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Tobacco Use and Its Impact on Health

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Tobacco Use and Its Impact on Health Tobacco Use and Its Impact on Health Gender, Women, and the Tobacco Epidemic 3. Prevalence of women. For this reason, much of the available prevalence data focuses on cigarette smoking. However, in some Tobacco Use countries, e.g. India and Indonesia, chewing tobacco and Factors and other smoked products (e.g. bidis, kreteks, and water pipes) are used by many women. We use case-studies of Infl uencing Initiation particular countries to highlight women’s use of smokeless and Maintenance tobacco and other tobacco products. Th e predominance of examples of initiation and maintenance in industrialized Among Women countries is not deliberate but is a refl ection of the more limited research in developing countries. Th e types Introduction of infl uences and their importance in shaping youth behaviour in the industrialized world are likely to diff er from those in developing countries, depending on Tobacco consumption has fallen substantially over the social and cultural norms, socioeconomic conditions, past 30 years in many industrialized countries as a result of and the political context of a country. Where available, increasing awareness of the hazards of tobacco use and the representative studies from developing countries are used implementation of aggressive and eff ective tobacco control in this chapter to highlight potential similarities and policies. In contrast, over the same time period, tobacco diff erences in factors that infl uence young people to take consumption has been increasing in the developing world; up smoking. developing nations now consume the greatest share of the world’s cigarette production.1 Just as global tobacco consumption is shifting between industrialized and Prevalence and Trends developing countries, the tobacco pandemic is spreading to women in a variety of settings. Historically, smoking Prevalence of Smoking by women in industrialized countries increased during the last century, lagging behind the rise in men by about 20 to 30 years.2 Th is rise among women can be attributed In 2006, more than 1 billion smokers in the world to weakening social, cultural, and political constraints, consumed about 5.7 trillion cigarettes.1,6 An additional coupled with women’s earning power and targeted 700 billion bidis are consumed annually in India alone.7 marketing by tobacco companies. Today, the prevalence Th ere is wide variation in smoking prevalence among both of smoking among women in some countries remains males and females from one region to another. Globally, high, while surveillance data from other countries provide the prevalence of smoking is higher for men (40% in warning of increasing use among youth, particularly girls. 2006) than for women (nearly 9% in 2006), and males account for 80% of all smokers (nearly 1 billion).* Th is chapter discusses the prevalence of tobacco use among women and girls and explores the factors that Table 3.1 provides regional estimates of smoking infl uence the initiation and maintenance of their tobacco prevalence in 2006. In the Americas and Europe, the use. Th e factors that motivate women to continue smoking prevalence of female smoking is high, around 17% and are quite diff erent from those that encourage young 22%, respectively. Th e disparity between male and female girls to start. Factors driving initiation are complex and smoking prevalence is greater in other regions of the varied,3 not only between industrialized and developing world. For example, male smoking prevalence is near 37% countries, but also between diff erent groups within a in South-East Asia and 57% in the Western Pacifi c, while country. Maintenance of tobacco use results from nicotine prevalence among women is around 4% to 5%. Th ese addiction, lack of awareness of risk, and diffi culty in patterns refl ect diff ering social norms, cultural traditions, quitting, which is driven by diverse psychosocial and environmental factors, as well as dependence.4,5 * Unpublished data elaborated by the World Health Organization Tobacco Free Initiative (WHO TFI), based on WHO Report on the Global Tobacco In many countries, manufactured cigarettes are the Epidemic, 2009: Implementing Smoke-Free Environments. Geneva, World predominant form of tobacco used by both men and Health Organization, 2009. 29 Gender, Women, and the Tobacco Epidemic: 3. Prevalence of Tobacco Use and Factors Influencing Initiation and Maintenance Among Women and demographic factors. Socioeconomic influences must data may be affected by some underreporting of smoking also be considered.8 among women, particularly in countries where it is socially and culturally unacceptable for women to smoke. Recent global estimates of smoking prevalence by age group are limited. The trends in smoking prevalence by age are A generally consistent finding is that rates of both always dynamic and reflect a combination of age, period, and daily and current smoking are higher among men than cohort effects. In most settings, smoking initiation usually among women, as shown in Table 3.3. However, there is occurs during adolescence, and prevalence increases until considerable variation among countries. In some countries, early or middle adulthood, beyond which smoking declines such as the United States and the United Kingdom, the with age. This decline with age reflects the cumulative impact rates among men and among women are nearly equal, of smokers quitting and smokers dying prematurely over time. and in some, such as Sweden, the rates among women Trends by age within a country are based on changes in the are even higher than those among men. In some Asian rate and age of initiation and patterns of smoking cessation, countries, only a small percentage of women smoke, while which change over time as a result of the interplay between the majority of men are smokers. These differences reflect pro-tobacco and anti-tobacco forces. different stages of the smoking epidemic in each country,2 as well as the influence of social norms, cultural traditions, In addition to differences in prevalence by gender and and socioeconomic and demographic factors. age group, there is significant variation by income status. As seen in Table 3.2, the majority of the world’s smokers In addition to the generally lower prevalence of smoking (81%) are in low- and middle-income countries. Smoking among women, women tend to smoke fewer cigarettes prevalence among males in middle-income countries (45%) per day than men. Table 3.4 presents estimates of the is higher than that among males in high-income countries number of cigarettes smoked per day by male and female (32%), while the reverse is true for females (7% in middle- smokers in a sample of countries. These data are compiled income countries and 18% in high-income countries). These from various sources, using different survey designs and Table 3.1. Smoking Prevalence and Number of Smokers Among Adults (Age 15 and Older), by WHO Region and Gender, 2006a b Total Smoking Prevalence (%) % of All Smokers WHO Region Smokersb Male Female Overall (millions) African Region (AFR) 16 2 9 41 4 Region of the Americas (AMR) 27 17 22 145 12 Eastern Mediterranean Region (EMR) 30 4 17 60 5 European Region (EUR) 44 22 32 238 21 South-East Asia Region (SEAR) 37 4 21 248 21 Western Pacific Region (WPR) 57 5 31 430 37 World / Total 40 9 24 1 164 100 Source: Based on WHO Report on the Global Tobacco Epidemic, 2009: Implementing Smoke-Free Environments. Geneva, World Health Organization, 2009. a These estimates are not age-standardized (i.e. the effects of the underlying age structures across countries are not removed) and should be used with caution when making comparisons of smoking prevalence across regions. For this reason, these estimates differ to those published in WHO’s World Health Statistics Report, 2010. b All estimates have been rounded off. 30 Gender, Women, and the Tobacco Epidemic: 3. Prevalence of Tobacco Use and Factors Influencing Initiation and Maintenance Among Women smoking definitions, but they indicate the differences in GYTS was conducted from 2000 to 2007.22 The potential smoking behaviour between men and women. increase in female youth smoking raises great concern for the future burden of tobacco use and tobacco-related Differences in smoking prevalence between young disease among women. male and female smokers are less evident. Data from the Global Youth Tobacco Survey (GYTS) for 13- to 15-year- old students suggest a similar pattern of smoking among Trends in Smoking Prevalence boys and girls in many areas of the world. Table 3.5 shows the prevalence of cigarette and other tobacco-product use Fortunately, tobacco consumption has fallen over by sex and region. The GYTS data presented include 29 the past several decades in many industrialized coun- Member States in AFR (19 national and 10 subnational); tries. Consumption among men peaked around 1970 in 34 Member States and four territories in AMR (25 national many countries, but patterns over time among women and 13 subnational); 21 Member States and two geograph- have been more variable. In the United States, the preva- ical regions in EMR (17 national and six subnational); 28 lence of smoking increased steadily between the 1930s Member States and one United Nations administered and 1964, when more than 40% of all adult Americans province in EUR (28 national and one subnational); 10 smoked.23 Since then, smoking prevalence has decreased, Member States in SEAR (eight national and two subna- and it dropped below 20% in 2007 (22% in men, 17% tional); and 18 Member States, two
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