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

jkruger@cdc.gov

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