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Combating the tobacco epidemic in North America: challenges and opportunities
  1. Brian A King1,
  2. Indu B. Ahluwalia1,
  3. Adriana Bacelar Gomes2,
  4. Geoffrey T. Fong3,4
  1. 1Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2Pan American Health Organization, Washington, DC, USA
  3. 3Department of Psychology and School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
  4. 4Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  1. Correspondence to Dr Brian A King, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; baking{at}

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According to the WHO, the Region of the Americas has the second lowest tobacco use prevalence of any WHO region.1 WHO projections based on trends since 2000 indicate that the Region of the Americas, which includes both North and South America, is the only region expected to achieve a 30% relative reduction in tobacco use by 2025.1 However, there are approximately 127 million persons who report smoking tobacco in the Americas Region,2 a majority of whom reside in North America.3 North America consists of 23 countries with a combined population of nearly 600 million people, or approximately 7.5% of the world’s population in 2019.4 Among North American countries, data from 2017 for persons aged 15 years or older show current tobacco smoking prevalence ranged from 6.0% in Panama to 27.8% in Cuba.5 Among students aged 13–15 years old in North American countries with available data through 2017, current tobacco smoking prevalence ranged from 4.4% in Dominican Republic to 18.1% in Mexico.5 Tobacco smoking among adults is higher among males than females across North America. However, the difference in prevalence between sexes in the Region of the Americas is among the lowest of any WHO region5; this pattern is particularly pronounced among youth, where tobacco smoking among girls is similar to or higher among boys in most countries.2 5

Despite lower tobacco use relative to other regions, and future projected reductions,1 challenges remain to combating the tobacco epidemic in North America, including diversification of the product landscape, tobacco industry interference and uneven application of evidence-based strategies. This commentary discusses these challenges, as well as opportunities for future action to reduce the burden of tobacco use in North America.

Diversification of the product landscape

Over the past decade and a half, the tobacco and nicotine product landscape has evolved …

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  • Contributors BAK conceived of and drafted the report. BAK, IBA, ABG and GTF revised the report critically for important intellectual content. BAK, IBA, ABG and GTF approved the final report for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

  • Competing interests GTF has been an expert witness or consultant on behalf of governments in litigation involving the tobacco industry.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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