Evidence indicates rising use of non-cigarette tobacco products among youth, especially girls

The World Health Organization is urging governments to broaden tobacco control efforts in view of the rapid spread and growing variety of smoked and smokeless tobacco products, and increasing use of these products by young people who may be unaware of their harmful effects.

This year's World No Tobacco Day theme is "Tobacco: deadly in any form or disguise," focusing on the fact that all tobacco products are addictive, harmful and can cause death, regardless of the form, packaging, or name under which they are presented to the public.

The variety of tobacco products manufactured and marketed worldwide continues to expand. For example, new types of flavoured, "natural" or "organic" and roll-your-own cigarettes are often advertised and marketed with names and packaging that might mislead consumers into believing that they are less dangerous than conventional cigarettes.

Smokeless tobacco products, such as snus and snuff, previously popular in a limited number of countries, are being marketed heavily elsewhere to specific target groups: women (in cultures where it is not socially acceptable for them to smoke); young people (presented with flavoured and milder-tasting "starter" products); or to smokers (as an alternative in smoke-free environments). At the same time, forms of non-cigarette smoking, such as waterpipes, also known as "shishas", "narghiles" or "hubble-bubbles", are gaining wider acceptance around the world, especially among young people in cafés and on college campuses.

Dr Yumiko Mochizuki-Kobayashi, Director of the WHO Tobacco Free Initiative, stressed the urgent need for countries to implement stricter regulation of all forms of tobacco products, as required by the global tobacco treaty, the WHO Framework Convention on Tobacco Control (WHO FCTC). "We are faced with a unique public health challenge, as many tobacco products remain unregulated," she said. "Tobacco can kill in any guise, regardless of whether you smoke it, chew it or inhale it through a waterpipe, and that is why all products containing tobacco need to be regulated immediately, in all forms, worldwide."

Results from the Global Youth Tobacco Survey, a joint WHO and Centers for Disease Control and Prevention (CDC) initiative, show that in many countries the prevalence of use of tobacco products other than cigarettes (11.2 percent) among adolescents is higher than that of cigarette use (8.9 percent). In addition, in many countries adolescent girls are reporting similar rates of tobacco use to adolescent boys. This is different from adult data, which generally shows higher rates for males than females. These findings suggest that countries should develop, implement and enforce comprehensive tobacco control programs focusing especially on girls, and on all forms of tobacco use.

Dr Charles Warren, researcher in the CDC’s Global Tobacco Control Program, sees a worsening trend among people under 15 years of age. "Given the high rates of non-cigarette tobacco use among the young, especially girls, previous estimates of 10 million deaths a year by 2020 could be conservative," he said.

Tobacco use is the leading preventable cause of death globally, causing five million deaths a year. Evidence shows that smoking harms nearly every organ of the body. It is the cause of 90 per cent of lung cancer cases and is linked to many other types of cancer, such as cervical or kidney cancer, as well as emphysema, bronchitis, asthma and other respiratory diseases. Other health risks associated with tobacco use include other types of cancer, such as oral, throat and neck cancer, as well as heart attacks, stroke, other cardiovascular diseases and infertility.

Cigarettes remain the only legal product that kills half of its regular users when consumed as intended by the manufacturer. However, for all tobacco products, including cigarettes, information on tobacco ingredients and toxin deliveries remains inadequate. This gap needs to be filled with appropriate country-level regulation and further research.

Tobacco use continues to expand most rapidly in the developing world, where half of tobacco-related deaths occur. By 2020, if current trends continue, 7 out of every 10 tobacco-related deaths will be in the developing world.

"Tobacco use is the major contributor to what is now a global chronic disease epidemic," said Dr Catherine Le Galès-Camus, Assistant Director-General, Noncommunicable Diseases and Mental Health, WHO. "Regulating all forms of tobacco products cannot be delayed. It is vital to any effective tobacco control programme, and a must if we are to control this epidemic," she added.

This year's World No Tobacco Day builds on the success of the first Conference of the Parties to the WHO FCTC, held in Geneva in February. One of the decisions taken by the 113 full Contracting Parties at the Conference was to create a group charged with developing guidelines for tobacco product regulation.