Elsevier

The Lancet

Volume 367, Issue 9512, 4–10 March 2006, Pages 749-753
The Lancet

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

https://doi.org/10.1016/S0140-6736(06)68192-0Get rights and content

Summary

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.

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

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