Young low and middle-income country (LMIC) smokers— implications for global tobacco control

The trajectory of adolescent tobacco use is the best predictor for the global lung cancer community to anticipate future smoking-related disease. Tobacco use viewed as risky behaviour tells us about future implications for the local adolescent population as it enters adulthood. Adolescent tobacco use as an indicator of local tobacco control tells us about the effects of local control measures, the impact for example, of the Framework Convention on Tobacco Control (FCTC) (1) and about potential vulnerabilities (such as to tobacco industry marketing) of the population in question. Worldwide, the level of adolescent tobacco use ranges from around 2% to over 30% depending on region and on the form of tobacco (cigarette or other), in data presented from the Global Youth Tobacco Survey on the Tobacco Atlas (2). Overall about a fifth of young teenagers (13–15 years) around the world are smokers (3). High-income countries (HICs) may have lower levels of adolescent tobacco use. In Australia for example, 2016 data from the National Drug Strategy Household Survey (4) show that smoking in teenagers aged 14–19 is at an all-time low of 3.0% down from 7.0% in 2013. Other countries with low rates include the United States (8% of high-school students) (5) and the UK (3% of 11–15-year-olds) (6). The Australian experience particularly reflects the value of policy innovation, plain tobacco packaging and sharp tobacco tax increases, on a background of comprehensive tobacco control policies over decades. This emphasises the importance of MPOWER measures (7) and adhering to the principles of the FCTC (1).