FRIDAY, Aug. 17 (HealthDay News) -- Because pro-tobacco forces often overshadow less well-funded tobacco-control strategies, global tobacco use remains high, particularly in low- and middle-income countries, according to the world's largest study on tobacco use.

The research, published Aug. 17 in the journal The Lancet, revealed that more resources are needed to fully implement tobacco-control strategies to educate people about the harmful effects of tobacco products and help them quit smoking.

"Our data reflect industry efforts to promote tobacco use," lead study author Gary Giovino, chairman of the department of community health and health behavior at the University at Buffalo School of Public Health and Health Professions, said in a university news release. "These include marketing and mass media campaigns by companies that make smoking seem glamorous, especially for women. The industry's marketing efforts also equate tobacco use with Western themes, such as freedom and gender equality."

"Governments around the world need to start giving economic and regulatory advantages to agricultural products that promote health instead of to products like tobacco that kill people," Giovino added.

The study involved 14 low- and middle-income countries involved in the Global Adult Tobacco Survey. Specifically, the researchers focused on Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam. From 2008 to 2010, more than 248,000 people from these countries were interviewed in person on their tobacco use.

The interviews were compared to nearly 189,000 surveys conducted in the United States and the United Kingdom.

The investigators found that 49 percent of men and 11 percent of women in the Global Adult Tobacco Survey countries smoked or used smokeless tobacco. Although rates of smoking among women from these countries remained low, they started smoking earlier. The women started using tobacco around age 17, rather than in their 20s.

The most popular form of tobacco is cigarettes, the research showed, and 64 percent of tobacco users were smokers.

China had the highest number of tobacco users, including about 53 percent of men. In all, 301 million Chinese people used some form of tobacco. India trailed closely behind with 274 million tobacco users (48 percent of men). The researchers noted quit ratios were also lowest in these countries, along with Russia and Egypt.

The study authors pointed out that pro-tobacco forces in these countries impede efforts to control tobacco use and, in some countries, the government actually owns the tobacco industry.

"China National Tobacco, for example, which is owned by the Chinese government, sponsors dozens of elementary schools, where students are subjected to pro-tobacco propaganda. Some messages even equate tobacco use with academic success," said Giovino, who is also a former chief of epidemiology in the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention. "I find that mind-boggling."

The tobacco industry also has developed ways to make tobacco products more palatable for nonsmokers who are using them for the first time, the investigators found.

"These products are technologically designed to mask harshness, provide particular taste sensations and increase nicotine delivery," the study authors wrote.

"These characteristics are designed to ease the transition from experimentation to regular use, especially among young people," Giovino explained.

Quit ratios were highest in the United States and the United Kingdom, as well as in Brazil and Uruguay, where tobacco-control programs are the strongest, the researchers pointed out.

"In the absence of effective actions, about 1 billion people worldwide will die prematurely in the next century from tobacco use, and most of those deaths -- and the health care and economic costs that come with them -- will be borne by lower- and middle-income countries," Giovino said.

Tobacco-control strategies need more funding so tobacco use can be monitored, nonsmokers can be protected and those who use tobacco products can get the help they need to quit, the researchers concluded.

More information

The U.S. Centers for Disease Control and Prevention has more information on smoking and tobacco use.

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