Story
Projected impact of a national Tobacco 21 policy in the Kingdom of Saudi Arabia
Key takeaway
Saudi Arabia is considering raising the legal smoking age to 21 to curb high youth smoking rates. This policy could significantly reduce smoking among young people in the country if implemented.
Quick Explainer
The researchers developed a simulation model to project the potential impact of raising the legal age to purchase tobacco products from 18 to 21 years old in Saudi Arabia. The model estimated smoking initiation and cessation rates among males, the primary smokers in the country. By implementing this "Tobacco 21" policy in the simulation, the model predicted a modest reduction in male smoking prevalence by 2100, primarily by deterring youth from taking up smoking. While the projected benefits are relatively modest, the researchers suggest Tobacco 21 could support Saudi Arabia's goals to reduce non-communicable disease, but would likely need to be paired with additional policies focused on increasing smoking cessation rates to achieve the country's ambitious smoking reduction targets.
Deep Dive
Technical Deep Dive: Projected Impact of Tobacco 21 in Saudi Arabia
Overview
This study used a tobacco smoking simulation model to project the potential impact of implementing a national Tobacco 21 policy in the Kingdom of Saudi Arabia (KSA). Tobacco 21 refers to raising the minimum legal age to purchase tobacco products from 18 to 21 years old.
Problem & Context
- Tobacco smoking is especially high among males in KSA, with 27.5% of males aged 15+ reporting smoking in 2019.
- Youth smoking is also a concern, with 6.8% of 13-15 year olds currently using tobacco products, despite the 18-year minimum age.
- To address youth smoking, some countries have implemented Tobacco 21 policies, but no other Middle Eastern countries besides Kuwait have done so.
Methodology
- The researchers developed the KSA Tobacco Control Policy (TCP) model using data from 3 nationally representative health surveys in KSA.
- The model estimated smoking initiation and cessation rates for males, as smoking rates are low among females in KSA.
- The Tobacco 21 policy was implemented in the model as a 34% (15%-53%) reduction in smoking initiation for ages 18-20.
- The economic impact was evaluated using the 2024 KSA value of a statistical life, which ranges from $1.65 million to $5.15 million USD.
Results
- Under the status quo scenario, male smoking prevalence in KSA was projected to decrease to 10.2% by 2100.
- Implementing Tobacco 21 in 2026 was projected to further decrease smoking prevalence to 9.4% (8.9%, 9.8%) by 2100.
- These reductions would avert nearly 5,000 (2,200, 7,800) premature deaths and gain 155,000 (69,000, 241,000) life years from 2026-2100.
- The total expected economic benefit ranges from $1.67 to $5.19 billion USD (6.25 to 19.45 billion SAR).
Interpretation
- The projected impact of Tobacco 21 in KSA, while modest, would support the country's goals to reduce non-communicable diseases and deaths.
- However, even under the best-case conditions, Tobacco 21 alone is unlikely to achieve KSA's Vision 2030 smoking prevalence target of 9%. Additional policies to substantially increase smoking cessation are needed.
Limitations & Uncertainties
- The analysis relied on parameter estimates from survey data, which may not fully capture real-world dynamics.
- The model did not account for potential substitution to other tobacco/nicotine products.
- The economic benefits were estimated using a broad statistical life value, not granular health cost data.
What Comes Next
The researchers recommend that KSA policymakers consider implementing Tobacco 21 as part of a comprehensive tobacco control strategy, while also pursuing additional interventions to boost smoking cessation rates and further reduce smoking prevalence.
