Tobacco Use and Tobacco-Related Behaviors - 11 Countries, 2008-2017

Abstract

Each year, tobacco use is responsible for approximately 8 million deaths worldwide, including 7 million deaths among persons who use tobacco and 1.2 million deaths among nonsmokers exposed to secondhand smoke (SHS) (1). Approximately 80% of the 1.1 billion persons who smoke tobacco worldwide reside in low- and middle-income countries (2,3). The World Health Organization's (WHO's) Framework Convention on Tobacco Control (FCTC) provides the foundation for countries to implement and manage tobacco control through the MPOWER policy package,* which includes monitoring tobacco use, protecting persons from SHS, warning them about the danger of tobacco, and enforcing bans on tobacco advertising, promotion, or sponsorship (tobacco advertising) (4). CDC analyzed data from 11 countries that completed two or more rounds of the Global Adult Tobacco Survey (GATS) during 2008-2017. Tobacco use and tobacco-related behaviors that were assessed included current tobacco use, SHS exposure, thinking about quitting because of warning labels, and exposure to tobacco advertising. Across the assessed countries, the estimated percentage change in tobacco use from the first round to the most recent round ranged from -21.5% in Russia to 1.1% in Turkey. Estimated percentage change in SHS exposure ranged from -71.5% in Turkey to 72.9% in Thailand. Estimated percentage change in thinking about quitting because of warning labels ranged from 77.4% in India to -33.0% in Turkey. Estimated percentage change in exposure to tobacco advertising ranged from -66.1% in Russia to 44.2% in Thailand. Continued implementation and enforcement of proven tobacco control interventions and strategies at the country level, as outlined in MPOWER, can help reduce tobacco-related morbidity and mortality worldwide (3,5,6).

FIGURE 1

Estimated prevalence of current tobacco use, secondhand smoke exposure, thinking about quitting because of warning labels, and exposure to tobacco advertisements, promotions, or sponsorships among persons aged ≥15 years — Global Adult Tobacco Survey, Turkey, 2008, 2012, and 2016^,, * For current tobacco use, secondhand smoke exposure, and thinking about quitting because of warning labels, between surveys in 2008 and 2012, prevalence estimates with p-values <0.05 were considered statistically significant. ^† For current tobacco use, secondhand smoke exposure, and thinking about quitting because of warning labels, between surveys in 2012 and 2016, prevalence estimates with p-values <0.05 were considered statistically significant. ^§ For secondhand smoke exposure, thinking about quitting because of warning labels, and exposure to tobacco advertisements, promotions, or sponsorships, between surveys in 2008 and 2016, prevalence estimates with p-values <0.05 were considered statistically significant.

FIGURE 2

Estimated change in current tobacco use^, prevalence among persons aged ≥15 years — Global Adult Tobacco Survey (GATS), 11 countries,^,, 2008–2017 * Current tobacco use is defined as either smoking tobacco or using smokeless tobacco either “every day” or “some days.” ^† Percentage change is calculated as [(t2-t1)/t1] x 100 where t1 is the prevalence reported during the first round of GATS and t2 is the prevalence reported during the most recent round. ^§ Statistically significant change (p<0.05) was noted for Bangladesh, Brazil, India, Philippines, Russia, Ukraine, and Uruguay. ^¶ In the most recent round of GATS, Russia and Ukraine did not cover certain geographic areas that were covered in the baseline round. ** In 2008, Brazil completed one round of GATS and, in 2013, integrated GATS into its national health survey conducted among adults aged ≥18 years. Thus, Brazil’s data across time compares results for adults aged ≥18 years.