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Over Half of Sites in Global Youth Tobacco Survey Show No Gender Difference in Cigarette Smoking

Last updated March 18, 2020

Approved by: Subramanian Malaisamy MD, MRCP (UK), FCCP (USA)

Helsinki, Finland – A new report released today at the World Conference on Tobacco or Health shows that little difference exists between the genders in cigarette smoking among youth. Results also show that girls and boys are using non-cigarette tobacco products such as spit tobacco, bidis, and water pipes at similar rates, and that these rates are often as high or higher than youth cigarette smoking rates.


Over Half of Sites in Global Youth Tobacco Survey Show No Gender Difference in Cigarette Smoking

Helsinki, Finland – A new report released today at the World Conference on Tobacco or Health shows that little difference exists between the genders in cigarette smoking among youth. Results also show that girls and boys are using non-cigarette tobacco products such as spit tobacco, bidis, and water pipes at similar rates, and that these rates are often as high or higher than youth cigarette smoking rates.

These findings suggest that projections of future tobacco-related deaths worldwide might be underestimated because they are based on current patterns of tobacco use among adults, where females are only about one-fourth as likely as men to smoke cigarettes. In the new study of young people ages 13 to 15, no gender difference was found in over half of the sites surveyed for cigarette smoking (61 of 120) and in over 70 percent of the sites surveyed for other tobacco product use (82 of 117).

The lack of gender differences in cigarette smoking rates was found in some of the sites in five of the six World Health Organization (WHO) regions; in addition, no significant gender difference existed in rates of other tobacco use at more than half of the sites in these same regions. Only the Eastern Mediterranean Region had a majority of sites with boys significantly more likely to smoke cigarettes and use other tobacco products.

The new survey also found that young people’s use of cigarettes and other tobacco products varied dramatically by site. For example, cigarette smoking among boys ranged from 0.5 percent in Delhi and Goa, India, to 41.8 percent in Bamako, Mali. Use of other tobacco products among girls ranged from 0.4 percent in Macao, China, to 62.2 percent in the Northern Mariana Islands.

Although adult-to-youth comparisons are difficult to make because of wide variations in survey methods and timeframe, the following table shows that differences in male-to-female smoking ratios were consistently smaller among youth in the new study than among adults in previous studies.


Male-to-Female Smoking Ratios* by WHO Region

  Adults Youth

Africa 7.2 : 1 2.2 : 1

Americas 1.6 : 1 1.2 : 1

Eastern Mediterranean 8.8 : 1 4.3 : 1

Europe 1.8 : 1 1.2 : 1

Southeast Asia 11.0 : 1 4.2 : 1

Western Pacific 7.5 : 1 1.7 : 1

(*Ratio of male smoking prevalence to female smoking prevalence)

The report, published in the August issue of the American School Health Association’s Journal of School Health, is from the Global Youth Tobacco Survey (GYTS). The GYTS is the largest survey of its kind in the world, surveying over one million adolescents from more than 150 countries. It is a collaborative effort of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services, the World Health Organization (WHO) and its Regional Offices, the Canadian Public Health Association, other international agencies, and individual countries.

Tobacco use is one of the chief preventable causes of death in the world. The WHO currently attributes 4.9 million deaths per year to tobacco use, a total expected to double in two to three decades. WHO and CDC developed the GYTS to track tobacco use among young people across countries using a common methodology and core questionnaire. The GYTS surveillance system is intended to enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs.

“The data from this report have major implications for tobacco control,” said Charles W. Warren, PhD, CDC’s lead scientist on the GYTS. “First, programs specific to gender must be developed which emphasize the serious health consequences of tobacco use, especially the risk of poor reproductive health and health risks to infants exposed to tobacco toxins during pregnancy. Second, the widespread use of other tobacco products in addition to cigarettes in many countries means that tobacco control programs must be broad in scope.”

“This finding could raise the projection of 10 million tobacco related deaths per year, by the year 2030, which does not reflect these high rates of tobacco use among girls,” said Vera da Costa e Silva, PhD, project manager for the WHO’s Tobacco Free Initiative. “The GYTS will be one of the primary data monitoring systems used by countries as they begin to develop, implement, and evaluate their tobacco control programs to reduce these rates. Surveillance systems like the GYTS will become vital components used by countries to monitor and evaluate their strategies and programs implemented to meet the goals and targets of the Framework Convention on Tobacco Control (FCTC).”

The GYTS is a school-based survey of students from public and private schools. The classrooms are chosen randomly within selected schools, and all students in selected classes are eligible for participation. The questionnaire is self-administered, anonymous, and confidential. Although the survey has a core set of questions, participating countries may add questions of special interest. The GYTS has been completed in 25 sites in the African Region, 42 sites in the Americas, 14 sites in the Eastern Mediterranean Region, eight sites in Europe, 22 sites in Southeast Asia, and 10 sites in the Western Pacific Region.

The WHO and CDC aim to expand the number of participating countries so that they will have a standard tool to monitor components of their tobacco control programs, to measure trends, and to evaluate the effectiveness of intervention programs designed to reduce tobacco use among youth.

For more information about the Global Youth Tobacco Survey visit the CDC Web site at http://www.cdc.gov/tobacco/global/GYTS.htm

(Note to Reporters: GYTS is the source of the youth data in the Gender Differential table. The source of the adult data is WHO’s Tobacco or Health: A Global Status Report, 1997.)

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First uploaded: March 18, 2020
Last updated: March 18, 2020