Background

Universally, smoking cessation rates among established smokers are poor. Preventing young people from starting use of and becoming addicted to tobacco products remains a key strategy to end the tobacco epidemic. Previous country-specific studies have found that initiation of smoking tobacco use occurs predominantly among young people and have found mixed progress in reducing the prevalence of smoking tobacco use among young people. Current and comparable estimates for all countries are needed to inform targeted interventions and policies.

Methods

We modelled two indicators: prevalence of current smoking tobacco use among young adults aged 15–24 years, and the age at which current smokers aged 20–54 years in 2019 began smoking regularly. We synthesised data from 3625 nationally representative surveys on prevalence of smoking and 254 on age at initiation. We used spatiotemporal Gaussian process regression to produce estimates of the prevalence of smoking and age of initiation by sex, for 204 countries and territories for each year between 1990 and 2019.

Findings

Globally in 2019, an estimated 155 million (95% uncertainty interval 150–160) individuals aged 15–24 years were tobacco smokers, with a prevalence of 20·1% (19·4–20·8) among males and 4·95% (4·64–5·29) among females. We estimated that 82·6% (82·1–83·1) of current smokers initiated between ages 14 and 25 years, and that 18·5% (17·7–19·3) of smokers began smoking regularly by age 15 years. Although some countries have made substantial progress in reducing the prevalence of smoking tobacco use among young people, prevalence in 2019 still exceeds 20% among males aged 15–24 years in 120 countries and among females aged 15–24 years in 43 countries.

Interpretation

The fact that most smokers start smoking regularly before age 20 years highlights the unique window of opportunity to target prevention efforts among young people and save millions of lives and avert health-care costs in the future. Countries can substantially improve the health of their populations by implementing and enforcing evidence-based tobacco control policies that prevent the next generation from initiating smoking.

Funding

Bloomberg Philanthropies.

中文翻译：

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1990 年至 2019 年 204 个国家和地区青少年吸烟和开始吸烟流行的空间、时间和人口统计学模式

背景

普遍而言，既定吸烟者的戒烟率很低。防止年轻人开始使用烟草产品并使其上瘾仍然是结束烟草流行的关键战略。以前针对特定国家的研究发现，开始使用烟草主要发生在年轻人中，并且发现在降低年轻人吸烟流行率方面取得的进展喜忧参半。需要对所有国家进行当前和可比较的估计，以便为有针对性的干预措施和政策提供信息。

方法

我们模拟了两个指标：15-24 岁年轻人中当前吸烟的流行率，以及 2019 年 20-54 岁当前吸烟者开始定期吸烟的年龄。我们综合了 3625 项具有全国代表性的吸烟流行率调查数据和 254 项关于开始年龄的调查数据。我们使用时空高斯过程回归来估计 1990 年至 2019 年间每年 204 个国家和地区的吸烟流行率和按性别分列的吸烟年龄。

发现

2019 年，全球估计有 1.55 亿（95% 不确定区间 150-160）年龄在 15-24 岁之间的人是吸烟者，男性患病率为 20·1%（19·4-20·8），男性为 4·95 % (4·64–5·29) 女性。我们估计 82·6% (82·1-83·1) 的当前吸烟者在 14 至 25 岁之间开始吸烟，18·5% (17·7-19·3) 的吸烟者在 15 岁时开始定期吸烟年。尽管一些国家在降低年轻人吸烟率方面取得了实质性进展，但 2019 年 120 个国家 15-24 岁男性和 43 个国家 15-24 岁女性的流行率仍超过 20%。

解释

大多数吸烟者在 20 岁之前就开始定期吸烟这一事实凸显了在年轻人中开展预防工作并挽救数百万人生命并避免未来医疗保健费用的独特机会之窗。各国可以通过实施和执行以证据为基础的烟草控制政策，防止下一代开始吸烟，从而大大改善其人口的健康状况。

资金

布隆伯格慈善机构。