Introduction
Most studies use the prevalence of current smoking as an indicator to quantify the burden of smoking.
However, length and intensity of smoking, as well as time since cessation for former smokers are also
known to impact smoking-related health risks. The aim of this study was to quantify and compare the
burden of smoking across the European Union (EU) using a range of smoking burden indicators.
Methods
We conducted a cross-sectional analysis using data from the March 2017 Eurobarometer 87.1
(n=27,901 aged ≥15 years in 28 Member States [MS]) and the Tobacco Control Scale. We defined five
indicators of smoking burden including the prevalence of current and ever smoking, length of smoking,
pack-years, and discounted pack-years and ranked EU MS by each indicator. Two-level linear and
logistic regressions were performed to assess the association between these indicators and sociodemographic and tobacco policy factors.
Results
Wide variations across the EU countries were observed in all smoking burden indicators. While some
MS ranked consistently high (e.g. Greece, France) or consistently low (e.g. Ireland, United Kingdom)
in all indicators, we found substantial discrepancies in ranking depending on the indicator used for MS
such as Malta, Denmark, Finland and the Netherlands. All indicators of smoking burden were lower
among women and respondents without financial difficulties; however, the magnitude of those
inequalities varied two-fold among the different indicators.
Conclusions
Using a range of smoking burden indicators can be more informative than relying on prevalence alone.
Our analysis highlights the limitations of relying solely on prevalence of current smoking to estimate
the burden of smoking and the potential value of more nuanced indicators. We recommend that
multiple and more nuanced indicators that consider former smokers, intensity and duration of smoking
should be utilised to monitor tobacco use and evaluate tobacco control policies.