Researchers involved with an international study of tobacco use in three billion individuals say the findings point to an urgent need for policy change in low- and middle-income countries. The [removed]study[/removed] appears in The Lancet.

Published in a special issue on respiratory medicine, the findings are from the Global Adult Tobacco Survey, (GATS). GATS was created by major national and international health agencies to improve the ability of countries to design, implement and evaluate anti-tobacco efforts.

The survey focused on 14 low- and middle-income GATS countries (Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam), making comparisons with the United States and the United Kingdom.

The nationally representative surveys were conducted in GATS countries from 2008 to 2010, via face-to-face interviews with 248,452 respondents. Data on another 188,895 respondents from the United States and United Kingdom were also included.

The researchers found that 49% of men and 11% of women in the GATS countries used tobacco (smoked, smokeless, or both). While women’s tobacco rates remain low, women are beginning to smoke as early as men—around age 17 instead of in their 20s.

China had the highest number of tobacco users at 301 million people (including 52.9% of men) followed by India, with 274 million people (47.9% of men). Quit ratios were highest in the United States and the United Kingdom as well as in Brazil and Uruguay, where tobacco control activities are strongest. The researchers found that quit ratios were lowest in China, India, Russia, and Egypt.

While tobacco is consumed in various ways, from chewing tobacco to snuff to waterpipes and hand-rolled bidis, the findings show that most tobacco users (64%) smoked manufactured cigarettes.

According to Gary A. Giovino, PhD, lead author of the study and chair of the department of community health and health behavior at the University at Buffalo School of Public Health and Health Professions, the magnitude of global tobacco use revealed in the current study reflects powerful pro-tobacco forces that often overpower the less well-funded tobacco control strategies.

“Our data reflect industry efforts to promote tobacco use,” he says. “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.”

Industry efforts also influence governments to back off of anti-tobacco regulations, he says, adding that in some countries the government owns the tobacco industry. “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,” says Giovino, who previously served as chief of epidemiology in the Office on Smoking and Health at the Centers for Disease Control and Prevention (CDC). “I find that mind-boggling.”

What is needed, he says, is the deliberate allocation of more resources to fully implement tobacco control strategies, such as the MPOWER strategies of the World Health Organization that monitor tobacco use, protect nonsmokers, offer help with quitting, warn people about the dangers of tobacco use via large, graphic warning labels on tobacco packages and hard-hitting mass media campaigns, enforce advertising restrictions, and raise taxes on tobacco products.

In addition, Giovino says governments need to give economic and regulatory advantages to agricultural products that promote health instead of to products like tobacco that kill people.

Source: University of Buffalo