Tobacco may kill 1 billion in next century

U. BUFFALO (US) — An international survey of tobacco use shows there is an urgent need for policy change in low- and middle-income countries.

Published in the journal The Lancet, the findings paint a disturbing picture of global tobacco use influenced by powerful and manipulative pro-tobacco forces, says lead author Gary A. Giovino, chair of Community Health and Health Behavior at the University at Buffalo School of Public Health and Health Professions.

“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.”


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 greater.

“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 health care and economic costs that come with them, will be borne by lower- and middle-income countries.”

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

“This is the largest tobacco use prevalence study ever reported in the scientific literature,” says co-author Samira Asma,  Chief of Global Tobacco Control at the CDC.

The study surveyed 3 billion people in 14 low- and middle-income 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 countries from 2008 to 2010, via face-to-face interviews with 248,452 respondents.  Data on another 188,895 respondents from the US and UK were also included.

Among the research findings:

  • 49 percent of men and 11 percent of women in the GATS countries used tobacco (smoked, smokeless, or both)
  • While women’s tobacco use rates remain low, women are beginning to smoke as early as men, around age 17 instead of in their 20s
  • 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 US 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

Promotion and design

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. “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 paper states.

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,” Giovino says.

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.

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).

Researchers from the University of Southern California and University College London contributed to the study, which was funded by Bloomberg Philanthropies’ Initiative to Reduce Tobacco Use, the Bill and Melinda Gates Foundation, and the Brazilian and Indian governments.

Source: University at Buffalo