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

The recent report[1] Tobacco Control Report for the Region of the Americas 2022 presents progress in implementing 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 increased from 28 to 16.3 % 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.

Measures MPOWER recommended by the WHO aim to monitor and prevent smoking, but also to protect people from tobacco smoke by establishing tobacco-free spaces. They include recommendations intended to help people stop smoking and invite countries to warn against the dangers of tobacco, particularly through broad graphic health warnings, to eliminate all advertising, promotion and sponsorship in favor of tobacco and to increase taxes on these products.

The 35 member states in the region have all adopted the measure establishing tobacco-free places in indoor collective 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. Furthermore, the development and accessibility of new tobacco and nicotine products, particularly electronic cigarettes, adds a new challenge, both globally and regionally. The fact remains that despite these obstacles, the Region has the second lowest smoking prevalence in the world.

An overall decrease but disparities depending on the country

The Region of the Americas saw a decrease in the prevalence of tobacco use among adults over 15 years of age, from 28 % in 2000 to 16.3 % in 2020. The region ranks second in the world after Africa where the more recent epidemic affects 10.3% of this population. As in the WHO European region, differences in consumption between sexes are the lowest. The male/female ratio is 1.9 (21.3 % men and 11.3 % women), while the global ratio is 4.7 (36.7 % men and 7.8 % of women), reaffirming the need for the region to strengthen the gender dimension in the tobacco control policies and strategies deployed.

Chile is the country where the most adults use 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 who smoke, followed by El Salvador (7.7%) and Peru (8.1%).

Regarding 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 record a tobacco use prevalence of 14.9 % by 2025, meaning it is on track to achieve target 5 of the WHO Global Action Plan for Prevention and the fight against non-communicable diseases, namely a relative reduction of 30 % in the prevalence of smoking among people aged 15 and over.

Disparities in the application of anti-tobacco 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 aimed at creating tobacco-free places to protect against exposure to passive smoking, as of December 31, 2021, the region is overall the most advanced.

The progress made in this area is the result of years of commitment and initiatives on the part of political leaders and civil society actors in these countries who are very involved in the implementation of the treaty's protection measures. . When the FCTC came into force in 2005, only Uruguay provided its citizens with effective protection against 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 best practices.

Other measures, such as increasing taxes on tobacco, have progressed more slowly and nine countries in the Americas region have not yet taken any action in this area.

Brazil is the only country in the region to have implemented the entire MPOWER system at its highest level of application. Panama, Uruguay, Canada, Mexico, Costa Rica and Chile have put 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 % of the population are covered by surveillance measures, tobacco-free places, cessation assistance and health warnings, implemented at the highest levels. The most significant increase in population coverage was observed for the health warnings measure, with an increase of 61% between 2007 and 2021, reaching coverage of almost 90% of the population. This measure is closely followed by the measure of tobacco-free public places, with an increase of 59 %, now covering 96% of the population. As mentioned previously, the tax increase measure had the lowest coverage, covering only 27 % of the region's population.

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

In summary :

• 24 countries are implementing protection measures against exposure to second-hand smoke through tobacco-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 tobacco use among adults and young people;
• 6 countries offer a complete smoking cessation support system;
• 9 have implemented a total ban on tobacco advertising, promotion and sponsorship;
• 3 countries apply taxes on tobacco that represent 75 % or more of the retail price (recommended by the WHO).

In 2020, on a global scale, there are major disparities regarding the application of MPOWER system measures. For example, Europe had the largest number of countries (42/53) with a surveillance system producing periodic, recent and representative data for adults and young people, while no countries Africa had not implemented this measure at the highest level of application. 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 tobacco 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 was the first country in Latin America to ban advertising, promotion and sponsorship. British American Tobacco and Philip Morris International tried three times to counter the measure. The Panamanian Supreme Court ruled in favor 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-tobacco 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 interference by the tobacco industry has been ensured thanks to the active engagement of civil society. Following the adoption of legislation on the packaging and labeling of tobacco products in Uruguay in 2010, Philip Morris initiated international proceedings against that country before the International Center for World Bank Investment Dispute Settlement (ICSID), alleging that the country's legislation violated a 1988 investment protection agreement between Switzerland (current PMI basis) and Uruguay. In July 2016, an arbitration court ruled in favor of Uruguay to protect the health of its population through measures consistent with the WHO Framework Convention to reduce tobacco consumption. These actions taken by South American countries remind health stakeholders around the world that there is no inevitability and that the attacks of the tobacco industry can be countered.

The threat of new tobacco and nicotine products

According to the report, new products such as electronic cigarettes and heated tobacco products are increasingly available and accessible, posing a threat to tobacco control and reducing the number of smokers. The report adds that terms used by the industry to promote these products, such as "reduced risks", tend to sow confusion and provide a false sense of security in circumstances where there is no scientific evidence demonstrating that consumption of these products is safe. The report recalls that the main objective of this communication is to attract new users while capturing smokers who want to quit.

The WHO notes that “ Electronic cigarettes are particularly dangerous for adolescents. Nicotine is a highly addictive product, and young people's brains continue to develop until around age 25. »

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

Call to strengthen legislation around these new products

The initiation of the use of electronic cigarettes, particularly among young people, raises concerns. This leads to a call to regulate 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, hand-rolling tobacco, etc.), which would ensure that these products are subject to all the provisions of the FCTC treaty. of the WHO. 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, on the occasion of 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 smoking device (vaping and heating tobacco) is prohibited under a resolution of 2009 of 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 and heated tobacco products.

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 project is awaiting discussion in the Chamber of Deputies.

Keywords: Americas, South America, Latin America, WHO, tobacco, new products, young people, tobacco reduction, tobacco control

©Tobacco Free Generation

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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] Generation without tobacco, All of South America now covered by smoking ban in public places, published on January 14, 2021, accessed on August 18, 2022[4] Generation without tobacco, Mexico bans the sale of electronic cigarettes, published June 8, 2022, accessed August 19, 2022National Committee Against Smoking |