Tunisia: Smoking mainly affects men and the less educated

The results of the latest MICS survey show a relative stability of smoking in Tunisia, which concerns one in two men and remains at a very high level among them. Smoking prevalence is falling among men aged 15-19 as well as in rural areas, and increasing in urban areas. This persistence of significant smoking argues for the strengthening of anti-smoking measures. The Multiple Indicator Cluster Survey (MICS) is an international survey program developed by UNICEF. Tunisia has already experienced five waves of this survey since 2000, the last in 2023. The MICS Tunisia 2023 is based on a sample of 11,000 households, two thirds of which are in urban areas and one third in rural areas.[1]. It covers several health indicators, which include maternal health, child health, education, drinking water and social coverage. One of its components is devoted to tobacco and alcohol consumption. Carried out by the National Institute of Statistics (INS) and coordinated by the Ministry of Economy and Planning (MEP), MICS Tunisia 2023 benefited from the technical and financial support of UNICEF, and contributions from the United States Agency for International Development (USAID) and the German Development Bank (KfW).

Heavy smoking, especially among men

Smoking appears relatively stable but has shown a very slight increase in Tunisia since the 2018 MICS survey. It is mainly present among men, at a significant level. According to this survey, the smoking prevalence is 49.8 % in 2023 compared to 49.4 % in 2018 among men, and 1.9 % in 2023 compared to 1.7 % in 2018 among women. Smoking prevalence is increasing significantly among men aged 20-24 (49.9 % in 2023, compared to 44 % in 2018) and 35-39 (58.9 % in 2023, compared to 47.5 % in 2018), while it is decreasing among those aged 15-19 (16.5 % in 2023, compared to 22.4 % in 2018). This smoking is particularly concentrated in urban areas: 52.3 % of male smokers (50.4 % in 2018) live in urban areas and 44.8 % (47.3 % in 2018) in rural areas, while 2.8 % of female smokers (2.3 % in 2018) live in urban areas and in rural areas this consumption seems exceptional, even non-existent, and less than 0.5%. The socio-educational level plays in two different directions. Among men, the prevalence of smoking is higher when the level of education is low. A decreasing prevalence is recorded, from 59.4 % in 2018 to 56.5 % in 2023, among men with a primary education level, and from 60.1% in 2018 to 50.4 % in 2023 among men who are not in school. On the other hand, it is increasing among men with higher education qualifications, increasing from 41.4% in 2018 to 44.4% in 2023. The wealthiest households show slightly higher prevalences (48.3 % among men and 4.1 % among women) than the poorest (46.2 % among men, 0.3 % among women).

High mortality rate attributable to smoking

Smoking prevalence remains at a particularly high level among Tunisian men, which places Tunisia at the top of the Maghreb countries in terms of smoking. The weight of smoking in Tunisia is estimated at 20 % of overall mortality. The head of government and nine ministers had signed, on the occasion of World No Tobacco Day in May 2023, a charter aimed at strengthening the fight against tobacco[2]. This charter was intended in particular to relaunch the implementation of measures recommended by the Framework Convention on Tobacco Control of the World Health Organization (WHO). The results of this latest survey highlight the challenges[3]. Keywords: Tunisia, survey, UNICEF, smoking prevalence, tobacco use

©Generation Without Tobacco

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[1] Situation of mother and child, Multiple Indicator Cluster Survey (MICS) Tunisia 2023, 24 p. [2] WHO-Eastern Mediterranean Region, Meeting of the ministerial group for tobacco control in Tunisia, accessed February 22, 2024. [3] Ben Yahia M, Tunisia: Tobacco, the male curse, Réalités Online, published on February 14, 2024, consulted on February 22, 2024. National Committee Against Smoking |