Americas: A drop in consumption following the implementation of effective anti-smoking measures

The recent report[1] on Tobacco Control in the Americas Region 2022 presents progress in the implementation of MPOWER tobacco control measures[2] during the period 2018-2021. While significant progress has been noted, the report also highlights disparities between countries. Tobacco use has fallen from 28 to 16.3 percent of the adult population in the Americas over the past two decades, but new tobacco and nicotine products pose a threat, according to the Pan American Health Organization.

The measures MPOWER WHO recommendations aim to monitor and prevent tobacco use, as well as protect people from tobacco smoke by establishing smoke-free spaces. They include recommendations to help people quit smoking and call on countries to warn of the dangers of tobacco, including through broad graphic health warnings, to eliminate all tobacco advertising, promotion and sponsorship, and to increase taxes on these products.

All 35 Member States in the region have adopted the measure establishing smoke-free places in indoor communal spaces. 26 of them have even adopted best practices in the field, thus protecting 96% of the region's population from exposure to the risk of passive smoking. However, the report highlights how the global COVID-19 pandemic is considered one of the most significant threats to the implementation of additional tobacco control measures. In addition, the development and accessibility of new tobacco and nicotine products, particularly e-cigarettes, add a new challenge, both globally and regionally. Despite these obstacles, the Region is the second in the world with the lowest tobacco prevalence.

An overall decrease but disparities between countries

The Region of the Americas has seen a decrease in the prevalence of tobacco use among adults aged 15 and over, from 28.1% in 2000 to 16.3% in 2020. The region ranks second globally after Africa, where the more recent epidemic affects 10.3% of this population. As in the WHO European Region, the gender gap in consumption is the smallest. The male-to-female ratio is 1.9 (21.3% of men and 11.3% of women), while the global ratio is 4.7 (36.7% of men and 7.8% of women), reaffirming the need for the region to strengthen the gender dimension in tobacco control policies and strategies.

Chile is the country with the highest prevalence of adults consuming tobacco (29.2 %), followed by Argentina (24%), the United States (23%), Uruguay (21.5%) and Cuba (17.9%). Panama, for its part, has the lowest prevalence with 5% of the adult population smoking, followed by El Salvador (7.7%) and Peru (8.1%).

For adolescents (individuals aged 13 to 15 years), among the 35 states, Canada reported the lowest prevalence (1.1%), followed by the United States (5.4%) and Brazil (6.9%) while Dominica reported the highest prevalence (25.3%), followed by Argentina (20.2%) and Mexico (19.8%).

The Region is expected to have a tobacco use prevalence of 14.9 % by 2025, which means it is on track to achieve Target 5 of the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases, namely a relative reduction of 30 % in tobacco use prevalence among people aged 15 years and older.

Disparities in the application of anti-smoking measures

Of the 6 countries in the world that have not ratified the FCTC, 4 are in the Americas (United States, Cuba, Argentina and Haiti).

Regarding the implementation of the measure to create smoke-free places to protect against exposure to passive smoking, as of December 31, 2021, the region is generally the most advanced.

The progress made in this area is the result of years of commitment and initiatives by political leaders and civil society actors in these countries, who are deeply involved in implementing the treaty’s protections. When the FCTC entered into force in 2005, only Uruguay provided its citizens with effective protection from second-hand smoke in public spaces. In contrast, Southeast Asia has the smallest number of countries (2/11) that have adopted policies banning smoking in public places based on good practices.

Other measures, such as increasing tobacco taxes, have progressed more slowly, with nine countries in the Americas region yet to take any action.

Brazil is the only country in the region to have implemented the entire MPOWER framework at its highest level of application. Panama, Uruguay, Canada, Mexico, Costa Rica, Chile have implemented 4 of the 6 MPOWER measures at their highest level of application. Several countries have not implemented any measures (Belize, Cuba, Dominican Republic, Dominica, Grenada, Haiti, Nicaragua, Saint Kitts and Nevis, Saint Vincent and the Grenadines).

Since 2007, the percentage of the Americas population covered by at least one MPOWER measure has increased significantly. More than 60,000 people are covered by surveillance, smoke-free places, cessation support, and health warnings measures, implemented at the highest levels. The most significant increase in population coverage was observed for the health warnings measure, with an increase of 61,000 between 2007 and 2021, reaching a coverage of almost 90,000 people. This measure is closely followed by the smoke-free public places measure, with an increase of 59,000, now covering 96,000 people. As mentioned earlier, the tax increase measure had the lowest coverage, covering only 27,000 people in the region.

Table - Status of implementation of MPOWER measures and adult smoking prevalence in the Americas region

In summary:

• 24 countries implement measures to protect against exposure to second-hand smoke through smoke-free spaces;
• 22 countries require large graphic warnings about the dangers of smoking on packages;
• 10 countries have surveillance systems providing recent, periodic and representative data on adult and youth smoking;
• 6 countries offer a comprehensive system of smoking cessation support;
• 9 have implemented a total ban on tobacco advertising, promotion and sponsorship;
• 3 countries apply tobacco taxes that represent 75 % or more of the retail price (recommended by WHO).

In 2020, there were major global disparities in the implementation of MPOWER measures. For example, Europe had the highest number of countries (42/53) with a surveillance system producing periodic, recent and representative data for adults and young people, while no country in Africa had implemented this measure at the highest level of implementation. The same goes for smoking cessation services, which are not offered in any African country.

The ability of South American countries to resist the pressures and actions of cigarette companies

The tobacco industry is very active in preventing the adoption of regulations in the region[3]. However, it has suffered setbacks in recent years. In 2008, Panama became the first country in Latin America to ban advertising, promotion and sponsorship. British American Tobacco and Philip Morris International have tried three times to challenge the measure. The Panamanian Supreme Court ruled in favour of the Ministry of Health's text and validated the preventive measures adopted to combat the tobacco epidemic in the country. In 2010, in Peru, during the discussion of the anti-smoking bill in parliamentary committees, the participation of representatives of the tobacco industry was not allowed in accordance with the provisions of the treaty. The protection of public policies from tobacco industry interference has been ensured thanks to the active engagement of civil society. Following Uruguay’s adoption of tobacco packaging and labeling legislation in 2010, Philip Morris filed an international lawsuit against the country at the World Bank’s International Centre for Settlement of Investment Disputes (ICSID), alleging that the country’s legislation violated a 1988 investment protection agreement between Switzerland (the current basis of PMI) and Uruguay. In July 2016, an arbitration tribunal ruled in favor of Uruguay protecting the health of its population through measures consistent with the WHO Framework Convention to reduce tobacco consumption. These actions by South American countries are a reminder to health stakeholders around the world that tobacco industry attacks are not inevitable and can be countered.

The threat of new tobacco and nicotine products

According to the report, new products such as e-cigarettes and heated tobacco products are becoming increasingly available and accessible, posing a threat to tobacco control and the reduction of smoking. The report adds that the terms used by the industry to promote these products, such as "reduced risk", tend to sow confusion and give a false sense of security in circumstances where there is no scientific evidence that the use of these products is safe. The report reiterates that the main objective of this communication is to attract new users while capturing smokers who want to quit.

WHO notes that " E-cigarettes are especially dangerous for teenagers. Nicotine is a highly addictive substance, and young people's brains continue to develop until about age 25. »

Of the 26 countries in the Region with data on e-cigarette use, the United States has the highest prevalence of current e-cigarette use among adolescents (19.6 %), and Brazil the lowest (0.2 %). In all countries with data, e-cigarette use is more prevalent among adolescent boys, with the exception of Venezuela and Colombia, where the prevalence of e-cigarette use is almost equal among girls and boys.

Call to strengthen legislation around these new products

The initiation of e-cigarette use, particularly among young people, raises concerns. This calls for regulating these products in the same way as tobacco products. The report also recommends explicitly classifying heated tobacco products in the same category as other tobacco products (cigarettes, cigars, rolling tobacco, etc.), which would ensure that these products are subject to all provisions of the WHO FCTC treaty. According to the authors of the report, such an approach is likely to protect public health objectives and avoid regulatory loopholes.

Several countries in Latin America already prohibit or restrict the marketing and promotion of electronic cigarettes and heated tobacco products through various legal texts.[4].

According to the Mexican president, who signed a decree On May 31, World No Tobacco Day, banning the marketing and circulation of electronic cigarettes, these products cannot be considered less risky alternatives. In Brazil, the sale, importation and advertising of any electronic device for smoking (vaping and heated tobacco) is prohibited under a resolution 2009 from the National Health Surveillance Agency (Anvisa).

Argentina prohibits the importation, distribution, marketing and advertising of all vaping products. In Uruguay, Decree 534/2009 prohibits the marketing, importation, registration as a trademark or patent and advertising of all vaping products and heated tobacco.

In March 2021, the Chilean Senate passed a bill to amend the Tobacco Law and regulate the sale, advertising and consumption of electronic cigarettes, prohibiting their sale to minors. This bill is pending discussion in the Chamber of Deputies.

Keywords: Americas, South America, Latin America, WHO, smoking, new products, youth, smoking reduction, tobacco control

©Generation Without Tobacco

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[1] Pan American Health Organization. Report on Tobacco Control for the Region of the Americas 2022. Washington, DC: PAHO; 2022. Available from: https://doi.org/10.37774/9789275125892. [2] M: monitor tobacco use and prevention policies; P: protect people from tobacco smoke; O: provide help to quit smoking; W: warn about the dangers of tobacco; E: enforce the ban on tobacco advertising, promotion and sponsorship; R: increase tobacco taxes. [3] Tobacco-free generation, All of South America now covered by public smoking ban, published on January 14, 2021, consulted on August 18, 2022 [4] Tobacco-free generation, Mexico bans sale of e-cigarettes, published June 8, 2022, accessed August 19, 2022 National Committee Against Smoking |