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The association between current smoking and coronavirus disease 2019 (COVID-19) progression remains uncertain. We aim to provide up-to-date evidence of the role of cigarette smoking in COVID-19 hospitalisation, severity and mortality. On 23 February 2022 we conducted an umbrella review and a traditional systematic reviewviaPubMed/Medline and Web of Science. We used random-effects meta-analyses to derive pooled odds ratios of COVID-19 outcomes for smokers in cohorts of severe acute respiratory syndrome coronavirus 2 infected individuals or COVID-19 patients. We followed the Meta-analysis of Observational Studies in Epidemiology reporting guidelines. PROSPERO: CRD42020207003. 320 publications were included. The pooled odds ratio for currentversusnever or nonsmokers was 1.08 (95% CI 0.98–1.19; 37 studies) for hospitalisation, 1.34 (95% CI 1.22–1.48; 124 studies) for severity and 1.32 (95% CI 1.20–1.45; 119 studies) for mortality. Estimates for formerversusnever-smokers were 1.16 (95% CI 1.03–1.31; 22 studies), 1.41 (95% CI: 1.25–1.59; 44 studies) and 1.46 (95% CI 1.31–1.62; 44 studies), respectively. Estimates for ever-versusnever-smokers were 1.16 (95% CI 1.05–1.27; 33 studies), 1.44 (95% CI 1.31–1.58; 110 studies) and 1.39 (95% CI 1.29–1.50; 109 studies), respectively. We found a 30–50% excess risk of COVID-19 progression for current and former smokers compared with never-smokers. Preventing serious COVID-19 outcomes, including death, seems the newest compelling argument against smoking.

Summary: Background: There are concerns that the use of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) in children and adolescents could potentially be harmful to health. Understanding the extent of use of these devices is crucial to informing public health policy. We aimed to synthesise the prevalence of ENDS or ENNDS use in children and adolescents younger than 20 years. Methods: In this systematic review and meta-analysis, we undertook an electronic search in five databases (MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, and Wiley Cochrane Library) from Jan 1, 2016, to Aug 31, 2020, and a grey literature search. Included studies reported on the prevalence of ENDS or ENNDS use in nationally representative samples in populations younger than 20 years and collected data between the years 2016 and 2020. Studies were excluded if they were done in those aged 20 years or older, used data from specialist panels that did not apply appropriate weighting, or did not use methods that ensured recruitment of a nationally representative sample. We included the most recent data for each country. We combined multiple national estimates for a country if they were done in the same year. We undertook risk of bias assessment for all surveys included in the review using the Joanna Briggs Institute Critical Appraisal Checklist (by two reviewers in the author list). A random effects meta-analysis was used to pool overall prevalence estimates for ever, current, occasional, and daily use. This study was prospectively registered with PROSPERO, CRD42020199485. Findings: The most recent prevalence data from 26 national surveys representing 69 countries and territories, with a median sample size of 3925 (IQR 1=2266, IQR 3=10 593) children and adolescents was included. In children and adolescents aged between 8 years and younger than 20 years, the pooled prevalence for ever (defined as any lifetime use) ENDS or ENNDS use was 17·2% (95% CI 15–20, I2=99·9%), whereas for current use (defined as use in past 30 days) the pooled prevalence estimate was 7·8% (6–9, I2=99·8%). The pooled estimate for occasional use was 0·8% (0·5–1·2, I2=99·4%) for daily use and 7·5% (6·1–9·1, I2=99·4%) for occasional use. Prevalence of ENDS or ENNDS use was highest in high-income geographical regions. In terms of study quality, all surveys scored had a low risk of bias for the sampling frame used, due to the nationally representative nature of the studies. The most poorly conducted methodological feature of the included studies was subjects and setting described in detail. Few surveys reported on the use of flavours or types of ENDS or ENNDS. Interpretation: There is significant variability in the prevalence of ENDS and ENNDS use in children and adolescents globally by country income status. These findings are possibly due to differences in regulatory context, market availability, and differences in surveillance systems. Funding: World Health Organization and the Bill & Melinda Gates Foundation.

Background: This systematic review described the association between electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) use among non-smoking children and adolescents aged

Background This systematic review described the association between electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) use among non-smoking children and adolescents aged Methods We searched five electronic databases and the grey literature up to end of September 2020. Prospective longitudinal studies that described the association between ENDS/ENNDS use, and subsequent tobacco use in those aged < 20 years who were non-smokers at baseline were included. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Data were extracted by two reviewers and pooled using a random-effects meta-analysis. We generated unadjusted and adjusted risk ratios (ARRs) describing associations between ENDS/ENNDS and tobacco use. Findings A total of 36 publications met the eligibility criteria, of which 25 were included in the systematic review (23 in the meta-analysis) after exclusion of overlapping studies. Sixteen studies had high to moderate risk of bias. Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82; p2: 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07; p2: 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57; p2: 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30; p = 0·47, I2: 0%)) at follow up. For other tobacco use, ARR ranged between 1·55 (95% CI 1·07, 2·23) and 8·32 (95% CI: 1·20, 57·04) for waterpipe and pipes, respectively. Additionally, two studies examined the use of ENNDS (non-nicotine devices) and found a pooled adjusted RR of 2·56 (95% CI: 0·47, 13·94, p = 0.035). Conclusion There is an urgent need for policies that regulate the availability, accessibility, and marketing of ENDS/ENNDS to children and adolescents. Governments should also consider adopting policies to prevent ENDS/ENNDS uptake and use in children and adolescents, up to and including a ban for this group.

Each year, tobacco use causes approximately 7 million deaths worldwide, including approximately 6 million among tobacco users and an estimated 890,000 among nonsmokers exposed to secondhand smoke (1). Tobacco use is a leading preventable cause of disease globally and has been determined to cause adverse health outcomes such as coronary heart disease, stroke, and multiple types of cancer, including lung cancer (2-4). Approximately 80% of the world's 1.1 billion tobacco smokers reside in low- and middle-income countries (4). Some persons do not fully understand the health risks associated with tobacco smoking (5-9), and studies have indicated that increasing knowledge about the adverse health effects of smoking can contribute to decreases in smoking, increases in cessation attempts, and increases in successful cessation (3,7,10). CDC analyzed 2008-2016 Global Adult Tobacco Survey (GATS) data from 28 countries to assess tobacco smoking prevalence, quit attempts, and knowledge about tobacco smoking risks among persons aged ≥15 years. Across countries, the median prevalence of tobacco smoking was 22.5%, and a median of 42.5% of tobacco smokers had made a quit attempt in the preceding 12 months. The median prevalences of knowing that tobacco smoking causes stroke, heart attack, and lung cancer were 73.6%, 83.6%, and 95.2%, respectively. Implementation of proven tobacco control interventions, including strategies that increase knowledge about the health risks posed by tobacco use, might help to reduce tobacco use and tobacco-related disease, including heart disease, stroke, and lung cancer (3-5).

Summary Background The WHO Framework Convention on Tobacco Control (WHO FCTC) has mobilised efforts among 180 parties to combat the global tobacco epidemic. This study examined the association between highest-level implementation of key tobacco control demand-reduction measures of the WHO FCTC and smoking prevalence over the treaty's first decade. Methods We used WHO data from 126 countries to examine the association between the number of highest-level implementations of key demand-reduction measures (WHO FCTC articles 6, 8, 11, 13, and 14) between 2007 and 2014 and smoking prevalence estimates between 2005 and 2015. McNemar tests were done to test differences in the proportion of countries that had implemented each of the measures at the highest level between 2007 and 2014. Four linear regression models were computed to examine the association between the predictor variable (the change between 2007 and 2014 in the number of key measures implemented at the highest level), and the outcome variable (the percentage point change in tobacco smoking prevalence between 2005 and 2015). Findings Between 2007 and 2014, there was a significant global increase in highest-level implementation of all key demand-reduction measures. The mean smoking prevalence for all 126 countries was 24·73% (SD 10·32) in 2005 and 22·18% (SD 8·87) in 2015, an average decrease in prevalence of 2·55 percentage points (SD 5·08; relative reduction 10·31%). Unadjusted linear regression showed that increases in highest-level implementations of key measures between 2007 and 2014 were significantly associated with a decrease in smoking prevalence between 2005 and 2015). Each additional measure implemented at the highest level was associated with an average decrease in smoking prevalence of 1·57 percentage points (95% CI −2·51 to −0·63, p=0·001) and an average relative decrease of 7·09% (−12·55 to −1·63, p=0·011). Controlling for geographical subregion, income level, and WHO FCTC party status, the per-measure decrease in prevalence was 0·94 percentage points (−1·76 to −0·13, p=0·023) and an average relative decrease of 3·18% (−6·75 to 0·38, p=0·079). This association was consistent across all three control variables. Interpretation Implementation of key WHO FCTC demand-reduction measures is significantly associated with lower smoking prevalence, with anticipated future reductions in tobacco-related morbidity and mortality. These findings validate the call for strong implementation of the WHO FCTC in the WHO's Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013–2020, and in advancing the UN's Sustainable Development Goal 3, setting a global target of reducing tobacco use and premature mortality from non-communicable diseases by a third by 2030. Funding Health Canada, Canadian Institutes of Health Research, Ontario Institute for Cancer Research and Canadian Cancer Society Research Institute.

Three global reports issued by the World Health Organization (WHO) track and report on trends in the prevalence of tobacco smoking from 2000 to 2025 based on data from national surveys.This review aimed to compare regional and country-level projections for current tobacco smoking as presented in the WHO trend reports. These changes were considered in the context of improved monitoring and tobacco control policies.Regional and country-level results in the WHO trend reports were considered in terms of the projected percentage point increase of current tobacco smoking between 2000 and 2025. Data on national surveys and policy implementation came from the relevant WHO reports.In the 2019 trend report, the prevalence of current tobacco smoking among males is projected to decrease by less than 2 percentage points by 2025. Eight countries featured in both the 2015 and 2019 WHO trend reports. Seven of these countries indicated a more encouraging projection (a decline in their projected increase between 2000 and 2025) for current male tobacco smoking in the 2019 report than in the 2015 report. For five out of these seven countries, their monitoring and tobacco control policy implementation improved over the same period.Countries in the Region should implement additional national surveys to improve the accuracy of prevalence estimates, allow further projections to be performed and motivate policy-makers to make positive policy changes. Solutions to under-reporting biases during surveys should be considered. Governments should use trend projections to guide effective tobacco control policies to reduce tobacco use in the Region.معدل انتشار التدخين في إقليم شرق المتوسط.هبة فؤاد، أليسون كومار، رندة حمادة، فاطمة العوا، زي شن، تشارلز فريزر.ثلاثة تقارير عالمية صادرة عن منظمة الصحة العالمية ترصد اتجاهات معدل انتشار تدخين التبغ وتتتبَّعها من عام 2000 إلى عام 2025 بناءً على بيانات من دراسات استقصائية وطنية.كان هذا الاستعراض يهدف إلى عقد مقارنة بين التوقعات الإقليمية والقُطرية للمعدل الحالي لتدخين التبغ التي وردت في تقارير المنظمة عن الاتجاهات، ودراسة هذه التغييرات في سياق تحسُّن الرصد وسياسات مكافحة التبغ.تُدرَس النتائج الإقليمية والقُطرية الواردة في تقارير المنظمة عن الاتجاهات من حيث الزيادة المئوية المتوقعة في المعدل الحالي لتدخين التبغ بين عامي 2000 و2025. وتُستقى البيانات الخاصة بالدراسات الاستقصائية الوطنية وتنفيذ السياسات من التقارير ذات الصلة الصادرة عن المنظمة.من المتوقع في تقرير الاتجاهات لعام 2019 أن ينخفض المعدل الحالي لتدخين التبغ بين الذكور بنسبة تقل عن 2٪ بحلول عام 2025. وتناول كلا تقريري المنظمة بشأن الاتجاهات لعامي 2015 و2019 ثمانيةَ بلدان. وفي سبعة من هذه البلدان كانت توقعات المعدل الحالي لتدخين التبغ بين الذكور في تقرير 2019 تبعث على الأمل بدرجة أكبر مقارنةً بتقرير 2015 (إذ حدث انخفاض في الزيادة المتوقعة بين عامي 2000 و2025). وقد شهدت خمسة من هذه البلدان السبعة تحسناً في كلٍّ من الرصد وتنفيذ سياسة مكافحة التبغ.ينبغي لبلدان الإقليم تنفيذ دراسات استقصائية وطنية إضافية لتحسين دقة التقديرات الخاصة بمعدل الانتشار، والسماح بإجراء مزيد من التوقعات، وتحفيز واضعي السياسات على إجراء تغييرات إيجابية في السياسات. وينبغي النظر في إيجاد حلول للتحيزات التي يوجد تقصير في الإبلاغ عنها خلال الدراسات الاستقصائية. وينبغي للحكومات أن تسترشد بالتوقعات الخاصة بالاتجاهات في وضع سياسات فعالة لمكافحة التبغ من أجل الحد من تعاطي التبغ في الإقليم.Prévalence du tabagisme dans la Région de la Méditerranée orientale.Trois rapports mondiaux publiés par l’Organisation mondiale de la Santé (OMS) rendent compte des tendances en matière de prévalence du tabagisme entre 2000 et 2025 sur la base de données issues d’enquêtes nationales.La présente analyse visait à comparer les projections au niveau des régions et des pays concernant le tabagisme durant la période d’étude, comme présenté dans les rapports de l’OMS sur les tendances en la matière. Ces modifications sont examinées dans un contexte d’amélioration des politiques de surveillance et de lutte antitabac.Les résultats au niveau des régions et des pays fournis par les rapports de l’OMS sur les tendances ont été pris en compte en termes d’augmentation prévue d’un point de pourcentage du tabagisme entre 2000 et 2025. Les données sur les enquêtes nationales et l’application des politiques provenaient de rapports pertinents publiés par l’OMS.Selon les projections du rapport 2009 sur les tendances, la prévalence du tabagisme chez les hommes au moment de l’analyse devrait baisser de moins de deux points de pourcentage d’ici 2025. Huit pays de la Région étaient représentés dans les deux rapports sur les tendances de 2015 et 2019. Sept ces huit pays indiquaient une projection plus encourageante (à savoir une diminution de la projection relative à l’augmentation entre 2000 et 2025) pour le tabagisme chez les hommes en 2019, par rapport à 2015. Cinq de ces sept pays ont connu une amélioration de l’application de leurs politiques de surveillance et de lutte antitabac.Les pays de la Région devraient réaliser des enquêtes nationales supplémentaires pour améliorer la précision des estimations de la prévalence, permettre la réalisation de nouvelles projections et inciter les responsables de l’élaboration des politiques à les faire évoluer positivement. Des solutions devraient être envisagées quant au biais de sous-notification lors des enquêtes. Les gouvernements devraient utiliser les projections de tendances pour orienter l’élaboration de politiques de lutte antitabac efficaces et réduire le tabagisme dans la Région.

Three global reports published by the World Health Organization (WHO) report trends in the prevalence of tobacco smoking from 2000 to 2025 based on data from national surveys.The is study aimed to: (i) compare current and projected prevalence rates of tobacco smoking presented in these reports for males ≥ 15 years in countries of the Eastern Mediterranean Region; and (ii) assess changes in the prevalence rates in the context of changes in tobacco monitoring and control policies in these countries.Regional and country-level data on tobacco smoking were extracted from the trend reports. Percentage point differences between the estimated prevalence of tobacco smoking in 2010 and the projected prevalence in 2025 were calculated for countries with available data. Data on implementation of national surveys and policies on tobacco use were obtained from relevant WHO reports.In the latest trend report (2019), the prevalence of male current tobacco smoking is projected to decrease by less than 2 percentage points in the Region (from 33.1% in 2010 to 31.2% in 2025). The projections for male tobacco smoking for 2025 in the 2019 report are more encouraging than in the 2015 report in seven of the eight countries of the Region. For five of these seven countries, implementation of tobacco monitoring and tobacco control policies improved over the same period.Countries of the Region need to conduct additional national tobacco-use surveys to improve the accuracy of prevalence estimates and projections. Such data can help guide policy-makers to implement policies to control tobacco smoking.معدل الانتشار التقديري والمتوقع لتدخين التبغ في صفوف الذكور، إقليم شرق المتوسط، من 2000 إلى 2025.هبة فؤاد، أليسون كومار، رندة حمادة، فاطمة العوا، زي شن، تشارلز فريزر.رصدت ثلاثة تقارير عالمية نشرتها منظمة الصحة العالمية اتجاهات معدل انتشار تدخين التبغ من عام 2000 إلى عام 2025 استناداً إلى البيانات المستمدة من المسوحات الوطنية.هدفت هذه الدراسة إلى: (1) مقارنة معدلات الانتشار الحالية والمتوقعة لتدخين التبغ والواردة في تلك التقارير للذكور الذين تتراوح أعمارهم بين 15 أو أكثر في بلدان إقليم شرق المتوسط؛ (2) تقييم التغيرات في معدلات الانتشار في سياق التغيرات التي تطرأ على سياسات رصد التبغ ومكافحته في تلك البلدان.استُخرجت بيانات إقليمية وقُطرية بشأن تدخين التبغ من تقارير الاتجاهات. وتم احتساب فروق النقاط المئوية بين معدل الانتشار التقديري لتدخين التبغ في عام 2000 ومعدل الانتشار المتوقع في عام 2025 بالنسبة للبلدان التي تتوافر بشأنها البيانات. واُخِذَت البيانات حول تنفيذ المسوحات والسياسات الوطنية بشأن تعاطي التبغ من التقارير ذات الصلة الصادرة عن منظمة الصحة العالمية.يتوقع أحدث تقرير اتجاهات (2019) أن ينخفض المعدل الحالي لتدخين التبغ بين الذكور بنسبة تقل عن نقطتيْ مئويتيْ في إقليم شرق المتوسط (من 33.1 ٪ في 2010 إلى 31.2 ٪ في 2025). وجاءت التوقعات الخاصة بتدخين التبغ بين الذكور لعام 2025 في تقرير عام 2019 مُشجِّعة أكثر من تقرير عام 2015 في سبعة من بين ثمانية بلدان وردت معلومات عنها في كلا التقريريْن. وخلال نفس الفترة الزمنية، تحسَّن تنفيذ سياسات رصد التبغ ومكافحته على حد سواء في خمسة بلدان من تلك البلدان السبعة.ينبغي أن تُري بلدان الإقليم مسوحات وطنية إضافية لتحسين دقة تقديرات معدل الانتشا ر وتوقعاته. ويمكن أن تساعد تلك البيانات في توجيه راسمي السياسات لتنفيذ سياسات إيجابية لمكافحة تدخين التبغ.Estimations et projections de la prévalence du tabagisme chez les hommes dans la Région de la Méditerranée orientale pour la période 2000-2025.Trois rapports mondiaux publiés par l'Organisation mondiale de la Santé (OMS) rendent compte des tendances en matière de prévalence du tabagisme entre 2000 et 2025 sur la base de données issues d'enquêtes nationales.L’étude a pour objectifs : i) de comparer les taux de prévalence actuels et prévus du tabagisme présentés dans ces rapports pour les hommes âgés de 15 ans et plus dans les pays de la Région de la Méditerranée orientale ; et ii) d’évaluer les évolutions des taux de prévalence dans le contexte des changements apportés aux politiques de surveillance et de lutte antitabac dans ces pays.Les données régionales et nationales sur le tabagisme ont été extraites des rapports concernant les tendances. Les différences de points de pourcentage entre la prévalence estimée du tabagisme en 2010 et la prévalence prévue pour 2025 ont été calculées pour les pays pour lesquels des données étaient disponibles. Les données relatives à la mise en œuvre des enquêtes nationales et des politiques de lutte antitabac ont été tirées des rapports pertinents de l’OMS.Dans le dernier rapport sur les tendances (2019), il est prévu que la prévalence du tabagisme chez les hommes devrait baisser de moins de deux points de pourcentage dans la Région de la Méditerranée orientale (de 33,1 % en 2010 à 31,2 % en 2025). Les projections dans le rapport de 2019 concernant le tabagisme chez les hommes pour l’année 2025 sont plus encourageantes que celles du rapport de 2015 dans sept des huit pays de la Région qui sont inclus dans les deux rapports. La mise en œuvre de politiques de surveillance et de lutte antitabac s’est améliorée dans cinq de ces sept pays au cours de la même période.Les pays de la Région doivent mener des enquêtes nationales supplémentaires pour améliorer l’exactitude des estimations et des projections de la prévalence. De telles données peuvent aider à guider les responsables de l'élaboration des politiques dans la mise en œuvre de politiques positives pour lutter contre le tabagisme.

The last decade has seen unprecedented achievements in global tobacco control. These include the entry into force of the WHO Framework Convention on Tobacco Control (WHO FCTC) and 179 states, as well as the European Union, becoming Parties to the Treaty,leading to an increased global cognizance of the negative health and economic impact of tobacco use. Governments around the world continue to adopt and implement effective tobacco control strategies and financial contributions from major philanthropies have increased the levels of financial support for tobacco control efforts in low- and middle-income countries. The UN high-level summit on Noncommunicable Diseases (NCDs) in 2011 and the 2015 adoption of the Sustainable Development Goals (SDGs), in which NCDs and acceleration of implementation of WHO FCTC are included as specific targets, represent an increased global recognition of theneed to address tobacco use prevalence as a key element of NCD interventions...

Summary Background Countries have agreed on reduction targets for tobacco smoking stipulated in the WHO global monitoring framework, for achievement by 2025. In an analysis of data for tobacco smoking prevalence from nationally representative survey data, we aimed to provide comprehensive estimates of recent trends in tobacco smoking, projections for future tobacco smoking, and country-level estimates of probabilities of achieving tobacco smoking targets. Methods We used a Bayesian hierarchical meta-regression modelling approach using data from the WHO Comprehensive Information Systems for Tobacco Control to assess trends from 1990 to 2010 and made projections up to 2025 for current tobacco smoking, daily tobacco smoking, current cigarette smoking, and daily cigarette smoking for 173 countries for men and 178 countries for women. Modelling was implemented in Python with DisMod-MR and PyMC. We estimated trends in country-specific prevalence of tobacco use, projections for future tobacco use, and probabilities for decreased tobacco use, increased tobacco use, and achievement of targets for tobacco control from posterior distributions. Findings During the most recent decade (2000–10), the prevalence of tobacco smoking in men fell in 125 (72%) countries, and in women fell in 155 (87%) countries. If these trends continue, only 37 (21%) countries are on track to achieve their targets for men and 88 (49%) are on track for women, and there would be an estimated 1·1 billion current tobacco smokers (95% credible interval 700 million to 1·6 billion) in 2025. Rapid increases are predicted in Africa for men and in the eastern Mediterranean for both men and women, suggesting the need for enhanced measures for tobacco control in these regions. Interpretation Our findings show that striking between-country disparities in tobacco use would persist in 2025, with many countries not on track to achieve tobacco control targets and several low-income and middle-income countries at risk of worsening tobacco epidemics if these trends remain unchanged. Immediate, effective, and sustained action is necessary to attain and maintain desirable trajectories for tobacco control and achieve global convergence towards elimination of tobacco use. Funding Ministry of Health, Labour and Welfare, Japan; Ministry of Education, Culture, Sports and Technology, Japan; Department of Health, Australia; Bloomberg Philanthropies.