Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence.Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period.Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019 / Kendrick, Parkes J; Reitsma, Marissa B; Abbasi-Kangevari, Mohsen; Abdoli, Amir; Abdollahi, Mohammad; Abedi, Aidin; Abhilash, E S; Aboyans, Victor; Adebayo, Oladimeji M; Advani, Shailesh M; Ahinkorah, Bright Opoku; Ahmad, Sohail; Ahmadi, Keivan; Ahmed, Haroon; Aji, Budi; Akalu, Yonas; Akunna, Chisom Joyqueenet; Alahdab, Fares; Al-Aly, Ziyad; Alanezi, Fahad Mashhour; Alanzi, Turki M; Alhabib, Khalid F; Ali, Tilahun; Alif, Sheikh Mohammad; Alipour, Vahid; Aljunid, Syed Mohamed; Alomari, Mahmoud A; Amin, Tarek Tawfik; Amini, Saeed; Amu, Hubert; Ancuceanu, Robert; Anderson, Jason A; Andrei, Catalina Liliana; Andrei, Tudorel; Ansari-Moghaddam, Alireza; Antony, Benny; Anvari, Davood; Arabloo, Jalal; Arian, Nicholas D; Arora, Monika; Artanti, Kurnia Dwi; Asmare, Wondwossen Niguse; Atnafu, Desta Debalkie; Ausloos, Marcel; Awan, Asma Tahir; Ayano, Getinet; Aynalem, Getie Lake; Azari, Samad; B, Darshan B; Badiye, Ashish D; Baig, Atif Amin; Banach, Maciej; Banerjee, Srikanta K; Barker-Collo, Suzanne Lyn; Bärnighausen, Till Winfried; Barqawi, Hiba Jawdat; Basu, Sanjay; Bayati, Mohsen; Bazargan-Hejazi, Shahrzad; Bekuma, Tariku Tesfaye; Bennett, Derrick A; Bensenor, Isabela M; Benzian, Habib; Benziger, Catherine P; Berman, Adam E; Bhagavathula, Akshaya Srikanth; Bhala, Neeraj; Bhardwaj, Nikha; Bhardwaj, Pankaj; Bhattacharyya, Krittika; Bibi, Sadia; Bijani, Ali; Biondi, Antonio; Braithwaite, Dejana; Brenner, Hermann; Brunoni, Andre R; Burkart, Katrin; Burugina Nagaraja, Sharath; Butt, Zahid A; Caetano dos Santos, Florentino Luciano; Car, Josip; Carreras, Giulia; Castaldelli-Maia, Joao Mauricio; Cattaruzza, Maria Sofia Sofia; Chang, Jung-Chen; Chaturvedi, Pankaj; Chen, Simiao; Chido-Amajuoyi, Onyema greg; Chu, Dinh-Toi; Chung, Sheng-Chia; Ciobanu, Liliana G; Costa, Vera Marisa; Couto, Rosa A S; Dagnew, Baye; Dai, Xiaochen; Damasceno, Albertino Antonio Moura; Damiani, Giovanni; Dandona, Lalit; Dandona, Rakhi; Daneshpajouhnejad, Parnaz; Darega Gela, Jiregna; Derbew Molla, Meseret; Desta, Abebaw Alemayehu; Dharmaratne, Samath Dhamminda; Dhimal, Meghnath; Eagan, Arielle Wilder; Ebrahimi Kalan, Mohammad; Edvardsson, Kristina; Effiong, Andem; El Tantawi, Maha; Elbarazi, Iffat; Esmaeilnejad, Saman; Fadhil, Ibtihal; Faraon, Emerito Jose A; Farwati, Medhat; Farzadfar, Farshad; Fazlzadeh, Mehdi; Feigin, Valery L; Feldman, Rachel; Filip, Irina; Filippidis, Filippos; Fischer, Florian; Flor, Luisa Sorio; Foigt, Nataliya A; Folayan, Morenike Oluwatoyin; Foroutan, Masoud; Gad, Mohamed M; Gallus, Silvano; Geberemariyam, Biniyam Sahiledengle; Gebregiorgis, Birhan Gebresillassie; Getacher, Lemma; Getachew Obsa, Abera; Ghafourifard, Mansour; Ghanei Gheshlagh, Reza; Ghashghaee, Ahmad; Ghith, Nermin; Gil, Gabriela Fernanda; Gill, Paramjit Singh; Ginawi, Ibrahim Abdelmageed; Goharinezhad, Salime; Golechha, Mahaveer; Gopalani, Sameer Vali; Gorini, Giuseppe; Grivna, Michal; Guha, Avirup; Guimarães, Rafael Alves; Guo, Yuming; Gupta, Rajat Das; Gupta, Rajeev; Gupta, Tarun; Gupta, Vin; Hafezi-Nejad, Nima; Haider, Mohammad Rifat; Hamadeh, Randah R; Hankey, Graeme J; Hargono, Arief; Hay, Simon I; Heidari, Golnaz; Herteliu, Claudiu; Hezam, Kamal; Hird, Thomas R; Holla, Ramesh; Hosseinzadeh, Mehdi; Hostiuc, Mihaela; Hostiuc, Sorin; Househ, Mowafa; Hsiao, Thomas; Huang, Junjie; Ibeneme, Charles Ugochukwu; Ibitoye, Segun Emmanuel; Ilic, Irena M; Ilic, Milena D; Inbaraj, Leeberk Raja; Irvani, Seyed Sina Naghibi; Islam, Jessica Y; Islam, Rakibul M; Islam, Sheikh Mohammed Shariful; Islami, Farhad; Iso, Hiroyasu; Itumalla, Ramaiah; Jaafari, Jalil; Jain, Vardhmaan; Jakovljevic, Mihajlo; Jang, Sung-In; Jayaram, Shubha; Jeemon, Panniyammakal; Jha, Ravi Prakash; Jonas, Jost B; Jürisson, Mikk; Kabir, Ali; Kabir, Zubair; Kalankesh, Leila R; Kanchan, Tanuj; Kandel, Himal; Kapoor, Neeti; Karch, André; Karimi, Salah Eddin; Kebede, Kindie Mitiku; Kelkay, Bayew; Kennedy, Ryan David; Khader, Yousef Saleh; Khan, Ejaz Ahmad; Khayamzadeh, Maryam; Kim, Gyu Ri; Kimokoti, Ruth W; Kivimäki, Mika; Kosen, Soewarta; Koulmane Laxminarayana, Sindhura Lakshmi; Koyanagi, Ai; Krishan, Kewal; Kugbey, Nuworza; Kumar, G Anil; Kumar, Nithin; Kurmi, Om P; Kusuma, Dian; Lacey, Ben; Landires, Iván; Lasrado, Savita; Lauriola, Paolo; Lee, Doo Woong; Lee, Yo Han; Leung, Janni; Li, Shanshan; Lin, Hualiang; Liu, Wei; Lugo, Alessandra; Madhava Kunjathur, Shilpashree; Majeed, Azeem; Maleki, Afshin; Malekzadeh, Reza; Malta, Deborah Carvalho; Mamun, Abdullah A; Manjunatha, Narayana; Mansouri, Borhan; Mansournia, Mohammad Ali; Martini, Santi; Mathur, Manu Raj; Mathur, Prashant; Mazidi, Mohsen; Mckee, Martin; Medina-Solís, Carlo Eduardo; Mehata, Suresh; Mendoza, Walter; Menezes, Ritesh G; Miazgowski, Bartosz; Michalek, Irmina Maria; Miller, Ted R; Mini, Gk; Mirica, Andreea; Mirrakhimov, Erkin M; Mirzaei, Hamed; Misra, Sanjeev; Mohammad, Yousef; Mohammadian-Hafshejani, Abdollah; Mohammed, Shafiu; Mokdad, Ali H; Molokhia, Mariam; Monasta, Lorenzo; Moni, Mohammad Ali; Moradzadeh, Rahmatollah; Morrison, Shane Douglas; Mossie, Tilahun Belete; Mubarik, Sumaira; Mullany, Erin C; Murray, Christopher J L; Nagaraju, Shankar Prasad; Naghavi, Mohsen; Naik, Nitish; Nalini, Mahdi; Nangia, Vinay; Naqvi, Atta Abbas; Narasimha Swamy, Sreenivas; Naveed, Muhammad; Nazari, Javad; Nduaguba, Sabina O; Negoi, Ruxandra Irina; Neupane Kandel, Sandhya; Nguyen, Huong Lan Thi; Nigatu, Yeshambel T; Nixon, Molly R; Nnaji, Chukwudi A; Noubiap, Jean Jacques; Nowak, Christoph; Nuñez-Samudio, Virginia; Ogbo, Felix Akpojene; Oguntade, Ayodipupo Sikiru; Oh, In-Hwan; Olagunju, Andrew T; Owolabi, Mayowa O; P A, Mahesh; Pakshir, Keyvan; Pana, Adrian; Panagiotakos, Demosthenes; Panda-Jonas, Songhomitra; Pandey, Ashok; Parekh, Utsav; Park, Eun-Cheol; Park, Eun-Kee; Pashazadeh Kan, Fatemeh; Pathak, Mona; Pawar, Shrikant; Pestell, Richard G; Pham, Hai Quang; Pinheiro, Marina; Pokhrel, Khem Narayan; Pourshams, Akram; Prashant, Akila; Radfar, Amir; Rahimi-Movaghar, Vafa; Rahman, Mohammad Hifz Ur; Rahman, Muhammad Aziz; Rahmani, Amir Masoud; Ram, Pradhum; Rana, Juwel; Ranabhat, Chhabi Lal; Rathi, Priya; Rawaf, David Laith; Rawaf, Salman; Rawassizadeh, Reza; Renzaho, Andre M N; Rezapour, Aziz; Riaz, Mavra A; Roever, Leonardo; Ronfani, Luca; Roshandel, Gholamreza; Roy, Ambuj; Roy, Bedanta; Saddik, Basema; Sahebkar, Amirhossein; Salehi, Sana; Salimzadeh, Hamideh; Samy, Abdallah M; Sanabria, Juan; Santric-Milicevic, Milena M; Sao Jose, Bruno Piassi; Sathian, Brijesh; Sawhney, Monika; Saya, Ganesh Kumar; Schwendicke, Falk; Seidu, Abdul-Aziz; Senthil Kumar, Nachimuthu; Sepanlou, Sadaf G; Shafaat, Omid; Shah, Syed Mahboob; Shaikh, Masood Ali; Shannawaz, Mohammed; Sharafi, Kiomars; Sheikh, Aziz; Sheikhbahaei, Sara; Shigematsu, Mika; Shiri, Rahman; Shishani, Kawkab; Shivakumar, K M; Shivalli, Siddharudha; Shrestha, Roman; Siabani, Soraya; Sidemo, Negussie Boti; Sigfusdottir, Inga Dora; Sigurvinsdottir, Rannveig; Silva, João Pedro; Singh, Ambrish; Singh, Jasvinder A; Singh, Virendra; Sinha, Dhirendra Narain; Skryabin, Valentin Yurievich; Skryabina, Anna Aleksandrovna; Soroush, Ali; Soyiri, Ireneous N; Sreeramareddy, Chandrashekhar T; Stein, Dan J; Steiropoulos, Paschalis; Stortecky, Stefan; Straif, Kurt; Suliankatchi Abdulkader, Rizwan; Sulo, Gerhard; Sundström, Johan; Tabuchi, Takahiro; Tadesse, Eyayou Girma; Tamiru, Animut Tagele; Tareke, Minale; Tareque, Md Ismail; Tarigan, Ingan Ukur; Thakur, Bhaskar; Thankappan, Kavumpurathu Raman; Thapar, Rekha; Tolani, Musliu Adetola; Tovani-Palone, Marcos Roberto; Tran, Bach Xuan; Tripathy, Jaya Prasad; Tsegaye, Gebiyaw Wudie; Tymeson, Hayley D; Ullah, Saif; Unim, Brigid; Updike, Rachel L; Uthman, Olalekan A; Vacante, Marco; Vardavas, Constantine; Venketasubramanian, Narayanaswamy; Verma, Madhur; Vidale, Simone; Vo, Bay; Vu, Giang Thu; Waheed, Yasir; Wang, Yanzhong; Welding, Kevin; Werdecker, Andrea; Whisnant, Joanna L; Wickramasinghe, Nuwan Darshana; Wubishet, Befikadu Legesse; Yamagishi, Kazumasa; Yano, Yuichiro; Yazdi-Feyzabadi, Vahid; Yeshaw, Yigizie; Yimmer, Mohammed Zewdu; Yonemoto, Naohiro; Yousefi, Zabihollah; Yu, Chuanhua; Yunusa, Ismaeel; Yusefzadeh, Hasan; Zaman, Muhammed Shahriar; Zamani, Mohammad; Zamanian, Maryam; Zastrozhin, Mikhail Sergeevich; Zastrozhina, Anasthasia; Zhang, Jianrong; Zhang, Zhi-Jiang; Zhong, Chenwen; Zuniga, Yves Miel H; Gakidou, Emmanuela. - In: THE LANCET PUBLIC HEALTH. - ISSN 2468-2667. - 6:7(2021), pp. e482-e499. [10.1016/S2468-2667(21)00065-7]
Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019
Ausloos, Marcel;Biondi, Antonio;Cattaruzza, Maria Sofia Sofia;Liu, Wei;Unim, Brigid;
2021
Abstract
Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence.Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period.Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
