BUFFALO, N.Y. - An international
survey of tobacco use in three billion individuals, published
in the current issue of The Lancet, demonstrates an urgent need for
policy change in low- and middle-income countries, according to the
University at Buffalo professor who led the research.
"Governments around the world need to start giving economic and
regulatory advantages to agricultural products that promote health
instead of to products like tobacco that kill people," says lead
author Gary A. Giovino, PhD, chair of the Department of Community
Health and Health Behavior at the University at Buffalo School of
Public Health and Health Professions.
Giovino is an international authority on tobacco use surveys; he
previously was chief of epidemiology in the Office on Smoking and
Health at the Centers for Disease Control and Prevention (CDC).
He describes the implications of the research in this video (http://www.youtube.com/watch?v=IXfYFz_hhXM).
The survey results, Giovino says, paint a disturbing picture of
global tobacco use influenced by powerful and manipulative
While 100 million lives were lost prematurely due to tobacco use
in the last century, the study notes that the World Health
Organization estimates that if current trends continue, the number
of preventable, premature deaths in this century will be far
"In the absence of effective actions, about one billion people
worldwide will die prematurely in the next century from tobacco
use," says Giovino, "and most of those deaths and the healthcare
and economic costs that come with them, will be borne by lower- and
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
"This is the largest tobacco use prevalence study ever reported
in the scientific literature," says co-author Samira Asma, DDS,
Chief of Global Tobacco Control, CDC.
The study 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
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
U.S. and UK were also included.
The research reveals:
-- 49 percent of men and 11 percent of women in the 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 instead of in
--while tobacco is consumed in various ways, from chewing
tobacco and snuff to waterpipes and hand-rolled bidis, most tobacco
users (64 percent) smoked manufactured cigarettes
-- China had the highest number of tobacco users at 301 million
people (including 52.9 per cent of men) followed by India, with 274
million people ( 47.9 percent of men).
-- Quit ratios were highest in the U.S. and the UK as well as in
Brazil and Uruguay, where tobacco control activities are strongest;
they were lowest in China, India, Russia and Egypt.
According to Giovino, 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
"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. "I find that mind-boggling."
The high consumption of manufactured cigarettes is also a direct
result of sophisticated technological manipulation, he says. "These
products are technologically designed to mask harshness, provide
particular taste sensations and increase nicotine delivery," the
That works not just to keep current smokers smoking but also to
make it more palatable for nonsmokers who are experimenting. "These
characteristics are designed to ease the transition from
experimentation to regular use, especially among young people,"
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 (http://www.who.int/tobacco/mpower/en/)
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.
The research was funded by Bloomberg Philanthropies' Initiative
to Reduce Tobacco Use, the Bill and Melinda Gates Foundation and
the Brazilian and Indian governments.
Co-authors with Giovino and Asma are Sara A. Mirza, PhD, Jason
Hsia, PhD, Jeremy Morton, and Krishna M. Palipudi, PhD of the CDC;
Jonathan M. Samet of the Institute for Global Health, University of
Southern California; Prakash C. Gupta, ScD, of the Healis-Sekhsaria
Institute for Public Health in Mumbai; Martin J. Jarvis of
University College London; Neeraj Bhala and Richard Peto of the
University of Oxford and Witold Zatonski, MD of the Maria
Sklodowska-Curie Memorial Cancer Center and Institute of Oncology,
Warsaw and the Institute of Rural Health, Lublin, Poland.