adult tobacco brochure 2015
2015
Monitoring tobacco control among adults in selected
Member States of South-East Asia Region
– at a glance
Message
Tobacco continues to be a major public health problem in the WHO
South-East Asia Region, causing premature deaths and compounding the
increasing epidemic of noncommunicable diseases such as chronic lung
disease, heart ailments and cancer.
One fourth of the world’s smokers and over 80% of the world’s smokeless
tobacco users live in the Region. There are 290 million smokeless tobacco
users and 246 million smokers in the Region, as per recent estimates.
The findings of the Global Adult Tobacco Survey (GATS) and STEPwise
approach to noncommunicable diseases risk factor surveillance (STEPs)
show that 35% of adults are exposed to second-hand smoke at work
and over 45% at their homes. Nearly 35% of the people in the Region
use tobacco in one form or another; 19.7% use smokeless tobacco and
18.3% people smoke. As many as 35% smokers have been unsuccessful in
quitting tobacco due to absence of tobacco cessation support, while two
in five smokers have thought of quitting cigarette smoking after seeing
the health warning on cigarette packages.
Strengthening tobacco control policies, strictly enforcing existing laws
that ban tobacco promotion, enhancing graphic health warnings on all
tobacco products, implementing interventions to prevent exposure to
second-hand smoke, and most importantly, initiating tobacco cessation
measures with trained health workforce are key to stopping tobacco use
in the Region. While continuous efforts are being made to stop the use
of tobacco, more needs to be done.
This brochure provides an opportunity to review in graphic form
the effects of public health policies and tobacco control interventions in
Member States of the Region. In compliance with Article 21 of the WHO
Framework Convention on Tobacco Control (WHO FCTC), Member States
in the Region have been monitoring tobacco control using the standard
protocols of GATS and STEPs. Member States are committed to protecting
their people from the ill effects of tobacco and WHO commends and
continues to support them in their efforts to protect the people from the
scourge of tobacco.
Dr Poonam Khetrapal Singh
Regional Director
WHO South-East Asia Region
Introduction
The Global Adult Tobacco Survey (GATS) is a nationally representative
household survey that was launched in February 2007 as a new component
of the ongoing Global Tobacco Surveillance System (GTSS). GATS enables
countries to collect data on adult tobacco use and key tobacco control
measures for the 15+ years age group. Results from GATS assist countries
in the formulation, tracking and implementation of effective national
tobacco control interventions, and comparison with results from other
countries. The STEPwise approach to noncommunicable disease risk factor
surveillance (STEPs) of the World Health Organization (WHO) comprises
a population-based survey to collect information on the major modifiable
NCD risk factors, which has been used in many countries. WHO has a
set of core indicators derived from STEPs for monitoring NCD risk factors
nationally and globally. These core indicators were deemed practical and
easily obtainable by countries at all levels of technical capacity. Both data
systems assist countries in fulfilling their obligations under the World
Health Organization (WHO) Framework Convention on Tobacco Control
(FCTC) to generate comparable data within and across countries. WHO has
developed MPOWER, a package of selected demand reduction measures
contained in WHO FCTC.
This brochure contains data from GATS for Bangladesh (2009), India
(2009–2010), Indonesia (2011) and Thailand (2011) for the 15+ years
age group and from STEPs for (1) Maldives (2011), Myanmar (2008) and
Sri Lanka (2008) for the 15–64 years age group; (2) Nepal (2013) for the
15–69 years age group; and (3) Bhutan (2014) and Timor-Leste (2014)
for the 18–69 years age group.
Computation of regional prevalence: Corresponding to age- and
sex- specific prevalence of each tobacco use indicator, the latest 2015
population estimate for each country from the United Nations Population
Division publication “Population Prospects, The 2012 Revision” were used
to compute the number of tobacco users by age and sex for each country.
These numbers from of all countries of the South-East Asia Region were
summed up to come up with the regional aggregate. These were then
divided by the aggregated population of the Region, resulting in the overall
regional prevalence in percentage.
Tobacco use – Smoked and/or Smokeless
100
Figure 1: Percentage of current tobacco users
90
Nearly 35% adults in the Region use
tobacco in one or another form, ranging
from 20% in Maldives to 56% in TimorLeste.
80
74
Percentage
70
71
67
60
58
56
52
50
44
40
34
30
20
27
25
25
18
0
14
*Sub-national
Maldives
(Malé)*
Sri Lanka
Bhutan
Thailand
Total
5
Nepal
Male
Numerator: Number of current daily and less
than daily tobacco smokers and/or smokeless
tobacco users
Denominator: Total number of respondents
8
7
29
21
20
4
SEA Region
29
20
14
10
43
36
35
31
Indicator: Percentage of respondents who
currently use tobacco
48
41
36
35
48
47
India
Female
Indonesia
Myanmar
Bangladesh Timor-Leste
Tobacco use – Smoked
100
Figure 2: Percentage of current tobacco
smokers
90
80
Percentage
70
Nearly one in five (18%) adults in the
Region smokes, ranging from 7% in
Bhutan to 49% in Timor-Leste.
70
67
60
50
40
35
33
29
30
20
49
47
45
45
7
10
3
14
11
*Sub-national
Denominator: Total number of respondents
10
3
3
Bhutan
India
Sri Lanka
Nepal
Total
10
8
3
0
Numerator: Number of current daily and
less than daily tobacco smokers
24
23
22
19
19
14
0
SEA Region
35
27
24
18
Indicator: Percentage of adults who currently
smoke tobacco
Maldives
(Malé)*
Male
2
Myanmar
Female
Bangladesh
3
Thailand
3
Indonesia Timor-Leste
Tobacco use – Smokeless
100
Figure 3: Percentage of current smokeless
tobacco users
90
80
Nearly one in five (22%) adults in the
Region uses smokeless tobacco, ranging
from 2% in Indonesia to 30% in Myanmar.
Percentage
70
60
51
50
Indicator: Percentage of adults who currently
use smokeless tobacco
40
33
31
30
27
24
22
20
16
10
2
2
0
SEA Region Indonesia
*Sub-national
20
18
15
2
27
27
20
16.1
27
28
26
26
18
Numerator: Number of current daily and less
than daily smokeless tobacco users
30
16
11
3 4 1
3
5
6
Maldives
(Malé)*
Thailand
Sri Lanka
5
1
Total
Nepal
Male
Bhutan
Female
Timor-Leste
India
Bangladesh
Myanmar
Denominator: Total number of respondents
HOME
Secondhand smoke – at home
100
92
90
95
87
78
80
81
Over 45% of adults are exposed to second
hand smoke at home in this Region,
ranging from 21% in Bhutan to 92% in
Timor-Leste.
75
Percentage
70
50
56
55
60
53
46
46 45
40
40
36
30
21
21 21
20
25
32
52
41
40 39
37
36
58
55
Figure 4: Percentage of persons who were
exposed to secondhand smoke at home
Indicator: Percentage of persons who were
exposed to tobacco smoke at home in the
past 30 days
35
27
23
Numerator: Number of respondents who
reported being exposed to smoke at home
during the past 30 days
10
Denominator: Total number of respondents
0
SEA Region
*Sub-national
Bhutan
Maldives
(Malé)*
Thailand
Nepal
Total
India
Male
Myanmar
Female
Bangladesh
Indonesia
Timor-Leste
WORKPLACE
Secondhand smoke – at workplace
100
Figure 5: Percentage of persons exposed to
secondhand smoke at workplace
90
80
74
Percentage
70
67
43
35
37
37
30
29
24
20
32
25
20
17
19
41
33
31
31
39
39
37
51
51
48
50
30
62
58
60
40
35% adults are exposed to secondhand
smoke at workplace in the Region,
ranging from 17% in Maldives to 62% in
Bangladesh.
31
23
19
Numerator: Number of respondents who
reported being exposed to smoke in indoor
areas at work during the past 30 days
11
10
0
SEA Region
*Sub-national
Maldives
(Malé)*
Bhutan
India
Indicator: Percentage of indoor workers who
were exposed to tobacco smoke at work in
the past 30 days
Thailand
Total
Nepal
Male
Myanmar
Female
Timor-Leste
Indonesia
Bangladesh
Denominator: Number of respondents who
work outside of the home who usually work
indoors or both indoors and outdoors
NO
SMOKING
Smokers tried to stop smoking
100
NO
SMOKING
Figure 6: Percentage of current smokers
who tried to stop smoking in past 12 months
90
82
80
75
69
Percentage
70
66
60
48
50
40
Nearly 35% smokers in the Region tried
to stop smoking, ranging from 23% in
Timor-Leste to 69% in Bhutan.
45
35
36
35
30
26 27
30
23
20
19
39
37
37
39
38
38
44
39
Indicator: Percentage of adults who smoked
tobacco during the past 12 months who tried
to quit during the past 12 months
47
39
32
30
Numerator: Number of current
smokers who tried to quit during
12 months and former tobacco
who have been abstinent for
Monitoring tobacco control among adults in selected
Member States of South-East Asia Region
– at a glance
Message
Tobacco continues to be a major public health problem in the WHO
South-East Asia Region, causing premature deaths and compounding the
increasing epidemic of noncommunicable diseases such as chronic lung
disease, heart ailments and cancer.
One fourth of the world’s smokers and over 80% of the world’s smokeless
tobacco users live in the Region. There are 290 million smokeless tobacco
users and 246 million smokers in the Region, as per recent estimates.
The findings of the Global Adult Tobacco Survey (GATS) and STEPwise
approach to noncommunicable diseases risk factor surveillance (STEPs)
show that 35% of adults are exposed to second-hand smoke at work
and over 45% at their homes. Nearly 35% of the people in the Region
use tobacco in one form or another; 19.7% use smokeless tobacco and
18.3% people smoke. As many as 35% smokers have been unsuccessful in
quitting tobacco due to absence of tobacco cessation support, while two
in five smokers have thought of quitting cigarette smoking after seeing
the health warning on cigarette packages.
Strengthening tobacco control policies, strictly enforcing existing laws
that ban tobacco promotion, enhancing graphic health warnings on all
tobacco products, implementing interventions to prevent exposure to
second-hand smoke, and most importantly, initiating tobacco cessation
measures with trained health workforce are key to stopping tobacco use
in the Region. While continuous efforts are being made to stop the use
of tobacco, more needs to be done.
This brochure provides an opportunity to review in graphic form
the effects of public health policies and tobacco control interventions in
Member States of the Region. In compliance with Article 21 of the WHO
Framework Convention on Tobacco Control (WHO FCTC), Member States
in the Region have been monitoring tobacco control using the standard
protocols of GATS and STEPs. Member States are committed to protecting
their people from the ill effects of tobacco and WHO commends and
continues to support them in their efforts to protect the people from the
scourge of tobacco.
Dr Poonam Khetrapal Singh
Regional Director
WHO South-East Asia Region
Introduction
The Global Adult Tobacco Survey (GATS) is a nationally representative
household survey that was launched in February 2007 as a new component
of the ongoing Global Tobacco Surveillance System (GTSS). GATS enables
countries to collect data on adult tobacco use and key tobacco control
measures for the 15+ years age group. Results from GATS assist countries
in the formulation, tracking and implementation of effective national
tobacco control interventions, and comparison with results from other
countries. The STEPwise approach to noncommunicable disease risk factor
surveillance (STEPs) of the World Health Organization (WHO) comprises
a population-based survey to collect information on the major modifiable
NCD risk factors, which has been used in many countries. WHO has a
set of core indicators derived from STEPs for monitoring NCD risk factors
nationally and globally. These core indicators were deemed practical and
easily obtainable by countries at all levels of technical capacity. Both data
systems assist countries in fulfilling their obligations under the World
Health Organization (WHO) Framework Convention on Tobacco Control
(FCTC) to generate comparable data within and across countries. WHO has
developed MPOWER, a package of selected demand reduction measures
contained in WHO FCTC.
This brochure contains data from GATS for Bangladesh (2009), India
(2009–2010), Indonesia (2011) and Thailand (2011) for the 15+ years
age group and from STEPs for (1) Maldives (2011), Myanmar (2008) and
Sri Lanka (2008) for the 15–64 years age group; (2) Nepal (2013) for the
15–69 years age group; and (3) Bhutan (2014) and Timor-Leste (2014)
for the 18–69 years age group.
Computation of regional prevalence: Corresponding to age- and
sex- specific prevalence of each tobacco use indicator, the latest 2015
population estimate for each country from the United Nations Population
Division publication “Population Prospects, The 2012 Revision” were used
to compute the number of tobacco users by age and sex for each country.
These numbers from of all countries of the South-East Asia Region were
summed up to come up with the regional aggregate. These were then
divided by the aggregated population of the Region, resulting in the overall
regional prevalence in percentage.
Tobacco use – Smoked and/or Smokeless
100
Figure 1: Percentage of current tobacco users
90
Nearly 35% adults in the Region use
tobacco in one or another form, ranging
from 20% in Maldives to 56% in TimorLeste.
80
74
Percentage
70
71
67
60
58
56
52
50
44
40
34
30
20
27
25
25
18
0
14
*Sub-national
Maldives
(Malé)*
Sri Lanka
Bhutan
Thailand
Total
5
Nepal
Male
Numerator: Number of current daily and less
than daily tobacco smokers and/or smokeless
tobacco users
Denominator: Total number of respondents
8
7
29
21
20
4
SEA Region
29
20
14
10
43
36
35
31
Indicator: Percentage of respondents who
currently use tobacco
48
41
36
35
48
47
India
Female
Indonesia
Myanmar
Bangladesh Timor-Leste
Tobacco use – Smoked
100
Figure 2: Percentage of current tobacco
smokers
90
80
Percentage
70
Nearly one in five (18%) adults in the
Region smokes, ranging from 7% in
Bhutan to 49% in Timor-Leste.
70
67
60
50
40
35
33
29
30
20
49
47
45
45
7
10
3
14
11
*Sub-national
Denominator: Total number of respondents
10
3
3
Bhutan
India
Sri Lanka
Nepal
Total
10
8
3
0
Numerator: Number of current daily and
less than daily tobacco smokers
24
23
22
19
19
14
0
SEA Region
35
27
24
18
Indicator: Percentage of adults who currently
smoke tobacco
Maldives
(Malé)*
Male
2
Myanmar
Female
Bangladesh
3
Thailand
3
Indonesia Timor-Leste
Tobacco use – Smokeless
100
Figure 3: Percentage of current smokeless
tobacco users
90
80
Nearly one in five (22%) adults in the
Region uses smokeless tobacco, ranging
from 2% in Indonesia to 30% in Myanmar.
Percentage
70
60
51
50
Indicator: Percentage of adults who currently
use smokeless tobacco
40
33
31
30
27
24
22
20
16
10
2
2
0
SEA Region Indonesia
*Sub-national
20
18
15
2
27
27
20
16.1
27
28
26
26
18
Numerator: Number of current daily and less
than daily smokeless tobacco users
30
16
11
3 4 1
3
5
6
Maldives
(Malé)*
Thailand
Sri Lanka
5
1
Total
Nepal
Male
Bhutan
Female
Timor-Leste
India
Bangladesh
Myanmar
Denominator: Total number of respondents
HOME
Secondhand smoke – at home
100
92
90
95
87
78
80
81
Over 45% of adults are exposed to second
hand smoke at home in this Region,
ranging from 21% in Bhutan to 92% in
Timor-Leste.
75
Percentage
70
50
56
55
60
53
46
46 45
40
40
36
30
21
21 21
20
25
32
52
41
40 39
37
36
58
55
Figure 4: Percentage of persons who were
exposed to secondhand smoke at home
Indicator: Percentage of persons who were
exposed to tobacco smoke at home in the
past 30 days
35
27
23
Numerator: Number of respondents who
reported being exposed to smoke at home
during the past 30 days
10
Denominator: Total number of respondents
0
SEA Region
*Sub-national
Bhutan
Maldives
(Malé)*
Thailand
Nepal
Total
India
Male
Myanmar
Female
Bangladesh
Indonesia
Timor-Leste
WORKPLACE
Secondhand smoke – at workplace
100
Figure 5: Percentage of persons exposed to
secondhand smoke at workplace
90
80
74
Percentage
70
67
43
35
37
37
30
29
24
20
32
25
20
17
19
41
33
31
31
39
39
37
51
51
48
50
30
62
58
60
40
35% adults are exposed to secondhand
smoke at workplace in the Region,
ranging from 17% in Maldives to 62% in
Bangladesh.
31
23
19
Numerator: Number of respondents who
reported being exposed to smoke in indoor
areas at work during the past 30 days
11
10
0
SEA Region
*Sub-national
Maldives
(Malé)*
Bhutan
India
Indicator: Percentage of indoor workers who
were exposed to tobacco smoke at work in
the past 30 days
Thailand
Total
Nepal
Male
Myanmar
Female
Timor-Leste
Indonesia
Bangladesh
Denominator: Number of respondents who
work outside of the home who usually work
indoors or both indoors and outdoors
NO
SMOKING
Smokers tried to stop smoking
100
NO
SMOKING
Figure 6: Percentage of current smokers
who tried to stop smoking in past 12 months
90
82
80
75
69
Percentage
70
66
60
48
50
40
Nearly 35% smokers in the Region tried
to stop smoking, ranging from 23% in
Timor-Leste to 69% in Bhutan.
45
35
36
35
30
26 27
30
23
20
19
39
37
37
39
38
38
44
39
Indicator: Percentage of adults who smoked
tobacco during the past 12 months who tried
to quit during the past 12 months
47
39
32
30
Numerator: Number of current
smokers who tried to quit during
12 months and former tobacco
who have been abstinent for