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.”

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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.

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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.

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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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