ArticlesPatterns of global tobacco use in young people and implications for future chronic disease burden in adults
Introduction
Tobacco use increases risk of developing several cancers and diseases of the cardiovascular and respiratory systems. Therefore tobacco use is one of the main preventable causes of chronic disease and death in developed countries and is the second leading cause of death worldwide.1, 2, 3, 4 Estimates of the future burden of tobacco-related disease are based on lung cancer deaths and calculation of the smoking impact ratio.5 The global burden of disease estimates a doubling in the number of deaths every year from tobacco use, from 5 million in 2005, to 10 million in 2020.2 However, a missing important determinant in calculating the future burden of chronic disease is the cumulative exposure to tobacco.
The Global Youth Tobacco Survey (GYTS) could begin to provide requisite data to allow for projection of the cumulative exposure to tobacco. This survey is a joint project of WHO, the US Centers for Disease Control and Prevention (CDC), the Canadian Public Health Association (CPHA), and most WHO member states. The survey aims to obtain standardised behavioural data from same-aged young people on prevalence of cigarette and other tobacco use; perceptions and attitudes about tobacco; access and availability of tobacco products; and exposure to secondhand smoke, school curricula, media and advertising, and smoking cessation interventions.
Detailed surveillance on prevalence of youth tobacco use was not available before the development and expansion of GYTS. In 1999, WHO and CDC initiated the survey in an effort to provide recent, high quality, international data for youth tobacco use. Consistency and comparability across GYTS surveys were key design elements of the surveillance system. Survey sites in 131 countries and the Gaza Strip and West Bank have used similar school-based sampling strategies and field procedures; participants have answered a core set of questions; and data have been processed by consistent procedures. The resulting GYTS surveillance system is the world's largest body of comparable data for youth tobacco use.
With this report, we aimed to present findings from the GYTS on current cigarette smoking, current use of tobacco products other than cigarettes, susceptibility to smoking among non-smokers, and exposure to secondhand smoke at home and in public places.
Section snippets
Participants
GYTS is a school-based survey focusing on students aged 13–15 years. The questionnaire is self-administered in classrooms, and school, class, and student anonymity is maintained throughout the GYTS process. Participation in the survey by schools and students is voluntary. The GYTS research protocol was approved by WHO, CDC, and CPHA. WHO regional offices work with participating countries to ensure that the protocol is followed. All ethics committee and consent procedures are decided at the
Results
Between 1999, and 2005, data for GYTS were obtained at 395 sites in 131 countries and the Gaza Strip and West Bank among students aged 13–15 years. National-level data have been gathered in 93 countries, and data at state, province, region, or city level in 38 countries. WHO counts 192 member states distributed between six regions. GYTS was undertaken at 59 sites in 25 countries in the African region, 118 sites in 37 countries in the region of the Americas, 40 sites in 20 countries and the Gaza
Discussion
Tobacco use is a major worldwide contributor to deaths from chronic diseases, and findings from the GYTS suggest that current dire warnings of a doubling of the death toll to 10 million deaths per year by 2020 could be a conservative estimate, and the true toll from tobacco use could be even greater than this amount. Small differences in patterns of tobacco use between boys and girls, high use of tobacco products other than cigarettes, high susceptibility to smoking among never-smokers, and
References (24)
- et al.
Selected major risk factors and global and regional burden of disease
Lancet
(2002) - et al.
Alternative projections of mortality and disability by cause, 1990–2020: Global Burden of Disease Study
Lancet
(1997) - et al.
Mortality from smoking in developed countries 1950–2000: indirect estimation from National Vital Statistics
(1994) Monographs on the evaluation of carcinogenic risks to humans, vol 83: tobacco smoke and involuntary smoking
(2004)Monographs on the evaluation of carcinogenic risks to humans, vol 85: betel-quid and areca-nut chewing and some areca-nut-derived nitrosamines
(2004)- et al.
Validation of susceptibility as a predictor of which adolescents take up smoking in the United States
Health Psychol
(1996) - et al.
SUDAAN: software for the statistical analysis of correlated data—user's manual, release 7.5
(1997) - et al.
Tobacco use by youth: a surveillance report from the Global Youth Tobacco survey project
Bull World Health Organ
(2000) Tobacco use among youth: a cross country comparison
Tob Control
(2002)Differences in worldwide tobacco use by gender: findings from the Global Youth Tobacco Survey
J Sch Health
(2003)
Tobacco use and the cardiovascular disease epidemic in developing countries: global crises and opportunity in the making
Ethn Dis
Tobacco: the global challenge for health promotion
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