Tobacco Consumption and Adult Prevalence in the Eastern Mediterranean and Neighboring Regions

1
Tobacco Consumption and Adult Prevalencein the
Eastern Mediterranean and Neighboring Regions

• Lecturer Hillel R. Alpert
• Harvard School of Public Health
• Cyprus International Institute For the
  Environment and Public Health
• Making Smoking History A Training Course
• February 27 March 2 , 2005
• Lanarca, Cyprus

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SOURCES OF TOBACCO USE DATA

• Prevalence
• Tobacco use surveys, Scientific literature, WHO,
  MOHs,national statistics offices, tobacco control
  organizations.
• Cigarette Production, Trade, and Consumption
• Food and Agriculture Organization of the United
  Nations (FAO). FaoStat Statistical databases.
• URL http//apps.fao.org
• United Nations Industrial Commodity Trade
  Statistics Database (COMTRADE).
• URL http//unstats.un.org/unsd/comtrade/
• United States Department of Agriculture, Foreign
  Agricultural Service. Production, Supply, and
  Distribution. (PSD Online)
• URL http//www.fas.usda.gov/psd (currently being
  updated)
• Commercial

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Estimating tobacco use

• Estimates of the use of tobacco products can
  originate from various types of data.
• self-reported tobacco use prevalence surveys
  (prevalence consumption)
• consumption derived from production and trade
  statistics (apparent consumption)
• consumption estimated from national cigarette
  sales data (usually based on tax records)

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Prevalence vs. consumption

• Prevalence surveys
• provide important insights into patterns of
  consumption according to gender, age, income,
  education, etc.
• distinguishes between a change in the number of
  smokers and changes in consumption per smoker.
• consumption data (the number of cigarettes
  consumed) based on surveys suffer from
  significant underreporting.
• infrequent availability of trend data
• the subjective nature of surveys and differences
  in survey methodology (questions, definitions,
  languages, etc.) also make comparison of
  estimates across (and within!) countries
  difficult.

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Prevalence vs. consumption (cont.)

• Consumption
• production and trade statistics are objective
  data that eliminate the underreporting problem
• data are readily available across time and
  countries. This feature, as well as the
  availability of centralized data sources using
  common methodologies, allows for good
  comparability.
• most large-scale tobacco statistics are only
  available for manufactured cigarettes.
• cannot be used for analyzing changes in gender,
  age, income and education distribution and they
  do not permit a distinction between a change in
  the number of smokers and changes in consumption
  per smoker

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Prevalence vs. consumption (cont.)

• Consumption (cont)
• illicit trade will lead to under- or
  over-estimating consumption of tobacco products
• different measurement units can yield diverging
  trends and biased point estimates
• Stockpiling
• transient populations
• Sales data based on tax records
• present the same general advantages and
  disadvantages as those described for production
  and trade statistics
• sales data are not as readily available across
  countries and are not available in centralized
  databases
• do not suffer from the limitations associated
  with measuring and reporting units or stockpiling
  and exclude duty-free sales

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Purposes of Tobacco Surveys

• Baseline and trended data pertaining to tobacco
  use and other important parameters.
• Estimate health and economic costs due to use of
  tobacco products (e.g. CPS-II and
  smoking-attributable morbidity and mortality)
• Identify tobacco control needs and develop
  strategies (e.g. policy, counter-marketing, youth
  access, treatment of nicotine dependence)
• Evaluate tobacco control interventions

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Survey Domains

• Knowledge, Attitudes, and Beliefs
• Health Effects
• Health and Social Influences
• Acceptability / Norms
• Youth Access
• Parental involvement
• Retailer Practices
• Perceived Availability
• Media / Advertising / Exposure / Awareness
• Advertising
• Promotion
• Anti-Tobacco Campaigns
• Policy
• Price, Taxation
• Clean Indoor Air

• Tobacco Use
• Current Use
• Past Use
• Age of Initiation
• Product
• Cigarette, cigar, pipes, smokeless, bidi, kretek
• Brands and sub-brands
• Degree of Inhalation
• Cessation
• Behaviors
• Counseling
• Environmental Tobacco Smoke (ETS) Exposure
• Workplace
• Public
• Home
• Policy

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Standard Definitions of Smoking Status

• Current smoker is someone who, at the time of the
  survey, smokes any tobacco product either daily
  or occasionally.
• Daily smoker is someone who smokes any tobacco
  product at least once a day.
• Occasional smoker is someone who smokes, but not
  every day.

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Standard Definitions of Smoking Status (cont.)

• A Former smoker is someone, who, at the time of
  the survey, does not smoke at all, but smoked 100
  or more cigarettes (or the equivalent amount of
  tobacco) in his/her lifetime.
• Ever smokers are defined as those who have ever
  smoked at least 100 cigarettes (or the equivalent
  amount of tobacco) in their lifetime.
• Never Smokers are those who either have never
  smoked at all, or have smoked less than 100
  cigarettes (or the equivalent amount of tobacco)
  in their life time.

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Additional Questions To Ask

• What type of tobacco do respondents report
  smoking?
• What frequency of smoking defines a smoker?
• What is the age range of adult and youth and
  how were the respondents selected?
• Where was the survey conducted? Was it conducted
  throughout the country or territory?

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PREVALENCE OF FEMALE ADULT TOBACCO USE IN EMRO
AND REGION
21
24.3
8.8
10.3
20.1
21.7
0.9
23
32
18
3.1
29
4.7
9
4.2
10.5
5
10
18
2.7
5
14
6.6
4.8
0.9
8.2
1
0.2
1.5
29
10
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PREVALENCE OF MALE ADULT TOBACCO USE IN EMRO AND
REGION
47.5
25.5
40.7
42.7
28
33.8
24.1
43.8
40
60
67.5
46.8
24.8
52.8
61.4
38.1
40
30
32.7
40
44
34.4
43.8
43.6
22.4
40
24
13.2
23.5
60
75
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Measuring Consumption

• Production and Trade
• Total Cigarette Consumption Production
  Imports Exports
• Per Capita Consumption (Production Imports
  Exports) / (Population 15 years and older)
• Cigarette Sales (e.g. tax collections records)
• Tax Collections / Tax per Pack
• Over- or understatement possible due to smuggling
  and stockpiling

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Per Capita Consumption of Cigarettes By Region
1998-2002
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Total Cigarette Consumption 1970-2000 byWHO
Regions and Levels of Development (million
sticks)
Source Guindon GE, Boisclair D. Past, Current,
and Future Trends in Tobacco Use HNP Discussion
Paper Economics of Tobacco Control February
2003, 2nd Edition.
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Per Capita Expenditure on Cigarettes by Region
1998-2002
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Africa / Middle East Cigarette Consumption Trends
by Country 1998-2002
19
Asia Pacific Cigarette Consumption Trends by
Country 1998-2002
20
Eastern Europe Cigarette Consumption Trends by
Country 1998-2002
21
Western Europe Cigarette Consumption Trends by
Country 1998-2002
22
Per- Capita Cigarette Consumption (million
pieces)In Countries in the Eastern Mediterranean
Region and Surroundings
Figures are for Year 2000, except where noted.
Sources Guindon Ge, Bosclair D. Past, Current,
and Future Trends in Tobacco Use. February, 2003
ACS Tobacco Control Country Profiles, 2003. Data
from COMTRADE, USDA, FAO, UNSD0
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• THANK YOU FOR YOUR ATTENTION AND HELP IN MAKING
  SMOKING HISTORY IN AND AROUND THE EASTERN
  MEDITERRANEAN REGION!
• Hillel R. Alpert
• halpert_at_hsph.harvard.edu