Female smoking in Switzerland: an epidemiological perspective

Linguistic, geographic and socioeconomic disparities

Based on 2017 ESS data (author’s note: detailed data for 2022 are not yet available), variations in the extent of smoking among women are observed among the linguistic regions (OBSAN, 2024[3]; Figure W2). Swiss Italian-speaking women (29.2% smokers) presented a higher proportion of smokers than Swiss French-speaking women (24.7%) and Swiss German-speaking women (22.4%). The total prevalence of smoking among women reached 23.3% in the 2017 ESS survey.

At the cantonal level, prevalence levels surpassing 25% were registered in the cantons of Ticino (29.1%), Neuchatel (27.1%), Geneva (25.8%), and Jura (25.7%). Conversely, the cantons of Uri (15.3%), Obwalden (17.4%), St Gallen (19.0%) and Graubünden (19.2%) showed a smoking prevalence among women of less than 20% (OBSAN, 2024[4]). Still based on 2017 ESS data, differences linked to the types of residential regions were also observed: in all linguistic regions and cantons combined, the prevalence of smoking was slightly higher among women living in so-called urban regions (24.2% smokers) than among those living in rural (21.9%) or intermediate regions (21.6%). These differences did not, however, reach a statistically significant level of difference.

Data from the 2017 ESS also reveal statistically significant variations in smoking among women according to socioeconomic criteria such as nationality, whether or not they were gainfully employed, and their level of education (Figure W2). While the proportion of smokers reached 25.8% among women of other nationalities, the proportion was 22.6% among female Swiss citizens (a statistically significant difference). Being considered active (engaged in paid activity) was even more strongly associated with a greater proportion of female smokers (26.7%, versus 17.6% for non-active women smokers). Relatively significant differences were also observed among women over age 25, depending on their education level: those who had at most completed type II secondary training (25.5%) and – to a lesser extent – those who only completed compulsory secondary training (22.7%) showed smoking rates higher than those who had completed higher professional or university studies (20.0%).

School survey: One 15-year-old schoolgirl in 30 smokes daily

• Among 15-year-old girls, almost one in 30 smokes daily (3.1%) and approximately one girl in three (31.0%) has already tried smoking a cigarette.

Figures on smoking from the HBSC survey (Delgrande et al., 2023[6]) reveal that in 2022, 3.1% of 11-year-old girls had already tried cigarettes (having consumed at least once in their life) and that this proportion increased considerably with age, reaching 31.0% by age 15. Cigarette consumption during the 30 days preceding the survey shows similar trends, with 16.6% of 15-year-old girls reporting having smoked during this period. Finally, although smoking remains almost non-existent below the age of 13, daily cigarette consumption already affected 0.5% of 13-year-old girls, 1.5% of 14 year olds, and 3.1% of 15 year olds. Thus, in Switzerland in 2022, almost one in 30 15-year-old girls smoked daily.

Gender differences that have been diminishing for several decades

• During the 1990s, smoking among women increased significantly – even more than among men. It has since diminished, but less markedly among women than men.
• Gender differences have been continually diminishing for more than 30 years.

The Swiss Health Survey has been monitoring the evolution of tobacco consumption in the population age 15 and over since 1992. While an increase in smoking prevalence was observed among women over the period 1992 to1997 (+3.7 percentage points), this increase was followed by a phase of slight reductions between 1997 and 2007 (-2.3 percentage points in 2002; -1.9 percentage points in 2007). A phase of relative stagnation followed between 2007 and 2017 (+0.6 percentage points in 2012; -0.9 percentage points in 2017), before a new, more significant decline in 2022 (-2.5 percentage points; Figure W3). Although these trends are generally shared with the evolution of smoking prevalence among men, the ESS data highlight that the prevalence gap between men and women has continually narrowed since the early 1990s.

Note that a secondary analysis published in 2018 (Gmel et al. 2018[7]) jointly considered different sources of available data (the ESS, but also those of the Health Behavior in School-aged Children project and the Swiss Addiction Monitoring) and concluded in particular that, all ages combined, the evolution of tobacco consumption in Switzerland between 1992 and 2016 generally reflected what is described in international literature as the “smoking epidemic”[8],[9]. According to this concept, since smoking started and progressed more rapidly among men, peaks of higher prevalence are observed more quickly over time for men than for women. Similarly, after reaching a peak, the decrease in smoking prevalence would generally be anticipated over time for men, compared to women. According to this theory, women would follow in the footsteps of men 10 to 30 years later, both in the phase of progression of smoking and in the subsequent phases of stabilisation and reduction.

Young women are more often smokers than young men

As mentioned previously, data from the 2022 ESS show that currently, in the age group 15 to 24, the proportion of female smokers – 26.2% – surpasses that of male smokers – 25.4%. And as also mentioned, such an observation is relatively exceptional from an epidemiological point of view. The finding is based on a difference in the evolution of smoking behaviours between males and females in this age group. While an overall trend towards a leveling out of gender differences has been observed since the implementation of the ESS (first survey in 1992), the 15- to 24-year-old age group appears to be particularly affected by this phenomenon.

In effect, the difference between males and females peaked at 10.3 percentage points for this age group during the first wave of the ESS (36.0% male smokers versus 25.7% female smokers in 1992). After a marked increase in smoking prevalence for both males (+10.6 percentage points) and females (+14.8 percentage points) in this age group in 1997, both population subgroups saw their smoking prevalence decrease more or less regularly until 2022, however not at the same rate: -10.6 percentage points for males ages 15 to 24 over the period 1992 – 2022 compared to +0.5 percentage points for females of this age group over this same period.

Note that since the 1997 peak in smoking prevalence, smoking has declined significantly more for males ages 15 to 24 than for men in age groups 25 to 34 and 35 to 44. This trend was not observed in females. Smoking among females ages 15 to 24 exceeds that of women ages 25 to 34 and 35 to 44. One plausible hypothesis is that preventative measures taken across Switzerland since the 1990s, which have mainly targeted the youngest population subgroups (i.e. minors and young adults), could have impacted young men differently to young women, possibly due to other external or environmental factors (e.g. in the marketing of tobacco products).

Tobacco consumption level of female smokers

• More than two-thirds of women smokers smoke daily, which represents around one woman in seven within the entire population (14.0%).
• A woman who uses tobacco daily smokes an average of 11.3 cigarettes a day, according to 2016 data.

Concerning the intensity and level of consumption, the available results from the 2022 Swiss Health Survey are limited to the proportion of people smoking daily and occasionally (FSO, 2024[11]) and to the proportion of people consuming on average a given number of cigarettes per day across the entire population – and therefore independently of smoking status (OFS, 2023[12]). In total, an estimated 14.0% of females age 15 and over smoke daily, and 6.8% of the female population smoke occasionally (OFS, 2024[13]). Thus, more than two-thirds of female smokers smoke daily. Note that the age groups 55 to 64 years (17.7%) and 35 to 44 years (15.6%) are the most affected by daily smoking. In terms of consumption alone, data from the 2022 ESS reveal that 2.3% of women consume on average one pack or more of cigarettes per day (compared to 6.1% of men; OFS, 2023[14]).

Based on 2017 data from the ESS (OFS, 2020[15]), female smokers – whether they smoke daily or not – consumed on average 8.5 cigarettes per day (10.4 for male smokers) and just under one-sixth (15.1%) of female smokers consumed at least 20 cigarettes per day (OBSAN, 2024[16]). Note that these data highlight that the share of female smokers consuming at least 20 cigarettes is changing in stages among women: in 2017, this proportion was close to or less than 10% among female smokers under age 35 and was close to or exceeded 20% among those ages 35 to 74 (Figure W4).

Note also that in 2016 the CoRolAR survey by Swiss Addiction Monitoring estimated that women who consumed cigarettes daily smoked on average of 11.3 cigarettes per day (compared to 15.4 cigarettes for a male daily smoker; Gmel et al., 2017[17]).

Types of tobacco products consumed by females in Switzerland

• Traditional cigarettes are by far the tobacco product consumed the most by female smokers in Switzerland.

Concerning the types of tobacco products consumed, the most recent detailed data available are those from the 2017 Swiss Health Survey. The data reveal that cigarettes still were then (and certainly still are) the flagship product of women's smoking in Switzerland: 96.0% of smokers consumed mainly or only tobacco in this form (among male smokers this share was 84.1%; OFS, 2020[19]). The use of other products appeared marginal then with 6.2% of female smokers reporting smoking a water pipe (shisha or hookah); 3.1% consuming electronic cigarettes with nicotine (ENDS); 2.7% cigarillos; 2.3% electronic cigarettes without nicotine; 1.5% heated tobacco products such as IQOS; 1.2% cigars; and finally 0.3% pipes (Figure A1A-9). Note however that the legal framework and the ENDS market have evolved significantly since the 2017 ESS. In particular, the sale of liquids with nicotine was not yet legal (only their importation individually was) and the new generation of products such as Juul and Puff Bar were not yet available in Switzerland.

Only a few figures relating to the use of ENDS were published in the Swiss Health Survey of consumption prevalence for 2022 (OFS, 2023[20]). It thus appears that in 2022, 6% of females ages 15 to 24 used electronic cigarettes, compared to 5% of males of the same age, and a total of 3% of the entire population age 15 and over. These are the only figures available at present.

Finally, regarding heated tobacco products (IQOS, etc.), data from the 2022 Omnibus “Health and Lifestyle”[21] survey inform us that a total of 2.3% of females age 15 and over smoke this type of tobacco product daily (OFSP, 2023[22]). Note that in total, men and women combined, daily consumption of this type of tobacco was mainly observed among daily (5.6%) and occasional (2.7%) smokers and among ex-smokers (4.3%).

School surveys: Types of products consumed by students

• In 2022, 6% of females ages 15 to 24 used electronic cigarettes (ENDS), representing 3% of the population age 15 or over.
• At age 15, 7.5% of schoolgirls consume ENDS very frequently (at least 10 days over the course of the previous 30 days).
• A not insignificant proportion of 15-year-old girls also consume other tobacco products like water pipes (hookahs) and snus, as well as heated tobacco products (HTP).

The 2022 HBSC survey documented, in addition to questions concerning “traditional cigarettes”, the prevalence of electronic cigarette consumption (ENDS) for students ages 11 to 15, and for those ages 14 and 15 years, the prevalence of consumption of heated tobacco products (HTP), water pipes, snuff, and snus (Delgrande et al., 2023[24]).

As part of this survey, the prevalence of experience, or lifetime use, of electronic cigarettes among students reached 2.4% by the age of 11, 7.8% by age 12, 18.2% by age 13, 31.9 % by age 14, and 40.1% by age 15. The levels of prevalence were slightly lower for girls than for boys at each age.

The use of ENDS over the previous 30 days remained relatively limited among girls ages 11 (1.1%) and 12 (2.8%), but then increased rapidly: 10.0% of girls age 13, 19.1% of those age 14, and 25.0% of those age 15 reported ENDS use during the 30 days preceding their participation in the 2022 survey. Note that a considerable proportion of young girls ages 13 to 15 reported having used ENDS for 10 days or more in the 30 days preceding the survey: 3.4% – or more than one in 30 – at age 13; 5.9% – more than one in 17 – at age 14; and 7.4% – more than one in 14 – at age 15. Note that while in terms of prevalence of experience, boys systematically surpassed girls, girls systematically surpassed boys in terms of frequency of use – 10 days or more over the previous 30 days.

Concerning other tobacco products, the 2022 HBSC survey notes that 4.9% of 14-year-old girls and 8.0% of 15-year-old girls had smoked a water pipe at least once in the previous 30 days[25]. Also, 4.2% of 14-year-old girls and 5.6% of 15-year-old girls[26] had used snuff, and 2.4% of 14-year-old girls and 2.9% of 15-year-old girls[27] had used tobacco products (HTP) during the 30 days preceding the survey.

AT Switzerland, August 2024

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