1. Prevalence of tobacco use and purchase patterns in 14 low and middle income countries Judy Kruger, PhD, Office on Smoking and Health, CDC, Atlanta, GA Jason Hsia, PhD, Global Tobacco Control, CDC, Atlanta, GA Glenda Blutcher-Nelson, MSc, Global Tobacco Control Branch, CDC, Atlanta, GA Samira Asma, DDS MPH, Global Tobacco Control Branch, CDC, Atlanta, GA on behalf of the GATS Collaborative Group

2. Presenter Disclosure  Judy Kruger  The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:  No relationships to disclose

3. Overview of WHO FCTC and MPOWER Purpose and methodology of Global Adult Tobacco Survey (GATS) Summary of findings Conclusions Outline

4. WHO FCTC: Tools WHO FCTC provides a foundation for countries to implement and manage tobacco control WHO’s MPOWER package assists country-level implementation of effective measures to reduce tobacco demand

5.  Integrate tobacco surveillance programs into national, regional, and global health surveillance programs so that data are comparable and can be analyzed at the regional and international levels, as appropriate WHO FCTC

6. MPOWER  Monitor tobacco use & prevention policies  Protect people from tobacco smoke  Offer help to quit tobacco use  Warn about the dangers of tobacco  Enforce bans on tobacco advertising, promotion & sponsorship  Raise taxes on tobacco

7. Global Tobacco Surveillance System GPS GPHSS GLOBAL HEALTH PROFESSIONS STUDENT SURVEY GLOBAL SCHOOL PERSONNEL SURVEY GYTS GLOBAL YOUTH TOBACCO SURVEY GLOBAL ADULT TOBACCO SURVEY GATS TQS TOBACCO QUESTIONS FOR SURVEYS

8. GATS Purpose and Procedures  GATS collects data on tobacco use and key tobacco control measures using a standardized global protocol in a nationally representative sample  Systematic procedures:  Core questionnaire & optional questions  Sampling design  Series of manuals & guidelines  Expert questionnaire review

9. GATS Methodology  Core questionnaire with optional questions  Options for countries to add additional questions  Face-to-face personal interview survey In-person interviews were obtained in the local language  Electronic data collection using handheld devices

10. GATS Sample Design  Nationally representative household survey of persons aged 15 years and older  Multi-stage, geographically clustered sample design  Household-based sampling  Stratified for rural/urban, male/female

11. More Information on GATS Country Fact Sheets Country Reports GTSSData http://nccd.cdc.gov/gtssdata/default/default.aspx

12. Purpose of the Study  We used data from the 2008-2010 Global Adult Tobacco Survey (GATS) to examine:  The prevalence of use of tobacco products, including both smoked and smokeless, and  The most common purchase locations for manufactured cigarettes

13. Standardized Questions  “Do you currently smoke tobacco [use smokeless tobacco] on a daily basis, less than daily, or not at all?” Current tobacco smoking is defined as daily or less than daily Current smokeless use is defined as daily or less than daily  “On average, how many [specific product named] do you use [per day/week]?” - Manufactured cigarettes- Hand-rolled cigarettes - Bidis- Pipes full of tobacco - Water pipe- Oral tobacco use - Nasal tobacco use Current tobacco products use is defined as daily/weekly or less than daily/weekly

14. Standardized Questions “The last time you purchased manufactured cigarettes for yourself, where did you buy them?” Current bidis or smokeless tobacco user is defined as daily/weekly or less than daily/weekly “The last time you purchased bidis [smokeless tobacco] for yourself, where did you buy them?” Current manufactured cigarette smoker is defined as daily or less than daily -Store- Street vendor -Kiosk- Other [vending machine, military store, duty-free store, outside the country, Internet and from another person] -Store- Street vendor -Kiosk

15. Data Analysis  Years surveyed: 2008-2010  14 countries: Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam  Overall sample size ranged from 69,296 (India) to 5,581 (Uruguay)  Overall response rates ranged from 65.1% (Poland) to 97.7% (Russia)

16. Percentages of Current Tobacco Smoking* Source: Global Adult Tobacco Survey, 2008-2010 MenWomen * Current tobacco smoking is defined as daily or less than daily

17. Percentages of Current Smokeless Use* Source: Global Adult Tobacco Survey, 2008-2010 MenWomen *Current smokeless use is defined as daily or less than daily

18. Percentages of Smoked Tobacco Products* Source: Global Adult Tobacco Survey, 2008-2010 Pipes full of tobacco * Defined as current tobacco product user if they reported daily or less than daily/weekly Manufactured cigarettes Hand-rolled cigarettes Water pipes

19. Bidis and Smokeless Products* Source: Global Adult Tobacco Survey, Bangladesh (2009) and India (2009-2010) Smokeless Product UseBidis Use 11.2% Bangladesh 9.2% India 26.8% Bangladesh 23.3% India *Current bidis or smokeless tobacco products use is defined as daily/weekly or less than daily/weekly

20. Source of Last Manufactured Cigarettes* Purchased in Percent Source: Global Adult Tobacco Survey, 2008-2010 *Current manufactured cigarette smoker is defined as daily or less than daily

21. Source of Last Manufactured Cigarettes* Purchased in Percent Source: Global Adult Tobacco Survey, 2008-2010 Street vendor *Current manufactured cigarette smoker is defined as daily or less than daily

22. Source of Last Manufactured Cigarettes* Purchased in Percent Source: Global Adult Tobacco Survey, 2008-2010 * Current manufactured cigarette smoker is defined as daily or less than daily

23. Source of Last Bidis* Purchased in Percent Source: Global Adult Tobacco Survey, India (2009-2010) *Current bidis tobacco user is defined as daily/weekly or less than daily/weekly India

24. Source of Last Smokeless* Purchased in Percent Source: Global Adult Tobacco Survey, India (2009-2010) *Current smokeless tobacco user is defined as daily/weekly or less than daily/weekly

25. Key Study Findings  Current tobacco smoking and smokeless use is more common in men than women  Smoked tobacco product use varied in prevalence across the 14 countries and the most common are: manufactured cigarettes, waterpipes, hand-rolled cigarettes and pipes full of tobacco  Oral smokeless tobacco is more common than nasal smokeless tobacco Note: Includes 14 GATS countries (Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, Viet Nam) Source: Global Adult Tobacco Survey, 2008-2010

26. Key Study Findings Continued  The most common purchase locations for manufactured cigarettes was stores, followed by kiosks, street vendors, and ‘some other location’  The most common purchase locations for bidis and smokeless products was stores, followed by kiosks, and street vendors in India Note: Includes 14 GATS countries (Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, Viet Nam) Source: Global Adult Tobacco Survey, 2008-2010

27. Discussion  More research is needed on the use of emerging tobacco products  Information about tobacco use patterns and availability can help guide tobacco control policy  Identification of location of purchase is useful to inform intervention targets

28. Conclusions  Monitoring tobacco use and prevention policies supports WHO FCTC  Assessment of purchase pattern locations can assist countries implement community-based tobacco control policies  Tobacco use assessment assists country-level implementation of effective measures to reduce the worldwide burden of tobacco use  Supports public and policy actions  Encourages change in social norms

29. Additional Information is available on the website www.cdc.gov/tobacco/global Thank you! Judy Kruger jkruger@cdc.gov For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health