Not available
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 90 80 74 70 67 58 52 44 35 36 25 25 14 4 SEA Region Maldives (Malé)*
Figure 1: Percentage of current tobacco users Nearly 35% adults in the Region use tobacco in one or another form, ranging from 20% in Maldives to 56% in TimorLeste. Indicator: Percentage of respondents who currently use tobacco 29
71 56
Percentage
60 50 40 30 20 10 0 18 20 47 34 27 48 48 41 31 35 20 14 8 Bhutan Thailand Nepal India
43 29 21
36
Numerator: Number of current daily and less than daily tobacco smokers and/or smokeless tobacco users Denominator: Total number of respondents
7 Sri Lanka
5 Indonesia Myanmar Bangladesh Timor-Leste
*Sub-national
Total
Male
Female
Tobacco use – Smoked 100 90 80 70 67 70
Figure 2: Percentage of current tobacco smokers Nearly one in five (18%) adults in the Region smokes, ranging from 7% in Bhutan to 49% in Timor-Leste. Indicator: Percentage of adults who currently smoke tobacco Numerator: Number of current daily and less than daily tobacco smokers 10 2 Myanmar Bangladesh
Percentage
60 50 40 30 20 10 0 18 7 3 SEA Region
45 33 24 11 3 14 3 India
45
47 35
49
35 29 19 10 0 Sri Lanka Nepal
27 19 22 8 23
24
14
Denominator: Total number of respondents
3 Maldives (Malé)*
3 Thailand
3 Indonesia Timor-Leste
Bhutan
*Sub-national
Total
Male
Female
Tobacco use – Smokeless 100 90 80 70
Figure 3: Percentage of current smokeless tobacco users Nearly one in five (22%) adults in the Region uses smokeless tobacco, ranging from 2% in Indonesia to 30% in Myanmar. 51
Percentage
60 50 40 30 22 20 10 0 16 2 2 2 3 4 1 Maldives (Malé)*
Indicator: Percentage of adults who currently use smokeless tobacco 27 31 24 15 3 5 1 Sri Lanka
33 27 27 20 11 5 16.1 26 18 20
27
28 26
30 16
Numerator: Number of current daily and less than daily smokeless tobacco users Denominator: Total number of respondents
18 6
SEA Region Indonesia *Sub-national
Thailand
Nepal
Bhutan
Timor-Leste
India
Bangladesh
Myanmar
Total
Male
Female
HOME
Secondhand smoke – at home 100 90 80 70 78 81 75 92 95 87
Figure 4: Percentage of persons who were exposed to secondhand smoke at home 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. Indicator: Percentage of persons who were exposed to tobacco smoke at home in the past 30 days Numerator: Number of respondents who reported being exposed to smoke at home during the past 30 days
Percentage
60 50 40 30 20 10 0 SEA Region *Sub-national Bhutan Maldives (Malé)* Thailand Nepal India
55 53 46 46 45 40 36 21 21 21 25 27 23 32 36 37 35 41 40 39
56 55
58 52
Myanmar
Bangladesh
Indonesia
Timor-Leste
Denominator: Total number of respondents
Total
Male
Female
WORKPLACE
Secondhand smoke – at workplace 100 90 80 70 74 67 58 48 43 35 37 24 25 11 29 19 30 32 19 37 31 23 37 31 39 33 51 39 51 41 31 62
Figure 5: Percentage of persons exposed to secondhand smoke at workplace 35% adults are exposed to secondhand smoke at workplace in the Region, ranging from 17% in Maldives to 62% in Bangladesh. Indicator: Percentage of indoor workers who were exposed to tobacco smoke at work in the past 30 days Numerator: Number of respondents who reported being exposed to smoke in indoor areas at work during the past 30 days Nepal Myanmar Timor-Leste Indonesia Bangladesh
Percentage
60 50 40 30 20 10 0 SEA Region *Sub-national
20 17
Maldives (Malé)*
Bhutan
India
Thailand
Total
Male
Female
Denominator: Number of respondents who work outside of the home who usually work indoors or both indoors and outdoors
Smokers tried to stop smoking 100 90 80 70 82 75 69 66
NO SMOKING
NO SMOKING
Figure 6: Percentage of current smokers who tried to stop smoking in past 12 months Nearly 35% smokers in the Region tried to stop smoking, ranging from 23% in Timor-Leste to 69% in Bhutan. Indicator: Percentage of adults who smoked tobacco during the past 12 months who tried to quit during the past 12 months Numerator: Number of current smokers who tried to quit during 12 months and former tobacco who have been abstinent for <12 Indonesia Thailand India Maldives (Malé)* Bangladesh Bhutan
Percentage
60 50 40 30 20 10 0 SEA Region *Sub-national Timor-Leste Nepal
48 45 35 36 35 23 26 27 19 23 30 30 37 37 39 38 39 38 39 44 39 32 47
tobacco the past smokers months
Total
Male
Female
Denominator: Total number of current tobacco smokers and former tobacco smokers who have been abstinent for <12 months
NO SMOKING
NO SMOKING
Advised to stop smoking 100 90 80 70
Figure 7: Prevalence of current smokers advised by a health care provider to stop smoking in past 12 months Nearly two in five (42%) adults have been advised by health-care providers to stop smoking, ranging from 22% in Nepal to 56% in Thailand. 55
Percentage
60 50 42 40 33 30 22 20 10 0 SEA Region *Sub-national Nepal Timor-Leste Bhutan Maldives (Malé)* Indonesia India
53 43 33 23 21 23 22 23 32 35 34 26 13 35 36 47 46 39
62 53 56
56
Indicator: Percentage of current tobacco smokers and recent quitters (<12 months) who visited a doctor or health-care provider (HCP) during the past 12 months and were advised to quit smoking tobacco Numerator: Number of current tobacco smokers and former tobacco smokers who have been abstinent for <12 months who report being advised to quit smoking during a visit to a health-care provider within the past 12 months Denominator: Number of current tobacco smokers and former tobacco smokers who have been abstinent for <12 months who visited a health-care provider in the past 12 months
Bangladesh
Thailand
Total
Male
Female
Thought of quit smoking 100 90 80 70 63 63 59 75 74 84 83
NO SMOKING
NO SMOKING
Figure 8: Percentage of current smokers who saw health warnings on cigarette packages and thought of quitting in the last 30 days Nearly two in five (38%) smokers thought of quitting smoking because of health warnings on the cigarette packages in the Region, ranging 5% in Timor-Leste to 84% Bhutan. Indicator: Percentage of adults who currently smoke tobacco Numerator: Number of current daily and less than daily tobacco smokers Denominator: Total number of respondents
Percentage
60 50 40 30 20 10 0 SEA Region *Sub-national
50 40 38 28 27 ~ Not available ~
40 34 33 ~ Not available ~ Bhutan
38
17 11 5 5 3 Indonesia Maldives (Malé)* India Thailand
10
Timor-Leste
Bangladesh
Total
Male
Female
The findings from the Global Adult Tobacco Survey (GATS, 2009–2011) and STEPwise approach to noncommunicable disease risk factor surveillance (STEPs, 2008–2015) have been presented in graphic form and by year on important indicators of tobacco control in selected Member States of the Region. The data presented in graphic form will be particularly useful for programme managers, tobacco control advocates and any other relevant stakeholders for generating credible evidence to further promote tobacco control. For further information, please contact: Dr Dhirendra N Sinha Regional Adviser Surveillance (Tobacco Control) E-mail: sinhad@who.int Mr Naveen Agarwal Data Analyst, (Tobacco Control) E-mail: agarwaln@who.int World Health House Indraprastha Estate Mahatma Gandhi Marg New Delhi-110002, India www.searo.who.int
WHO Library Cataloguing-in-Publication data Monitoring tobacco control among adults in selected Member States South-East Asia Region – At a glance. 1. Smoking cessation. 5. Tobacco use. 2. Tobacco Products. 6. South-East Asia. 3. Tobacco smoke pollution. 7. World Health Organization 4. Tobacco, Smokeless.
ISBN 978 92 9022 489 1
ISBN 978-92-9022-489-1
(NLM classification: HD 9130)