Differences by Sex in Tobacco Use and Awareness of Tobacco Marketing—Bangladesh, Thailand, and Uruguay, 2009

May 28, 2010 / Vol. 59 / No. 20

MMWR Highlights

Background

• The Global Adult Tobacco Survey (GATS) is a nationally representative household survey conducted among persons aged 15 years or older using a standard and consistent core questionnaire, sample design, and data collection and management protocols to ensure comparability across countries.
• CDC designed GATS to help countries produce national and subnational estimates on tobacco use, exposure to secondhand smoke, and smoking cessation attempts.
• GATS provides nationally representative data on adult tobacco use and exposure to tobacco marketing that is comparable across countries.
• In 2009, GATS was conducted for the first time in 14 countries. The Ministries of Health in Bangladesh, Thailand, and Uruguay had released data in time to be included in this report.
• The 2009 GATS response rate was 93.6% in Bangladesh (9,629 interviews completed), 94.2% in Thailand (20,566 interviews completed), and 95.6% (5,581 interviews completed) in Uruguay.

Overview

• This report used data from the 2009 Global Adult Tobacco Surveys (GATS) conducted in Bangladesh, Thailand, and Uruguay to examine gender differences in tobacco use (smoked and smokeless) and awareness of tobacco marketing.
• Tobacco use differences are the result of a complex interaction of personal, familial, cultural, and social factors.

Tobacco Use

• In all three countries, current tobacco use is higher in men (compared with women), but the gender-specific pattern of tobacco use varies significantly across countries.

Smoking prevalence

• In Bangladesh, 1.5% of women are current smokers, compared with 44.7% of men.
• In Thailand, 3.1% of women are current smokers, compared with 45.6% of men.
• In Uruguay, 19.8% of women are current smokers, compared with 30.7% of men.

• In 2009, the U.S. government, 14 states, and Washington, DC increased cigarette excise taxes.

Smokeless tobacco use

• In Bangladesh, the prevalence of smokeless tobacco use is 27.9% for women, compared with 26.4% for men. There is not a statistically significant difference between these numbers.
• In Thailand, the prevalence of smokeless tobacco use is 6.3% for women, compared with 1.3% for men.
• Uruguay has almost no smokeless tobacco use; only one sample respondent in the entire survey of 5,581 men and women reported smokeless tobacco use.

• As of December 31, 2009 excise tax rates among states ranged from $0.07 cents per pack in South Carolina to $3.46 per pack in Rhode Island. The average excise tax among all states was $1.34 per pack.

Gender-specific patterns

• In Bangladesh, although smoking prevalence among women is low, smokeless tobacco use is substantial and approximately equal among men and women.
• In Thailand, smokeless tobacco use is greater among women than men.

Tobacco Marketing Awareness and Exposure

• In Thailand and Uruguay, little or no difference in awareness of cigarette marketing (in and outside of stores where cigarettes are sold) was observed between men and women, but a large difference was observed in Bangladesh.
  • In Bangladesh, 68% of men and 29.3% of women noticed any cigarette marketing.
  • In Thailand, 17.4% of men and 14.5% of women noticed any cigarette marketing.
  • In Uruguay, 49% of men and 40% of women noticed any cigarette marketing.
• In all countries, exposure to tobacco advertising, sponsorship, and promotion was greater among young adult women (15–24 years of age) than among older women (25 years of age or older).
  • In Bangladesh, 37.9% of women aged 15–24 years and 25.6% of women aged 25 years or older noticed any cigarette marketing.
  • In Thailand, 28.1% of women aged 15–24 years and 11.2% of women aged 25 years or older noticed any cigarette marketing.
  • In Uruguay, 62.5% of women aged 15–24 years and 34.9% of women aged 25 years or older noticed any cigarette marketing.

Editorial Notes from the Report

• Tobacco marketing plays a significant role in the initiation and maintenance of tobacco use; the tobacco industry spends tens of billions of dollar annually on direct and indirect advertising of tobacco products.
• Report results support the need for continued implementation and enforcement of the World Health Organization's Framework Convention on Tobacco Control and MPOWER package.