The impact of inter-survey differences in the definition of current smokeless tobacco use on comparability of US national and state-specific prevalence estimates, 2009-2011.

BACKGROUND: We assessed how varying definitions of adult current smokeless tobacco (SLT) use affected overall prevalence estimates. METHODS: National prevalence estimates were from five surveys: 2009-2010 National Health and Nutrition Examination Survey (NHANES), 2009-2010 National Adult Tobacco Survey (NATS), 2010-2011 Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 2010 National Survey on Drug Use and Health (NSDUH), and 2010 National Health Information Survey (NHIS). State-specific prevalence estimates were from three surveys: 2009-2010 NATS, 2010-2011 TUS-CPS, and 2010 Behavioral Risk Factor Surveillance System (BRFSS). Current SLT use definitions were as follows: past 5-day use (NHANES), past 30-day use (NATS and NSDUH), and "every day" or "some days" use (TUS-CPS, NHIS, and BRFSS). Inter-survey variations further existed in number and types of SLT products assessed. RESULTS: National prevalence estimates of current SLT use were as follows: NATS (3.9%), NSDUH (3.6%), NHIS (2.8%), NHANES (2.3%), and TUS-CPS (1.6%). State-specific prevalence estimates of SLT use were generally lower for TUS-CPS (median=2.1%, range: 0.5% in California and New York, to 7.2% in Wyoming) compared to either BRFSS (median=4.0%: range: 0.9% in Washington D.C., to 8.2% in Wyoming) or NATS (median=4.7%; range: 1.3% in New Jersey, to 9.8% in Wyoming). CONCLUSION: Concerted efforts are needed among interagency groups to harmonize SLT definition within different surveys.

Poly-tobacco use among adults in 44 countries during 2008-2012: evidence for an integrative and comprehensive approach in tobacco control.

INTRODUCTION: The concurrent use of multiple tobacco products (i.e., poly-tobacco use) might hinder efforts to reduce overall tobacco use, particularly considering that use of some non-cigarette tobacco products may be popular in some regions due to social, cultural, or economic reasons. This study assessed poly-tobacco use patterns among persons aged ≥15 years old from 44 countries. METHODS: Data from 44 countries in all six World Health Organization regions were obtained from the 2008 to 2012 Global Adult Tobacco Surveys (n=19 countries), and the Special Eurobarometer 385 (77.1) survey, 2012 (n=25 countries). Correlates of poly-tobacco use were assessed using multivariate logistic regression analyses (p<0.05). RESULTS: Overall prevalence of poly-tobacco use ranged from 0.8% (Mexico) to 11.9% (Denmark). In 28 countries, 20% or more of current smokers of manufactured cigarettes concurrently used at least one other tobacco product and this proportion was highest in India (66.2%) and lowest in Argentina (4.4%). After adjusting for other factors, the likelihood of being a poly-tobacco user among all respondents was lower among females (aOR=0.09; 95% CI: 0.08-0.11), and among respondents from upper-middle-income (aOR=0.53, 95% CI: 0.43-0.66), and lower-middle-income countries (aOR=0.64; 95% CI: 0.51-0.81) compared to high-income countries. Increased likelihood of poly-tobacco use was observed among respondents from the South-East Asian region compared to those from the European region (aOR=1.58, 95% CI: 1.35-1.85), as well as among respondents aged ≥65 years (aOR=2.10; 95% CI: 1.73-2.54), compared to those aged <25 years. CONCLUSIONS: The pattern of tobacco use varied widely, underscoring the need for intensified efforts towards implementing policies that address all tobacco products, not only manufactured cigarettes.

Country tobacco laws and article 11 of the WHO Framework Convention on Tobacco Control: a review of tobacco packaging and labeling regulations of 25 countries.

BACKGROUND: Urgent, evidence-based tobacco control efforts have been advocated by the WHO through the Framework Convention on Tobacco Control (FCTC) articles and guidelines. The level of implementation of these guidelines varies by country and region. This paper identifies areas of alignment and non-alignment of country tobacco laws with respect to the FCTC's article 11 requirements, which lists guidelines for regulating tobacco packaging and labeling. METHODS: Countries from each of the six WHO regions were ranked by number of smokers and 25 countries were selected, representing countries from all WHO regions with the highest number of smokers. A scoring guide based on the FCTC article 11 requirements was created and used to rank country tobacco laws and assess levels of alignment as well as identify common areas of weakness and strength. RESULTS: Across the countries examined, laws were generally strong in mandating the display of health warning messages on the front and back of cigarette packs and cartons. However, they were deficient in prohibiting the display of emission yields, and placing warnings at the top of the principal display area, as well as requiring health messages on tobacco's negative social and economic outcomes. CONCLUSION: Country tobacco packaging and labeling laws can be strengthened by greater compliance with the FCTC article 11 guidelines.