcohol and Other Drugs 2019 15-16 Italy European School Survey Project on Alcohol and Other Drugs 2019 15-16 Jamaica Global Youth Tobacco Survey 2017 13-15 Japan National survey on underage smoking and drinking 2017 Junior-High Kazakhstan Health Behaviour in School-aged Children 2018 11-15 Kiribati Global Youth Tobacco Survey 2018 13-15 Kyrgyzstan Global Youth Tobacco Survey 2019 13-15 Lao People's Democratic Republic Global Youth Tobacco Survey 2016 13-15 Latvia Global Youth Tobacco Survey 2019 13-15 Lithuania European School Survey Project on Alcohol and Other Drugs (ESPAD) 2019 15-16 Malaysia National Health and Morbidity Survey - Adolescent Health Survey 2017 13-17 Malta European School Survey Project on Alcohol and Other Drugs 2019 15-16 Marshall Islands Global Youth Tobacco Survey 2016 13-15 Mauritania Global Youth Tobacco Survey 2018 13-15 Mauritius Global Youth Tobacco Survey 2016 13-15 Micronesia (Federated States of) Global Youth Tobacco Survey 2019 13-15 Monaco European School Survey Project on Alcohol and Other Drugs (ESPAD) 2019 15 to 16 Mongolia Global Youth Tobacco Survey 2019 13-15 Montenegro European School Survey Project on Alcohol and Other Drugs 2019 15-16 Morocco Global Youth Tobacco Survey 2016 13-15 Netherlands (Kingdom of the) European School Survey Project on Alcohol and Other Drugs 2019 15-16 New Zealand ASH Year 10 Survey 2022 14-15 Nicaragua Global Youth Tobacco Survey 2014 13-15 Niue Global Youth Tobacco Survey 2019 13-15 Norway European School Survey Project on Alcohol and Other Drugs 2019 15-16 Oman Global Youth Tobacco Survey 2016 13-15 Palau Global Youth Tobacco Survey 2022 13-15 Panama Global Youth Tobacco Survey 2017 13-15 Papua New Guinea Global Youth Tobacco Survey 2016 13-15 127 Table A2.4 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Paraguay Global Youth Tobacco Survey 2019 13-15 Peru Global Youth Tobacco Survey 2014 13-15 Philippines Global Youth Tobacco Survey 2019 13-15 Poland European School Survey Project on Alcohol and Other Drugs 2019 15-16 Portugal European School Survey Project on Alcohol and Other Drugs 2019 15-16 Qatar Global Youth Tobacco Survey 2018 13-15 Republic of Moldova Global Youth Tobacco Survey 2019 13-15 Romania European School Survey Project on Alcohol and Other Drugs 2019 15-16 Russian Federation Global Youth Tobacco Survey 2021 13-15 Saint Lucia Global Youth Tobacco Survey 2017 13-15 Saint Vincent and the Grenadines Global Youth Tobacco Survey 2018 13-15 San Marino Global Youth Tobacco Survey 2018 13-15 Saudi Arabia Global Youth Tobacco Survey 2022 13-15 Serbia European School Survey Project on Alcohol and Other Drugs 2019 15-16 Seychelles Global Youth Tobacco Survey 2015 13-15 Slovakia European School Survey Project on Alcohol and Other Drugs 2019 15-16 Slovenia European School Survey Project on Alcohol and Other Drugs 2019 15-16 Spain European School Survey Project on Alcohol and Other Drugs 2019 15-16 Suriname Global Youth Tobacco Survey 2016 13-15 Sweden The Swedish Council for Information on Alcohol and Other Drugs 2022 15-16 Switzerland Health Behaviour in School-aged Children 2022 15-15 Thailand Global Youth Tobacco Survey 2015 13-15 North Macedonia European School Survey Project on Alcohol and Other Drugs 2019 15-16 Togo Global Youth Tobacco Survey 2019 13-15 Trinidad and Tobago Global Youth Tobacco Survey 2017 13-15 Tunisia Global Youth Tobacco Survey 2017 13-15 Ukraine European School Survey Project on Alcohol and Other Drugs 2019 15-16 United Kingdom 1 Smoking, Drinking and Drug Use Among Young People in England 2018 15-15 United States of America National Youth Tobacco Survey 2020 Middle-school Uruguay Global Youth Tobacco Survey 2019 13-15 Uzbekistan Global Youth Tobacco Survey 2021 13-15 Vanuatu Global Youth Tobacco Survey 2017 13-15 Venezuela Global Youth Tobacco Survey 2019 13-15 Viet Nam Viet Nam Youth Tobacco Survey 2022 13-15 Yemen Global Youth Tobacco Survey 2014 13-15 1 This survey is subnational. 128 2.4 Estimated prevalence rates and numbers of adults who use e-cigarettes. Source of prevalence rates: the most recent nationally-representative population-based survey among adults completed in each country in the period 2013–2022, if any. Specific surveys used are listed in Table A2.5. Source of population numbers: World population prospects, 2022 revision, medium fertility variant, population estimates by sex and year for 2021. United Nations, Department of Economic and Social Affairs, Population Division, 2022. Available from https://esa.un.org/unpd/wpp/Download/Standard/Population/. Method: For each country and for each sex, the number of current e-cigarette users aged 15 years or older was calculated using current e-cigarette use prevalence rates published in the country’s most recent survey (age ranges vary) and multiplying by the population aged 15 years or older for the appropriate sex. In the period 2013-2022, 70 countries were covered by a survey. Countries without a survey reporting e-cigarette use in the period were assumed to have no e-cigarette users. The number of e-cigarette users aged 15 years or older was summarized by World Bank country income group regions, by WHO regions (specified below) and globally by dividing the number of e- cigarette users in each region by the population of the region aged 15 years or older. The method results in a global underestimate of e-cigarette users aged 15 years or older which would improve if more countries survey e-cigarette use in future. 129 Table A2.5 Most recent national school-based survey that reports rates of e-cigarette use among adults, 2013–2022 COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Argentina Encuesta Nacional de Factores de Riesgo Para Enfermedades No Transmisibles 2018 18 + Australia National Drug Strategy Household Survey 2019 14 + Austria Eurobarometer 2020 15 + Bahamas Bahamas STEPS 2019 18-69 Bangladesh Global Adult Tobacco Survey (GATS) 2017 15 + Belarus STEPS Survey 2020 18-69 Belgium Enquête sur le tabagisme 2021 15 + Bolivia (Plurinational State of) STEPS Survey 2019 18-69 Brunei Darussalam STEPS Survey 2016 18-69 Bulgaria Eurobarometer 2020 15 + Cambodia National Adult Tobacco Survey of Cambodia 2021 15 + Canada Canadian Community Health Survey 2021 15 + Chile Estudio Nacional de Drogas en Población General de Chile 2022 15-64 China China Chronic Disease and Nutrition Surveillance 2018-19 18 + Colombia Estudio Nacional de Consumo de Sustancias Psicoactivas en Colombia 2019 12-65 Costa Rica Global Adult Tobacco Survey (GATS) 2015 15 + Croatia Eurobarometer 2020 15 + Cyprus Eurobarometer 2014 15 + Czechia National Research on Tobacco and Alcohol Use in the Czech Republic (NAUTA) 2021 15 + Denmark Monitorering af danskernes rygevaner 2022 15-79 Ecuador STEPS Survey 2018 18-69 El Salvador Encuesta Nacional de Alcohol y Tabaco (ENAT) 2022 18 + Estonia Eurobarometer 2020 15 + Finland National FinSote Survey 2020-21 20 + France Baromètre santé 2021 18-75 Georgia National tobacco survey 2019 18-69 Germany Deutsche Befragung zum Rauchverhalten (DEBRA) 2021 14 + Greece Eurobarometer 2020 15 + Hungary Eurobarometer 2020 15 + Iceland Tóbakskönnun by Gallup 2021 18-64 India Global Adult Tobacco Survey (GATS) 2016-17 15 + Indonesia Global Adult Tobacco Survey (GATS) 2021 15 + Ireland Healthy Ireland Survey 2022 15 + Italy Survey by DOXA/ISS 2022 15 + Kazakhstan Global Adult Tobacco Survey (GATS) 2019 15 + 130 Table A2.5 (continued) COUNTRY TITLE OF SURVEY YEAR AGE GROUP (YEARS) Latvia Addictive substance use among general population 2020 15-64 Lithuania GPS Study - Study of the Prevalence of Psychoactive Substance Use in the General Population 2021 15-64 Luxembourg Le tabagisme au Luxembourg 2021 16 + Malaysia National Health and Morbidity Survey 2019 15-75 Malta Eurobarometer 2020 15 + Marshall Islands Hybrid Household Survey of NCD risk factors and substance use 2017-18 18 + Mexico Encuesta Nacional de Salud y Nutrición 2021 20 + Nepal STEPS Survey 2019 15-69 Netherlands (Kingdom of the) Eurobarometer 2020 15 + New Zealand New Zealand Health Survey 2020-21 15 + Panama Encuesta Nacional de Salud 2019 15 + Philippines Global Adult Tobacco Survey (GATS) 2021 15 + Poland Public Opinion Research Center (CBOS) nicotine consumption survey 2021 18 + Portugal Eurobarometer 2020 15 + Qatar Global Adult Tobacco Survey (GATS) 2013 15 + Republic of Korea Korea National Health and Nutrition Examination Survey (KNHANES) 2019 19 + Republic of Moldova STEPS Survey 2021 18-69 Romania Eurobarometer 2020 15 + Russian Federation Selective monitoring of the health of the population survey (Rosstat) 2018 15 + Saint Lucia STEPS Survey 2019 18 + Saudi Arabia Global Adult Tobacco Survey (GATS) 2019 15 + Senegal Global Adult Tobacco Survey (GATS) 2015 15 + Serbia Survey of the effects and attitudes related to the Law on protection of the citizens from exposure to tobacco smoke 2019 18 + Slovakia Eurobarometer 2020 15 + Slovenia National Survey on the Impact of the Pandemic of Life 2021 18 + South Africa Global Adult Tobacco Survey (GATS) 2021 15 + Spain European Health Interview Survey (EHIS) 2019-20 15 + Sweden Eurobarometer 2020 15 + Switzerland Enquête Santé et Lifestyle 2022 15 + Ukraine Global Adult Tobacco Survey (GATS) 2017 15 + United Arab Emirates National Health Survey (STEPS) 2017-18 18-69 United Kingdom Eurobarometer 2020 15 + United States of America National Health Interview Survey (NHIS) 2020 18 + Uruguay Global Adult Tobacco Survey (GATS) 2016-17 15 + Uzbekistan Uzbekistan STEPS Survey 2019 18-69 Viet Nam Global Adult Tobacco Survey (GATS) 2015 15 + 131 3.1 World Bank grouping of countries by income (2022) Source: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519, accessed 5/12/2022. High-income economies Andorra, Antigua and Barbuda, Australia, Austria, Bahamas, Bahrain, Barbados, Belgium, Brunei Darussalam, Canada, Chile, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Latvia, Lithuania, Luxembourg, Malta, Monaco, Nauru, Netherlands (Kingdom of the), New Zealand, Norway, Oman, Palau, Poland, Portugal, Qatar, Republic of Korea, Saint Kitts and Nevis, San Marino, Saudi Arabia, Seychelles, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, Trinidad and Tobago, United Arab Emirates, United Kingdom, United States of America, Uruguay. Upper middle-income economies Albania, Argentina, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Botswana, Brazil, Bulgaria, China, Colombia, Cook Islands, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, Equatorial Guinea, Fiji, Gabon, Georgia, Grenada, Guatemala, Guyana, Iraq, Jamaica, Jordan, Kazakhstan, Lebanon, Libya, Malaysia, Maldives, Marshall Islands, Mauritius, Mexico, Montenegro, Namibia, Niue, North Macedonia, Panama, Paraguay, Peru, Republic of Moldova, Romania, Russian Federation, Saint Lucia, Saint Vincent and the Grenadines, Serbia, South Africa, Suriname, Thailand, Tonga, Türkiye, Turkmenistan, Tuvalu, Venezuela (Bolivarian Republic of). Lower middle-income economies Algeria, Angola, Bangladesh, Belize, Benin, Bhutan, Bolivia (Plurinational State of), Cabo Verde, Cambodia, Cameroon, Comoros, Congo, Côte d'Ivoire, Djibouti, Egypt, El Salvador, Eswatini, Ghana, Haiti, Honduras, India, Indonesia, Iran (Islamic Republic of), Kenya, Kiribati, Kyrgyzstan, Lao People's Democratic Republic, Lesotho, Mauritania, Micronesia (Federated States of), Mongolia, Morocco, Myanmar, Nepal, Nicaragua, Nigeria, Pakistan, Papua New Guinea, Philippines, Samoa, Sao Tome and Principe, Senegal, Solomon Islands, Sri Lanka, Tajikistan, Timor-Leste, Tunisia, Ukraine, United Republic of Tanzania, Uzbekistan, Vanuatu, Viet Nam, Zambia, Zimbabwe. Low-income economies Afghanistan, Burkina Faso, Burundi, Central African Republic, Chad, Democratic People's Republic of Korea, Democratic Republic of the Congo, Eritrea, Ethiopia, Gambia, Guinea, Guinea- Bissau, Liberia, Madagascar, Malawi, Mali, Mozambique, Niger, Rwanda, Sierra Leone, Somalia, South Sudan, Sudan, Syrian Arab Republic, Togo, Uganda, Yemen.  Cook Islands, Niue and Venezuela (Bolivarian Republic of) were not allocated to an income group by the World Bank. To avoid excluding these three countries from the analysis, we have used the same groups as the UNdata website data.un.org (Cook Islands and Venezuela (Bolivarian Republic of)) and the Pacific Community website https://spc.int/our-members/niue/details (Niue). 132 3.2 World Health Organization regional grouping of countries WHO African Region Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cabo Verde, Cameroon, Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Eswatini, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, South Africa, South Sudan, Togo, Uganda, United Republic of Tanzania, Zambia, Zimbabwe. WHO Region of the Americas Antigua and Barbuda, Argentina, Barbados, Belize, Bolivia (Plurinational State of), Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, United States of America, Uruguay, Venezuela (Bolivarian Republic of). WHO South-East Asia Region Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste. WHO European Region Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Monaco, Montenegro, Netherlands (Kingdom of the), North Macedonia, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, Türkiye, Turkmenistan, Ukraine, United Kingdom of Great Britain and Northern Ireland, Uzbekistan. WHO Eastern Mediterranean Region Afghanistan, Bahrain, Djibouti, Egypt, Iran (Islamic Republic of), Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, Yemen. WHO Western Pacific Region Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Lao People's Democratic Republic, Malaysia, Marshall Islands, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu, Viet Nam. 133 3.3 Analysis grouping of countries The groups of countries - used to fill gaps in the global analyses of all estimates in this report due to countries with no data - are as follows: African Islands Comoros, Madagascar, Mauritius, Seychelles. Australasia Australia, New Zealand. Caribbean Antigua and Barbuda, Bahamas, Barbados, Cuba, Dominica, Dominican Republic, Grenada, Haiti, Jamaica, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago. Central America Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama. Eastern Africa Burundi, Djibouti, Eritrea, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Somalia, Uganda, United Republic of Tanzania, Zambia, Zimbabwe. Eastern Asia China, Democratic People's Republic of Korea, Japan, Mongolia, Republic of Korea. Eastern Europe Armenia, Azerbaijan, Belarus, Bulgaria, Czechia, Estonia, Georgia, Hungary, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Poland, Republic of Moldova, Romania, Russian Federation, Slovakia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan. Middle Africa Angola, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Sao Tome and Principe. Northern Africa Algeria, Egypt, Libya, Morocco, South Sudan, Sudan, Tunisia. 134 Northern Europe Denmark, Finland, Iceland, Norway, Sweden. Oceania Cook Islands, Fiji, Kiribati, Marshall Islands. Micronesia Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu. South America Argentina, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, Venezuela. South-Central Asia Afghanistan, Bangladesh, Bhutan, India, Iran, Maldives, Nepal, Pakistan, Sri Lanka. South-Eastern Asia Brunei Darussalam, Cambodia, Indonesia, Lao People's Democratic Republic, Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste, Viet Nam. Southern Africa Botswana, Eswatini, Lesotho, Namibia, South Africa. Southern Europe Albania, Andorra, Bosnia and Herzegovina, Croatia, Cyprus, Greece, Israel, Italy, Malta, Montenegro, North Macedonia, Portugal, San Marino, Serbia, Slovenia, Spain, Türkiye. USA, Canada, Ireland and United Kingdom Canada, Ireland, United Kingdom, United States of America. Western Africa Benin, Burkina Faso, Cape Verde, Cote d'Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo. 135 Western Asia Bahrain, Iraq, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, United Arab Emirates, Yemen. Western Europe Austria, Belgium, France, Germany, Luxembourg, Monaco, Netherlands (Kingdom of the), Switzerland. 20 Avenue Appia • CH–1211 Geneva 27 • Switzerland www.who.int/tobacco