# Smoking in Albania

Smoking in Albania is prevalent as about 40% of Albanians smoke regularly. In Europe, only Turkey has a higher smoking rate than Albania. Albanians annually spend more than €300 million on tobacco products. Zog I of Albania was reported to smoke 200 cigarettes a day. Albania adopted tough anti-smoking laws in 2007, but they are not strictly enforced. Smoking prevalence is increasing, especially among females ages 13 to 15. The smoking rate for teens between the ages of 13 and 15 is currently 15%.

## Prevalence and trends

The World Health Organization aims to achieve a tobacco-free Europe by 2040. However, despite this goal, smoking rates in Albania are rising, with a World Bank report revealing that 38.8% of Albanians are tobacco users, as reported by Euronews in April 2023. Roland Shuperka, a tobacco protection policy expert, notes that Albania faces significant challenges in reaching this objective. Although Albania is among the top 90 countries for anti-smoking policies, some measures are difficult to enforce. Shuperka suggests that smokers who struggle to quit should consider using smokeless tobacco products. While such alternatives are popular among about 30% of smokers in some European countries, they are used by less than 5% of smokers in Albania.
In a 2001 survey conducted in the capital of Tirana, smoking prevalence and its determinants were examined among adults aged 25 and over. Smoking rates were found to be on par with those in other Western societies. The study, which included 1,120 participants, found that 41% had smoked at some point, with 28% being smokers when surveyed—37.6% of men and 19.3% of women. The age-standardized smoking prevalence for Tirana was 31.2%, with higher rates among those aged 25-34. Of active smokers, 16.5% smoked more than 20 cigarettes a day, and 67.3% smoked their first cigarette within 30 minutes of waking. Only 11% of smokers had ever tried to quit, and the primary reason for quitting among ex-smokers was health concerns. The survey also highlighted that smoking was more prevalent among men with lower educational achievements and showed no consistent association with employment or income. This prevalence is similar to that in other Western societies, indicating that tobacco-related health issues may significantly increase in the future.
Toçi et al. (2017) investigated smoking trends among Albanian adolescents between 2011 and 2015 using data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) surveys. They found a notable decrease in current smoking rates, from 13.3% in 2011 to 11.2% in 2015. The study identified significant predictors of smoking, including male gender, enrollment in private schools, class skipping, poor academic performance, easy access to cigarettes, and parental unawareness of students' weekend activities.
A study published in 2020 examined changes in tobacco smoking behavior in Albania between 2008–09 and 2017–18, using data from the Demographic and Health Surveys. It found that smoking likelihood decreased by 23% over this period, after accounting for socioeconomic and demographic factors. The study highlighted a strong association between tobacco use and alcohol consumption, with binge drinkers being 59% more likely to smoke than moderate drinkers. It also revealed significant differences in smoking patterns based on gender, income, and education. Specifically, smoking decreased with higher wealth and education among men, while among women, smoking increased with higher education but showed varied patterns with income.
The notably high prevalence of smoking among young women in Albania is a trend frequently observed in post-communist countries.

## Tobacco control policies

Albania's tobacco control framework encompasses a range of measures aimed at reducing smoking rates and mitigating health risks. This comprehensive approach includes smoke-free environments, advertising restrictions, health warnings, cessation support, and taxation. The effectiveness of these policies, however, has been mixed.
In Albania, legislation mandates that all enclosed public spaces, including offices, restaurants, cafés, bars, public transport, health care facilities, and educational institutions (excluding universities), must be smoke-free. Despite this, enforcement remains challenging due to limited resources and the lack of a formal complaint system. However, the introduction of smoke-free laws in 2014 has been notably effective, reducing smoking experimentation by 23%. This significant reduction is likely due to both the new smoke-free regulations and the cumulative impact of the tobacco control measures enacted in 2013 . To underscore the seriousness of enforcement, the government has imposed substantial fines on high-profile bars and restaurants for violations. These enforcement actions have been widely publicized through the media, reinforcing their deterrent effect.
Over the years, Albania has introduced several key laws to strengthen its tobacco control efforts. The 2001 law initially banned tobacco advertising on TV, radio, print media, and billboards, though enforcement was weak. The 2007 law expanded this prohibition to include all forms of tobacco advertising, promotion, and sponsorship on radio, TV, and print media, and established a minimum age for tobacco sales. Further measures were introduced with Law No. 8691 in 2013, which aimed to control informal tobacco production, sales, and advertising by nearly doubling the maximum fines. The subsequent Law No. 76/2014 added additional restrictions on tobacco use in indoor spaces, mandated educational programs about the health risks of tobacco on TV, and increased fines for violations of smoke-free regulations. Health warnings on tobacco packages are required to cover 50% of both the front and rear of the package, featuring 16 messages about the dangers of tobacco, written in the country’s principal languages. These warnings do not include graphic images or photographs.
A pack of cigarettes costs 200 Albanian Lek (ALL), approximately 1.93 USD, with taxes comprising 64.08% of the total price, including 16.67% VAT and 45.0% excise tax. Studies have found that cigarette pricing strongly affects smoking experimentation among teenagers. Specifically, for every 1 Albanian Lek increase in cigarette prices, smoking experimentation is expected to decrease by approximately 1.2%. A 10% price increase (14.6 Lek) would reduce the hazard of smoking experimentation by nearly 17%. The impact of price increases is more pronounced for females, with a 10% increase in price expected to reduce smoking likelihood by about 20% among females compared to 14% among males.
In terms of smoking cessation support, resources are available at some health clinics and primary care facilities, but the lack of a toll-free quit line and nicotine replacement therapies limits their reach and effectiveness.
The implementation of gender-sensitive interventions tailored to specific demographic groups, such as targeting lower-income men and educated, higher-income women differently, have been suggested to enhance the effectiveness of Albania's tobacco control policies.