Challenges in tobacco control in Serbia

Background Serbia is among European countries with the highest smoking prevalence among adults. According to data from 2018, 38% of the population aged 18 years or older, smoke daily or occasionally. Among contributing factors to high smoking prevalence is low compliance with the smoke free law as well as the gaps in that law. Tobacco Product Directive which regulates tobacco products in EU member states is not transposed to Serbian legislation yet. Cigarettes are the most frequently used product, but in recent years new products are on the market contributing to the increase in tobacco/nicotine use. In addition, some old tobacco products such as waterpipes are gaining in popularity. The aim of this analysis is to explore the use of tobacco/nicotine products, other than cigarettes among Serbian adults.

Method Data used in this analysis were obtained through a survey conducted in 2018 on a nationally representative sample of 1059 Serbian adults. This was omnibus survey and data was collected through computer assisted personal interviewing in households. In addition, data from previous surveys conducted with the same methodology and sample size were used to compare changes in trends in tobacco/nicotine use.

Results Lifetime prevalence of electronic cigarette use is 13%, while less than 1% of adults reported current daily (0.2%) or occasional (0.6%) use. Compared with 2017, the percentage of occasional e-cigarette users increased from 0.3% to 0.6% while daily e-cigarette use stayed the same. Compared with the previous year, there is a noticeable increase in lifetime prevalence of heated tobacco products (HTPs) from 3.0% in 2017 to 7.6% in 2018. Current use of HTPs in 2018 is 1.1% (0.7% occasionally and 0.4% daily). The increase in lifetime prevalence is also significant for waterpipe smoking, from 5.9% in 2017 to 8.9% in 2018.

Conclusion While the prevalence of cigarette smoking remains the same since years, waterpipe and heated tobacco product use increase contributing to the increase in overall tobacco use. E-cigarette use stabilized among the adult population, but taking into account the insufficient relevant legislation, e-cigarette use still remain a challenge in Serbia. Changing patterns of tobacco/nicotine use call for the implementation of evidence-based interventions.