Tobacco use

1. Key messages

15% of the population were daily smokers in 2018 in Belgium, lower than the EU-15 average. This proportion is higher in men (18%) than in women (12%) and higher in Wallonia (18%) than in Brussels (16%) and Flanders (13%).
The prevalence of daily smoking has decreased by 40% between 1997 and 2018.
4.1% of the population were regular users of e-cigarettes in 2018 in Belgium, higher than the EU-15 average. It is higher in men (5.5%) than in women (2.7%) and higher in Flanders (4.4%) than in Wallonia (3.8 %) and Brussels (3.3%).
Fewer young people (15-24) were daily smokers in 2018 (11% vs 17% in 2013) and 5.5% were regular users of electronic cigarettes.
Socio-economic disparities are large in smoking behavior: the proportion of daily smokers and electronic cigarette users is 2.4 times smaller in the higher versus the lower educated people.

2. Background

Smoking 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 and respiratory diseases. Smoking habits taken at a young age are more difficult to quit and lead to more years exposed to tobacco. Reducing tobacco smoking is a priority target for health policy. In 2016, the Ministry of Health had set as target to decrease the prevalence of daily smoking to 17% in 2018 [1].

In this report, we first present the evolution of the smoking behaviour: occasional, daily, and heavy smoking. We then put the focus on daily smokers, 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, vaping has become a fashion trend, and teenagers start using electronic cigarettes before smoking tobacco. 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.

3. Evolution in smoking

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).

Type of smokers in the population aged 15 and over, Belgium, 1997-2018
Source: Health Interview Survey, Sciensano [2]

4. Daily smokers

Belgium

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 in some extent due to a health selection effect, for instance because non-smokers live longer.

Prevalence of daily smoking among people aged 15 and over, by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [2]

Regional specificities

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

Trends

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.

Prevalence of daily smoking among people aged 15-24, by sex, Belgium, 1997-2018
Source: Health Interview Survey, Sciensano [2]

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.

  • Men
  • Women

Prevalence of daily smokers in men aged 15 and over, by region, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Prevalence of daily smokers in women aged 15 and over, by region, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Socio-economic disparities

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.

Prevalence of daily smoking by educational level, Belgium, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

International comparison

The prevalence of daily smoking was lower in Belgium compared to the EU-15 average for 2018.

  • Men
  • Women

Prevalence of daily smoking among men, by country (EU-15), 2018 or nearest year
Source: OECD Health Data [3]

Prevalence of daily smoking among women, by country (EU-15), 2018 or nearest year
Source: OECD Health Data [3]

5. Regular use of e-cigarette

Belgium

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.

Prevalence of regular (at least 1x/week) e-cigarette use among the population aged 15 years and over, by age group and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [2]

Regional disparities

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%).

Prevalence of regular (at least 1x/week) e-cigarette use aged 15 and over, by sex and region, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Socio-economic disparities

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

Prevalence of regular (at least 1x/week) e-cigarette use aged 15 and over, by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

International comparison

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.

Prevalence of electronic cigarettes or similar electronic devices use, by country (EU-15), 2017
Source: Eurobarometer 458 [3]

6. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

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 aged 15 and over that smokes every day.

References

  1. Anti-smoking policy plan, Belgian Federal Minister of Health, 2016. http://www.maggiedeblock.be/2016/04/09/anti-rook-beleidsplan-met-rookverbod-in-wagen-met-kinderen-en-accijnsverhoging/
  2. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/SitePages/Reports.aspx
  3. OECD Health Data, 2018 or nearest year. http://stats.oecd.org/
  4. Eurobarometer 458: Attitudes of Europeans towards tobacco and electronic cigarettes, 2017. https://data.europa.eu/euodp/en/data/dataset/S2146_87_1_458_ENG