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WHO: Global male tobacco use number expected to decline for first time on record

After years of steady increases, the number of males using tobacco around the world will decline for the first time on record, the World Health Organization projected in a new report.

The WHO expects the number of male tobacco users to decrease by 2 million in 2020 to 1.091 billion and by another 4 million in 2025 to 1.087 billion, down from a peak in 2018 of 1.093 billion male tobacco users. The projections assume that countries continue and in some cases accelerate tobacco control efforts such as enforcing bans on advertising and raising taxes on tobacco products.

"Fewer males using tobacco products means fewer people will suffer the avoidable pain and death that they cause," said Ruediger Krech, the WHO's director of the Department of Health Promotion, on a call with reporters Dec. 18. "The decline in tobacco use proves that tobacco control measures work, like taxation, banning smoking in public places, stopping marketing and protecting children from tobacco."

More than 8 million people die from tobacco use each year, the WHO said.

The declines in the number of male tobacco users would come after the figure increased by 7 million from 2010 to 2015. The rate of male tobacco use has declined since 2000 when it was 50% and is estimated to decrease to 37.5% in 2020.

The total number of tobacco users has declined since 2000 because of continued decreases in the number of female tobacco users, the WHO said. The number of female tobacco users is expected to decline to 235 million in 2020 for a rate of 8%. The percentage of total tobacco users worldwide is expected to continue to decline from 33.3% in 2000 to 20.9% in 2025.

Rates of tobacco use are declining in all six regions of the world designated by WHO. The South-East Asia region, which includes Indonesia and India, has long had the highest prevalence of tobacco use, according to the WHO report. In 2025, the South-East Asia region is projected to have an average rate for tobacco use of 25.1%, down from around 47% in 2000.

WHO's goal is to achieve a 30% relative reduction in global tobacco use prevalence in the period from 2010 to 2025. The only region WHO expects to reach this goal is the Americas, which in 2010 had a tobacco use rate of 23%. The Western Pacific region is expected to experience the lowest rate of decline, with the WHO projecting a relative reduction of around 12% from 2010 to 2025. The Western Pacific region includes China, Korea, Japan and Australia.

"Although admirable progress is being made, the tobacco epidemic is far from over," Naoko Yamamoto, assistant director general for Universal Healthcare/Healthier Populations at the WHO, said in the report. "Progress towards reducing tobacco use everywhere in the world is uneven and some groups are getting left behind."

The WHO did not discuss the role e-cigarettes and vaping products are playing in global tobacco-use declines, though big tobacco companies such as Altria Group Inc. have attributed declining cigarette sales in part to the rise of smokeless devices as they increasingly invest in such products. The WHO plans to publish a report in February on e-cigarettes.

"There is a lot of risks associated with e-cigarettes, and we're going to be a bit more concrete about those risks," Krech said when asked about the upcoming report.

The WHO report on e-cigarettes would land at a time when societies around the world are debating the merits of electronic nicotine devices.

A study published Dec. 16 in the American Journal of Preventive Medicine claimed to show e-cigarette use increases a person's risks of developing chronic lung diseases, but a consensus view has yet to emerge. The U.S. Food and Drug Administration continues to weigh the risks e-cigarettes pose, especially when it comes to the growing number of younger users, and the help e-cigarettes may provide in getting smokers to quit.

"There are anecdotal reports that some former smokers have successfully transitioned completely to e-cigarettes, but the on-ramp for kids is getting wider and wider and wider," said Mitch Zeller, the FDA's director of the Center for Tobacco Products, at a Dec. 4 congressional hearing. "Our job as regulators is to figure out how to balance those two uses of the product."

A Trump Administration proposal to clear the market of most flavored e-cigarette products has stalled, but the U.S. is poised to raise the federal age to buy tobacco products including e-cigarettes from 18 to 21, a measure that has broad industry backing from companies such as market leader JUUL Labs Inc.

Heated tobacco products were included in WHO's definition of tobacco products, but there was not enough data to be able to analyze them separately, Alison Commar, a technical officer at the WHO's tobacco control unit and one of the report's lead authors, said on the call with reporters.

The WHO's report is based on nationally representative population-based surveys dating from 1990 to 2018. Results were produced for 149 countries.