Lancet Public Health. 2021 Jul;6(7):e482-e499. doi: 10.1016/S2468-2667(21)00065-7. Epub 2021 May 28.
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.
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.
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.
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.
Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.
与吸烟相比，嚼烟及其他类型无烟烟草的使用受到全球卫生界的关注较少。然而，这种行为在世界许多地区都很普遍，并且与多种不良健康后果相关。了解年龄、时间、地点和性别方面的流行趋势对于政策制定以及监测和评估对《世界卫生组织烟草控制框架公约》的承诺至关重要。
作为2019年全球疾病、伤害及风险因素负担研究的一部分，我们采用一种建模策略估计嚼烟使用的流行率，该策略使用了多种无烟烟草产品的信息。我们生成了1990年至2019年204个国家和地区15岁及以上人群嚼烟使用流行率的时间序列，包括按年龄和性别的具体估计值。我们还将这些趋势与同一时期吸烟的趋势进行了比较。
2019年，15岁及以上人群中有2.739亿人（95%不确定区间为2.585亿至2.909亿）使用嚼烟，全球年龄标准化嚼烟使用率为4.72%（4.46%至5.01%）。2.282亿（2.136亿至2.447亿；83.29%[82.15%至84.42%]）嚼烟使用者生活在南亚地区。2019年，15至19岁年轻人中，有七个地区的使用率超过10%。尽管1990年至2019年期间全球年龄标准化吸烟率显著下降（年化变化率：-1.21%[-1.26%至-1.16%]），但嚼烟方面未观察到类似进展（0.46%[0.13%至0.79%]）。在12个使用率最高的国家（孟加拉国、不丹、柬埔寨、印度、马达加斯加、马绍尔群岛、缅甸、尼泊尔、巴基斯坦、帕劳、斯里兰卡和也门）中，只有也门的嚼烟使用率显著下降，即1990年至2019年期间男性使用率下降了-0.94%[-1.72%至-0.14%]，而12个国家中有9个国家的吸烟率显著下降。在女性中，这12个国家中没有一个国家的嚼烟使用率显著下降，而在该时期，12个国家中有7个国家的吸烟率显著下降。
嚼烟在世界几个地区，主要是南亚，仍然是一个严重的公共卫生问题。我们发现1990年至2019年期间嚼烟使用率变化不大，并且在一些国家，控烟措施对吸烟率的影响比对嚼烟使用率的影响大得多。减轻嚼烟对健康的影响需要更强有力的法规和政策，特别是针对嚼烟使用的政策，尤其是在使用率高的国家。
彭博慈善基金会和比尔及梅琳达·盖茨基金会。
