1

Addiction to tobacco smoking and its consequences to population of

Uzbekistan

Ministry of Health World Bank Republic of Uzbekistan Physician Advanced Training Institute, Tashkent

Mamatova N.,Usmanova G., Makhkamova N.

Tashkent, December 13, 2007

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Objectives • Assess addiction to

tobacco products consumption

• Assess influence on population health

• Assess tobacco smoking consequences to country’s economy

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Methodology (1)

Primary data

Household survey

Ambulatory and hospital patients survey

Secondary data

Mortality data

Morbidity data

Deaths from diseases attributable to smoking

Demographic data for 2005

GDPEmployment &

wages

Life expectancy

4

Methodlogy (2)

1000 HHs

1395

1080 Hospital patients

315 Ambulatory

patients

Andijan provinceBukhara province Jizzak province

Namangan provinceSamarqand province

Syrdarya provinceTashkent provinceFergana provinceCity of Tashkent

Householdsurvey

Ambulatory and hospital patients survey

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Methodology (3)

• (1) Malignant neoplasms• (2) Cardiovascular diseases • (3) Respiratory system diseases • (4) Digestive system diseases

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Household surveydata analysis

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Overall prevalence of tobacco consumption by genders, 2006

Source: Uzbekistan’s Household Survey, 2006 .

Nasvai consumption is higher among males!!!

Prevalence of tobacco consumption by genders

23%

0%

11%

20%

1%

10%

0%

5%

10%

15%

20%

25%

Male Female Total

Nasvai consumption Cigarette consumption

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Ages of starting cigarette and nasvai consumption

7,0%

85,0%

8,0%7,5%

84,5%

8,0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Aged under 16 Aged 16 + Do not remember

Cigarettes Nasvai

Data on urban and rural area is almost similar

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Total years of smoking among male smokers, by age

30%

6%2% 2%

25%

9%6% 4%

21%

14%

3%

23%

71%

90%93%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

20-29 30-39 40-49 50-59

Less than 2 years 3-5 years 6-9 years 10 and more

10

2%

11%

30%

42%

27%

10%

20%

2%

15%

39%

32%

29% 28%

23%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

15-19 20-29 30-39 40-49 50-59 above 60 total

Currently smoke Currently use nasvai

Highest consumption of tobacco products accounts for people aged 30-49!!!!!!

Tobacco consumption by male smokers, by years of smoking experience

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The higher is the level of education, the higher is cigarette consumption and the lower is nasvai

consumption!!!

Prevalence of cigarette and nasvai consumption among men by level of education

9

21

26

15

26

19

Incomplete secondary Complete secondary Higher/ Incomplete higher

Cigarettes Nasvai

Source: Uzbekistan’s Household Survey, 2006

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The higher is the income, the higher is cigarette

consumption and the lower is nasvai consumption!!!Prevalence of tobacco consumption among males, by income, in 2006 (%)

1620

24

31

21

12

0

10

20

30

40

Low Middle High

Level of income

Prevalence of smoking Prevalence of nasvai consumption

Source: Uzbekistan’s Household Survey

13

Cigarette consumption prevails in the capital, while nasvai is more common for the rural

area!!!! Addiction to tobacco consumption among men by place of

residence

14

26

3

16

7

23

Urban Rural Capital

Nasvai Cigarettes

N

Source: Uzbekistan’s Household Survey, 2006.

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Majority of inveterate smokers (who smoke 11+ cigarettes a day) are male smokers aged 30-39 (26%)

and 40-49 (43%)!!!!! % of inveterate male smokers by age

21

37

31

11

18

31

39

1211

26

43

20

20-29 30-39 40-49 50-59

Age groups

1-4 cigarettes 5-10 cigarettes 11+ cigarettes

Sources: Uzbekistan’s Household Survey, 2006.

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31% of individuals who consume nasvai every day are aged 30 - 39

Intensity of nasvai consumption among males by age groups

1

15

3121

12 10

57

78

93 8996 95

15-19 20-29 30-39 40-49 50-59 Above 60

Age group

% nasvai consumers

Every day as % of total number of nasvai consumers Every day as % w ithin the age group

Source: Uzbekistan’s Household Survey, 2006.

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Only 9% of respondents believe that smoking mostly effects heart and cardiovascular

system

77%

9%3% 2% 2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Respiratory system Cardiovascular system Digestive system Liver Mouth cavity

Awareness of smoking hazard

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15% of respondents are not aware of nasvai consumption hazard

37%

25%

15%

23%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Mouth and its parts Stomach/Digestive system

Do not know Other

Awareness of nasvai consumption hazard

18

55

48 47

35

11

19

25

35

1513

10 129

12 1113

64 4

2

0

10

20

30

40

50

60

TV My own opinion Relatives,friends,

acquantances

Health workers Newspapers

15-19 20-39 40-59 60 and above

Sources of information on the hazard of tobacco products consumption (%)

Information about smoking hazard is mostly obtained from TV programs

19

48

38

1618

7 84 5 2 3

25

28

0

5

10

15

20

25

30

35

40

45

50

Behaviourpattern of

friends

Wishing toseem adult

Behaviourpattern ofparents

Taking afterheroes, stars

Taking afterbrothers,

sisters

Other

Male Female

Reasons for starting tobacco products consumption, by gender (%)

Decision to start smoking is stimulated mostly by friends

20

12%6% 8% 6%

16%13%

64%

76%

0%

10%

20%

30%

40%

50%

60%

70%

80%

In the living room In the kitchen/hall On the stairs In the street

During cold season During warm season

Passive smoking

21

Do not like it anymore

45%

Health problems30%

High prices16%

Other reasons9%

Reasons to quit smoking

22

53%

14%

33%

Do not like it anymoreHealth problems

Other reasons

Reasons to quit nasvai consumption

23

Main places for buying cigarettes

2%15%

24%

59%

0%

10%

20%

30%

40%

50%

60%

Booth Bazaar Shop Street retailers

24

Number of cigarettes typically bought by smokers

69%64%

25%31%

5% 5%2% 1%

0%

10%

20%

30%

40%

50%

60%

70%

A pack of 20cigarettes

Severalcigarettes

A pack of 10cigarettes

Other quantity

Urban Rural

25

Consequences to human health of tobacco smoking

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Morbidity attributable to smoking

1 767 355 (aged 35+) MAS

79 892 (aged 35+)suffer from ТАD

42 237 (aged 35+) ТАDattributable to smoking

53% 2%

27

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

Total male deaths Number of TAD at theage of 35+

Deaths from TAD atthe age of 35+

Deaths attributable to smoking (2004)

41%

27%

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Deaths attributable to smoking, by nosology

Malignant neoplasms; 14%

Cardiovascular diseases; 75%

Respiratory system diseases;

11%

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Life years potentially lost because of smoking, 2004

Name Life years potentially lost

Minimum Maximum

Malignant neoplasms 7.5 18.4

Cardiovascular diseases 4.4 17.3

Respiratory system diseases 14.4 17.5

Total 4.42 18.9

A human who died because of smoking lost an average of 12 potential years of his/her life

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