ets finland edited final version sept 03

8/12/2019 Ets Finland Edited Final Version Sept 03

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Childrens Exposure to

Environmental Smoke / InvoluntarySmoking in Developing Countries:

Current Situation and Implications

for Health and Development

Enis Bar

andAyda A. Yrekli

World Bank,

Washington, D.C.


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Outline

Overview

Health effects

Determinants of ETS

Review of evidence on determinantsfrom developing countries

Estimation of exposure to ETS by level

of income and regionsRecommendations


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Determinants of ETS Exposure

The intensity of exposure

The number of smokers

The extent of cigarette consumption

The behavior of smokers

Legislation that restricts smoking inpublic and work places and its

enforcement.


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In Developing Countries

Same negative health effects

But of different magnitude due to variation in the relative importance of exposure

determinants, mostly smoking behavior

legislation

prevailing social norms and ecology, and

as a result of different health and socioeconomic impact

in terms of health consequences (nutrition, co-morbidity)

healthcare costs

absenteeism

societal response (tolerance, compliance, complacency, etc)


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Intensity of ExposureNumber of smokers around the globe

2000

Number of Smokers by Income Groups

17%11%

44%

27%

0

100

200

300

400

500

600

LI LMI UMI HI#ofsmoker

s,Million

1.2 billion smokers globally

83% of global smokers (956 million)

live in developing countries Prevalencerate (in 90s)

Male Female

Bangladesh 40 10

Turkey 59 26

Vietnam 73 4

Pakistan 36 9

China 63 4

Indonesia 63 2

Russia 63 14

Philippines 75 18

Egypt 43 5

Prevalence rate in selected

developing countries


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Intensity of ExposureGlobal Cigarette Consumption 2000

In 2000, 6.2 Trillion Cigarettes Smoked Worldwide.

Developing Countries Smoked 74% of Global Cigarette

Consumption (4.6 Trillion Cigarettes)

Global cigarette consumption

6260 billion pieces

26%

10%

44%

21%

0

500

1000

1500

2000

2500

3000

LI LMI UMI HI

Billi on of cigarettes and % share i n the globe

Consumption

(mil. pieces)

% global

share

LI 1295 21

LMI 2733 43

UMI 613 10

HI 1619 26

Total 6260 100

China 1688 27

India 947 15

LI w/o India 348 6

LMI w/o China 1045 17


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Intensity of Exposure

Daily SmokeDaily 11 to 21 sticks smoked by

smokers

Daily cigarette consumption per smoker in 2000

11

1412

21

0

5

10

15

20

25

LI LMI UMI HI


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Smokerssmoking behavior:

Evidence from Indonesia 1995National Health Survey 1995

# of Total HH 31,126,882

# of HH member 109,154,973

# of smoker 38,652,636# of smoker smoke

at home 36,888,636

Average

HH member 3.51

Smoker per HH 1.24Smoker smoke at home 1.18

# of cigarettes smoked/day 11

pieces

Estimated ETS Exposure% of smokers smoke at home 95.4%

Average non-smoker per household 2.26

% of HH members exposed to ETS 65%

Source: Authors estimate based on National Health Survey data, 1995


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Smokerssmoking behavior:

Evidence from Turkey

% of smokers who smoke at home and in front of

children in Ankara, Turkey

90%97%

87% 84%100%

63%

85%

60%49%

77%

Teachers Mothers Journalist Physicians Parliamentarians

At home Front of children

Source: Bilir, N et al. 1997. Smoking behavior and attitudes, Ankara, Turkey


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High ETS Exposure Among 13-15 Year Olds in

Selected Low and Low-middle Income

Countries

% children exposed % children exposed

LMI At

home

At public

places

At

home

At public

places

Indonesia 69 84 China 54 51

Philippines 58 75 India 59 67

Jordan 67 61 Nepal 36 47

Russia 55 73 Nigeria 34 50

Bolivia 46 62 Sri Lanka 56 68

Venezuela 44 48 Ukraine 49 72

Uruguay 64 79 Zimbabwe 35 58

Source: GYTS Survey Data, 1999-00-01


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Smoking restrictions in various

places

Countries HCFacilities

EducationFacilities

Buses Waitingareas

Entertainmentcenters

Shoppingcenters

China B B B B B B

Philippines N N N N N N

Thailand B D B D B B

Iran B B B B B B

Turkey D D D D D D

Poland D D N D D D

Indonesia B B D N N N

Nigeria B B B N N N

Malaysia B B B B B B

B: banned, N: None, D: Designated areas


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Source of Data

Nations: Prevalence rates

USDA: Cigarette consumption

WBI: Children and adult population

GYTS: ETS exposure among 13-15 y of age


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Percentage of 1.8 billion children

aged 0-14 years living in

developing countries, 2000

0-14 yrs old

population

(mil)

% share in

total pop.

% share in

global child

population

Low Income 842 37% 47%

Low Middle Income 628 27% 35%

Upper Middle Income 172 29% 10%

High Income 162 18% 9%

LI and LMI 1,471 32% 82%

All Developing 1,642 33% 91%

Developed 162 18% 9%

Total 1,805 31% 100%

Source: WBI and Authors calculation


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Children (0-14 years old ) and ETS exposureSelected countries with the highest child population

and ETS exposure, 2000

Total (0-14

age) child

pop. (Million)

% share in

global 0-14

age child

population

% of ETS Exposure 13-

15 years old students

Home Public

Places

India 340 18.9 59 67China 314 17.4 54 51

Indonesia 65 3.6 9 84

Pakistan 58 3.2 N/A N/A

Nigeria 57 3.2 34 50

Philippines 28 2.6 58 75

Vietnam 26 1.5 N/a N/a

Russia 26 1.4 55 73

Total 994 55 N/A N/A


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Top 10 countries w/highest child population

and ETS exposure

0-14 age

population

% share in

global 0-14

age

% of 13-15 age exposed to

ETS

Home Public

India 340 18.9 59 67

China 313 17.4 54 51

Indonesia 65 3.6 69 84

Pakistan 58 3.2 N/A N/ANigeria 57 3.2 34 50

Bangladesh 51 2.8 N/A N/A

Ethiopia 29 2.6 N/A N/A

Philippines 28 2.6 58 75

Vietnam 26 1.5 N/A N/A

Russia 26 1.4 55 73

Total 0-14 pop.(top 10) 944 55.0

Global 0-14 pop. 1805


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Over 900 million children living in

developing world were exposed to ETS

in 2000.

Source: World Bank Estimation

Number of Children (0-14 age) exposed to ETS at

home and public places, 2000

(Million)

461

365

99

925

379

371

84

834

LI

LMI

UMI

TOTAL

# exposed at public places # exposed at home


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Percentage of children 0-14y of age

exposed to ETS at home in developing

countries, 2000

Income

Groups

# of exposed

children at home

in developing

world (million)

% share

within

income

group

% share in

developing

world

% share

globally

LI 380 48% 23% 21%

LMI 371 55% 22% 20%

UMI 84 44% 5% 4%

Total 837 46%

Source: Authors calculation


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Percentage of children 0-14y of age

exposed to ETS in public places in

developing countries, 2000

Income

Groups

# of exposed

children in public

places in

developing world(million)

% share

within

income

group

% share in

developing

world

% share

globally

LI 461 59% 28% 26%

LMI 365 53% 21% 20%

UMI 99 57% 7% 6%

Total 925 51%

Authors calculation


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Top 10 UMI countries with the highestnumber of children exposed to ETS at

home and public placesRegion Country # of children

exposed to ETS

at home (mil)

# of children

exposed to ETS in

public places (mil)

LAC Brazil 25 32

LAC Mexico 17 21

ECA Turkey 12 11

AFRICA S. Africa 6 8

LAC Argentina 5 7

EAP Korea Rep. 5 6

ECA Poland 5 5

MENA S. Arabia 5 6

LAC Venezuela 4 5

EAP Malaysia 4 5


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Top 10 LMI countries with the highest

number of children exposed to ETS at


exposed to ETS

at home (mil)

# of children

exposed to ETS in

public places (mil)

EAP China 171.0 166.0

EAP Indonesia 35.2 34.2

SA Pakistan 32.2 21.9

MENA Iran 16.0 14.6

EAP Philippines 15.4 15.0

MENA Egypt 15.2 13.9

ECA Russia 14.4 18.9

EAP Thailand 8.8 8.6

MENA Morocco 6.7 6.1

MENA Iraq 6.5 5.9


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Top 10 LI countries with the highest

number of children exposed to ETS at


exposed to ETS

at home (mil)

# of children

exposed to ETS in

public places (mil)

SA India 199.0 227.8

SA Bangladesh 29.7 34.0

AFRICA Nigeria 18.4 27.6

EAP Vietnam 14.0 13.3

AFRICA Ethiopia 9.3 14.0

EAP Myanmar 8.5 8.1

AFRICA Congo Dem.Rep. 8.0 12.0

SA Afghanistan 6.8 7.7

MENA Yemen 5.9 3.6

SA Nepal 5.5 6.3


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Results

91% of global children aged 0-14 years live in

developing world.83% of global smokers (956 million) live in developing

countries.

In 2000, developing countries smoked 74% of global

cigarette consumption (4.6 trillion cigarettes).

Lower number of cigarettes smoked per capita.

Still high rate of ETS exposure at homes and public

places:

Over 800 million children are exposed to ETS at homes and

900 million in public places in developing countries.

Most smokers still smoke near non-smokers and/or in

front of children.


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Conclusion: Policy Implications

Implementation of Framework Convention onTobacco Control, including legislative initiativesinclusive of ETS;

Higher taxes, especially where price elasticity is

higher; andInvolvement of professional associations (teachers,doctors, police force), womens groups, athletes, etcto mobilize social elites to challenge and changeprevailing social norms and enforce existing laws andordinances.

More comprehensive public health action, bundledwith IAP and other initiatives.


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Conclusion: Research Implications

There is a need to:

Identify culture-specific determinants of ETSamenable to interventions, including risk perceptionand communication;

Pilot innovative programs involving role models

(teachers, mothers, athletes, etc.) and targetinghome environments;

Estimate ETS attributable burden of disease andhealth care costs in developing countries;

Document and cost non-health related effects ofETS, e.g. absenteeism from school, work, etc; and

Seek synergism with other development issues suchas IAP due to coal, biomass use, etc.

ets finland edited final version sept 03

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