Europe: How has the tobacco epidemic evolved since 1970?

Tobacco consumption dynamics have been highly variable across Europe over the past four decades. This is shown by a recent study published in the journal Tobaco Control, which compiled data on consumption trajectories (prevalence, consumption intensity) from 41 European countries and former European countries.[1], between 1970 and 2015.

The reference model for understanding the evolution of tobacco consumption describes a recurring dynamic, known as the "inverted U". Thus, tobacco consumption begins at a low level, then increases rapidly over two to three decades, driven in particular by a high prevalence of smoking among men. Then, the implementation of tobacco control policies allows a successive plateau in consumption to be reached and a gradual decline in the tobacco epidemic.[2].

A theoretical model for understanding the general dynamics of the tobacco epidemic

However, observing consumption dynamics allows us to qualify this model, and shows a great variability depending on the country, subject to specific geopolitical, economic, geographical and socio-demographic contexts. For example, while the inverted U-shaped trajectory was observed in the former countries of the Soviet Union between 1960 and 1992, the dissolution of the USSR in 1991 was followed by a second rapid increase in tobacco consumption and mortality. This break in the dynamics can be explained by the political, social and economic upheaval at work in the former USSR, notably resulting in the privatization of the tobacco industry.[3].

Unequal regional dynamics in Europe

The study published in Tobacco Control shows that almost all countries in Northern, Western, and Southern Europe have experienced a stable or declining trend in tobacco consumption. Eastern Europe, on the other hand, characterized by a stabilization of its tobacco consumption until the 1980s, went through a period of generalized increase in the 2000s, followed by a downward trend in the 2010s. Finally, the Southeastern European region is marked by a very inconsistent dynamic of its tobacco consumption, alternating successively between periods of stability, increases, and decreases during the period studied.

The great variability of tobacco consumption between countries

The study highlights a very wide variability in consumption dynamics between countries. The most common typology identified by the study's authors is that of the "stability with a single decline" model, which is found in Scandinavian countries, with the exception of Norway, in Slovenia, as well as in Western countries such as the Netherlands, Germany, and France. The latter experienced overall stability, followed by a sharp decline in the early 2000s, with Jacques Chirac's first Cancer Plan, leading to the first significant tax increases on tobacco products. Other countries, such as Ireland and several Central European countries, experienced a continuous decline between 1970 and 2015, while others, such as the former Yugoslavia, alternated between periods of increased and stable consumption.

Decline in tobacco consumption in Europe is not inevitable

For the study's authors, these data help to qualify the idea of a widespread and inevitable decline in tobacco consumption following collective awareness of the risks associated with tobacco use. The assurance of a natural decline in tobacco consumption levels can lead policymakers to develop a false sense of security. In reality, the decline in tobacco consumption does not respond to a mechanical and inevitable logic, but is the result of proven and consistent public health policies.

FT

[1] East Germany, USSR, Yugoslavia in particular

[2] Lopez AD, Collishaw NE, Piha T, A descriptive model of the cigarette epidemic in developed countries, Tobacco Control 1994;3:242.

[3] Poirier MJ, Lin G, Watson LK, et al, Classifying European cigarette consumption trajectories from 1970 to 2015, Tobacco Control Published Online First: 07 January 2022. doi: 10.1136/tobaccocontrol-2021-056627