Where ‘Smoke-Free’ Isn’t the Norm: Global Tobacco Use Booms in Developing World

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JEFFREY BROWN: Even as smoking declines in the U.S. and other countries, a new study published in the British medical journal “The Lancet” reveals that the use of tobacco in developing countries is booming.

The report titled “The Global Adult Tobacco Survey” looked at tobacco users in 14 developing nations and included data from the U.S. and the U.K. for comparison. It found that about half the men across the low- and middle-income nations use tobacco, mostly smoke products. The number was much smaller for women, 11 percent. But the survey found that women are starting at younger ages than in the past.

Russia had the highest rates — 60 percent of men and 22 percent of women used tobacco in some form. And China had the largest number of users, some 300 million.

In the meantime, health advocates in Australia, which wasn’t included in the new study, scored a victory last week in their fight against tobacco use. The nation’s high court upheld a new law requiring that cigarette boxes feature vivid images and warnings on them without company logos.

The World Health Organization says that if current trends continue, the global death toll from tobacco will reach eight million a year by 2030.

And we’re joined now by Gary Giovino, the lead epidemiologist on the new study. He’s the chair of the Department of Community Health and Health Behavior at the University at Buffalo in New York.

Welcome to you.

Let me just ask you first, what was the most important thing that came from this study for you?

GARY GIOVINO, State University of New York at Buffalo: Well, the magnitude of tobacco use in the different countries, the fact that we saw some different patterns, that smoking, for example, is very high among men and women in Russia, especially young men and women. In Russia, Turkey and Ukraine, it was very high.

Another very important finding was the dominance of the manufactured cigarette.

A lot of people think cigarettes are just tobacco chopped up and wrapped in paper. But the manufactured cigarette is a technologically sophisticated device designed to mask harshness and inject flavors and increase nicotine.

So, and these are made by multinational tobacco corporations or government corporations that promote their use and work to undermine efforts to reduce their use.

JEFFREY BROWN: One thing that jumped out at me was the low number of people who quit smoking once they have started, especially as compared to in the U.S., for example. What does that tell you? Why is that happening?

GARY GIOVINO: Well, I think we have some cultures, particularly, for example, in China and India, where quitting isn’t emphasized.

Only 10 percent of people in China and India who have ever smoked daily have quit. That compares to about 45 percent when we look at age-standardized data in the United States and the United Kingdom, where tobacco control efforts, where efforts to educate people about tobacco use and encourage quitting and prevent initiation, have been going on for a long time.

And it’s also much lower, for example, than 35 percent around in Brazil and Uruguay, where they have been doing tobacco control for a while. So, I hope that China and India, the governments will look at that and try to improve their efforts to promote quitting among people who have become addicted and daily smokers.

JEFFREY BROWN: Well, why do you think the rise is happening and these kinds of disparities is happening when you — particularly as the numbers go down in the U.S. and other countries?

GARY GIOVINO: Well, many of the same things that we saw happening in America, with tobacco being glamorized, with tobacco being made — with marketing being directed towards women that make it look glamorous, that make it look like a — something that’s associated with gender equality and freedom.

Those kinds of things are happening. And we’re seeing the age of initiation going down in many of our low- and middle-income countries.

And, of course, we have social norms that support tobacco. In many of these countries, for example, they haven’t given smoke-free the privilege, the right. They haven’t given smoke-free the default option, where many people are still bathed in tobacco smoke.

So, smoking is the norm, instead of non-smoking being the norm, in many countries where quitting hasn’t become normative.

In Brazil and Uruguay, tobacco control has been going strongly, and they have very strong smoke-free provisions.

JEFFREY BROWN: We mentioned in our set-up what’s going on in Australia, what they’re preparing to do with the labels. Is something like that possible or do-able in some of these countries? What do we know that does work?

GARY GIOVINO: Well, plain packaging is theoretically possible in any country.

That will be challenged in court, but the Australian highest court upheld the legal challenge. And it really doesn’t cost governments much money to — I mean, except to defend the lawsuits — to mandate plain packaging and to mandate very strong warning labels.

Very strong warning labels inform smokers better than weaker warning labels, so graphic warning labels that give a strong message about the health effects of tobacco.

The other things that work are protecting non-smokers, of course, offering people help with quitting, hard-hitting mass media campaigns, and enforcing advertising bans or restrictions.

In many countries, they can actually ban advertising. And they do. In our country, we can only restrict it. And then also raising taxes — when the price goes up, consumption goes down. But then, in many countries, they use some of the money that they get from raising taxes to fund media campaigns, for example, and other tobacco-control strategies.

JEFFREY BROWN: Gary Giovino, thanks so much for joining us.

GARY GIOVINO: My pleasure. Thank you.