Knowledge on the health effects of tobacco use in 22 low- and middle-income countries

Background

Knowledge on the health effects of tobacco use deters initiation and is associated with cessation, and is important for developing anti-smoking educational programs. However, few studies have examined factors associated with knowledge about these risks in low- and middle-income countries. We sought to determine: 1) levels of knowledge about health effects of tobacco use, and 2) demographic, behavioral, and environmental factors associated with knowledge towards tobacco use.

Methods

We used data from the Global Adult Tobacco Survey (GATS), a nationally representative household survey of persons aged ≥15 years. GATS are standardized, in-person surveys conducted between 2008-2013 in 22 countries, including Argentina, Bangladesh, Brazil, China, Egypt, Greece, India, Indonesia, Malaysia, Mexico, Nigeria, Panama, Philippines, Poland, Qatar, Romania, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam. Information was gathered on demographics, tobacco use behavior, and exposure to anti-tobacco information as well as knowledge about tobacco-related illnesses.

Results

In all countries surveyed, knowledge about specific tobacco-related diseases varied.  Respondents who believed smoking causes lung cancer ranged from 73.0% (Nigeria) to 98.6% (Argentina), heart attack ranged from 38.7% (China) to 95.0% (Egypt), and stroke ranged from 27.2% (China) to 89.2% (Romania). Factors associated with poorer levels of knowledge on tobacco-related diseases also varied by country and included tobacco use, education level, place of residence, sex, and age.

Conclusions

Identifying knowledge gaps on the health impact of tobacco use and its associated risk factors will strengthen anti-smoking educational messages and can inform tobacco control policies and programs for more effective interventions.