Largest-Ever Survey on Global Tobacco Use Issues Dire Warnings

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Nearly half of all men and more than 1 in 10 women use tobacco in many developing countries, and women are starting to smoke at earlier ages, according to the largest survey to date on international tobacco use. If current trends continue, warns the World Health Organization (WHO), tobacco could kill a billion people around the world in this century.

The authors of the new study say the numbers call for urgent changes in tobacco policy and regulation in developing nations. While tobacco use is declining in industrialized countries, it remains strong — or is even increasing — in low- and middle-income countries, a trend the authors attribute to powerful pro-tobacco forces worldwide.

“Our data reflect industry efforts to promote tobacco use,” said lead study author Gary Giovino of the School of Public Health and Health Professions at the University at Buffalo in New York, in the statement. “These include marketing and mass media campaigns by companies that make smoking seem glamorous, especially for women. The industry’s marketing efforts also equate tobacco use with Western themes, such as freedom and gender equality.”

(MORE: Teens and Tobacco Use: Why Declines in Youth Have Stalled)

The study, the Global Adult Tobacco Survey (GATS), looked at smoking trends among people ages 15 and older from 16 countries, estimating that there are 852 million tobacco users in these countries. GATS targeted 14 low- and middle-income countries — Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam — and also included data from the United States and the United Kingdom for comparison.

Nationally representative surveys were conducted during face-to-face interviews with 248,452 participants in the GATS countries in 2008-10. Data from the U.K. and the U.S. came from the U.K. General Lifestyle Survey and U.S. Tobacco Use Supplement to the Current Population Survey, respectively, which had a total of 188,895 respondents. The researchers’ extensive sampling was enough to estimate tobacco use among 3 billion people.

Most tobacco users smoke cigarettes: 41% of men and 5% of women, but other popular forms of tobacco include cigars, chewing tobacco and water pipes. Already, nearly 6 million people die from tobacco-related causes each year, according to WHO. Other key findings from the study:

  • About 49% of men and 11% of women in GATS countries used tobacco (smoked, smokeless or both)
  • Although women’s tobacco use rates remain low, women are beginning to smoke as early as men, around age 17
  • Countries with the highest number of quitters were the U.S. and the U.K., as well as Brazil and Uruguay, “where tobacco control activities are strongest.”
  • Quit rates were lowest in China, India, Russia and Egypt. “In India and Bangladesh, smokeless tobacco use is very high and oral cancer rates are among the highest in the world,” says Giovino.

(PHOTOS: Cigarette Warnings Around the World)

China had the largest number of tobacco users overall, at 301 million people, followed by India, with 274 million. The problem is lack of anti-tobacco regulations. “China National Tobacco, for example, which is owned by the Chinese government, sponsors dozens of elementary schools, where students are subjected to pro-tobacco propaganda. Some messages even equate tobacco use with academic success,” said Giovino.

Smoking rates were highest in Russia, however, where 60% of men and 22% of women use tobacco; by comparison, 53% of men and 2% of women in China use tobacco. Tobacco use rates were also high in Ukraine (50% of men, 11% of women) and Turkey (48% of men, 15% of women). “In countries like Russia, Ukraine, and Turkey, use among adolescents and young adults is very high and indicates a public health crisis in their future unless effective action is taken to reduce use,” says Giovino.

In some countries the rates are rising. CNN reported:

“One place where we know it’s gone up, unfortunately, is Egypt — as a result of the revolution,” said Edouard Tursan D’Espaignet of WHO”s tobacco control program.

The GATS study found 38% of men and less than 1% of women smoked in Egypt as of 2010.

However, government regulations limiting smoking in certain places fell apart after Hosni Mubarak’s regime was ousted last year, and “the tobacco industry walked in very, very aggressively” to market its product amid the chaos, said Tursan D’Espaignet.

“We are hearing things like ‘Smoking is a way to show you’re free from the previous regime,'” he said.

(MORE: How Much Weight Will You Gain After You Quit Smoking?)

Tobacco company marketing is a central part of the problem, say the study authors. In poorer countries, pro-tobacco forces can spend a lot more money than their tobacco-control counterparts.

In richer countries like the U.S., in contrast, tobacco use has been declining: currently, about 19% of adults smoke. Smoking among teens has also been dropping, but the rate of decline has recently stalled, as states cut funding for tobacco-control programs.

And while cigarette consumption fell 33% in the U.S. over the previous decade, there was a corresponding 123% increase in the consumption of other smokable tobacco, like pipes and cigars, including among teens. Why? They’re cheaper. “The U.S. industry is expanding to promote use of other tobacco products such as snuff and cigars — many of these are flavored,” says Giovino.

(MORE: Cigarette Smokers Switch to Cigars and Pipes to Save Money)

Some countries are making huge strides in getting people to quit. In Australia, for example, the country’s High Court upheld a ruling this week barring company logos from appearing on cigarette packs; starting in December, cigarette boxes will come in plain packaging emblazoned with grim health warnings and disturbing photos of the health effects of smoking. The country is urging other governments to adopt the same policy.

To solve high tobacco consumption worldwide, Giovino says three groups that need to be held accountable: the tobacco industry; governments, which can choose to regulate tobacco or not; and consumers.

“All three have a role to play in changing the trends, but experience tells us that the interplay between pro-tobacco and anti-tobacco forces is what determines trends in tobacco use,” says Giovino. “So we want to reduce the pro-tobacco forces and increase anti-tobacco forces.”

Proven ways to reduce smoking rates include enforcing tobacco advertising bans, raising the price of tobacco products, helping smokers quit and protecting people from secondhand smoke, and raising awareness about the hazards of smoking by using warning labels and increasing public education campaigns.

The study was published in the British medical journal The Lancet.

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18 comments
JohnDavidson
JohnDavidson

JOINT STATEMENT ON THE RE-ASSESSMENT OF THE TOXICOLOGICAL TESTING OF TOBACCO PRODUCTS" 7 October, the COT meeting on 26 October and the COC meeting on 18 November 2004.

http://cot.food.gov.uk/pdfs/cotstatementtobacco0409

"5. The Committees commented that tobacco smoke was a highly complex chemical mixture and that the causative agents for smoke induced diseases (such as cardiovascular disease, cancer, effects on reproduction and on offspring) was unknown. The mechanisms by which tobacco induced adverse effects were not established. The best information related to tobacco smoke - induced lung cancer, but even in this instance a detailed mechanism was not available. The Committees therefore agreed that on the basis of current knowledge it would be very difficult to identify a toxicological testing strategy or a biomonitoring approach for use in volunteer studies with smokers where the end-points determined or biomarkers measured were predictive of the overall burden of tobacco-induced adverse disease."

In other words ... our first hand smoke theory is so lame we can't even design a bogus lab experiment to prove it. In fact ... we don't even know how tobacco does all of the magical things we claim it does.

The greatest threat to the second hand theory is the weakness of the first hand theory.

Drew Hadz
Drew Hadz

Again people should be aware that nicotine by itself as in an electronic cigarette is mostly safe barring overdose... nicotine IS very toxic but in small amounts it is about as bad as caffeine. Many drugs used in medicine are measured in very small doses because they too are very toxic but in these small doses are safe.

E-cigs should be promoted a bit better but the FDA is attacking them with bad science including a chemical only found in a single of the 16 cartridges they tested being labeled a common poison found in all E-cigs. Im not sure what to think of the bad science here but the point is that nicotine removed from tobacco is many hundreds of times less harmful

Guest
Guest

 I never smoke. At the same time my elder sister husband smokes for the

past several years and he seemed to be hale and healthy. He never even

cough. If according to medical theory the rate at which he smoke, he

should have got serious ailments. But, he not even has BP or Sugar etc.,

Puzzles me a lot. More over he is also an alcohol abuser. Only thing

about him was he's too money greedy and lives happily with wife's income

as she's a Dentist at Wollongong. Also he gives all troubles to the

elders in the family. Never goes to work. So, according to me, medical

theory is wrong regarding smoking habit, coz I see such live example

which were quite different.

alkalitta
alkalitta

the high price of getting sick

f_galton
f_galton

Smoking is fun and relaxing. If you don't want to smoke, don't smoke, but don't interfere with my right to choose.

Kumar Vjy
Kumar Vjy

·      

Tabacco in any from Result high suffering Death

‘TAKE  A OATH TODAY 

TO MAKE YOURSELF FREE FROM TABACCO FOR LIFELONG”.

Kumar Vjy
Kumar Vjy

·      

Tabacco in any from Result high suffering Death

‘TAKE  A OATH TODAY 

TO MAKE YOURSELF FREE FROM TABACCO FOR LIFELONG”.

Chanakya Ch
Chanakya Ch

Smoking is bad for the smoker and society around him. No doubt about it. But why project possible deaths ? We have more people being killed on account of various reasons like Gun licence, terrorism, accidents etc., apart from various health related and non tobacco related factors. 

Sonny Blaise
Sonny Blaise

Alexandra, how much money are American tobacco companies spending in their foreign marketing, and how has that number changed over the course of the past two decades as the domestic U.S. market has declined for them?

BIll W
BIll W

Jordan, nicotine is not any more dangerous than caffeine as used normally by tobacco users. Now lets talk about the second hand smoke your car is putting out... 

alkalitta
alkalitta

my cars don't smoke.

but yah Bill keep sucking on them until you cough up pieces of your lungs

Kim Far
Kim Far

 Hey how about this: All these people want to make it so we have to quit smoking. Well you just cant make something i have been doing illegal. But: you can make a certain date where if your not born before it you cant do it. How about if you were born after 2013 your Not Allowed To Smoke. Simple as that. Then over time all the butt holes that dont like smoking will be happy

Invidia
Invidia

Last time I checked caffeine doesn't cause cancer, nor does it come packaged with hundreds of harmful chemicals.  

According to wikipedia: "The risk of dying from lung cancer before age 85 is 22.1% for a male smoker and 11.9% for a female smoker.... The corresponding estimates for lifelong nonsmokers are a 1.1% and a 0.8%."

Kim Far
Kim Far

 you trust wikipedia?! You should know not to trust the internet more then 50% I can go and change wikipedia and make it say what ever the hell i want. Hey go check it now it says smoking around children is one of the best things to do, are you going to listen now?

and i take my cigarette's away from the main doors of buildings and where people are going to be walking

W. Jones Jordan
W. Jones Jordan

The active ingredient of the tobacco leaf is nicotine, a substance far more toxic than cocaine: less than an ounce of nicotine can kill an adult in a matter of minutes and tobacco is without any doubt the drug with the greatest impact on American health. In 1990 about 400,000 American deaths were attributed to tobacco, a number about eight times as many people as died from all the illegal drugs put together. Tobacco remains legal only because it has always been profitable; it was the first important American export: “Fun, exciting, and wildly addictive, tobacco was an in­stant hit around the globe….”

--from Mental Health Business, the Alliance of Psychiatry, Drug Makers amp;Congress.

Kim Far
Kim Far

 Dude under an ounce of cocaine can kill you in minutes.  your death stats are 22 years old... so your numbers of 400k need to be changed, you just used that year to make your article commit look more "bigger and intellectual". Iam only hating on you because you are discriminating against me. You ever heard on MLK and the days when people had to go to the back of the bus? Well if you guys keep it up we are filling a suit of public discrimination. Because your banning us from going places, calling us names and and treating us like segregation.  Have fun W.Jones

W. Jones Jordan
W. Jones Jordan

I'm  not sure I understand what you're saying, but I'm sorry to have offended you. If you have figures on the LD50 of nicotine and cocaine, I would greatly appreciate having them.