Falling prevalence of smoking: how low can we go?
- Correspondence to: Professor S Chapman School of Public Health, University of Sydney, Edward Ford Building A27, Sydney, NSW 2006, Australia;
A sustained international initiative to fund major public awareness campaigns in nations that could never afford to run such campaigns would make a huge difference to nations in which such awareness remains rudimentary
How low might the prevalence of smoking fall in whole nations? Countries that have the lowest prevalence of smoking for both sexes combined are mostly those with strong cultural proscriptions against smoking by women. The NationMaster site (http://www.nationmaster.com), sourcing data from the World Health Organization, shows 44 nations where reported prevalence of smoking among women is <10%, 28 nations where it is <5% and 12 nations where it is <2% (Qatar reports that 0.5% women smoke). Very low smoking rates among women, which generally owe nothing to public health policies, can pull down the combined prevalence rate of smoking among men and women to levels well below those in nations where prevalence of smoking among women has been high, but has fallen. There are few, if any, strategic lessons for public health in examining most nations with very low prevalence of smoking among women in the hope of seeing a policy blueprint.
If large falls in the prevalence of smoking are the main consideration, there are four front-runners for the title of world’s most successful smoking control nation: Canada, Australia, USA and Sweden (table 1).
Sweden has attained the lowest prevalence of smoking among any nation, largely because of the major shift that has occurred from smoking to snus use in men: another 20% of men and 2% of women use snus daily, but do not smoke.1 At the state level, low daily smoking rates in California, USA (9.8%),4 New South Wales, Australia (13.9%)5 and British Columbia, Canada (11%)6 stand out. For several years in the 1990s, …