Keck School Professor Assists in World’s Largest Tobacco Use Study

Jonathan Samet, M.D., professor and Flora L. Thornton Chair of the Keck School's Department of Preventive Medicine

by USC Health Sciences Public Relations and Marketing Staff

New research published in the medical journal The Lancet reveals alarming trends in tobacco use from a nationally representative survey of 3 billion people in 16 countries, with nearly half of adult men in developing countries still using tobacco products; women increasingly starting to smoke at younger ages; and low quit rates in most countries. The study is the largest tobacco use prevalence study ever reported.

“The new Global Adult Tobacco Survey (GATS) data provide a picture of tobacco use globally and will be a benchmark for tracking the continuing epidemic of tobacco use,” said Jonathan Samet, M.D., an author of the study and professor and Flora L. Thornton Chair of the Keck School of Medicine of USC’s Department of Preventive Medicine. “Hopefully, as GATS continues it will document a decline in tobacco use resulting from global efforts to slow the epidemic.”

The study focused on adults (aged 15 years or older) from 14 low- and middle-income GATS countries (Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam), making comparisons with the United States and the United Kingdom. GATS was created by major national and international health agencies to improve the ability of countries to design, implement and evaluate anti-tobacco efforts.

The nationally representative surveys were conducted in GATS countries from 2008 to 2010, via face-to-face interviews with 248,452 respondents. Data on another 188,895 respondents from the U.S. and UK were also included.

The research reveals:

  • 49 percent of men and 11 percent of women in the GATS countries used tobacco (smoked, smokeless, or both)
  • although women’s tobacco use rates remain low, women are beginning to smoke as early as men, around age 17 instead of in their 20s
  • while tobacco is consumed in various ways, from chewing tobacco and snuff to waterpipes and hand-rolled bidis, most tobacco users (64 percent) smoked manufactured cigarettes
  • China had the highest number of tobacco users at 301 million people (including 52.9 per cent of men) followed by India, with 274 million people (47.9 percent of men).
  • Quit ratios were highest in the U.S. and the UK as well as in Brazil and Uruguay, where tobacco control activities are strongest; they were lowest in China, India, Russia and Egypt.

The survey results paint a disturbing picture of global tobacco use influenced by powerful and manipulative pro-tobacco forces, says lead author Gary A. Giovino, Ph.D., chair of the Department of Community Health and Health Behavior at the University at Buffalo School of Public Health and Health Professions in New York.

While 100 million lives were lost prematurely due to tobacco use in the last century, the study notes that the World Health Organization estimates that if current trends continue, the number of preventable, premature deaths in this century will be far greater.

“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 healthcare and economic costs that come with them, will be borne by lower- and middle-income countries,” Giovino said.

What is needed, Giovino adds, is the deliberate allocation of more resources to fully implement tobacco control strategies, such as the MPOWER strategies of the World Health Organization ( that monitor tobacco use, protect nonsmokers and offer help with quitting.

The research was funded by Bloomberg Philanthropies’ Initiative to Reduce Tobacco Use, the Bill and Melinda Gates Foundation and the Brazilian and Indian governments. Other authors include Samira Asma, DDS, Sara A. Mirza, Ph.D., Jason Hsia, Ph.D., Jeremy Morton, and Krishna M. Palipudi, Ph.D. of the CDC; Prakash C. Gupta, Sc.D., of the Healis-Sekhsaria Institute for Public Health in Mumbai; Martin J. Jarvis of University College London; Neeraj Bhala and Richard Peto of the University of Oxford and Witold Zatonski, M.D., of the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw; and the Institute of Rural Health, Lublin, Poland.

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