Samira Asma

Tobacco use by youth: a surveillance report from the Global Youth Tobacco Survey project

The Global Youth Tobacco Survey (GYTS) project was developed by the World Health Organization and the US Centers for Disease Control and Prevention to track tobacco use among youth in countries across the world, using a common methodology and core questionnaire. The GYTS is school based and employs a two-stage sample design to produce representative data on smoking among students aged 13-15 years. The first stage consists of a probabilistic selection of schools, and the second consists of a random selection of classes from the participating schools. All students in the selected classes are eligible for the survey. In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries. This report describes data from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland, the Russian Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela, and Zimbabwe. The findings show that tobacco use in the surveyed age group ranged from a high of 33% to a low of 10%. While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme. In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare. The majority of young people reported being taught in school about the dangers of smoking. Environmental tobacco smoke exposure was very high in all countries. These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes.

Patterns of global tobacco use in young people and implications for future chronic disease burden in adults

BACKGROUND Tobacco use is a leading preventable risk factor for many chronic disorders, which are expected to account for an increasing share of the global disease burden. As part of the Global Youth Tobacco Survey (GYTS), we aimed to assess the effect of tobacco use by young people on global mortality. METHODS GYTS is a school-based survey of students aged 13-15 years. The survey was undertaken at 395 sites in 131 countries and the Gaza Strip and West Bank. We questioned students about current tobacco use, susceptibility to smoking among non-smokers, and exposure to secondhand smoke at home and in public places. FINDINGS The difference in current cigarette smoking between boys and girls is narrower than expected in many regions of the world. Use of tobacco products other than cigarettes by students is as high as cigarette smoking in many regions. Almost one in five never-smokers reported they were susceptible to smoking in the next year. Student exposure to secondhand smoke was high both at home (more than four in ten) and in public places (more than five in ten). Never-smokers were significantly less likely than current smokers to be exposed to secondhand smoke at home (prevalence 39.1% [95% CI 36.6-41.6] vs 72.8% [64.0-81.6]) and in public places (49.5% [46.7-52.3] vs 81.2% [74.2-88.2]). INTERPRETATION Our findings are troubling for the future of chronic disease and tobacco-related mortality. Reduction of tobacco consumption will require a redoubling of efforts to prevent initiation and promote cessation among the large proportion of young people who currently use tobacco. High exposure to secondhand smoke suggests a need for countries to pass strong and effective smoke-free policies.

Change in tobacco use among 13—15 year olds between 1999 and 2008: findings from the Global Youth Tobacco Survey

Tobacco use is the leading preventable cause of death and disease in the world; yet little is known about the levels or patterns of youth tobacco use on a global basis. The purpose of this paper is to focus on change in youth tobacco use using data from 100 sites that have conducted repeat Global Youth Tobacco Surveys (GYTS). The GYTS is a school-based survey that collects data from students aged 13–15 years using a standardized methodology for constructing the sample frame, selecting schools and classes, and processing data. GYTS is conducted in school classes using self-administered anonymous data collection. The GYTS sample produces representative, independent, cross-sectional estimates for each sampling frame. Of the 100 sites surveyed, 61 reported no change over time in prevalence of cigarette smoking, likewise in 50 of the 97 sites with data on use of other tobacco products there was no change. However, 34 sites reported an increase in other tobacco use. This appears to be attributed to waterpipe, an emerging trend in tobacco use. Evidence was found supporting the idea that tobacco use among adolescent girls is likely increasing. The global tobacco control effort continues to face many challenges in reversing the tobacco epidemic. Few countries have implemented comprehensive tobacco control legislation laid out by the World Health Organization. The few countries that have adopted some of these proven policies can serve as examples in achieving positive results in curbing the tobacco epidemic. (Global Health Promotion, 2009; Supp (2): pp. 38–90)

Social Determinants of Health and Tobacco Use in Thirteen Low and Middle Income Countries: Evidence from Global Adult Tobacco Survey

Background Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries. Methodology/Principal Findings We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008–2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Viet Nam. These surveys provided information on 209,027 respondents aged 15 years and above and the country datasets were analyzed individually for estimating current tobacco use across various socio-demographic factors (gender, age, place of residence, education, wealth index, and knowledge on harmful effects of smoking). Multiple logistic regression analysis was used to predict the impact of these determinants on current tobacco use status. Current tobacco use was defined as current smoking or use of smokeless tobacco, either daily or occasionally. Former smokers were excluded from the analysis. Adjusted odds ratios for current tobacco use after controlling other cofactors, was significantly higher for males across all countries and for urban areas in eight of the 13 countries. For educational level, the trend was significant in Bangladesh, Egypt, India, Philippines and Thailand demonstrating decreasing prevalence of tobacco use with increasing levels of education. For wealth index, the trend of decreasing prevalence of tobacco use with increasing wealth was significant for Bangladesh, India, Philippines, Thailand, Turkey, Ukraine, Uruguay and Viet Nam. The trend of decreasing prevalence with increasing levels of knowledge on harmful effects of smoking was significant in China, India, Philippines, Poland, Russian Federation, Thailand, Ukraine and Viet Nam. Conclusions/Significance These findings demonstrate a significant but varied role of social determinants on current tobacco use within and across countries.

A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension

Elevated blood pressure is the strongest modifiable risk factor for cardiovascular disease worldwide. Despite extensive knowledge about ways to prevent as well as to treat hypertension, the global incidence and prevalence of hypertension and, more importantly, its cardiovascular complications are not reduced—partly because of inadequacies in prevention, diagnosis, and control of the disorder in an ageing world. The aim of the Lancet Commission on hypertension is to identify key actions to improve the management of blood pressure both at the population and the individual level, and to generate a campaign to adopt the suggested actions at national levels to reduce the impact of elevated blood pressure globally. The first task of the Commission is this report, which briefly reviews the available evidence for prevention, identification, and treatment of elevated blood pressure, hypertension, and its cardiovascular complications. The report focuses on how as-yet unsolved issues might be tackled using approaches with population-wide impact and new methods for patient evaluation and education in the broadest sense (some of which are not always strictly evidence based) to manage blood pressure worldwide. The report is built around the concept of lifetime risk applicable to the entire population from conception. Development of subclinical and sometimes clinical cardiovascular disease results from lifetime exposure to cardiovascular risk factors combined with the susceptibility of individuals to the harmful consequences of these risk factors. The Commission recognises the importance of other cardiovascular risk factors—eg, smoking, obesity, dyslipidaemia, and diabetes mellitus—on antihypertensive treatment. However, as a Commission on hypertension, this report focuses mainly on issues and actions related to elevated blood pressure. Previous action plans for improving management of elevated blood pressure and hypertension have not yet provided adequate results. Therefore, the Commission has identified ten essential and achievable goals and ten accompanying, mutually additive, and synergistic key actions that—if implemented effectively and broadly—will make substantial contributions to the management of blood pressure globally. The Commission deliberately has not listed these complementary key actions by priority because the balance between strength of evidence, feasibility, and potential benefit could differ by country.

Linking Global Youth Tobacco Survey (GYTS) Data to the WHO Framework Convention on Tobacco Control (FCTC): The Case for Brazil

OBJECTIVE The Global Youth Tobacco Survey (GYTS) in Brazil was developed to provide data on youth tobacco use to the National Tobacco Control Program. METHOD The GYTS uses a standardized methodology for constructing sampling frames, selecting schools and classes, preparing questionnaires, carrying out field procedures, and processing data. The GYTS questionnaire is self-administered and includes questions about: initiation; prevalence; susceptibility; knowledge and attitudes; environmental tobacco smoke; cessation; media and advertising. SUDDAN and Epi-Info Software were used for analysis. Weighted analysis was used in order to obtain percentages and 95% confidence intervals. RESULTS Twenty-three studies were carried out between 2002 and 2005 in Brazilian capitals: 2002 (9); 2003 (4); 2004 (2) and 2005 (9). The total number of students was 22832. The prevalence rate among the cities varied from 6.2% (João Pessoa, 2002) to 17.7% (Porto Alegre, 2002). CONCLUSION The tobacco use prevalence rates in 18 Brazilian cities show significant heterogeneity among the macro regions. Data in this report can be used to evaluate the efforts already done and also as baseline for evaluation of new steps for tobacco control in Brazil regarding the goals of the WHO FCTC.

Evolution of the Global Tobacco Surveillance System (GTSS) 1998–2008:

Tobacco use is one of the leading preventable causes of morbidity and mortality worldwide. Given that country-specific international data on tobacco use were limited or nonexistent, in 1998, the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the Canadian Public Health Association (CPHA) initiated the Global Tobacco Surveillance System (GTSS) to assist countries in establishing tobacco control surveillance and monitoring programs. GTSS includes collection of data through three school-based surveys: the Global Youth Tobacco Survey (GYTS) for youth; the Global School Personnel Survey (GSPS), and the Global Health Professions Student Survey (GHPSS) for adults; and one household survey: the Global Adult Tobacco Survey (GATS) for adults. The GTSS provides a globally implemented and consistent framework for conducting surveillance including standard sampling procedures, core questionnaire items, training in field procedures and analysis of data consistent across all GTSS countries. The GTSS also enhances the role of the nongovernmental sector by supporting participation of civil society agencies in surveillance, monitoring, and policy and program development. The synergy between countries passing tobacco control laws, regulations or decrees, ratifying and complying with the WHO Framework Convention on Tobacco Control, and conducting GTSS surveys offers a unique opportunity to develop, implement, and evaluate comprehensive tobacco control policy that can be helpful to each country document the development, growth, and collaboration in sustaining the GTSS. The report highlights countries’ involvement in tobacco control measures and the establishment of comprehensive tobacco control programs worldwide. This report can assist countries in prioritizing and developing tobacco control programs, including surveillance, evaluation, and policy development. (Global Health Promotion, 2009; Supp (2): pp. 04-37)

Prevalence of smoking and other smoking-related behaviors reported by the Global Youth Tobacco Survey (GYTS) in Thailand

IntroductionThailand ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) on November 8, 2004. The WHO FCTC requires all parties to inform all persons of the health consequences of tobacco consumption and exposure to tobacco smoke. Each party has agreed to develop, implement and evaluate effective tobacco control programs to measure progress in reaching the goals of the WHO FCTC.MethodsThe Global Youth Tobacco Survey (GYTS) was developed to provide data on youth tobacco use to countries for their development of youth-based tobacco control programs. Data in this report can be used as baseline measures for future evaluation of the tobacco control programs implemented by the Ministry of Public Health.ResultsOverall, about 1 in 10 Thai students are current smokers, this number including 4 times more boys than girls (17% versus 3.9%). Almost 2 in 10 Thai students start smoking before the age of 10, and almost 7 in 10 students are reported to have been exposed to smoke from others in public places. About 4 in 10 students are reported to have an object with a cigarette brand logo on it.ConclusionThe key for Thailand is to implement and enforce the provisions on indirect tobacco advertising, smoking in public places, selling tobacco to youths under 18 years of age, and to use the data from the GYTS to monitor progress toward achieving the goals of the WHO FCTC. When these goals are met, tobacco consumption and exposure in Thailand will have declined substantially.

Tobacco use among youth and adults in member countries of South-East Asia region: review of findings from surveys under the Global Tobacco Surveillance System.

BACKGROUND This paper examines the prevalence of current tobacco use among youth and adults in selected member countries of the South-East Asia Region using the data from school and household-based surveys included in the Global Tobacco Surveillance System. MATERIALS AND METHODS Global Youth Tobacco Survey (GYTS) data (years 2007-2009) were used to examine current tobacco use prevalence among youth, whereas Global Adult Tobacco Survey (GATS) data (years 2009-2010) were used to examine the prevalence among adults. GYTS is a school-based survey of students aged 13-15, using a two-stage cluster sample design, and GATS is a household survey of adults age 15 and above using a multi-stage stratified cluster design. Both surveys used a standard protocol for the questionnaire, data collection and analysis. RESULTS Prevalence of current tobacco use among students aged 13-15 varied from 5.9% in Bangladesh to 56.5% in Timor-Leste, and the prevalence among adults aged 15 and above was highest in Bangladesh (43.3%), followed by India (34.6%) and Thailand (27.2%). Reported prevalence was significantly higher among males than females for adults and youth in all countries except Bangladesh, Sri Lanka and Timor-Leste. Current use of tobacco other than manufactured cigarettes was notably higher than current cigarette smoking among youth aged 13-15 years in most countries of the Region, while the same was observed among adults in Bangladesh, India and Thailand, with most women in those countries, and 49% of men in India, using smokeless tobacco. CONCLUSION Tobacco use among youth and adults in member countries of the region is high and the pattern of tobacco consumption is complex. Tobacco products other than cigarettes are commonly used by youth and adults, as those products are relatively cheaper than cigarettes and affordable for almost all segments of the population. As a result, use of locally produced smoked and smokeless tobacco products is high in the region. Generating reliable data on tobacco use and key tobacco control measures at regular intervals is essential to better understand and respond with effective tobacco control intervention.

Cross-country comparison of waterpipe use: nationally representative data from 13 low and middle-income countries from the Global Adult Tobacco Survey (GATS)

Objective Evidence shows that smoking tobacco using a waterpipe is significantly associated with diseases. Despite this, waterpipe use seems to be increasing worldwide, though nationally representative data are not widely available. The Global Adult Tobacco Survey (GATS) provides an opportunity to measure various indicators of waterpipe use from nationally representative surveys. Methods Data were obtained for adults 15 years of age or older from 13 countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam) who completed GATS from 2008–2010. The GATS questionnaire collected data on current waterpipe use, including daily/less than daily prevalence and number of sessions per day/week. An optional waterpipe module measured former use, age of initiation, and level of consumption during a session. Results GATS was successful in producing nationally representative data on waterpipe use from 13 countries, many of which for the first time. The prevalence of waterpipe use among men was highest in Vietnam (13.0%) and Egypt (6.2%); among women, waterpipe use was highest in Russia (3.2%) and Ukraine (1.1%). While over 90% of adults in Ukraine thought smoking tobacco causes serious illness, only 31.4% thought smoking tobacco using a waterpipe causes serious illness. Conclusions GATS data provide the ability to analyse waterpipe use within a country and across countries. Monitoring of waterpipe use at a national level will better enable countries to target tobacco control interventions such as education campaigns about the negative health effects of waterpipe use.