Tobacco use

1. Key messages

2. Current and daily smoking - adults

The proportion of occasional smokers stays stable

In 2018, 19% of the population were current smokers, among them, 15% were daily smokers (including 4.7% of heavy smokers, i.e., smoking more than 20 cigarettes a day) and 4% were occasional smokers. The time trend is reassuring with a 40% decrease in daily smokers between 1997 and 2018. A decreasing part of smokers were heavy smokers, they were 4.7% of the population in 2018 (-52% compared to 1997).

In Belgium, more men are daily smokers than women

In 2018, more men (18%) than women (12%) smoked daily. The prevalence of daily smoking in men aged 25 to 64 years is still concerning, as it reaches more than 20%. In women, the prevalence increases with age up to 64 years, where 17% are daily smokers. Between 15 and 44 years of age, twice as many men smoke compared to women. Between 45 and 64, fewer men and more women are daily smokers compared to the previous ages. At older ages, the proportion of daily smokers is lower, with similar rates in both sexes. This can be to some extent due to a health selection effect, for instance, because non-smokers live longer.

The percentage of daily smokers is higher in Wallonia

Daily smoking prevalence was higher in Wallonia (18%) than in Brussels (16%) and in Flanders (13%).

A sharp decline in smoking has been observed since 1997

Since 1997, a relative reduction of 38% in men and 32% in women was observed in the prevalence of daily smoking in Belgium. Among youngsters (15-24), an important decrease of daily smokers (-35%) was observed in 2018 compared to 2013. Among women, an increase was initially observed in 2013, causing more young women to smoke than men in 2013; in 2018 this trend has reversed with an important decrease (-59%) in the prevalence of daily smoking.

Daily smoking prevalence has decreased in all regions and in both sexes since 1997; the decline was higher in men in Flanders and in women in Brussels.

People with lower levels of education are more likely to smoke daily

After adjustment for age, people with a lower secondary education had the highest prevalence of daily smokers, and were 3.1 times more likely to be daily smokers than people with the highest educational level in 2018, while people with the lowest educational level were 2.3 times more likely to be daily smokers than people with the highest educational level. The prevalence of daily smoking decreased in nearly all educational levels (except for the lower secondary education). From those successive cross-sectional surveys, one cannot know which part of the trends is due to a change in smoking behavior, or to a health selection effect.

Belgian women are more likely to be daily smokers than the EU-15 average

The prevalence of daily smoking was lower in Belgium compared to the EU-15 average for 2019. 

3. Regular use of e-cigarettes - adults

Young people use e-cigarettes more than their elders

In 2018, the prevalence of regular e-cigarette use in Belgium (4.1%) was higher in men (5.5%) than in women (2.7%). It is the highest in young men (15-34) and the lowest after the age of 65 years.

Flanders has the highest proportion of e-cigarette users 

The prevalence of regular e-cigarette use was higher in men in Flanders (5.9%) and in Wallonia (5.5%) than in Brussels (3.5%). It was higher in women in Flanders (3.0%) and Brussels (2.9%) than in Wallonia (2.2%).

People with lower levels of education are more likely to use e-cigarettes

People with secondary education were 2.4 times more likely to be regular e-cigarette users than people with tertiary education.

More Belgians use e-cigarettes than the EU-15 average

Eurobarometer 458 constitutes the only comparable source of information about the usage of electronic cigarettes in Europe but the comparison should be interpreted with caution due to the limited samples. In 2017, Belgium had a higher prevalence of users than the average EU-15 countries.

4. Current and daily smoking - adolescents

In 2018, 3.8% of secondary school adolescents aged 11-18 were daily smokers

Belgian HBSC studies show that in 2018, 17% of adolescents reported having at least tried tobacco once. Notably, a greater proportion of boys (19%) had engaged in this compared to girls (16%).

In secondary school, 3.8% of adolescents were daily smokers. An increase is observed by age, with adolescents aged 17-18 years old smoking at the highest rates. The difference between boys and girls is particularly marked in this age group, where boys (15%) are more likely to smoke daily than girls (11%). 

Adolescents from the French Community are more likely to be daily smokers 

The median age of tobacco experimentation is 14 years in the French Community and 15 years in the Flemish Community. More adolescents in the French Community were daily smokers than in the Flemish Community (4.4% vs. 3.4%). 

Daily smoking has significantly decreased in 2018 compared to 2006

In both Communities, the prevalence of boys and girls reporting smoking daily decreased between 2006 and 2018. In 2006, 9.3% of girls and 10% of boys were daily smokers, down to 3.2% of girls and 4.5% of boys in 2018.

During 2018, there was a slightly higher prevalence of daily smoking among boys and girls from the French Community compared to those from the Flemish Community.

Adolescents in vocational education are more likely to be daily smokers in both Communities

In both Communities, there are differences in educational track for patterns of daily smoking. In the French Community, students in vocational education smoke at higher rates (19%), followed by students in technical schools (14%) and those in general education (4.1%).In the Flemish Community, general education students smoked at the lowest rates (1,5%), compared to students in technical education (7,5%) and vocational education (13%).

Belgian adolescents compared favorably to the EU-15 average of current use of tobacco 

In the EU-15 countries, 15% of 15-year-old girls and 14% of 15-year-old boys reported smoking at least once in the past 30 days. Belgium is below the average with 12% of 15-year-old boys and 11% of 15-year-old girls reporting having smoked during this period.

5. Use of electronic cigarettes - adolescents

In Belgium in 2018, 19% percent of adolescents had ever tried an e-cigarette in their life, a higher proportion than for conventional cigarettes. Overall, more boys (24%) than girls (15%) had reported trying one.

The Flemish Community's HBSC survey for 2022  already shows that e-cigarette use has risen sharply in 2022 compared with 2018.

E-cigarette use increases with age among boys

In 2018, the prevalence of boys who had used an e-cigarette in the 30 days preceding the survey was highest among the older age groups (17-18 years old). Among girls, it was the 15-16 year-olds who used them most during this period.

More adolescents in the French Community use e-cigarettes than in the Flemish Community

Overall, 4.9% of girls and 9.9% of boys had used an e-cigarette in the 30 days preceding the survey. Girls and boys in the French Community used e-cigarettes more than those in the Flemish Community. 

Adolescents in general education are the least likely to use e-cigarettes

When it comes to e-cigarette use by educational track, adolescents in general education reported the least use (5,8%). Adolescents in vocational education used e-cigarettes the most (13%), followed by those in technical education (11%). Regional disparities were seen especially in technical and general education, where adolescents from the Flemish Community used e-cigarettes less than those from the French Community.

6. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

HBSC Fédération Wallonie-Bruxelles

HBSC Vlaanderen

Background

Tobacco use is one of the most important health-related risk factor and leads to high numbers of avoidable deaths and diseases. It is the major cause of lung cancer, is involved in the development of other kinds of cancer, and increases the risk of cardiovascular, respiratory, and other diseases. Smoking habits started at a young age are more difficult to quit and lead to more years exposed to tobacco. Exposure to nicotine in children and adolescents can have long-lasting, damaging effects on brain development. Young people who smoke are also at risk of asthma and impaired lung function and growth, and their physical fitness in terms of both performance and endurance is also reduced because of smoking [7]. Reducing tobacco use is a priority target for health policy. The 'Interfederal Strategy 2022-2028 for a tobacco-free generation' launched in 2022 targets young people in particular, and has set itself the following objectives: 1) to reduce the number of daily tobacco users in the 15-24 age group to 6% by 2028 and 2) reduce the number of people starting to use tobacco products to (almost) 0% by 2040 [8].

In this report, we first present the evolution of the smoking behaviour: occasional, daily, and heavy smoking for adults. We then put the focus on daily smokers (adults and adolescents), since this has internationally been selected as a key health indicator (OECD, Sustainable Development Goals).

Electronic cigarettes were first developed as a mean to quit smoking tobacco. Nowadays, the range of products has broadened, e-cigarette has gained in popularity, and adolescents more often start using electronic cigarettes before smoking tobacco. For many, e-cigarette use is a precursor to tobacco use. It is still too early to assess the long term health effects of this practice, but it is advised that non-smokers do not start vaping. Several questions have been integrated for the first time in Belgian Health Interview Survey 2018 to estimate the prevalence of users and their profiles. In this report, we focus on the indicator 'regular use of e-cigarette', i.e. the use of an e-cigarette at least once a week for adults and on the indicator ‘ used electronic cigarette in the past 30 days’ for adolescents.

Definitions

Age-standardized prevalence

Since smoking behaviors are strongly influenced by age, comparisons among regions and educational levels need to be standardized by age to have a similar age structure.

Current smokers

Current smokers are people who currently smoke, including daily and occasional smokers.

Electronic cigarette (e-cigarette)

An electronic cigarette (e-cigarette), or similar devices like e-pipe/e-cigar/e-chicha, are small electronic devices that allow simulating the act of smoking but do not burn tobacco and produce vapor from liquids instead. They can contain nicotine or not. A similar definition was used in the Health Interview Survey 2018 and in the Eurobarometer 458.

EU-15

The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.

Heavy smokers

Heavy smokers are people who smoke 20 or more cigarettes per day.

Prevalence of daily smoking

The prevalence of daily smoking is the percentage of the population that smokes every day.

References

1. Health Interview Survey, Sciensano, 1997-2018. https://www.sciensano.be/fr/projets/enquete-de-sante
2. OECD Health Data, 2019 ou année la plus proche. http://stats.oecd.org/
3. Baromètre européen 458: Attitudes des Européens envers le tabac et les cigarettes électroniques, 2017. https://data.europa.eu/euodp/en/data/dataset/S2146_87_1_458_ENG
4. HBSC Fédération Wallonie-Bruxelles, ULB, 2018. http://sipes.ulb.ac.be/
5. HBSC Vlaanderen, UGent, 2018. https://www.jongeren-en-gezondheid.ugent.be/ 
6. Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 2. Key data, WHO Regional Office for Europe, 2020. https://www.who.int/europe/health-topics
7. Smoking still a core challenge for child and adolescent health reveals WHO report, 2020. https://www.who.int/europe/news/item/05-06-2020-smoking-still-a-core-challenge-for-child-and-adolescent-health-reveals-who-report
8.  Plan de lutte contre le tabagisme, ministère fédéral belge de la santé, 2022. https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/20220323_strategie_interfederale_tabac_note_de_base_fr.pdf

Please cite this page as: Sciensano. Determinants of Health: Tobacco use, Health Status Report, 29 September 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/determinants-of-health/tobacco-use