000169859 001__ 169859 000169859 005__ 20240229133657.0 000169859 0247_ $$2doi$$a10.1016/S2468-2667(21)00065-7 000169859 0247_ $$2pmid$$apmid:34051920 000169859 0247_ $$2pmc$$apmc:PMC8251505 000169859 0247_ $$2altmetric$$aaltmetric:106603283 000169859 037__ $$aDKFZ-2021-01593 000169859 041__ $$aEnglish 000169859 082__ $$a610 000169859 1001_ $$aGBD 2019 Chewing Tobacco Collaborators$$b0$$eCollaboration Author 000169859 245__ $$aSpatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. 000169859 260__ $$aLondon$$bElsevier$$c2021 000169859 3367_ $$2DRIVER$$aarticle 000169859 3367_ $$2DataCite$$aOutput Types/Journal article 000169859 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1637159960_22468 000169859 3367_ $$2BibTeX$$aARTICLE 000169859 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000169859 3367_ $$00$$2EndNote$$aJournal Article 000169859 520__ $$aChewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control.We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period.In 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1·21% [-1·26 to -1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0·94% [-1·72 to -0·14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period.Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence.Bloomberg Philanthropies and the Bill & Melinda Gates Foundation. 000169859 536__ $$0G:(DE-HGF)POF4-313$$a313 - Krebsrisikofaktoren und Prävention (POF4-313)$$cPOF4-313$$fPOF IV$$x0 000169859 588__ $$aDataset connected to CrossRef, PubMed, , Journals: inrepo01.inet.dkfz-heidelberg.de 000169859 7001_ $$aKendrick, Parkes J$$b1 000169859 7001_ $$aReitsma, Marissa B$$b2 000169859 7001_ $$aAbbasi-Kangevari, Mohsen$$b3 000169859 7001_ $$aAbdoli, Amir$$b4 000169859 7001_ $$aAbdollahi, Mohammad$$b5 000169859 7001_ $$aAbedi, Aidin$$b6 000169859 7001_ $$aAbhilash, E. S.$$b7 000169859 7001_ $$aAboyans, Victor$$b8 000169859 7001_ $$aAdebayo, Oladimeji M$$b9 000169859 7001_ $$aAdvani, Shailesh M$$b10 000169859 7001_ $$aAhinkorah, Bright Opoku$$b11 000169859 7001_ $$aAhmad, Sohail$$b12 000169859 7001_ $$aAhmadi, Keivan$$b13 000169859 7001_ $$aAhmed, Haroon$$b14 000169859 7001_ $$aAji, Budi$$b15 000169859 7001_ $$aAkalu, Yonas$$b16 000169859 7001_ $$aAkunna, Chisom Joyqueenet$$b17 000169859 7001_ $$aAlahdab, Fares$$b18 000169859 7001_ $$aAl-Aly, Ziyad$$b19 000169859 7001_ $$aAlanezi, Fahad Mashhour$$b20 000169859 7001_ $$aAlanzi, Turki M$$b21 000169859 7001_ $$aAlhabib, Khalid F$$b22 000169859 7001_ $$aAli, Tilahun$$b23 000169859 7001_ $$aAlif, Sheikh Mohammad$$b24 000169859 7001_ $$aAlipour, Vahid$$b25 000169859 7001_ $$aAljunid, Syed Mohamed$$b26 000169859 7001_ $$aAlomari, Mahmoud A$$b27 000169859 7001_ $$aAmin, Tarek Tawfik$$b28 000169859 7001_ $$aAmini, Saeed$$b29 000169859 7001_ $$aAmu, Hubert$$b30 000169859 7001_ $$aAncuceanu, Robert$$b31 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$$aHuang, Junjie$$b168 000169859 7001_ $$aIbeneme, Charles Ugochukwu$$b169 000169859 7001_ $$aIbitoye, Segun Emmanuel$$b170 000169859 7001_ $$aIlic, Irena M$$b171 000169859 7001_ $$aIlic, Milena D$$b172 000169859 7001_ $$aInbaraj, Leeberk Raja$$b173 000169859 7001_ $$aIrvani, Seyed Sina Naghibi$$b174 000169859 7001_ $$aIslam, Jessica Y$$b175 000169859 7001_ $$aIslam, Rakibul M$$b176 000169859 7001_ $$aIslam, Sheikh Mohammed Shariful$$b177 000169859 7001_ $$aIslami, Farhad$$b178 000169859 7001_ $$aIso, Hiroyasu$$b179 000169859 7001_ $$aItumalla, Ramaiah$$b180 000169859 7001_ $$aJaafari, Jalil$$b181 000169859 7001_ $$aJain, Vardhmaan$$b182 000169859 7001_ $$aJakovljevic, Mihajlo$$b183 000169859 7001_ $$aJang, Sung-In$$b184 000169859 7001_ $$aJayaram, Shubha$$b185 000169859 7001_ $$aJeemon, Panniyammakal$$b186 000169859 7001_ $$aJha, Ravi Prakash$$b187 000169859 7001_ $$aJonas, Jost B$$b188 000169859 7001_ $$aJürisson, Mikk$$b189 000169859 7001_ $$aKabir, Ali$$b190 000169859 7001_ $$aKabir, Zubair$$b191 000169859 7001_ $$aKalankesh, Leila R$$b192 000169859 7001_ $$aKanchan, Tanuj$$b193 000169859 7001_ $$aKandel, Himal$$b194 000169859 7001_ $$aKapoor, Neeti$$b195 000169859 7001_ $$aKarch, André$$b196 000169859 7001_ $$aKarimi, Salah Eddin$$b197 000169859 7001_ $$aKebede, Kindie Mitiku$$b198 000169859 7001_ $$aKelkay, Bayew$$b199 000169859 7001_ $$aKennedy, Ryan David$$b200 000169859 7001_ $$aKhader, Yousef Saleh$$b201 000169859 7001_ $$aKhan, Ejaz Ahmad$$b202 000169859 7001_ $$aKhayamzadeh, Maryam$$b203 000169859 7001_ $$aKim, Gyu Ri$$b204 000169859 7001_ $$aKimokoti, Ruth W$$b205 000169859 7001_ $$aKivimäki, Mika$$b206 000169859 7001_ $$aKosen, Soewarta$$b207 000169859 7001_ $$aKoulmane Laxminarayana, Sindhura Lakshmi$$b208 000169859 7001_ $$aKoyanagi, Ai$$b209 000169859 7001_ $$aKrishan, Kewal$$b210 000169859 7001_ $$aKugbey, Nuworza$$b211 000169859 7001_ $$aKumar, G Anil$$b212 000169859 7001_ $$aKumar, Nithin$$b213 000169859 7001_ $$aKurmi, Om P$$b214 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