America is a great continent with very different social, political and economic realities. The term Latin America is used in the denomination of Spanish or Portuguese speaking American countries as opposed to countries of Anglo-Saxon origin and culture. The countries that integrate it, share some cultural similarities: having been colonial territories of Spain, Portugal and France. Among them, linguistic, ethnic, social, political, economic and climatic variations are observed, so it is difficult to speak of a uniform bloc. This reality extends, no doubt, to the issue of smoking, where there are also great asymmetries.1
Smoking is a serious public health problem in Latin America. It's still more common among men, but the gender gap is narrowing significantly. Young people are a high-risk group, with high consumption rates among adolescents.
According to the World Health Organization (WHO), it costs the region about 1% of GDP annually in direct and indirect costs, including health care expenses and lost labor productivity.2
In recent years, in Latin America, as throughout the world, significant efforts have been made to reduce the impact of the tobacco epidemic, achieving significant progress, but there is still a long way to go.
The first achievement of the Region of the Americas was the decrease in the prevalence of tobacco use, which went from 28% in 2000 to 16.3% in 2020, this represents the second lowest prevalence of current use in the world. Together with the European Region according to the WHO, the Region of the Americas shows the smallest difference in the prevalence of current tobacco use between adult women and men, which reaffirms the need to strengthen the gender aspect of policies and tobacco control strategies.3
Compared with other regions, the trend in Europe is that women reduce tobacco use the slowest in the world: in all other WHO regions, women are on track to reduce their rates by at least 30% of tobacco use by 2025. The Western Pacific Region is expected to have the highest rate of tobacco use among men and that this rate will remain above 45% in 2025.4
In 2020, the highest prevalence of current tobacco use in adults continued to be registered, as in previous reports, in Chile (29.2%) and the lowest, in Panama (5.0%).
Regarding the population between 13 and 15 years of age, of the 35 Member States of the Pan American Health Organization (PAHO), Brazil reported the lowest prevalence (6.9%), while the Dominican Republic reported the highest (25.3%). According to the fourth edition of the 2021 global report on trends in the prevalence of tobacco use 2000–2025, the average proportion of the population that uses tobacco in the Region of the Americas is slightly higher than the world average (11.3%, vs. 10.3%).4
The Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018–2022 prepared by PAHO establishes four strategic lines of action:
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Application of measures for completely smoke-free environments and on the packaging and labeling of tobacco products.
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Enforcement of the ban on advertising, promotion and sponsorship of tobacco products and adoption of measures to reduce their availability.
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Ratification of the Framework Convention on Tobacco Control (FCTC) and the Protocol to Eliminate Illicit Trade in Tobacco Products.
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Strengthening public health policy capacity to counter interference attempts to by the tobacco industry and those working to advance its interests.
To date, during the implementation of the mandates of the strategy, considerable progress has been made in many areas of tobacco control; however, the objectives established through these strategic lines of action were not fully achieved by the end of 2022.5
Despite the many challenges that have arisen during the reporting period, South America became in 2020 the first subregion of the Region of the Americas to be 100% smoke-free. There are 24 countries applying the smoke-free environment measure at the highest level of implementation and 22 countries applying the smoke-free measures to warn about the dangers of tobacco 65% of the regional population is covered by tobacco consumption monitoring policies.3
Most countries have implemented health warnings on their labeling.
In 2019, Uruguay and Canada enacted policies that now require plain packaging for tobacco products and in Costa Rica, in September 2022, Bill 22497 was approved, which proposes plain packaging and a standard color for tobacco products and their derivatives.
The Uruguayan government in 2022 decided to relax the current regulations on the sale of cigarettes regarding the packaging and labeling of tobacco products, because it marked “limitations” in marketing among between the “formal market against the competition of contraband cigarettes”. This could be seen as a step backwards in this country's emblematic fight for tobacco control.
Antigua and Barbuda, Venezuela (2019), and Mexico (2021) now have complete bans on the advertising, promotion, and sponsorship of tobacco products. This brings to nine the total number of countries in the Region of the Americas that implement measures related to the advertising, promotion, and sponsorship of tobacco products.
Three countries are implementing measures to ensure that total indirect taxes represent 75% or more of the retail price of tobacco products.
In Argentina, in recent years the data collected on smoking show that consumption has decreased, both in the young and adult population. The World School Health Survey (EMSE) in its three editions 2007, 2012 and 2018 shows a constant decrease in the consumption of any tobacco product in adolescents between 13 and 15 years of age: 22%, 20.5% and 16% respectively. In the same way, the editions of the National Survey of Risk Factors show a decrease in the prevalence in people over 18 years of age from 29.7% in 2005 to 22.2% in 2018.
In Chile, the highest-smoking country in the Region of the Americas, the prevalence of tobacco use has decreased from 42.2% (ENS 2009–2010) to 32.5% (ENS 2016–1017). Currently the government is working together with civil society to increase the tobacco tax again and add regulations on tobacco consumption such as plain packaging and a 100% ban on advertising.
Six States (Brazil, Canada, El Salvador, Jamaica, Mexico and the United States of America) have made national toll-free quit lines, accessible nicotine substitution treatment and tobacco cessation support services available to the population, enabling them to implement measures related to offering tobacco cessation assistance
Therefore, it is likely that the Region of the Americas is on track to achieve a 30% relative reduction in the prevalence of tobacco use among persons aged 15 years and older by the year 2025, in accordance with target 5 of the WHO global action plan for the prevention and control of noncommunicable diseases 2013–2020.
Despite these efforts, there is still much work to be done to reduce the prevalence of smoking in Latin America. One of the main barriers is the strong influence of the tobacco industries (TI) in the region, which have resisted public policy measures and promoted tobacco consumption through advertising campaigns and sponsorships. There are also challenges in implementing and enforcing laws against smoking in public places and in promoting healthy living alternatives.
The new productsThe increasing development and accessibility of new and emerging tobacco and nicotine product categories add to the challenge of accelerating tobacco control both globally and regionally.
Novel and emerging nicotine and tobacco products such as e-cigarettes and heated tobacco products (PTCs) are becoming more widely available and accessible, posing a threat to tobacco control.
The IT and related industries use various strategies to market these products, claiming to be harm reduction and effective smoking cessation aids. We have learned that they are strategies to maintain your market.6
The United States of America has the highest prevalence of current consumption of this type of cigarette at the regional level in the young population (19.6%); and Brazil, the lowest (0.2%). In all countries with available data, e-cigarette use is more frequent in adolescent boys, with the exception of Venezuela and Colombia, where the prevalence of e-cigarette use is almost equal in both young women and men.
Seven countries in the Region of the Americas have banned the sale of electronic cigarettes. The prohibition of the sale does not eliminate the possibility that these products enter the market illegally, for this reason five of these countries have also chosen to regulate their use, consistent with the legislation on smoke-free environments or the prohibition of their advertising, promotion and sponsorship. Eighteen countries have regulated the sale, consumption, and advertising of e-cigarettes: 11 regulate them as tobacco or tobacco-related products; 6, as consumer products, and 3, as therapeutic products.
These devices have had a remarkable growth in the region, generating a new generation of users, the vast majority of these new users being children, adolescents, and young people who previously did not smoke and are now regular users of these products. It is already clear enough that these products pose health risks and the safest approach is not to consume them.
SlopesThe Region of the Americas is on track to achieve target 5 of the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020, which calls for a 30% relative reduction in the prevalence of tobacco use among persons aged 15 years and older. The Region is expected to record a prevalence of 14.9% in current tobacco use and, based on current trend estimates, a regional prevalence of 14.3% is likely to be achieved before 2025.3–7
Significant advances have been made in Tobacco Control within the Region, but there are always new challenges, which require the development of new strategies that must be rapid and appropriate to face the changes generated especially by TI.
It is necessary that the countries of Latin America renew their commitments to protect their population from the dangers of tobacco and give priority to public health, generating effective and updated measures. Some have not yet ratified the FCTC, which should be resolved as soon as possible.
Without underestimating what has been achieved, it is essential not to delay what is pending.
Conflict of interestsThe authors state that they have no conflict of interests.
