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TOBACCO USE IN 3 BILLION INDIVIDUALS FROM 16 COUNTRIES

The Lancet, Volume 380, Issue 9842, Pages 668 - 679, 18 August 2012

Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys

Prof Gary A Giovino PhD a , Sara A Mirza PhD b, Prof Jonathan M Samet MD c, Prakash C Gupta ScD d, Prof Martin J Jarvis DSc e, Neeraj Bhala MRCP f, Prof Richard Peto MSc f, Prof Witold Zatonski MD g h, Jason Hsia PhD b, Jeremy Morton MS b, Krishna M Palipudi PhD b, Samira Asma DDS b, for The GATS Collaborative Group †

Summary below; full text is at http://download.thelancet.com/pdfs/journals/lancet/PIIS014067361261085X.pdf

Background

Despite the high global burden of diseases caused by tobacco, valid and comparable prevalence data for patterns of adult tobacco use and factors influencing use are absent for many low-income and middle-income countries. We assess these patterns through analysis of data from the Global Adult Tobacco Survey (GATS).

Methods

Between Oct 1, 2008, and March 15, 2010, GATS used nationally representative household surveys with comparable methods to obtain relevant information from individuals aged 15 years or older in 14 low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam). We compared weighted point estimates and 95% CIs of tobacco use between these 14 countries and with data from the 2008 UK General Lifestyle Survey and the 2006—07 US Tobacco Use Supplement to the Current Population Survey. All these surveys had cross-sectional study designs.

Findings

In countries participating in GATS, 48·6% (95% CI 47·6—49·6) of men and 11·3% (10·7—12·0) of women were tobacco users. 40·7% of men (ranging from 21·6% in Brazil to 60·2% in Russia) and 5·0% of women (0·5% in Egypt to 24·4% in Poland) in GATS countries smoked a tobacco product. Manufactured cigarettes were favoured by most smokers (82%) overall, but smokeless tobacco and bidis were commonly used in India and Bangladesh. For individuals who had ever smoked daily, women aged 55—64 years at the time of the survey began smoking at an older age than did equivalently aged men in most GATS countries. However, those individuals who had ever smoked daily and were aged 25—34-years when surveyed started to do so at much the same age in both sexes. Quit ratios were very low (<20% overall) in China, India, Russia, Egypt, and Bangladesh.

Interpretation

The first wave of GATS showed high rates of smoking in men, early initiation of smoking in women, and low quit ratios, reinforcing the view that efforts to prevent initiation and promote cessation of tobacco use are needed to reduce associated morbidity and mortality.

Funding

Bloomberg Philanthropies' Initiative to Reduce Tobacco Use, Bill and Melinda Gates Foundation, Brazilian and Indian Governments.

a Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA

b Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA

c Department of Preventive Medicine, Keck School of Medicine, Institute for Global Health, University of Southern California, Los Angeles, CA, USA

d Healis-Sekhsaria Institute for Public Health, CBD Belapur Navi Mumbai, India

e Department of Epidemiology and Public Health, University College London, London, UK

f Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK

g Department of Cancer Epidemiology and Prevention, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland

h European Health Inequalities Observatory, Institute of Rural Health, Lublin, Poland

Correspondence to: Prof Gary A Giovino, Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, 310 Kimball Tower, Buffalo, NY 14214-8028, USA

† Members listed in the appendix