The DOI matches its Crossref record; 28 of the 29 references it cites were found in a registry or an index; 7 of the 14 sources its claims cite were checked for support.
Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action
Open accessAbstract
Background: Despite compelling evidence on the health hazards of tobacco products accumulated over the past 70 years, smoking remains a leading cause of death worldwide. Policy action to control smoking requires timely, comprehensive, and comparable evidence on smoking levels within and across countries. This study provides a recent assessment of that evidence based on the methods used in the Global Burden of Disease (GBD) Study. Methods: We estimated annual prevalence of, and mortality attributable to smoking any form of tobacco from 1970 to 2020 and 1990–2020, respectively, using the methods and data sources (including 3431 surveys and studies) from the GBD collaboration. We modelled annual prevalence of current and former smoking, distributions of cigarette-equivalents per smoker per day, pack-years for current smoking, years since cessation for former smokers and estimated population-attributable fractions due to smoking. Results: Globally, adult smoking prevalence in 2020 was 32.6% (32.2% to 33.1%) and 6.5% (6.3% to 6.7%) among men and women, respectively. 1.18 (0.94 to 1.47) billion people regularly smoke tobacco, causing 7.0 (2.0 to 11.2) million deaths in 2020. Smoking prevalence has declined by 27.2% (26.0% to 28.3%) for men since 1990, and by 37.9% (35.3% to 40.1%) for women. Declines have been largest in the higher sociodemographic countries, falling by more than 40% in some high-income countries, and also in several Latin American countries, notably Brazil, where prevalence has fallen by 70% since 1990. Smoking prevalence for women has declined substantially in some countries, including Nepal, the Netherlands and Denmark, and remains low throughout Asia and Africa. Conversely, there has been little decline in smoking in most low- and middle-income countries (LMICs) with over half of all men continuing to smoke in large populations in Asia (China, Indonesia), as well as the Pacific Islands. Implications: While global smoking prevalence has fallen, smoking is still common and causes a significant health burden worldwide. The unequal pace of declines across the globe is shifting the epidemic progressively to LMICs. Smoking is likely to remain a leading cause of preventable death throughout this century unless smoking cessation efforts can significantly and rapidly reduce the number of smokers, particularly in Asia. Funding: XD and EG received funding through grant projects from Bloomberg Philanthropies (funding no. 66-9468) and the Bill & Melinda Gates Foundation (funding no. 63-3452).
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TL;DR
This Global Burden of Disease analysis estimates that global adult smoking prevalence in 2020 was 32.6% among men and 6.5% among women, with 1.18 billion smokers and 7.0 million smoking-attributable deaths. Although prevalence has declined since 1990, the epidemic is shifting toward low- and middle-income countries, especially in Asia.
Key findings
- In 2020, adult smoking prevalence was 32.6% (32.2% to 33.1%) among men and 6.5% (6.3% to 6.7%) among women; 1.18 (0.94 to 1.47) billion people regularly smoked tobacco, causing 7.0 (2.0 to 11.2) million deaths.
- Since 1990, smoking prevalence declined by 27.2% (26.0% to 28.3%) for men and 37.9% (35.3% to 40.1%) for women; declines were largest in higher sociodemographic countries, falling by more than 40% in some high-income countries, and Brazil’s prevalence fell by 70% since 1990.
- There has been little decline in most low- and middle-income countries, with more than half of adult men smoking in large Asian populations such as China (52%) and Indonesia, as well as Pacific Island countries; female prevalence remains low throughout Asia and Africa.
- By 2020, countries classified by epidemic phase were distributed for men as less than 10% incipient, 42% phase two, 25% phase three, and about one-quarter phase four; for women the respective distribution was 40/31/13/16.
Methods
- Using GBD 2020 methods, the study estimated annual prevalence of smoked tobacco use from 1970 to 2020 and attributable mortality/DALYs from 1990 to 2020 for 204 countries and territories by 5-year age group and sex; secondhand smoke, smokeless tobacco, electronic cigarettes, vaping products, and heated tobacco products were excluded.
- Data included 2808 nationally or subnationally representative surveys covering 200 of 204 countries, 623 studies for dose-response risk estimation, and consumption data from Euromonitor, the US Department of Agriculture, and the Food and Agriculture Organization; current and former smoking prevalence was modelled with spatiotemporal Gaussian process regression, and population-attributable fractions were calculated.
- Estimates were also provided by quintile of Sociodemographic Index, with countries grouped by their 2020 SDI; analyses were performed in R and Python.
Limitations
- The paper states that data quality and availability limitations, including data gaps and inconsistencies, lead to substantial uncertainty in trends and patterns of smoking prevalence and consumption in some countries, reducing the policy utility of the estimates.
- The paper notes that it used the direct method to estimate population-attributable fractions, whereas an indirect method has also been used; it reports that total burden due to smoking did not change significantly using different methods.
- Evident from the text: the analysis excludes secondhand smoke exposure, smokeless tobacco, electronic cigarettes, vaping products, and heated tobacco products, so the findings cover smoked tobacco use only; countries were grouped by 2020 SDI even though SDI can change over time.
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Claims the paper makes
48 Own result · 26 No basis given · 7 Own method · 7 Own interpretation · 4 Partly supported · 2 Not checked yet · 1 Supported · accuracy not yet measured
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In the paper
“We used a new meta-regression method 27 to re-estimate the dose-response risks of current smoking for 36 health outcomes caused by smoking, based on an updated systematic review of literature.3 4 We included 623 studies”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Dose-response risk curves
What the sources say
- Not checked — no full text of the sourcecites [27] Zheng, 2021, Trimmed constrained mixed effects models: formulations and algorithms, Journal of Computational and Graphical Statistics source
- Partly supportedcites [3] sourceExperimental — accuracy not yet measured
The Methods section (page unavailable) says GBD 2019 updated systematic reviews and meta-analysed relative risks as a function of exposure, supporting the cited background on updated literature. It does not report a smoking-specific re-estimation covering 36 outcomes or 623 studies; the Discussion > Limitations section says its dose–response reassessment was limited to dietary risks, kidney dysfunction, and air pollution. In the citing sentence, the new method and study count appear to describe the citing authors’ own work, rather than findings attributed to this source. (LLM, conf=0.86)
- Partly supportedcites [4] Reitsma, 2021, Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the global burden of disease study 2019, The Lancet sourceExperimental — accuracy not yet measured
The Methods section ('Dose-response risk curves') says the paper used meta-regression and a systematic review to estimate dose-response risks for 36 outcomes among current and former smokers. It reports data extracted from 902 eligible studies, not 623; the 623-study figure is not supported by this source. (LLM, conf=0.90)
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking prevalence has declined by 27.2% (26.0% to 28.3%) for men since 1990, and by 37.9% (35.3% to 40.1%) for women.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Abstract
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Globally, adult smoking prevalence in 2020 was 32.6% (32.2% to 33.1%) and 6.5% (6.3% to 6.7%) among men and women, respectively.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Abstract
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Globally, adult smoking prevalence in 2020 was 32.6% (32.2% to 33.1%) and 6.5% (6.3% to 6.7%) among men and women, respectively.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Abstract
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“1.18 (0.94 to 1.47) billion people regularly smoke tobacco, causing 7.0 (2.0 to 11.2) million deaths in 2020.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Abstract
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“1.18 (0.94 to 1.47) billion people regularly smoke tobacco, causing 7.0 (2.0 to 11.2) million deaths in 2020.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In most high SDI countries, as well as in Russia, Brazil and Mexico, youth smoking prevalence among men declined by more than 10 percentage points over the past 20 years.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
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In the paper
“For men, prevalence has declined by more than 10 percentage points in a number of countries since 2000 including Canada, Russia, the UK, Australia, Brazil and India”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Conversely, there has been little decline in smoking in most low-and middle-income countries (LMICs) with over half of all men continuing to smoke in large populations in Asia (China, Indonesia), as well as the Pacific Islands.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Abstract
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Overall, less than half of all countries (93) or territories were similarly classified based on male and female prevalence.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
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- Probably not a substantial claim. 10
- It may state two separate claims as one. 41
- The quote only partly states this claim. 1
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“smoking is the leading cause of disease burden in many countries.[3][4][5][6][7]”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > INTRODUCTION
What the sources say
- Partly supportedcites [3] sourceExperimental — accuracy not yet measured
The Results (Global attributable burden; page unavailable) say tobacco was the leading risk factor for attributable DALYs in seven of 21 regions. The National findings report substantial smoking-attributable burden in many countries, but do not establish that smoking ranked first in those countries; the claim shifts a regional ranking to a national one. (LLM, conf=0.82)
- Partly supportedcites [4] Reitsma, 2021, Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the global burden of disease study 2019, The Lancet sourceExperimental — accuracy not yet measured
The Discussion (page not available in our copy) says smoking was the leading risk factor for deaths and DALYs among males globally. The Results report substantial smoking-attributable burden across countries, but do not establish that smoking ranks first for disease burden in many countries across the whole population. (LLM, conf=0.83)
- Not checked — no full text of the sourcecites [5] source
- Not checked — no full text of the sourcecites [6] source
- Not checked — no full text of the sourcecites [7] Peto R , Lopez AD , Boreham J . Health Effects of Tobacco Use: Global Estimates and Projections. In: Slama K , ed. Tobacco and health. Boston, MA: Springer US, 1995: 109–20. source
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
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In the paper
“Most importantly, they strongly suggest that tobacco control measures, particularly when implemented comprehensively, work, collectively leading to a 27.2% (95% CI: 26.0% to 28.3%) global decline in smoking prevalence among men since 1990, and a much larger decline, 37.9% (95% CI: 35.3% to 40.1%) among women.31 32”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > DISCUSSION
What the sources say
- Partly supportedcites [31] sourceExperimental — accuracy not yet measured
The Main section says tobacco-control policies reduce smoking prevalence and estimates that stronger combined policies would have produced further reductions. But its reported global declines are 7.7% for men and 15.2% for women between 2009 and 2017; it does not substantiate the cited 27.2% and 37.9% declines since 1990 or attribute those figures to the policies. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [32] source
boosteddirect- Asserted: passes — The authors put it forward as true.
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- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“This study complies with the Guidelines for Accurate and Transparent Health Estimates Reporting recommendations.30”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Guidelines for Accurate and Transparent Health Estimates Reporting compliance
What the sources say
- Supportedcites [30] source
The Summary identifies this paper as the GATHER reporting guidelines and says they comprise an 18-item checklist. The citation identifies the recommendations the citing authors say they followed; it is not evidence independently verifying their study's compliance. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Globally, 1.18 (95% CI: 0.94 to 1.47) billion people in 2020 regularly smoked some form of tobacco, causing 7.0 (95% CI: 2.0 to 11.2) million deaths, or about one in seven of all deaths that occurred that year.4”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > DISCUSSION
What the sources say
- Partly supportedcites [4] Reitsma, 2021, Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the global burden of disease study 2019, The Lancet sourceExperimental — accuracy not yet measured
The Abstract Findings report 1.14 billion current smokers and 7.69 million smoking-attributable deaths in 2019, not the claimed 1.18 billion and 7.0 million in 2020. The Results report that smoking accounted for 13.6% of all deaths in 2019, supporting the approximate ‘one in seven’ share, but not its attribution to 2020. Page numbers were not supplied in our copy. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“By 2020, the fraction of deaths due to smoking had declined to 15%-19% in the USA, Canada, the UK and most of Western Europe, and even lower, to 10%-14%, in Sweden, Norway, Finland, Australia and New Zealand.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
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In the paper
“Parts of North Africa (Egypt, Libya, Iran) and East Asia have seen some increase in male prevalence since 2000, as has Botswana.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Eighty-five (42%) countries have moved to phase two, with broad representation across all regions, indicating how pervasive the epidemic is.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
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In the paper
“From smoking levels in excess of 40% among men around 1970 in many high SDI countries, prevalence has more than halved over the past 50 years and has declined substantially in Latin America.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > DISCUSSION
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In the paper
“Conversely, with few exceptions, there has been little decline in smoking in most low-and middle-SDI countries, with more than half the adult male population in large populations of Asia (China, Indonesia) and Pacific Island countries smoking regularly.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > DISCUSSION
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In the paper
“In 2020, more than half of all adult men in parts of the Indo-Pacific region (Micronesia, Kiribati, Timor-Leste, Indonesia, Papua New Guinea, Solomon Islands) were smokers, as was the case for Armenia, Mongolia, Jordan (54%-56%) and China (52%).”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
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“Only 33 countries (16% of total) have transitioned to phase four with comparatively low (<20%) prevalence, including the USA, the UK, Australia, Canada, New Zealand, Japan and all of Scandinavia, except Denmark.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
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In the paper
“By 2000, smoking rates in the USA and several other OECD countries fell below 30%, and fell below 20% by 2020, except for a handful of countries in Europe, including Spain, France, Switzerland, Poland and Hungary.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
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In the paper
“Female prevalence data suggest that 40% of countries, half of them in sub-Saharan Africa, are still in the incipient stage of the epidemic, with very low prevalence.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
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In the paper
“By far the largest declines in consumption have occurred in the high SDI group, falling by about 50%, compared with 25%-30% in other SDI groups.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
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In the paper
“Smoking also claimed 15%-20% of deaths among women at these ages in the USA, Canada and Ireland, and 10%-15% in Australia, where the impact of smoking control measures was already apparent.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
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In the paper
“female prevalence has not changed significantly since 2000 in most countries, or declined by less than 10 percentage points.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
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In the paper
“Smoking rates among women in the more high SDI countries never attained the levels of men, typically lagging male smoking by two to three decades.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > DISCUSSION
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In the paper
“Female prevalence was highest (34%-40%) in Pacific Island countries (Nauru, Micronesia, Kiribati), but less than 2%-3% for women in several countries in Africa, as well as Tajikistan and Sri Lanka”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
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In the paper
“All are low or low-middle SDI countries, including 10 in sub-Saharan Africa, and 6 Caribbean countries, including Haiti and the Dominican Republic.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“One-quarter of countries (50) have reduced male smoking prevalence to below 25% (phase four), primarily the Anglo-Saxon nations, all of Scandinavia, including Denmark, as well as Singapore, Belgium and the Netherlands, where smoking rates had been among the highest in the world.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“By 2000, male prevalence had already declined substantially in many countries, but remained high in Eastern Europe, Southeast Asia, China, Spain (among Western Europe) and parts of Latin America.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Typically, smoking currently causes 10%-14% of female deaths in the USA, Canada and Europe, but remains low as a cause of deathless than 5%-throughout Asia and Africa.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In 2020, consumption among men was highest in Southeast and East Asia, rising sharply between 1970 and 1990, followed by modest declines.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“had fallen to less than 1 in 10 deaths in Mexico and tropical Latin America, and remained low in sub-Saharan Africa.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Prevalence has also declined among other sociodemographic categories, less so in the high-middle sociodemographic group.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > DISCUSSION
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Prevalence has started to decline in 52 countries (25%) classified into phase three, including 10 from Southeast Asia (including China), and 5 in the Pacific, including Fiji and Tonga.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Onequarter of these are Pacific Island countries, another quarter include Russia, and Central and Eastern European countries, and 10 countries are in Latin America.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The most noticeable change was an increase in the fraction of former smokers, most of whom were former daily smokers.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among 27 phase three countries, 17 are high-income Western European nations, as well as Argentina, Chile and Uruguay, and 8 countries from Central/Eastern Europe.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Female consumption is highest in the high SDI group, being about twice the level in other SDI categories, although consumption levels have fallen by about 60% since 1970.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There has been little change over the past few decades in the number of cigarette-equivalents smoked per smoker per day, except for the high SDI category-although this decline appears to have stalled during the past 5 years-and the modest but steady increase in consumption in the high-middle SDI group”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among women, youth smoking prevalence also declined by more than 10 percentage points in the majority of high SDI countries, but by less than 10 percentage points in Japan and Eastern and Central European countries.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Prevalence fell further by 2020, particularly in Latin America and India, with levels below 30%.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among women, smoking prevalence in the high SDI group has fallen by about 50% since 1970, with little change evident for all other SDI categories.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interestingly, France and Portugal, alone among high-income countries, are at phase two, and six phase two countries are from sub-Saharan Africa.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thirteen Pacific Island countries or territories, 17 in sub-Saharan Africa, 15 from Central/Eastern Europe, 10 from Latin America and 16 from the Middle East/North African region have been classified phase two, as well as Indonesia and Timor-Leste, with the highest smoking rates in the world, and a handful of high-income countries, including Austria, Portugal, Cyprus and Chile.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Another 12 are from Central/Eastern Europe, including Russia, Hungary and Poland, and 2 (Mexico and Cuba) from Latin America.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“male consumption is highest in the high-middle SDI group, being about twice as high as for other SDI categories.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > RESULTS
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Another 31% (64 countries) have moved into phase two, with rising prevalence and little evidence of decline.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“cigarette smoking is estimated to have caused over 100 million deaths last century and will cause over 1 billion deaths this century unless more effective measures are taken to end the tobacco epidemic.19”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > INTRODUCTION
What the sources say
- Not checked yetcites [19] Peto R , Lopez AD . Future worldwide health effects of current smoking patterns. Jossey-Bass, 2001. Available: https://espace.library.uq.edu.au/view/UQ:114032 [Accessed 29 Sep 2021].
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- The authors state this as an assumption: The addiction will eventually kill half of all smokers.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“While global smoking prevalence has fallen, smoking is still common and causes a significant health burden worldwide.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“we mapped all non-reference case definitions to our reference case definitions.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Prevalence of smoked tobacco use
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our findings should be interpreted taking into consideration the study's limitations, primarily related to data quality and availability.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking is likely to remain a leading cause of preventable death throughout this century unless smoking cessation efforts can significantly and rapidly reduce the number of smokers, particularly in Asia.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Abstract
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This is much less evident among the next sociodemographic category (high-middle), although this may well reflect compositional issues since the experience of China would dominate this category, at least in more recent years.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We produced 1000 draws from the posterior distribution of ST-GPR and used the 25th and the 975th draws to construct uncertainty intervals around the final estimates.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Prevalence of smoked tobacco use
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Predictions of 1 billion deaths from smoking this century unless there is urgent and substantial progress with cessation strategies 19 highlight the enormous toll of avoidable mortality that smoking will cause, in the absence of effective national policy responses, especially in high prevalence countries.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > DISCUSSION
What the sources say
- Not checked yetcites [19] Peto R , Lopez AD . Future worldwide health effects of current smoking patterns. Jossey-Bass, 2001. Available: https://espace.library.uq.edu.au/view/UQ:114032 [Accessed 29 Sep 2021].
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“systematic data quality checks were performed to identify and exclude implausible or inconsistent data.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Prevalence of smoked tobacco use
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Smoking also claimed 15%-20% of deaths among women at these ages in the USA, Canada and Ireland, and 10%-15% in Australia, where the impact of smoking control measures was already apparent.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The authors state this as an assumption.
The addiction will eventually kill half of all smokers.
“assuming that the addiction will eventually kill half of all smokers”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Among 27 phase three countries, 17 are high-income Western European nations, as well as Argentina, Chile and Uruguay, and 8 countries from Central/Eastern Europe.”
§ Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action > Original research
Reported 27 · recomputed 28
Citations
Cites
Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30925-9 · Cited by 19,358
Self-citationCorrespondence - Tranexamic acid for traumatic brain injury
(2005) · London School of Economics and Political Science Theses Online (London School of Economics and Political Science) · doi:10.1016/s0140-6736 · Cited by 11,894
Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30752-2 · Cited by 9,854
Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study
Murray, C. J., & Lopez, A. D. (1997) · The Lancet · doi:10.1016/s0140-6736(96)07495-8 · Cited by 4,492
Mortality in relation to smoking: 50 years' observations on male British doctors
Doll, R., Peto, R., Boreham, J., & Sutherland, I. (2004) · BMJ · doi:10.1136/bmj.38142.554479.ae · Cited by 2,920
Reitsma, M. B., Fullman, N., Ng, M., Salama, J. S., Abajobir, A., Abate, K. H., Abbafati, C., Abera, S. F., Abraham, B., Abyu, G. Y., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30819-x · Cited by 2,028
Self-citationGuidelines for accurate and transparent health estimates reporting: the GATHER statement
Stevens, G. A., Alkema, L., Black, R. E., Boerma, J. T., Collins, G. S., Ezzati, M., Grove, J. T., Hogan, D. R., Hogan, M. C., Horton, R., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30388-9 · Cited by 1,798
21st-Century Hazards of Smoking and Benefits of Cessation in the United States
Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N., McAfee, T., & Peto, R. (2013) · New England Journal of Medicine · doi:10.1056/nejmsa1211128 · Cited by 1,767
Reitsma, M. B., Kendrick, P. J., Ababneh, E., Abbafati, C., Abbasi-Kangevari, M., Abdoli, A., Abedi, A., Abhilash, E. S., Abila, D. B., Aboyans, V., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01169-7 · Cited by 1,759
Self-citationSmoking prevalence and cigarette consumption in 187 countries, 1980-2012
Ng, M., Freeman, M. K., Fleming, T. D., Robinson, M., Dwyer-Lindgren, L., Thomson, B., Wollum, A., Sanman, E., Wulf, S., Lopez, A. D., et al. (2014) · JAMA · doi:10.1001/jama.2013.284692 · Cited by 1,576
Self-citation
Research works printed but not linked: 1
- United States Public Health Service Office of the Surgeon General, National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health . Smoking Cessation: A Report of the Surgeon General. Washington (DC) : US Department of Health and Human Services 2020. Available: http://www.ncbi.nlm.nih.gov/books/NBK555591/ [Accessed 13 Dec 2021].
Cited by
Sorted by citations
Feigin, V. L., Abate, M. D., Abate, Y. H., ElHafeez, S. A., Abd-Allah, F., Abdelalim, A., Abdelkader, A. F. I., Abdelmasseh, M., Abd-Elsalam, S. M., Abdi, P., et al. (2024) · The Lancet Neurology · doi:10.1016/s1474-4422(24)00369-7 · Cited by 2,060
Wanhainen, A., HERZEELE, I. V., Gonçalves, F. B., Bellmunt-Montoya, S., Bérard, X., Boyle, J. R., D’Oria, M., Prendes, C. F., Karkos, C. D., Kazimierczak, A., et al. (2024) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2023.11.002 · Cited by 1,317
Dyrskjøt, L., Hansel, D. E., Efstathiou, J. A., Knowles, M. A., Galsky, M. D., Teoh, J. Y., & Theodorescu, D. (2023) · Nature Reviews Disease Primers · doi:10.1038/s41572-023-00468-9 · Cited by 612
“More than 1 billion people are estimated to smoke tobacco globally but smoking prevalence has decreased since 1990 by ~27% in men and 38% in women 22,23 .”
Global Disparities of Cancer and Its Projected Burden in 2050
Bizuayehu, H. M., Ahmed, K. Y., Kibret, G. D., Dadi, A. F., Belachew, S. A., Bagade, T., Tegegne, T. K., Venchiarutti, R. L., Kibret, K. T., Habte, A., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.43198 · Cited by 456
van Hoogstraten, L. M. C., Vrieling, A., van der Heijden, A. G., Kogevinas, M., Richters, A., & Kiemeney, L. A. L. M. (2023) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-023-00744-3 · Cited by 404
Metadata
- Authors
- Dai, X., Gakidou, E., & Lopez, A. D.
- Affiliations
- University of Washington (US)
- Venue
- Tobacco Control
- Publisher
- BMJ
- Published
- 2022-03
- Volume
- 31
- Issue
- 2
- Pages
- 129-137
- ISSN
- 0964-4563 (ISSN-L)
- 1468-3318
- OpenAlex
- W4214882427
- Cited by
- 535
- References
- 28
- Citations by year
- 2026: 107 · 2025: 177 · 2024: 153 · 2023: 75 · 2022: 23
- FWCI
- 66.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Tobacco Control (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bloomberg Philanthropies
- Bill and Melinda Gates Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
- Keywords
- smoking prevalence, smoking-related mortality, population attributable fraction, pack-years, smoking cessation, sex differences in smoking, low- and middle-income countries, tobacco control, global burden of disease, Latin America
- MeSH terms
- Global Burden of Disease, Adult, Female, Humans, Male, Smoking, Global Health, Prevalence, Policy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-29, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-29 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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