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Prevalence of tobacco use and purchase patterns in 14 low and middle income countries. Judy Kruger, PhD , Office on Smoking and Health, CDC, Atlanta, GA Jason Hsia, PhD , Global Tobacco Control, CDC, Atlanta, GA Glenda Blutcher-Nelson, MSc , Global Tobacco Control Branch, CDC, Atlanta, GA - PowerPoint PPT Presentation
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Prevalence of tobacco use and purchase patterns in 14 low and
middle income countries
Judy Kruger, PhD, Office on Smoking and Health, CDC, Atlanta, GA
Jason Hsia, PhD , Global Tobacco Control, CDC, Atlanta, GAGlenda Blutcher-Nelson, MSc , Global Tobacco Control Branch,
CDC, Atlanta, GASamira Asma, DDS MPH , Global Tobacco Control Branch, CDC,
Atlanta, GAon behalf of the GATS Collaborative Group
Presenter Disclosure
Judy Kruger
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose
• Overview of WHO FCTC and MPOWER• Purpose and methodology of Global Adult Tobacco Survey
(GATS)• Summary of findings• Conclusions
Outline
WHO FCTC: Tools
• WHO FCTC provides a foundation for countries to implement and manage tobacco control
• WHO’s MPOWER package assists country-level implementation of effective measures to reduce tobacco demand
Integrate tobacco surveillance programs into national, regional, and global health surveillance programs so that data are comparable and can be analyzed at the regional and international levels, as appropriate
WHO FCTC
MPOWER
Monitor tobacco use & prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about the dangers of tobacco Enforce bans on tobacco advertising, promotion &
sponsorship Raise taxes on tobacco
Global Tobacco Surveillance System
GPS
GPHSS GLOBAL HEALTH PROFESSIONS STUDENT SURVEY
GLOBAL SCHOOL PERSONNEL SURVEY
GYTS GLOBAL YOUTH TOBACCO SURVEY
GLOBAL ADULT TOBACCO SURVEYGATS
TQS TOBACCO QUESTIONS FOR SURVEYS
GATS Purpose and Procedures
GATS collects data on tobacco use and key tobacco control measures using a standardized global protocol in a nationally representative sample
Systematic procedures: Core questionnaire & optional questions Sampling design Series of manuals & guidelines Expert questionnaire review
GATS Methodology
Core questionnaire with optional questions Options for countries to add additional questions Face-to-face personal interview survey
• In-person interviews were obtained in the local language Electronic data collection using handheld devices
GATS Sample Design
Nationally representative household survey of persons aged 15 years and older
Multi-stage, geographically clustered sample design Household-based sampling Stratified for rural/urban, male/female
More Information on GATS
• Country Fact Sheets• Country Reports• GTSSDatahttp://nccd.cdc.gov/gtssdata/default/default.aspx
Purpose of the Study
We used data from the 2008-2010 Global Adult Tobacco Survey (GATS) to examine:
The prevalence of use of tobacco products, including both smoked and smokeless, and
The most common purchase locations for manufactured cigarettes
Standardized Questions “Do you currently smoke tobacco [use smokeless tobacco] on a
daily basis, less than daily, or not at all?”Current tobacco smoking is defined as daily or less than daily Current smokeless use is defined as daily or less than daily
“On average, how many [specific product named] do you use [per day/week]?”
- Manufactured cigarettes - Hand-rolled cigarettes - Bidis - Pipes full of tobacco
- Water pipe - Oral tobacco use- Nasal tobacco use
Current tobacco products use is defined as daily/weekly or less than daily/weekly
Standardized Questions• “The last time you purchased manufactured cigarettes for yourself,
where did you buy them?”
Current bidis or smokeless tobacco user is defined as daily/weekly or less than daily/weekly
• “The last time you purchased bidis [smokeless tobacco] for yourself, where did you buy them?”
Current manufactured cigarette smoker is defined as daily or less than daily
- Store - Street vendor- Kiosk - Other [vending machine, military store, duty-free
store, outside the country, Internet and from another person]
- Store - Street vendor- Kiosk
Data Analysis
Years surveyed: 2008-2010 14 countries: Bangladesh, Brazil, China, Egypt,
India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam
Overall sample size ranged from 69,296 (India) to 5,581 (Uruguay)
Overall response rates ranged from 65.1% (Poland) to 97.7% (Russia)
Percentages of Current Tobacco Smoking*
Source: Global Adult Tobacco Survey, 2008-2010
Men Women
BrazilIndia
MexicoUruguay
PolandEgypt
BangladeshThailandVietnam
TurkeyPhillippines
UrkraineChina
Russia
0 10 20 30 40 50 60 70
21.624.324.8
30.736.937.6
44.745.647.447.947.6
5052.9
60.2
EgyptVietnam
BangladeshChinaIndia
ThailandMexico
PhillippinesUrkraine
BrazilTurkey
UruguayRussiaPoland
0 10 20 30 40 50 60 70
0.51.41.52.42.93.1
7.89
11.313.1
15.219.8
21.724.4
* Current tobacco smoking is defined as daily or less than daily
Percentages of Current Smokeless Use*
Source: Global Adult Tobacco Survey, 2008-2010
Men Women
Uruguay
Mexico
Vietnam
Urkraine
Brazil
China
Poland
Russia
Thailand
Phillippines
Egypt
Bangladesh
India
0 5 10 15 20 25 30 35
0
0.3
0.3
0.5
0.6
0.7
1
1
1.3
2.7
4.1
26.4
32.9
China
Urkraine
Uruguay
Poland
Russia
Brazil
Egypt
Mexico
Phillippines
Vietnam
Thailand
India
Bangladesh
0 5 10 15 20 25 30
0
0
0
0.1
0.2
0.3
0.3
0.3
1.2
2.3
6.3
18.4
27.9
*Current smokeless use is defined as daily or less than daily
Percentages of Smoked Tobacco Products*
Source: Global Adult Tobacco Survey, 2008-2010
Russia
China
Bangla
desh
Brazil
Turk
ey
Poland
Ukrain
e
Urugu
ay
Mexico
Philipp
ines
Thail
and
Vietna
mEg
yptInd
ia0123456789
10
0.8 0.5 0.4 0.3 0.3 0.2 0.2 0.2 0.1 0.1 0.1 0.1 0 0
Pipes full of tobacco
Russia
Turke
y
Poland
Ukrain
e
Philipp
inesChin
a
Urugu
ay
Vietna
mEg
ypt
Mexico
Thail
andBraz
il
Bangla
desh
India
0
10
20
30
40
5038.5
30.128.728.5 27 26.721.319.516.315.6 15 14.314.1
5.2
Thail
and
Urugu
ayBraz
il
Poland
Turke
yChin
a
Philipp
inesInd
ia
Ukrain
e
Vietna
mRus
sia
Bangla
desh
Mexico
Egyp
t0
1020
304050
14.18.1 5.1 3 2.6 2.3 1.9 1.2 1.1 1.1 0.7 0.4 0.3 0.1
Vietna
mRus
siaEg
ypt
Turke
y
Ukrain
eInd
ia
Bangla
desh
China
Urugu
ay
Thail
and
Poland
Philipp
ines
Mexico
Brazil
0123456789
10
6.4
3.8 3.32.3 2.1
0.9 0.7 0.4 0.1 0 0 0 0 0
* Defined as current tobacco product user if they reported daily or less than daily/weekly
Manufactured cigarettes
Hand-rolled cigarettes
Water pipes
Bidis and Smokeless Products*
Source: Global Adult Tobacco Survey, Bangladesh (2009) and India (2009-2010)
Smokeless Product UseBidis Use• 11.2%
Bangladesh• 9.2% India
• 26.8% Bangladesh• 23.3% India
*Current bidis or smokeless tobacco products use is defined as daily/weekly or less than daily/weekly
Source of Last Manufactured Cigarettes* Purchased in Percent
Source: Global Adult Tobacco Survey, 2008-2010
0102030405060708090
100 99.1 98.792.5 91.8
86.576.5
68 66.662.4 59.9
52 50.6
27.9 24.3
Store
*Current manufactured cigarette smoker is defined as daily or less than daily
Source of Last Manufactured Cigarettes* Purchased in Percent
Source: Global Adult Tobacco Survey, 2008-2010
Vietna
mInd
ia
Russia
Thail
and
Urkrai
ne
Mexico
Urugu
ayBraz
ilChin
a
Phillip
pines
Bangla
desh
Turke
y0
10
20
30
40
50
60
70
80
90
100
35.7
16.59.5 7.4
3 2.8 2.5 2.4 1.3 0.7 0.5 0.5
Street vendor
*Current manufactured cigarette smoker is defined as daily or less than daily
Source of Last Manufactured Cigarettes* Purchased in Percent
Source: Global Adult Tobacco Survey, 2008-2010
Poland
India
Urkrai
ne
Urugu
ay
Russia
Egyp
t
Turke
yBraz
il
Vietna
mMex
ico
Phillip
pines
0102030405060708090
100
40.9
30.3 26.8 25.719.3
13.35.8
1.5 1.4 0.4 0
Kiosk
*Current manufactured cigarette smoker is defined as daily or less than daily
Source of Last Bidis* Purchased in Percent
Source: Global Adult Tobacco Survey, India (2009-2010)
Store
Kiosk
Street vendor
Not reported
0 10 20 30 40 50 60 70 80 90 100
48.4
39.4
11.4
0.5
*Current bidis tobacco user is defined as daily/weekly or less than daily/weekly
India
Source of Last Smokeless* Purchased in Percent
Source: Global Adult Tobacco Survey, India (2009-2010)
Store
Kiosk
Street vendor
Not reported
0 10 20 30 40 50 60 70 80 90 100
54.7
31.9
10.4
3 India
*Current smokeless tobacco user is defined as daily/weekly or less than daily/weekly
Key Study Findings
Current tobacco smoking and smokeless use is more common in men than women
Smoked tobacco product use varied in prevalence across the 14 countries and the most common are: manufactured cigarettes, waterpipes, hand-rolled cigarettes and pipes full of tobacco
Oral smokeless tobacco is more common than nasal smokeless tobacco
Note: Includes 14 GATS countries (Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, Viet Nam)
Source: Global Adult Tobacco Survey, 2008-2010
Key Study Findings Continued
The most common purchase locations for manufactured cigarettes was stores, followed by kiosks, street vendors, and ‘some other location’
The most common purchase locations for bidis and smokeless products was stores, followed by kiosks, and street vendors in India
Note: Includes 14 GATS countries (Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, Viet Nam)
Source: Global Adult Tobacco Survey, 2008-2010
Discussion
More research is needed on the use of emerging tobacco products
Information about tobacco use patterns and availability can help guide tobacco control policy
Identification of location of purchase is useful to inform intervention targets
Conclusions
Monitoring tobacco use and prevention policies supports WHO FCTC
Assessment of purchase pattern locations can assist countries implement community-based tobacco control policies
Tobacco use assessment assists country-level implementation of effective measures to reduce the worldwide burden of tobacco use
Supports public and policy actions Encourages change in social norms
Additional Information is available on the website www.cdc.gov/tobacco/global
Thank you!Judy Kruger
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health PromotionOffice on Smoking and Health