The State of Smoking 2018Global Survey Findings and InsightsMonday, March 19, 2018

2

WELCOME

Dr. Derek YachPresident, Foundation for a Smoke-Free World

4

The survey was conducted by Kantar Public, an integrated consulting and research agency, which was engaged by the Foundation for a Smoke-Free World, Inc. The Foundation is an independent, private foundation formed and operated free from the control or influence of any third party. Philip Morris International, S.A. has provided the initial funding to the Foundation. The Foundation makes grants and supports medical, agricultural, and scientific research to end smoking and its health effects and to address the impact of reduced worldwide demand for tobacco.

Support and Disclaimer

5

Why Focus on the Smoker?

The experience of smoking is multifaceted and deeply personal. Therefore, the solutions we offer have to reflect an understanding of that experience, what smokers need, and what they want as they try to quit.

6

Purpose of the Survey

1. Understand smokers’ experiences and challenges2. Probe awareness of smoking and health impacts3. Assess perceptions of risk and influence on choices

Methodology

7

Quantitative: Global Survey• More than 17,000 participants• 13 countries• 7 languages• Representative of general

population 18+ years old• 3 profiles: smokers, ex-smokers,

non-smokers

Read the full methodological report at SmokeFreeWorld.org

Methodology

Qualitative: Focus Groups• Major cities in 7 of the 13

countries• Smokers who tried to quit at

least once• Ex-smokers• Providing additional context and

insights

8

Smoking Prevalence by Country & Gender

Country State of Smoking 2018 Global Poll WHO (2015)

Male (≥18 years)(Main sample)

Female (≥18 years)(Main sample)

Men (≥15 years) Women (≥15 years)

Brazil 11% 7.2% 19.3% 11.3%

France 31.5% 29.6% 29.8% 25.6%

Greece 37.9% 31.4% 52.6% 32.7%

Israel 22.2% 11.9% 41.2% 19.3%

India 17.1% 1% 20.4% 1.9%

Japan 25.9% 19.5% 33.7% 10.6%

Lebanon 57.5% 48.4% 45.4% 31%

Malawi 15.6% 4.4% 25.4% 6%

New Zealand 8.4% 6.1% - -

Russia 39.1% 16.7% 59% 22.8%

South Africa 49% 34.1% 31.4% 6.5%

United Kingdom 26.3% 15.9% 19.9% 18.4%

United States 26% 11.3% 19.5% 15%

Findings and Insights

Smoking is deeply integrated into most smokers’ daily lives, so quitting means more to them than just giving up cigarettes.

10

Understand Smokers’ Experiences and Challenges

11

Focus groups

Smokers’ Experiences and Challenges

Smoking isn’t just a physical addiction for smokers, it’s also a deeply engrained behavioral, emotional, and social part of their lives

Physical• Intense need/craving• Hard to concentrate• Insomnia• Weight gain

Behavioral• Habit• Ritual: routines

(with coffee, in car…)• Have something in hand• Social, going out w/ friends

Emotional• Pleasure• Calms stress/anger/anxiety• Irritable when not smoking• Inclusion w/ other smokers• Helps w/ boredom

Assess the LandscapeSmokers’ Experiences and Challenges

12BASE: SMOKERS

Smoking is a big part of many smokers’ daily rituals and routinesWhich of the following situations, if any, apply to you? (Multiple answers possible)(%, TOP THREE ANSWERS PER COUNTRY)

13BASE: ALL

Q5.3 Whichofthefollowingappliestoyou?Yourclosestfriendssmoke(%-APPLIESTOYOU)

95 93 91 8880

72 72 70 69 6863 59 59

100

7768 68

54 57 5647 46 49

3934

41

80

57

26

45

20

39

2716

1116 14 20 12

LB EL ZA RU MW BR FR UK US JP NZ IL IN

Smokers Ex-smokers Non-smokers

Smokers’ Experiences and Challenges

Smokers tend to have close friends who smokeWhich of the following applies to you?Your closest friends smoke(%, APPLIES TO YOU)

14

Q5.4 Whichofthefollowingappliestoyou?Yourpartner/spousesmokes(%-APPLIESTOYOU)

5648 44 42 38 37 36 34 30 29 29

14 13

42

25 27 2514

2217 14 16 18 19 6 826

2113

613

7 23 5 912 13

11 11

LB EL FR UK ZA US RU NZ IL BR JP IN MW

Smokers Ex-smokers Non-smokers

BASE: ALL

Smokers’ Experiences and Challenges

Smokers are more likely to have partners/spouses who smokeWhich of the following applies to you?Your partner/spouse smokes(%, APPLIES TO YOU)

Smokers know smoking is harmful and addictive and consider themselves in poorer health than non-smokers – yet they’re not as actively engaged with their doctors as non-smokers.

15

Probing Global Awareness of Smoking and Health Impacts

16

BASE: SMOKERS

Assess the Landscape

Assess the Landscape & Explore Influences

Smoking and Health: Awareness of Harm

Most smokers know smoking is harmful to their healthTo what extent do you agree or disagree with the following statements?Your smoking is harmful for your health(%, TOTAL “AGREE”)

17BASE: SMOKERS

Smoking and Health: Awareness of “Addiction”

Most smokers also consider themselves addicted to cigarettes

Do you consider yourself addicted to cigarettes?(%, TOTAL “ADDICTED”)

18BASE: ALL

Assess the LandscapeSmoking and Health: Perception of Personal Health

In general, how would you describe your health? Is it…(%, TOTAL “EXCELLENT/VERY GOOD”)

Smokers don’t think they are as healthy as non-smokers

Q9 Ingeneral,howwouldyoudescribeyourhealth?Isit…(%-TOTAL'EXCELLENT/VERYGOOD')

5145

36 33 33 32

19 19 19 16 13 128

4333 34

46

17

35 39

1625

15 1311

6

59 6253 50

6151

44

2734

28 29

12

11

EL ZA IL MW LB US NZ IN UK FR BR RU JP

Smokers Ex-smokers Non-smokers

19BASE: ALL

Q10 Howmanytimesdidyouvisitadoctororahealthcareproviderinthelast12months?(%-NEVER)

58 5449 47

39 3731 30

21 16 14 14 12

49

34 33

2128 24 22

17 1810

5 912

4051

3037 35 34 30

1927

19 516 13

MW LB RU ZA EL IN JP BR UK US IL FR NZ

Smokers Ex-smokers Non-smokers

Smoking and Health: Interaction w/ Healthcare Providers

Despite smokers’ concerns about their health, they don’t engage with their healthcare providers as frequently as non-smokers

How many times did you visit a doctor or a healthcare provider in the last 12 months?(%, “NEVER”)

There is significant confusion among smokers about relative harms of smoking and less harmful alternatives. Misconceptions impact their motivations and choices about best pathways to quit or switch to reduced harm products.

20

Assessing Perceptions of Risk and Influence on Choices

21

BASE: SMOKERS

Perceptions of Risk: Nicotine as a Substance

Smokers generally view nicotine as a harmful substance

And using the same scale, to what extent do you think a moderate daily use of the following substances can harm your health?(%, TOP THREE ANSWERS PER COUNTRY)

22

BASE: SMOKERS

Perceptions of Risk: Nicotine and Cancer

Many smokers believe nicotine in e-cigarettes causes cancerBased on what you know or believe, does smoking nicotine in products like electronic cigarettes cause… (Multiple answers possible)(%, TOP THREE ANSWERS PER COUNTRY – SMOKERS)

23BASE: SMOKERS

Perceptions of Risk: E-cigs vs. Combustible Cigarettes

In some countries, e-cigarettes ranked as or more harmful than smoking

Do you think smoking e-cigarettes and vaping devices is more or less harmful than smoking regular cigarettes?(%, SMOKERS)

24

n=442 n=712 n=540 n=349 n=349 n=567 n=189 n=378 n=613 n=731 n=297 n=653 n=623

BASE: EX-SMOKERS OR SMOKERS WHO HAVE ALREADY TRIED TO QUIT

(Variousstudiesindicatesuccessratesforsmokerstryingtoquitontheirownis<10%)

Smokers often try to quit without assistance(various studies indicate success rates for smokers trying to quit on their own is <10%)*

Perceptions and Choices: Methods Used to (Try to) Quit

Whichofthefollowingdidyouuseinordertoquitortotrytoquitsmoking?(Multipleanswerspossible)(%, TOP THREE ANSWERS PER COUNTRY)

* HughesJRetal.,Addiction. 2004Jan;99(1):29-38.

25BASE: USE ELECTRONIC CIGARETTES, E-CIGARETTES OR VAPING DEVICES

Perceptions and Choices: Use of E-cigs/Vaping

Smokers in some markets are beginning to use e-cigarettes/ vaping to reduce smoking or quit

Note: the sample size of e-cigarettes/vaping devices users is too small in Brazil, Israel, India, Lebanon, Malawi, Russia, and South Africa to present valid results

n=8 n=149 n=39 n=13 n=16 n=76 n=1 n=75 n=24 n=8 n=99n=131

(%, TOP THREE ANSWERS PER COUNTRY)

What is your primary reason for using an e-cigarette or vaping device?

26

To Help Smokers Quit or Reduce Their Risk, We Will…

Define and broaden awareness of the unique experiences and struggles of smokers and what support they really need

Catalyze the development of more effective tools, resources, and interventions to empower health professionals

Generate evidence to help provide guidance and education on the relative risk of cigarettes vs. reduced-harm products

Support innovation that expands the range of effective reduced-harm products that pave the way toward smoking cessation

27

www.smokefreeworld.org