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dc.contributor.authorGBD 2019 Chewing Tobacco Collaboratorsen_NZ
dc.date.accessioned2021-08-10T00:20:04Z
dc.date.available2021-08-10T00:20:04Z
dc.date.copyright2021en_NZ
dc.identifier.citationThe Lancet Public Health, Volume 6, Issue 7, July 2021, Pages e482-e499
dc.identifier.issn2468-2667en_NZ
dc.identifier.issn2468-2667en_NZ
dc.identifier.urihttp://hdl.handle.net/10292/14412
dc.description.abstractBACKGROUND: 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, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) 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: -1·21% [-1·26 to -1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). 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 (-0·94% [-1·72 to -0·14]), 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. FUNDING: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.en_NZ
dc.languageengen_NZ
dc.publisherElsevier
dc.relation.urihttps://www.sciencedirect.com/science/article/pii/S2468266721000657
dc.rights© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
dc.subjectAdolescenten_NZ
dc.subjectAdulten_NZ
dc.subjectAge Distributionen_NZ
dc.subjectFemaleen_NZ
dc.subjectGlobal Burden of Diseaseen_NZ
dc.subjectGlobal Healthen_NZ
dc.subjectHealth Statusen_NZ
dc.subjectHumansen_NZ
dc.subjectMaleen_NZ
dc.subjectMiddle Ageden_NZ
dc.subjectPopulation Surveillanceen_NZ
dc.subjectPrevalenceen_NZ
dc.subjectQuality-Adjusted Life Yearsen_NZ
dc.subjectRisk Factorsen_NZ
dc.subjectSex Distributionen_NZ
dc.subjectSmoking Cessationen_NZ
dc.subjectSmoking Preventionen_NZ
dc.subjectSocioeconomic Factorsen_NZ
dc.subjectTobacco, Smokelessen_NZ
dc.subjectYoung Adulten_NZ
dc.titleSpatial, 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 2019en_NZ
dc.typeJournal Article
dc.rights.accessrightsOpenAccessen_NZ
dc.identifier.doi10.1016/S2468-2667(21)00065-7en_NZ
aut.relation.endpagee499
aut.relation.issue7en_NZ
aut.relation.startpagee482
aut.relation.volume6en_NZ
pubs.elements-id435498
aut.relation.journalLancet Public Healthen_NZ


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