Tobacco control policies are needed to change smoking trends

1. Key messages

2. Tobacco use in Belgium remains a serious public health concern

Tobacco use is a major contributor to death and disability worldwide [1-3], including in Belgium. The Belgian Health Interview Survey (BHIS) has showed a decrease in self-reported daily smoking from a high of 25.5% of adults 15+ years in 1997 to 15.3% in 2018. Daily smoking prevalence from the survey data is highest in the Walloon Region at 18.8% followed by the Brussels Capital Region (16.5%) and the Flemish Region (13.3%). Men reported smoking at a higher rate than women (18.9% vs 12.1%). The age at starting a daily smoking habit has remained steady between 17 and 18 years in the BHIS since 2004.

The BHIS, a nationally representative, cross-sectional survey has been repeated roughly every five years since 1997, allowing for the creation of a modeled time-series on trends of tobacco use. The time-series fills in the gaps in missing data and serves as the basis for developing projections. The modeled estimates suggest that daily tobacco use in Belgium will continue to decrease in the coming decades, reaching less than 10% by 2040 among adults 15+ years assuming patterns in population demographics and current trends in daily smoking remain the same.

The Inter-federal Strategy for a Tobacco-free Generation set forth ambitious goals for reducing tobacco use

In 2022, Belgium adopted the Inter-federal Strategy 2022-2028 for a Tobacco-free Generation aimed at reducing smoking among the general population and young people aged 15-24 years. The vision of the plan is to achieve a generation that is tobacco-free and drastically reduce the prevalence of tobacco use in the general population.

The plan set ambitious targets for reductions in daily smoking as follows:

• Reduce the prevalence of daily smokers of tobacco to 10% by 2028 and 5% by 2040 among those 15+ years;
• Reduce, by 2040, the prevalence of people initiating tobacco use to 0% or nearly 0%;
• By 2028, reduce the number of daily smokers among the population 15-24 years to 6%.

To achieve these targets, a number of policy areas have been developed including fiscal measures, regulations on the composition of tobacco products and labelling of tobacco products, health literacy, and public information campaigns, reducing the impact of sales to minors and closer cooperation on monitoring and surveillance of tobacco use. We use the modeled time series projections to evaluate whether these targets are likely to be achieved if trends continue on the same trajectories as in the past (e.g. without significant policy changes).

Targets for daily smoking will not be achieved without policy action

National targets on reductions in daily smoking to 10% prevalence among those 15+ years by 2028 and 5% by 2040 will not be achieved assuming current trajectories continue into the future. If no new policies are implemented, the projected prevalence of daily smoking is not expected to drop below 10% before 2040. Daily smoking is higher among men than women and that gap is expected to persist although narrowing over time. The daily smoking prevalence in women is expected to drop below 10% by 2035, but for men this will not happen before 2040.

The prevalence of daily smoking is projected to decrease across all regions but remains highest in the Walloon Region and lowest in the Flemish Region. No region is projected to reach the targets - 10% daily smoking by 2028 or 5% daily smoking prevalence before 2040. Progress in reducing daily smoking is not equal across all ages. Daily smoking patterns vary by age. The greatest progress has been seen in the younger age groups (15-34 years) where policy efforts have been focused, with less progress among older age groups (55-74 years).

There is greater progress in reducing smoking in young people, but targets will still be missed if no new policies are implemented

The Inter-federal Strategy put forth a target to reduce daily smoking in young adults (15-24 years) by 6% by 2028. This target will not be reached on current trajectories and will not be reached before 2040. None of the three regions will reach the targets for young adults. Implementing new policies like the ones in the Inter-federal Strategy is urgently needed if targets are to be met. Daily smoking is highest among youth in the Brussels Capital Region.

The Inter-federal Strategy also calls for a reduction in the number of people initiating tobacco use to 0% or nearly 0% by 2040. The vast majority of people who smoke daily report having started their habit between the ages of 17 and 18 years. This is a critical age to intervene to reduce the number of people starting tobacco use. The projections for youth 15-19 years show that by 2040, daily smoking in this age group should reach <3%.

Targeted approaches need to take into account widening inequalities in tobacco use

There is a substantial gap in the prevalence of daily smoking across levels of educational attainment. This indicator, which is based on the number of years of formal schooling a person has completed, can be used as a proxy for overall socioeconomic status as it is strongly correlated with other indicators such as household income, level of deprivation, and employment status. These social determinants of health often go hand in hand with inequalities in risk behaviors, putting those in the most vulnerable categories at the greatest risk of disease.

When considering tobacco use, there is and has been a persistent difference in smoking rates between those who have had more than a secondary school education, and those who have not. This difference is maintained into the future, with a more rapid decrease among those with the most years of education. It is only this group in Belgium that is projected to reach both targets in the Inter-Federal Strategy on its current trajectory. Targeted approaches that take into account inequalities and vulnerability of different members of the community will be necessary in order to achieve targets for the whole of Belgium.

Policy actions

The Inter-federal Strategy proposes a number of ambitious policies designed to change the current trajectories and projections presented here towards the proposed targets. These strategies include: increases prices on tobacco products, restricting tobacco use in certain outdoor spaces, reducing the number of points of sale for tobacco, regulating the composition of tobacco products and increasing awareness on the harms of tobacco use to the general public. In addition, the Strategy proposes greater aid to those seeking to quit tobacco use through greater reimbursement for tobacco cessation products. The Strategy also recognizes and seeks to reduce the environmental impact of tobacco products and reinforces the need for improved monitoring on tobacco use in Belgium as well as a stable financing mechanism for tobacco control.

The projections presented here show what may be expected in terms of daily tobacco use if no policy changes are made, or only those existing policies from the past are maintained with no change. It is a “business as usual” scenario. Trends could change if policies are enforced, ideally leading to reductions, or if they are abandoned which could lead to increases. The magnitude of policies changes are not included in this analysis but could form the basis of health impact assessment for tobacco control to help inform policy and target development.

3. Read more

View the metadata for this indicator

Inter-federal Strategy 2022-2028 for a Tobacco-free Generation

Definitions

Daily smoking

Smoking at least one cigarette per day. This variable is based on self-reported data. The true prevalence of daily smoking may be higher if people hide their smoking habit.

Prevalence

Prevalence is a proportion of the population in a given time sharing a characteristic. It is often represented as a percentage.

References

1. Murray, C. J. L., Aravkin, A. Y., Zheng, P., et al (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2
2. Gisle, L., Demarest, S., & Drieskens, S. (2018). Enquête de santé 2018: Consommation de tabac. https://www.sciensano.be/en/biblio/enquete-de-sante-2018-consommation-de-tabac
3. World Health Organization. (2009). Global health risks: Mortality and burden of disease attributable to selected major risks. World Health Organization. https://apps.who.int/iris/handle/10665/44203

Please cite this page as: Sciensano. Factsheets: Tobacco control policies are needed to change smoking trends, Health Status Report, 26 Oct 2023, Brussels, Belgium, https://www.belgiqueenbonnesante.be/fr/etat-de-sante/factsheets/tobacco-control-policies-are-needed-to-change-smoking-trends