《世界卫生组织:2000-2030年全球烟草使用趋势报告(英文版)(144页).pdf》由会员分享,可在线阅读,更多相关《世界卫生组织:2000-2030年全球烟草使用趋势报告(英文版)(144页).pdf(144页珍藏版)》请在三个皮匠报告上搜索。
1、 WHO global report on trends in prevalence of tobacco use 20002030 WHO global report on trends in prevalence of tobacco use 20002030 WHO global report on trends in prevalence of tobacco use 20002030 ISBN 978-92-4-008828-3(electronic version)ISBN 978-92-4-008829-0(print version)World Health Organizat
2、ion 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-commerci
3、al 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
4、 or equivalent Creative Commons licence.If you create a translation of this work,you should add the following disclaimer along with the suggested citation:“This translation was not created by the World Health Organization(WHO).WHO is not responsible for the content or accuracy of this translation.Th
5、e original English edition shall be the binding and authentic edition”.Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization(http:/www.wipo.int/amc/en/mediation/rules/).Suggested citation
6、.WHO global report on trends in prevalence of tobacco use 20002030.Geneva:World Health Organization;2024.Licence:CC BY-NC-SA 3.0 IGO.Cataloguing-in-Publication(CIP)data.CIP data are available at https:/iris.who.int/.Sales,rights and licensing.To purchase WHO publications,see https:/www.who.int/publi
7、cations/book-orders.To submit requests for commercial use and queries on rights and licensing,see https:/www.who.int/copyright.Third-party materials.If you wish to reuse material from this work that is attributed to a third party,such as tables,figures or images,it is your responsibility to determin
8、e whether permission is needed for that reuse and to obtain permission from the copyright holder.The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.General disclaimers.The designations employed and the presentation of the material
9、 in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country,territory,city or area or of its authorities,or concerning the delimitation of its frontiers or boundaries.Dotted and dashed lines on maps represent approximate bo
10、rder lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned.Errors and omissions excepted,the names of pr
11、oprietary products are distinguished by initial capital letters.All reasonable precautions have been taken by WHO to verify the information contained in this publication.However,the published material is being distributed without warranty of any kind,either expressed or implied.The responsibility fo
12、r the interpretation and use of the material lies with the reader.In no event shall WHO be liable for damages arising from its use.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
13、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 glob
14、al trends in prevalence of tobacco use among people aged 15 years and older,by sex,20002030.7 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 numb
15、er 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 1315 years.27 3.5 Any
16、tobacco use among adolescents aged 1315 years.29 3.6 Cigarette smoking among adolescents aged 1315 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 repor
17、t on trends in prevalence of tobacco use 20002030 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
18、 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 f
19、or the Prevention and Control of Noncommunicable Diseases 20132020.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 set
20、backs 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 20002025,fourth edition.Six countries worldwide are still experiencing an increase in tobacc
21、o 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 Sus
22、tainable 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 countrie
23、s 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 Rdiger Krech Assistant Director-General Director Division of Universal Health CoverageHealthier Populations Department of Health Pr
24、omotion 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
25、 use 20002030.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
26、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.
27、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
28、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
29、 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 everyw
30、here.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 Gene
31、va),Vinayak Prasad(WHO Geneva),Edouard Tursan dEspaignet(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 t
32、he 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
33、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 Co
34、nvention 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 Of
35、fices: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,Melan
36、ie 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 20192023 GSHS Global school-base
37、d 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 WH
38、O 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 countrie
39、s and the EU are parties to this treaty.Only 11 of WHOs 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 towa
40、rds 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.
41、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 Me
42、mber 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
43、 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.Pre
44、vious rounds of estimates,published in the 2015,2018,2019 and 2021 editions of the WHO global report on trends in prevalence of tobacco use 20002025,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 add
45、ed 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 smok
46、eless 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 W
47、HO 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 WHOs global estimates of trends in tobacco use among persons
48、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 surv
49、eys 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 Wor
50、ld 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
51、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 m
52、any 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 chall
53、enging.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 tobac
54、co 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 stric
55、t 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)an
56、y 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
57、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 d
58、ata 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 ava
59、ilable.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 rou
60、nd.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 tobac
61、co 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 statisti
62、cal 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
63、file,as well as the list of surveys in the dataset,are available from the 0204060800470200042005200620072008200920000022Number of national surveysYear the survey was in the fieldSurveys adde
64、d to thedatabase since the lastestimates roundSurveys already in thedatabase,updated sincethe last estimates roundSurveys in the databasesince the last round withno updates4 WHO tobacco repository on Github.The original model analysed only the“smoked tobacco use”and“cigarette use”indicators.In 2018,
65、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
66、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 toba
67、cco 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
68、 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 summ
69、arizing prevalence between 2000 and the countrys 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 t
70、obacco 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
71、 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
72、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
73、 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 publishe
74、d 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 structu
75、res that are unlike the WHO Standard Population structure.The Sustainable Development Goal indicator calls on countries to report age-standardized rates.Each countrys trend category is reported in Table A1.7.Alongside this is an indication of reliability of the assessment,based on the quantity of th
76、e 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
77、“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 a
78、chieve 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 onl
79、y 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,pre
80、valence 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 populat
81、ion-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 thi
82、s 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 count
83、ries 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 d
84、ataset,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 populatio
85、n 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
86、having sufficient survey data to allow measurement and projection of tobacco use trends over the period 20002030.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
87、 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 9
88、1%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 Regions countries have sufficient survey data available to calculate tobacco use trends for this rep
89、ort(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 M
90、ember 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 ol
91、der,by sex,20002030 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 calle
92、d 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 ex
93、tra 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 prevalen
94、ce rate is projected to decline to 32.9%in 2025 and to 30.6%by 2030.Although these Year20002005200252030Relative reduction%%reduction target*Prevalence(%)32.729.326.423.921.719.818.118.41.3Average change over previous 5 years(%/year)-0.68-0.59-0.50-0.43-0.38-0.33-0.65-0.65Preva
95、lence(%)49.145.141.638.435.532.930.629.13.8Average change over previous 5 years(%/year)-0.79-0.71-0.63-0.58-0.53-0.47-1.28-1.28Prevalence(%)16.313.511.19.37.96.75.77.8-1.1Average 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 achiev
96、e the 2025 target from 2020 onwards.Reduction targetMalesBoth sexesFemalesProjected prevalenceEstimated prevalence8 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 t
97、o 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,20002030(estimates to 2020,projections to 2030)In 2000,around one in six women(16.3%)ag
98、ed 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 wom
99、en 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
100、just over five times by 2030(see Fig.2).49.145.141.638.435.532.930.632.729.326.423.921.719.818.116.313.511.19.37.96.75.70.020.040.060.080.0100.020002005200252030Prevalence of current tobacco use(%)MalesBoth sexesFemales9 3.1.3 Trends in prevalence of tobacco use by age Table 3:Global tren
101、ds in prevalence of tobacco use by age,20002030 Globally,the average rate of tobacco use among young people aged 1524 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 1524 years,tobacco use has declined fr
102、om 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 o
103、ver the observed period 20002022.The age-specific rates are projected to continue declining to 2030 for both males and females.The age-specific rates peak at age group 4554 for men(see Fig.3),and Age(years)200020052002220252030152420.518.516.815.313.813.312.711.8253431.028.225.423.121.220
104、.419.217.5354438.334.231.128.325.624.723.521.6455441.237.033.230.127.526.425.022.9556440.035.431.528.425.824.823.621.8657434.230.527.124.221.921.119.918.4758427.724.521.919.617.716.916.014.9 85 21.019.816.614.813.512.912.011.1152432.329.527.224.822.621.820.919.6253449.145.141.038.035.133.831.929.235
105、4458.653.949.945.842.040.839.236.3455460.656.051.748.144.943.441.238.1556456.151.647.944.641.640.539.236.8657447.343.840.337.335.434.533.131.3758439.836.333.631.329.128.127.226.3 85 33.531.628.326.024.423.822.521.115248.36.95.95.24.54.33.93.5253412.410.79.17.66.66.25.75.0354417.614.211.810.28.88.27.
106、46.4455421.918.014.812.010.09.58.77.5556424.719.915.813.110.79.98.77.3657423.119.115.712.710.29.58.57.0758419.616.413.511.29.38.67.66.3 85 15.514.311.09.17.87.36.55.6Estimated prevalence(%)Projected prevalence(%)FemalesMalesBoth sexes10 for women peak at age group 5564(see Fig.4).The absolute preval
107、ence 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,20002030(estimates to 2020,projections to 2030)Fig.4:Global trends in age pattern of tobacco use among females,20002030(estimates to 2020,projections t
108、o 2030)0070809035444554556465747584 85 Prevalence of current tobacco use(%)200020052002520300070809035444554556465747584 85 Prevalence of current tobacco use(%)20002005200252030 11 3.1.4 Trends in prevalence of tobacco use by WHO regi
109、on 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 Afric
110、an 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 2
111、2.0 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
112、.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
113、.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%1
114、4.0 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
115、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
116、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
117、 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 rat
118、e 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 E
119、uropean Region.This Region is very different from the other five Regions in terms of womens 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
120、 region averages,20002030(estimates to 2020;projections to 2030)00708090200252030Current tobacco use prevalence,both sexes(%)African RegionRegion of the AmericasSouth-East Asia RegionEuropean RegionEastern Mediterranean RegionWestern Pacific Region 13 Fig.5.1:Trends
121、in current tobacco use among males aged 15 years and older,WHO region averages,20002030(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
122、 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,20002030(estimates to 2020;projections to 2030)0070809
123、0200252030African RegionRegion of the AmericasSouth-East Asia RegionEuropean RegionEastern Mediterranean RegionWestern Pacific RegionMalesCurrent tobacco use prevalence(%)00708090200252030African RegionRegion of the AmericasSouth-East Asia Regio
124、nEuropean RegionEastern Mediterranean RegionWestern Pacific RegionFemalesCurrent 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 high
125、est prevalence among females is seen in the European Region(18%).South-East Asia and the Americas regions have similar prevalence levels at around 1011%.The lowest average rates among females continue to be seen in the African Region,Eastern Mediterranean Region,and Western Pacific Region,with rates
126、 of 24%.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 2
127、010 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
128、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-i
129、ncome 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
130、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 2122%.Low-income countries have experienced the lowest average prev
131、alence throughout the period 20002022,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%res
132、pectively.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
133、 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
134、 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 4
135、88 471 452 436 420 411 402 387 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 th
136、e 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
137、 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 2
138、33 224 211 193 The total number of tobacco users for both sexes combined has declined steadily over the period 20002022.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 billi
139、on 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.T
140、he 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 ma
141、le 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 us
142、ers 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 20002022,and thi
143、s 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,smokin
144、g 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 manufa
145、ctured 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 use
146、s 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 u
147、sers,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,2
148、022 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
149、 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.7.20.934.47.416.728.45.115.025.54.40.05.010.015.020.025.030.035.040.0Both
150、sexesMenWomenPrevalence(%)Any tobaccoSmoked tobaccoCigarettes 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 smoke
151、rs.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
152、 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.
153、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 Wo
154、rld 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
155、 16.7 15.0 1,2451,0222249958438001,0001,2001,400Both sexesMenWomenNo.of users(millions)Any tobaccoSmoked tobaccoCigarettes 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
156、 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
157、 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
158、 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 g
159、roup,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
160、 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
161、 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.
162、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
163、.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 o
164、f 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
165、 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 NC
166、D 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 countri
167、es have results from the analysis of tobacco use trends for this report.Collectively they cover 97%of the worlds 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 experien
168、ce 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 achie
169、ve 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
170、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
171、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 c
172、ountries 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 increa
173、se 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
174、 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 fr
175、om 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
176、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 worlds countries and 40%of the worlds population.They are spread across all six WHO regions,but the African Region ha
177、s 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 trac
178、k 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 Eur
179、opean Region has 97%of its population in countries experiencing an overall decline in tobacco use(see Table 10).56223260%10%20%30%40%50%60%70%80%90%100%GlobalAfrican RegionRegion of theAmericasSouth-East AsiaRegionEuropean RegionEasternMediterraneanRegionWestern Paci
180、ficRegion%of countries in the region(number of countries in bars)WHO Member States by category of trend in tobacco use prevalence,including NCD GAP target assessment 2010-2025 Data insufficient ornot availableIncreasingNo changeDecreasing but noton track for a 30%reductionDecreasing and ontrack for
181、a 30%reduction 24 Table 10:Status of tobacco use prevalence reduction target by WHO region,2022 WHO Regionare likely to achieve a 30%relative reductionare likely to achieve a decrease in prevalence but less than 30%are unlikely to experience a significant change in prevalenceare likely to experience
182、 an increase in prevalencedid not have enough data for calculating a trendwere assessed in totalAfrican Region53%37%0%1%9%100%Region of the Americas38%58%4%100%South-East Asia Region70%17%13%100%European Region22%75%1%0%1%100%Eastern Mediterranean Region32%29%11%16%12%100%Western Pacific Region12%88
183、%0%0%100%Global40%51%1%5%3%100%a Population figures are for all ages in 2022Proportion(%)of regions populationa living 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 countr
184、ies(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 o
185、f“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 tobac
186、co 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 e
187、stimated 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 o
188、f 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).MalesFemalesBothsexesMalesFemalesBothsexesAfrican Region2.91.42.29514Region of the Americas2.20.31.
189、29110South-East Asia Region24.911.818.419188280European Region2.60.31.49110Eastern Mediterranean Region8.91.85.422427Western Pacific Region2.30.41.318321High-income3.10.41.715217Upper middle-income1.70.31.017320Lower middle-income18.18.013.021694310Low-income5.32.03.611415Global9.03.56.3259103362The
190、 average estimates were constructed from surveys conducted in countries in the period 201 22022 and applied to each countrys United Nations estimated population in 2021.WHO regionWorld Bank country income group Average prevalence rate(%)Estimated no.of smokeless tobacco users(millions)26 Fig.9:Preva
191、lence of smokeless tobacco use,people aged 15 years and older Note:The average estimates were constructed from surveys conducted in countries in the period 20122022 and applied to each countrys population in 2021.See Annex 2.1 for more information.These prevalence estimates translate to at least 362
192、 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
193、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 b
194、y 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.621181519322
195、5392415202530GlobalAfrican RegionRegion of the AmericasSouth-East Asia RegionEuropean RegionEastern MediterraneanRegionWestern Pacific RegionPrevalence of current smokeless tobacco use(%)Both sexesMalesFemales 27 3.4 Smokeless tobacco use among adolescents aged 1315 years Data on smokeles
196、s tobacco use among adolescents aged 1315 years are available from 123 countries(63%of WHO Member States and 73%of the global population aged 1315 years)who asked questions about smokeless tobacco use in a school-based survey between 2012 and 2022 among children aged 1315 years or in equivalent grad
197、es.While prevalence is unknown in countries who are not monitoring smokeless tobacco use among adolescents aged 1315 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 1315 years report current use of smoke
198、less 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 1315 years use smokeless tobacco.These two regions,along with the Western Pacific Region,are also those with the best s
199、urvey coverage with at least 77%of the population aged 1315 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 1315),followed by the European Region(51%).Table 12:Prevalence of smokeless tob
200、acco use and number of users aged 1315 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 1315 years who use smokeless tobacco products.These numbers are un u
201、nderestimate as there are 71 countries with no data on this indicator.BoysGirlsBothsexesBoysGirlsBothsexesAfrican Region4.53.64.1213Region of the Americas2.41.62.0101South-East Asia Region4.42.83.6314European Region2.51.42.0001Eastern Mediterranean Region5.03.44.2112Western Pacific Region2.11.01.610
202、1High-income2.01.11.6001Upper middle-income2.41.41.9112Lower middle-income4.32.93.7437Low-income5.13.84.4112Global3.72.53.17512WHO regionWorld Bank country income group Average prevalence rate among people aged 13-15(%)Estimated no.of smokeless tobacco users aged 13-15(million)The average estimates
203、were constructed from surveys conducted in countries in the period 201 22022 and applied to each countrys United Nations estimated population in 2021.28 Table 12 shows that rates of smokeless tobacco use among adolescents aged 1315 years are highest on average in the Eastern Mediterranean Region and
204、 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 Pacif
205、ic 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 1315 years,20122022 Note:The average estimates were constructed from surveys conducted in countries in the period 201
206、22022 and applied to each countrys population in 2021.See Annex 2.2 for more information.Use of smokeless tobacco among adolescents aged 1315 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 to
207、bacco use only 31%of the groups population has been surveyed in the period therefore this income groups 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 RegionEastern Mediterranean RegionEuropean RegionSouth-East Asia RegionRegio
208、n of the AmericasAfrican RegionGlobalPrevalence of current smokeless tobacco use(%)Both sexesGirlsBoys 29 3.5 Any tobacco use among adolescents aged 1315 years In the decade 20122022,148 countries ran at least one school-based survey of children aged 1315 years asking about tobacco use.Collectively,
209、these surveys are representative of 80%of the worlds school-going adolescents aged 1315 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
210、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 estima
211、te 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 1315 years are cu
212、rrent users of some form of tobacco 25 million boys and 12 million girls.On average,around 10%of adolescents aged 1315 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 1315 years
213、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
214、.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-inco
215、me 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 20122022 and applied to each countrys United Nations estimated population in 2021.30 Of all WHO Regions,the South-East Asia Regi
216、on has the largest number of adolescent tobacco users aged 1315 years(11 million,or 30%of the global total).All WHO Regions have remarkably similar average prevalences of current tobacco use,in the range 911%,except the Western Pacific Region which has the lowest average rate at 8%(see Fig.11).Consi
217、dering that the Western Pacific Region average is heavily weighted by the prevalence in China(7%),the average for the remainder of this Regions 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
218、%of boys aged 1315 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,ado
219、lescents aged 1315 years,by WHO region Note:The average estimates were constructed from surveys conducted in countries in the period 2012-2022 and applied to each countrys population in 2021.See Annex 2.3 for more information.Among girls,the Region of the Americas and the European Region have the hi
220、ghest average rates at 910%.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 RegionEastern MediterraneanRegionEuropean Reg
221、ionSouth-East Asia RegionRegion of the AmericasAfrican RegionGlobalPrevalence of current tobacco use(%)Both sexesGirlsBoys 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%).F
222、ig.12:Prevalence of current tobacco use,adolescents aged 1315 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 countrys population in 2021.See Annex 2.3 for more information.Over 19 million ad
223、olescent 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 prev
224、alences 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 1213%.Among adolescent girls,the o
225、pposite 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 i
226、n 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 incomeLower middle incomeUpper middle incomeHigh incomeGlobalPrevalence of current tobacco use(%)Both sexesGirlsBoys 32 3.6 Cigarette smoking among adolescents aged 1315 yea
227、rs In the decade 20122022,149 countries ran at least one school-based survey of children aged 1315 years asking about cigarette use.Collectively,these surveys are representative of 81%of the worlds school-going adolescents aged 1315 years,which makes it possible to derive global and regional average
228、 rates of cigarette smoking for this age group.Table 14:Prevalence of current cigarette smoking and number of adolescents aged 1315 years smoking cigarettes,by sex,by WHO region and by World Bank country income group Globally,an estimated 19 million adolescents aged 1315 years(13 million boys and 6
229、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.).BoysGirlsBothsexesBoysGirlsBoth
230、sexesAfrican Region5.52.54.0213Region of the Americas6.06.16.0113South-East Asia Region7.11.74.5415European Region8.17.77.9113Eastern Mediterranean Region6.71.94.3202Western Pacific Region6.12.24.3213High-income5.66.15.8112Upper middle-income6.74.15.4325Lower middle-income6.81.94.4729Low-income5.72.
231、64.2112Global6.53.04.813619Average prevalence rate among people aged 13-15(%)Estimated number of cigarette smokers aged 13-15(millions)WHO regionWorld Bank country income group The average estimates were constructed from surveys conducted in countries in the period 201 22022 and applied to each coun
232、trys United Nations estimated population in 2021.33 Fig.13:Average prevalence of current cigarette smoking,adolescents aged 1315 years,by WHO region Note:The average estimates were constructed from surveys conducted in countries in the period 20122022 and applied to each countrys population in 2021.
233、See Annex 2.3 for more information.Globally an average of around 5%of adolescents aged 1315 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 Reg
234、ions 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 67%.Among girls,the European Region has the highest average rate of cigaret
235、te 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 RegionEastern MediterraneanRegionEuropean RegionSouth-East Asia RegionR
236、egion of the AmericasAfrican RegionGlobalPrevalence of current cigarette smoking(%)Both sexesGirlsBoys 34 Fig.14:Average prevalence of current cigarette smoking,adolescents aged 1315 years,by country income group Note:The average estimates were constructed from surveys conducted in countries in the
237、period 20122022 and applied to each countrys 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
238、 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 1315 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,cig
239、arette smoking prevalence is similar across income groups of countries,ranging from 67%.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 lo
240、wer 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%LowincomeLower middleincomeUpper middleincomeHighincomeGlobalPrevalence of current cigarette smoking(%)Both sexesGirlsBoys 35 3.7 Use of electronic nicotine de
241、vices 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 peoples health(11).Despite sometimes appearing simi
242、lar,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 bo
243、th 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
244、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 pr
245、evalence 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
246、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 20132022 Concerning current use of e-cigarettes among young people,data are increasingly avail
247、able 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
248、availability of national school-based surveys reporting prevalences of current e-cigarette use among adolescents 20132022 GlobalAfrican RegionRegion of the AmericasSouth-East Asia RegionEuropean RegionEastern Mediterranean RegionWestern Pacific RegionNo.of countries70/1942/4714/354/1137/533 /2110 /2
249、7%of population covered69%8%66%91%79%7%92%GlobalAfrican RegionRegion of the AmericasSouth-East Asia RegionEuropean RegionEastern Mediterranean RegionWestern Pacific RegionNo.of countries102/1946/4725/351/1144/537/2119/27%of population covered38%4%77%2%81%21%96%36 In total,102 countries now have at l
250、east one nationally representative school-based survey that monitors e-cigarettes prevalence among adolescents aged somewhere in the age range 1317 years.While these 102 countries represent 53%of all countries,they have in aggregate surveyed only 38%of the worlds population aged 1317.Of these,65 cou
251、ntries are monitoring the age group 1315 years.In contrast,the European Region surveys tend to be about school-going children aged 1516.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
252、the Regions 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 d
253、ata.In the South-East Asia Region,only 2%of the population aged 1317 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 t
254、rends 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 recal
255、culated 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 20002025 series,since the da
256、taset 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
257、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
258、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),o
259、ne 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 increasin
260、g rates,the total would be 35 countries,with all together only 8%of the worlds 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 tar
261、get 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
262、 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
263、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
264、Pacific Region largely reflect Chinas data,since 75%of the regions 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
265、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 futur
266、e 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
267、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 1315 years in most countries with data can acquire tobacco and other nicotine products for t
268、heir 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 quantiti
269、es 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 estim
270、ates 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 pri
271、vacy 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 informati
272、on 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 a
273、nd 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 adol
274、escents 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
275、 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 th
276、ey 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
277、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 countrys tobacco use trend is the effort the country invests in tobacco control.These efforts start with adopting a whole of
278、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
279、 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 decli
280、ne 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,countrie
281、s 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 negligi
282、ble.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 product
283、s 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 mo
284、nitoring 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 to
285、bacco 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,yo
286、ung 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 preve
287、nt 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
288、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 20132020.Geneva:World Health Organization;2013(https:/iris.who.int/
289、handle/10665/94384,accessed 10 October 2023).4.WHO NCD Accountability Framework,including Global Monitoring Framework for NCD prevention and control(2021 update)in alignment with the extension of the NCD Global Action Plan to 2030.Geneva:World Health Organization;2021(https:/cdn.who.int/media/docs/d
290、efault-source/ncds/ncd-surveillance/who-ncd-accountability-framework-for-ncd-implementation-roadmap.pdf,accessed 10 October 2023).5.WHO report on the global tobacco epidemic,2023:protect people from tobacco smoke.Geneva:World Health Organization;2023(https:/www.who.int/publications/i/item/9789240077
291、164,accessed 10 Oct 2023).6.Institute of Health Metrics and Evaluation,University of Washington,DISMOD-MR repository on Github(https:/ 10 Oct 2023).7.Bilano V,Gilmour S,Moffiet T,Tursan dEspaignet E,Stevens GA,Commar A et al.Global trends and projections for tobacco use,19902025:an analysis of smoki
292、ng indicators from the WHO Comprehensive Information System for Tobacco Control.Lancet.2015;385(9972):96676.8.World Bank country and lending groups.Washington DC:World Bank;2022(https:/datahelpdesk.worldbank.org/knowledgebase/articles/906519,accessed 9 August 2022).9.World Population Prospects,2022.
293、United Nations,Department of Economic and Social Affairs,Population Division,UN DESA/POP/2022/TR/NO.3.2022(https:/esa.un.org/unpd/wpp/Download/Standard/Population/,accessed 9 August 2022).10.Age standardization of rates:a new WHO standard.Geneva:World Health Organization;2001(https:/cdn.who.int/medi
294、a/docs/default-source/gho-documents/global-health-estimates/gpe_discussion_paper_series_paper31_2001_age_standardization_rates.pdf,accessed 10 October 2023).11.FCTC/COP/7/11 Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems(ENDS/ENNDS).New Delhi:Conference of the Part
295、ies to the WHO Framework Convention on Tobacco Control;2016(https:/fctc.who.int/publications/m/item/fctc-cop-7-11-electronic-nicotine-delivery-systems-and-electronic-non-nicotine-delivery-systems-(ends-ennds),accessed 10 October 2023).12.Heated Tobacco Products Information Sheet,2nd edition.Geneva:W
296、orld Health Organization;2020(https:/iris.who.int/bitstream/handle/10665/331297/WHO-HEP-HPR-2020.2-eng.pdf,accessed 10 Oct 2023).13.Freiberg A,Schubert M,Romero Starke K,Hegewald J,Seidler A.Rapid review on the influence of COVID-19 lockdown and quarantine measures on modifiable cardiovascular risk
297、factors in the general population.International Journal of Environmental Research and Public Health.2021;18(16):8567(https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC8393482/,accessed 7 November 2021).14.Carreras G,Lugo A,Stival C,Amerio A,Odone A,Pacifici R et al.Impact of COVID-19 lockdown on smoking c
298、onsumption in a large representative sample of Italian adults.Tobacco Control.2021;0:18.42 15.Many smokers used lockdown to quit.In:Eyewitness News website.Johannesburg:Eyewitness News;2021(https:/ewn.co.za/2020/06/08/many-smokers-used-lockdown-to-quit-surveys,accessed 17 July 2021).16.Salah HM,Shar
299、ma T and Mehta J.“Smoking Doubles the Mortality Risk in COVID-19:A Meta-Analysis of Recent Reports and Potential Mechanisms”,Cureus.2020 Oct;12(10):e10837(https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC7647838/).17.Preventing Tobacco Use Among Youth and Young Adults.USA:Office of the Surgeon General;20
300、12(https:/www.cdc.gov/tobacco/sgr/2012/index.htm,accessed 10 October 2023).18.Yoong SL,et al.Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents:a systematic review and meta-analysis,The Lancet Public Health,Volume 6,Issue 9,202
301、1,Pages e661-e673,ISSN 2468-2667,https:/doi.org/10.1016/S2468-2667(21)00106-7(https:/ 22 October 2023).19.Sreeramareddy CT,Acharya K,and Manoharan A.Electronic cigarettes use and dual use among the youth in 75 countries:estimates from Global Youth Tobacco Surveys(20142019).Sci Rep.2022 Dec 5;12(1):2
302、0967,2022(https:/pubmed.ncbi.nlm.nih.gov/36470977/,accessed 22 October 2023).20.Hammond D,Reid J,Burkhalter R,and Hong D.Trends in smoking and vaping among young people:findings from the International Tobacco Control Policy Evaluation Project youth survey.April 2023,University of Waterloo(https:/ 22
303、 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:/ 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 O
304、bservatory 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 s
305、moking 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,20002030,not age-standardized Table A1.6.Characteristic
306、s 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
307、 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
308、 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
309、 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
310、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 Cte dIvoire 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 .Eswatin
311、i 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 Femal
312、e 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
313、 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.
314、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
315、.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
316、 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 Tabl
317、e 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 Poin
318、t 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 Tanz
319、ania 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
320、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
321、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.
322、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 sexe
323、s 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.
324、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.
325、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 PR
326、Y 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 .Uni
327、ted 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 Femal
328、e 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
329、 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 Peoples 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
330、.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
331、 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
332、 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
333、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