Unexpected sharp increase in smoking in Poland. Did the Polish tobacco control strategy collapse?

INTRODUCTION

Tobacco use remains the main single preventable cause of premature deaths [1, 2]. At global scale, it contributes annually to almost 7.7 million deaths, and in Poland to over 80,000 [3, 4]. Comprehensive tobacco control policies, including the surveillance and monitoring of tobacco use, are key public health tools [3].
In the 1980s, cigarette consumption and lung cancer mortality rates in Poland ranked among the highest worldwide [1, 5-7]. Thanks to the implementation of comprehensive tobacco control policies in the 1990s, Poland built one of the most modern and comprehensive systems for tobacco control, including a surveillance and monitoring protocol [5, 7-11]. Cigarette consumption had been continuously estimated since 1923 and nationwide representative surveys on smoking prevalence were systematically conducted from 1974 to 2016, annually since 1985 [8, 9, 12, 13]. Poland’s 1995 Tobacco Control Law, identified in the early 2000s by the World Health Organization (WHO) as an example for other countries, was the basis for development of the National Program for Tobacco Control and Its Health Consequences, at that time one of the first and most comprehensive in Central and Eastern Europe [11]. Since then cigarette consumption and smoking prevalence and, later on, lung cancer mortality rates, systematically declined [2, 14-16] (Figures 1 and 2).
This paper aims to evaluate the level of smoking prevalence in 2025.

MATERIAL AND METHODS

A recent nationwide survey on tobacco smoking was conducted by the European Observatory of Health Inequalities at the University of Kalisz, Poland, from 22 to 27 April 2025 in collaboration with the Health Promotion Foundation in Nadarzyn, Poland. The study was supported by an unrestricted grant of the Watch Health Care Foundation in Warsaw, Poland. The study’s fieldwork was conducted by Opinia24, a Poland-based public opinion research agency. The study design, including survey concept, methods, tools and definitions of smoking behaviors, was based on the methodology used by our team in the years 1982-2016 [7, 13, 17]. A nationally representative cross-sectional sample of 1,500 respondents aged 15 and over was selected. The sample was proportionally selected with the use of post-stratified weights to the structure of the Polish adult population by gender, age, level of education, place of residence (rural or urban) and voivodeship. The study was conducted with the use of mixed-mode questionnaire interview techniques: Computer-Assisted Telephone Interview (CATI) and Computer-Assisted Web Interview (CAWI), each one administered with 50% of selected respondents. Web­appendix 1 includes all original questions from the survey questionnaire used for the categorization of analyzed smoking behaviors. All respondents were characterized by several demographic and economic variables used by Opinia24 in its surveys. Current cross-sectional analysis refers to the prevalence of basic smoking behaviors by gender. These are behaviors proposed to be used by the World Health Organization guidelines and broadly analyzed in recent and past international and Polish surveys: daily, occasional, former, and never smokers. Webappendix 2 includes definitions of these categories. Cross-sectional analysis was performed using the recent version of the SPSS Statistical Package and based on weighted data and results of c2 tests (p < 0.05).

RESULTS

Table 1 presents data on the prevalence of basic smoking behaviours in Poland in gender groups. In 2025, the prevalence of daily, occasional, former, and never smoking in all Polish adults was as follows: 26.1%, 4.9%, 20.6%, and 48.6%. In men, 31.5% were daily smokers, 5.4% occasional smokers, 24.0% former smokers, and 39.1% never smokers. In women, the prevalence of analyzed smoking behaviours was respectively 21.2%, 4.5%, 17.5%, and 56.8%.
The prevalence of analyzed smoking behaviors has substantially differed in gender groups (Pearson’s c2 test value is 48.11 with p < 0.001) (Table 1). Men were characterized by higher daily (male/female ratio: 1.49) and former (male/female ratio 1.37) smoking rates, while women had higher never smoking rates (male/female ratio: 0.69). The prevalence of occasional smoking was slightly higher in male than in female adults (male/female ratio: 1.2), but the diffe­rence was not statistically significant.

DISCUSSION

In 2016, Poland unexpectedly experienced a public health crisis. The National Programme for Reducing the Health Consequences of Tobacco Smoking, adopted by the Polish Parliament in 1995 and implemented until 2016, one of the most effective in the world [11, 13, 18], was first deprived of its statutory sources of funding, and then effectively dismantled. The provisions of the 1995 Act on the Protection of Health Against the Consequences of Tobacco Use and Tobacco Products, concerning the conduct of social and media campaigns, the financing of smoking-reduction activities, an anti-promotional and progressive price and tax policy, as well as systematic research on smoking prevalence, ceased to be implemented. This led to, among other things, the halting of the steady annual increase in cigarette prices, and the decline in cigarette sales, that had been observed since the early 2000s (from 88 billion cigarettes in 1999 to 41 billion in 2015) [18].
Between 2016 and 2022, following the changes in public health policy towards cigarettes, including excise tax policy, the real price of a pack of cigarettes steadily decreased, while their economic affordability increased [18, 19]. The corresponding rise in cigarette sales represents another public health phenomenon, as Poland was the only OECD country during this period in which cigarette sales rose by 20% [18, 19].
The results of our nationwide survey on smoking prevalence in the adult population, conducted in April 2025, fully confirm and quantify the effects of the weakening of public health policy towards cigarettes in Poland. A comparison of daily smoking prevalence in 2019 and 2025 indicates that in recent years Poland has experienced a sharp increase in the proportion of daily smokers among both men (from 26.9% to 31.5%) and women (from 18.1% to 21.2%) [20] (Figure 1). Currently, the prevalence of daily smoking in Poland (26%), which in 2016 placed the country in the middle of international rankings, has become high both in Central and Eastern Europe and across the European Union as a whole [6, 21].
The increase in cigarette sales by 8 billion units between 2016 and 2022, together with the significant rise in smoking prevalence, has clear health consequences [18, 19]. Based on estimates published by Brandt, Peto and Doll [1, 2, 22] it can be tentatively estimated that the 20% increase in cigarette sales may have contributed to 10,000-15,000 additional deaths attributable to tobacco in the years 2016-2022. This issue requires further in-depth research, comprehensive epidemiological analy­sis, and systematic monitoring of cigarette sales, smoking prevalence, and temporal trends in mortality from lung cancer and other tobacco-related diseases.
The demise of tobacco control policy in Poland weakens public health and necessitates an urgent resurrection of the comprehensive strategy implemented in the years 1995 to 2016.

CONCLUSIONS

In the past decade, smoking prevalence has increased sharply in Poland and is now at a high level when compared with EU countries. This public health calamity was caused by the shutdown of the country’s National Tobacco Control Strategy and Action Plan. Poland now requires the urgent implementation of a new comprehensive tobacco control strategy.

ACKNOWLEDGEMENT

The authors would like to thank Scott Thompson for his help in proofreading the text.

DISCLOSURE

The authors report no conflict of interest.

References