WHO FCTC Indicator Compendium · This WHO FCTC Indicator Compendium was developed in response to...
Transcript of WHO FCTC Indicator Compendium · This WHO FCTC Indicator Compendium was developed in response to...
1
WHO FCTC
Indicator Compendium
(1st edition)
October 2013
2
Introduction
This WHO FCTC Indicator Compendium was developed in response to the mandate given to the
Convention Secretariat, in cooperation with competent authorities within WHO, by the Conference of
the Parties at its fifth session.1 As envisaged in the decision, the Compendium is expected “to further
facilitate standardization of indicators and their use by Parties, including relevant definitions and sources
of information”.
The Compendium is expected to facilitate data collection and epidemiological surveillance of tobacco
consumption and related social, economic and health indicators within countries, as well as to assist
Parties in exchanging information on these indicators at both regional and global levels, in line with
Parties’ obligations under Articles 20.3 and 20.4 of the Convention.
The routine and periodical monitoring by Parties of the standardized indicators proposed in this
Indicator Compendium is strongly encouraged. Parties may consider incorporating the collection of data
in line with the proposed indicators into national data collection initiatives, including those performed
by non-health agencies and national statistical offices. This would greatly facilitate preparation of
implementation reports to the Conference of the Parties, allow trend analysis to be undertaken, enable
monitoring of the impact of implementation of the Convention nationally, and facilitate cross-country
comparison of data. Once Parties report to the Conference of the Parties using the indicators, the
Convention Secretariat analyses the reports and elaborates, on a biennial basis, global progress reports
on the implementation of the Convention, providing both regional and international comparisons.
The WHO FCTC Indicator Compendium includes quantitative indicators used in section 2 of the reporting
instrument (Tobacco consumption and related health, social and economic indicators), which, in most
cases, have not been defined in the treaty or implementation guidelines. These indicators are listed on
page 4. For each indicator, the following information is given: indicator name; data type representation;
rationale; definition; preferred data sources; other possible data sources; method of measurement;
disaggregation; expected frequency of data collection; comments; and useful links and sources.
The indicators were developed by using the World Health Statistics Indicator Compendium under the
WHO Indicator and Measurement Registry as a template. Sources consulted during the development of
the Compendium include several WHO departments. For non-health-related indicators, other sources
were checked and input received from the following: the World Bank, the International Monetary Fund
and the American Cancer Society (on taxation and price-related indicators); the United Nations
Conference on Trade and Development (on trade in tobacco products); the World Customs Organization
and Mr LukJoossens of the European Association of Cancer Leagues (on illicit trade in tobacco products);
the International Labour Organization (on employment in tobacco growing); and the Food and
Agriculture Organization of the United Nations (on tobacco leaf production).
This is the first edition of this Compendium prepared by the Convention Secretariat at the request of the
Conference of the Parties to be used by the Parties in the 2014 reporting cycle. Any feedback, comments
1 Decision FCTC/COP5(11).
3
and suggestions will be appreciated both before and at the sixth session of the Conference of the Parties,
and they will be taken into account for any further work on the Compendium.
Questions or suggestions concerning the content of the Compendium can be addressed to the
Convention Secretariat at: [email protected].
4
GLOSSARY OF ABBREVIATIONS
CIF = cost, insurance and freight
DALY = disability adjusted life year
DHS = Demographic and Health Survey
ESPAD = European School Survey Project on Alcohol and Other Drugs
FTE = full-time job equivalents
GATS = Global Adult Tobacco Survey
GDP = gross domestic product
GSHS = Global School-based Student Health Survey
GST = goods and services tax
GYTS = Global Youth Tobacco Survey
HBSC = health behaviour of school-aged children
ITC = International Tobacco Control Policy Evaluation Project
PAF = population attributable fraction
RR = relative risk
SAGE = WHO Study on Global Ageing and Adult Health
TAE = tobacco-attributable health-care expenditures
TAF = tobacco-attributable fraction
TAI = tobacco-attributable indirect morbidity costs
TAMC = tobacco-attributable indirect mortality costs
VAT = value added tax
WHO = World Health Organization
WHO STEPS = WHO STEPwise Approach to Surveillance
YPLL = years of potential life lost
YRBSS = Youth Risk Behaviour Surveillance System
5
List of indicators included in the Compendium2
1. Prevalence of tobacco smoking in the adult population……………………………………………… 7
1.1 Current smokers……………………………………………………………………………………………………………. 8
1.2 Daily smokers………………………………………………………………………………………………………………… 11
1.3 Occasional smokers………………………………………………………………………………………………………..13
1.4 Former smokers…………………………………………………………………………………………………………….. 18
1.5 Never smokers………………………………………………………………………………………………………………. 21
1.6 Average number of the most-consumed smoking tobacco product used per day
among daily smokers…………………………………………………………………………………………………….. 24
2. Prevalence of smokeless tobacco use in the adult population…………………………………….. 27
2.1 Current smokeless tobacco users………………………………………………………………………………….. 28
2.2 Daily smokeless tobacco users………………………………………………………………………………………. 31
2.3 Occasional smokeless tobacco users……………………………………………………………………………… 34
2.4 Former smokeless tobacco users…………………………………………………………………………………… 37
2.5 Never users of smokeless tobacco…………………………………………………………………………………. 40
2.6 Average number of the most-consumed smokeless tobacco product used per day
among daily users……………………………………………………………………………………………………….… 43
3. Prevalence of tobacco use by youth…………………………………………………………………………… 46
3.1 Current youth smokers………………………………………………………………………………………………..… 47
3.2 Current youth smokeless tobacco users………………………………………………………………………… 50
4. Exposure to tobacco smoke in the adult population…………………………………………………… 53
4.1 Percentage of adults exposed to tobacco smoke at home…………………………………………..… 54
4.2 Percentage of adults exposed to tobacco smoke in the workplace………………………………… 57
4.3 Percentage of adults exposed to tobacco smoke in public transport…………………………….. 60
5. Exposure to tobacco smoke in youth………………………………………………………………………….. 63
5.1 Percentage of youth exposed to tobacco smoke at home…………………………………………….. 64
5.2 Percentage of youth exposed to tobacco smoke in public places or public transport……. 67
6. Tobacco-related mortality…………………………………………………………………………………………. 70
6.1 Estimated total number of deaths attributable to tobacco use……………………………………... 71
2 Indicators included in this Compendium are the quantitative indicators used in section 2 of the reporting
instrument (Tobacco consumption and related health, social and economic indicators) of the WHO FCTC. The indicators are presented in the order in which they appear in the reporting instrument.
6
7. Tobacco-related costs………………………………………………………………………………………………… 74
7.1 Overall cost of tobacco use imposed on society……………………………………………………..…….. 75
7.2 Direct (health-care related) costs of tobacco use………………………………………………………..… 79
7.3 Indirect costs of tobacco use…………………………………………………………………………………..…….. 83
8. Supply of tobacco and tobacco products……………………………………………………………………. 87
8.1 Total volume of duty-free sales of tobacco products……………………………………………….……. 88
8.2 Volume of domestic production of tobacco and tobacco products………………………….……. 90
8.3 Volume of exports of tobacco and tobacco products……………………………………………….……. 93
8.4 Volume of imports of tobacco and tobacco products……………………………………………….…… 96
9. Seizures of tobacco products…………………………………………………………………………………..…. 99
9.1 Quantity of seized illicit tobacco products………………………………………………………………..…… 100
9.2 Percentage of smuggled tobacco products on the national tobacco market……………..……103
10. Tobacco growing…………………………………………………………………………………………………..…… 106
10.1 Number of workers involved in tobacco growing…………………………………………….……………. 107
10.2 Share of the value of tobacco leaf production in the national gross domestic product…. 110
11. Taxation of tobacco products…………………………………………………………………………………..… 112
11.1 Proportion of the retail price of the most widely sold brand of tobacco product
consisting of taxes…………………………………………………………………………………………………….…… 113
11.2 Specific excise tax…………………………………………………………………………………………………….……. 116
11.3 Ad valorem excise tax…………………………………………………………………………………………….……… 119
11.4 Import duty……………………………………………………………………………………………………….…..……… 122
11.5 VAT/GST/sales tax……………………………………………………………………………………………….………… 124
11.6 Earmarking of any percentage of taxation income for funding tobacco control……..……… 126
12. Price of tobacco products……………………………………………………………………………………..……. 128
12.1 Most widely sold brand of smoking or smokeless tobacco product………………………..……… 129
12.2 Retail price of a pack of the most widely sold brand of tobacco product……………….……… 131
Appendix 1. Smoking-related causes of death…………………………………………………………………………………… 133
7
1. PREVALENCE OF TOBACCO SMOKING IN THE ADULT POPULATION
8
1.1 Current smokers INDICATOR NAME
Current smokers
DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of current smoking of any tobacco product among adults is an important indicator to use
when calculating the health and economic burden of tobacco use imposed on society, and is also
important for informing policy-making and substantiating the need for action.
Routine and regular monitoring of this indicator is necessary to enable accurate monitoring and
evaluation of the impact of implementation of the WHO FCTC over time.
DEFINITION
A current smoker is someone who either smokes every day (daily smoker) or who currently smokes but
not every day (occasional or non-daily smoker).
At a population level, the prevalence of current smokers for a country is calculated as (the number of
respondents in a survey who indicated smoking every day + the number of respondents who indicated
smoking occasionally) divided by the total number of respondents to the survey.
"Tobacco smoking" includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water
pipes), fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
- multi-risk-factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
9
- other health surveys such as the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys, and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted by the
country’s national statistical offices, or any other relevant agency, or by national or international
research groups (and include academic research or studies carried out by nongovernmental
organizations). If no recent national data are available, country estimates may be found in the WHO
Global Health Observatory Data Repository.
METHOD OF MEASUREMENT
( )
( )
( )
( )
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender: data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age: taking into account the age range selected for the relevant survey, data on smoking
prevalence should be broken down by age groups (preferably by 10-year category, e.g. 25−34, 35−44).
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of current smokers contributes to effective monitoring and
evaluation of the impact of tobacco control policies. WHO recommends that such surveys be conducted
regularly (at least once every five years), and such repetition would also contribute to the creation of
tobacco-related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart
from the repeatability and frequency of the survey, other criteria that characterize a good national
surveillance system include: comparability; validity and reliability; mechanisms to translate findings into
action; and sustainability (of financial and human resources). Article 20.2 of the Convention calls upon
Parties to "establish, as appropriate, programmes for national, regional and global surveillance of the
10
magnitude, patterns, determinants and consequences of tobacco consumption and exposure to tobacco
smoke", expecting data to be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Global InfoBase: https://apps.who.int/infobase/
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO Global Health Observatory: http://apps.who.int/gho/data/view.main
- WHO Indicator Code Book Tobacco Control: http://apps.who.int/gho/data/node.main.1257?lang=en
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
- Eurostat (health status):
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/data
base
- European Health Interview Survey 2008:
http://epp.eurostat.ec.europa.eu/cache/ITY_SDDS/en/hlth_ehis_esms.htm
Other sources:
- ITC Project: http://www.itcproject.org/
11
1.2 Daily smokers INDICATOR NAME Daily smokers DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of daily smoking of any tobacco product among adults is an important indicator to use
when calculating the health and economic burden of tobacco on society, and is also important for
informing policy-making and substantiating the need for action.
Routine and regular monitoring of this indicator is necessary to enable accurate monitoring and
evaluation of the impact of implementation of the WHO FCTC over time.
DEFINITION
A daily smoker is someone who smokes any tobacco product at least once a day (people who smoke
every day apart from days of religious fasting are still classified as daily smokers).
The crude rate, expressed as a percentage of the total adult population, refers to the number of adults
who smoke any tobacco product daily per 100 of the adult population of the country, resulting from the
latest adult national tobacco use survey (or any other survey which asks tobacco use questions). The age
range to which the prevalence data for the entire adult population refer should be, for example, 15
years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s methodology.
When this crude prevalence rate is multiplied by the country’s adult population, the result is the number
of adults who are daily smokers of any tobacco product in the country.
The definition of "daily smoker" varies between surveys, but often means someone who smokes any
tobacco product at least once a day during a defined period leading up to the survey date.
"Tobacco smoking" includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water
pipes), fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.
12
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys, and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted by countries’
national statistical offices or any other relevant agency, or by national or international research groups
(and include academic research or studies implemented by nongovernmental organizations). If no
recent national data are available, country estimates may be found in the WHO Global Health
Observatory Data Repository.
METHOD OF MEASUREMENT
( )
( )
The prevalence of daily tobacco smokers should be less than or equal to the prevalence of current
tobacco smokers.
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and the combined (total)
prevalence should also be provided.
13
In the case of age, taking into account the age range selected to be applied for the relevant survey, data
on smoking prevalence should be broken down by age groups (preferably by 10-year category, e.g.
25−34, 35−44)
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of daily smokers contributes to effective monitoring and
evaluation of the impact of tobacco control policies. WHO recommends that such surveys be conducted
regularly (at least once every five years), and such repetition would also contribute to the creation of
tobacco-related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart
from the repeatability and frequency of the survey, other criteria that characterize a good national
surveillance system include: comparability; validity and reliability; mechanisms to translate findings into
action; and sustainability (of financial and human resources). Article 20.2 of the Convention calls upon
Parties to "establish, as appropriate, programmes for national, regional and global surveillance of the
magnitude, patterns, determinants and consequences of tobacco consumption and exposure to tobacco
smoke”, expecting data to be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Global InfoBase: https://apps.who.int/infobase/
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO Global Health Observatory: http://apps.who.int/gho/data/view.main
- WHO Indicator Code Book Tobacco Control:
http://apps.who.int/gho/data/node.main.1257?lang=en
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
- Eurostat (health status):
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/data
base
- European Health Interview Survey 2008:
http://epp.eurostat.ec.europa.eu/cache/ITY_SDDS/en/hlth_ehis_esms.htm
15
1.3 Occasional smokers
INDICATOR NAME
Occasional smokers
DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of occasional smoking of any tobacco product among adults is an important indicator to
use when calculating the health and economic burden of tobacco on society, and is also important for
informing policy-making and substantiating the need for action.
Routine and regular monitoring of this indicator is necessary to enable accurate monitoring and
evaluation of the impact of implementation of the WHO FCTC over time.
DEFINITION
An occasional smoker is someone who smokes, but not every day. Occasional smokers include: reducers
(people who used to smoke daily but now do not smoke every day); continuing occasionals (people who
have never smoked daily, but who have smoked 100 or more cigarettes – or the equivalent amount of
tobacco – in their lifetime and now smoke occasionally); and experimenters (people who have smoked
less than 100 cigarettes or the equivalent amount of tobacco in their lifetime and now smoke
occasionally).
The crude rate, expressed as a percentage of the total adult population, refers to the number of adults
who are occasional or non-daily smokers of any tobacco product per 100 of the adult population of the
country, resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions).
The age range to which the prevalence data for the entire adult population refer should be, for example,
15 years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s
methodology.
When this crude prevalence rate is multiplied by the country’s adult population, the result is the number
of adults who are occasional or non-daily smokers of any tobacco product in the country.
An “occasional smoker” is someone who smokes any tobacco product non-daily during a defined period
leading up to the survey date.
"Tobacco smoking" includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water
pipes) fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.
16
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys; and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted by the
country’s national statistical office or any other relevant agency, or by national or international research
groups (and include academic research or studies implemented by nongovernmental organizations). If
no recent national data are available, country estimates may be found in the WHO Global Health
Observatory Data Repository.
METHOD OF MEASUREMENT
( )
( )
In the numerator, occasional smokers include those respondents who are currently less than daily
smokers of any tobacco product, including formerly daily and never daily smokers of any tobacco
product in the adult population.
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age, taking into account the age range selected for the relevant survey, data on smoking
prevalence should be broken down by age group (preferably by 10-year category, e.g. 25−34, 35−44).
17
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of occasional smokers contributes to effective monitoring
and evaluation of the impact of tobacco control policies. WHO recommends that such surveys be
conducted regularly (at least once every five years), and such repetition would also contribute to the
creation of tobacco-related national surveillance systems as envisaged in Article 20.3(a) of the
Convention. Apart from the repeatability and frequency of the survey, other criteria that characterize a
good national surveillance system include: comparability; validity and reliability; mechanisms to
translate findings into action; and sustainability (of financial and human resources). Article 20.2 of the
Convention calls upon Parties to “establish, as appropriate, programmes for national, regional and
global surveillance of the magnitude, patterns, determinants and consequences of tobacco consumption
and exposure to tobacco smoke”, expecting data to be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Global InfoBase: https://apps.who.int/infobase/
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO Indicator Code Book Tobacco Control:
http://apps.who.int/gho/data/node.main.1257?lang=en
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
- Eurostat (health status):
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/dat
abase
- European Health Interview Survey 2008:
http://epp.eurostat.ec.europa.eu/cache/ITY_SDDS/en/hlth_ehis_esms.htm
Other sources:
- ITC Project: http://www.itcproject.org/
18
1.4 Former smokers
INDICATOR NAME
Former smokers
DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of former smoking of any tobacco product among adults is an important indicator of
cessation of tobacco use, and provides a baseline for evaluating the effectiveness of tobacco control
programmes over time.
DEFINITION
The definition of “former smokers” is: adults who were ever smokers of any tobacco product, and
currently do not smoke any tobacco product during a defined period leading up to the survey date.
Rare instances of smoking or experimental smoking can be discounted, and the individuals concerned
taken as having smoked "not at all”. Accordingly, a “former smoker” or “ex-smoker” may be defined as
“a person who has smoked at least 100 cigarettes or equivalent tobacco in his or her lifetime, but does
not smoke at all now”.
The crude rate, expressed as a percentage of the total adult population, refers to the number of adults
who are former smokers of any tobacco product per 100 of the adult population of the country,
resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions). The age
range to which the prevalence data for the entire adult population refer should be, for example, 15
years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s methodology.
When this crude prevalence rate is multiplied by the country’s adult population, the result is the number
of adults who are former smokers of any tobacco product in the country.
"Tobacco smoking" includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water
pipes), fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys, which may have been implemented by the Parties, include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
19
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys; and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted either by the
countries’ national statistical office, or any other relevant agency, or by national or international
research groups (including academic research or studies implemented by nongovernmental
organizations). If no recent national data are available, country estimates may be found in the WHO
Global Health Observatory Data Repository.
METHOD OF MEASUREMENT
( )
In the numerator the number of former smokers includes respondents who were ever daily or non-daily
smokers of any tobacco product, and who currently do not smoke any tobacco product in the surveyed
adult population.
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age, taking into account the age range selected for the relevant survey, data on smoking
prevalence should be broken down by age group (preferably by 10-year category, e.g. 25−34, 35−44).
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of former smokers contributes to effective monitoring and
evaluation of the impact of tobacco control policies. WHO recommends that such surveys be conducted
regularly (at least once every five years), and such repetition would also contribute to the creation of
tobacco-related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart
from the repeatability and frequency of the survey, other criteria that characterize a good national
20
surveillance system include: comparability; validity and reliability; mechanisms to translate findings into
action; and sustainability (of financial and human resources). Article 20.2 of the Convention calls upon
Parties to "establish, as appropriate, programmes for national, regional and global surveillance of the
magnitude, patterns, determinants and consequences of tobacco consumption and exposure to tobacco
smoke”.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
- Eurostat (health status):
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/data
base
- European Health Interview Survey 2008:
http://epp.eurostat.ec.europa.eu/cache/ITY_SDDS/en/hlth_ehis_esms.htm
Other sources:
- ITC Project: http://www.itcproject.org/
21
1.5 Never smokers
INDICATOR NAME
Never smokers
DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of never smokers of any tobacco product among adults is an important indicator of non-
initiation of tobacco use, and provides a baseline for evaluating the effectiveness of tobacco control
programmes over time.
DEFINITION
The definition of “never smoker” is someone who has never smoked any tobacco product in their lives.
Rare instances of smoking or experimental smoking can be discounted, and the individuals concerned
taken as having smoked "not at all”. Accordingly, a “never smoker” or “non-smoker” may be defined as
“a person who does not smoke now and has smoked fewer than 100 cigarettes or the equivalent
tobacco in his or her lifetime”.
The crude rate, expressed as a percentage of the total adult population, refers to the number of adults
who have never smoked any tobacco product in their life per 100 of the adult population of the country,
resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions). The age
range to which the prevalence data for the entire adult population refer should be, for example, 15
years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s methodology.
When this crude prevalence rate is multiplied by the country’s adult population, the result is the number
of adults who are never smokers of any tobacco product in the country.
"Tobacco smoking" includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water
pipes), fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.
PREFERRED DATA SOURCES
National household surveys using standard methods across time, to ensure capacity to measure changes
in levels over time. Examples of such surveys, which may have been implemented by the Parties, include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
22
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys; and other national household surveys that
may be about other topics such as household expenditure survey. Such surveys may be conducted
either by the country’s national statistical office, or any other relevant agency, or by international
research groups (including academic research or studies implemented by nongovernmental
organizations). If no recent national data are available, country estimates may be found in the WHO
Global Health Observatory Data Repository.
METHOD OF MEASUREMENT
( )
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age: taking into account the age range selected to be applied for the relevant survey, data
on smoking prevalence should be broken down by age group (preferably by 10-year category, e.g. 25−34,
35−44).
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of never smokers contributes to effective monitoring and
evaluation of the impact of tobacco control policies. WHO recommends such surveys be conducted
regularly (at least once every five years), and such repetition would also contribute to the creation of
tobacco-related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart
from the repeatability and frequency of the survey, other criteria that characterize a good national
surveillance system include: comparability; validity and reliability; mechanisms to translate findings into
action; and sustainability (of financial and human resources). Article 20.2 of the Convention calls upon
Parties to “establish, as appropriate, programmes for national, regional and global surveillance of the
23
magnitude, patterns, determinants and consequences of tobacco consumption and exposure to tobacco
smoke” expecting data to be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS:
- http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
- Eurostat (health status):
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/data
base
- European Health Interview Survey 2008:
http://epp.eurostat.ec.europa.eu/cache/ITY_SDDS/en/hlth_ehis_esms.htm
Other sources:
- ITC Project: http://www.itcproject.org/
24
1.6 Average number of the most-consumed smoking tobacco product used per day among daily
smokers
INDICATOR NAME
Average number of the most-consumed smoking tobacco product used per day among daily smokers
DATA TYPE REPRESENTATION
Count
RATIONALE
This information can be used to assess the most-consumed smoking tobacco product, as well as to
indirectly calculate sales of the most-consumed smoking tobacco product, individual average and
country per capita consumption of the most-consumed smoking tobacco product. (This information will
pertain to consumption by daily smokers only; contribution of occasional smokers to the overall per
capita consumption will need to be assessed separately.)
DEFINITION
Number of the most widely consumed smoking tobacco product used per day on average among daily
smokers during a defined period leading up to the survey date among daily smokers of that product.
This may differ for each country based on the type of smoked tobacco product most widely consumed.
"Tobacco smoking" includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water
pipes), fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys, and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted by the
25
countries’ national statistical office, or any other relevant agency, or by national or international
research groups (and include academic research or studies implemented by nongovernmental
organizations). If no recent national data are available, country estimates may be found in the WHO
Global Health Observatory Data Repository.
METHOD OF MEASUREMENT
(%)
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age: taking into account the age range selected for the relevant survey, data on smoking
prevalence should be broken down by age groups (preferably by 10-year category, e.g. 25−34, 35−44).
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the average number of the most-consumed tobacco product contributes to
effective monitoring and evaluation of the impact of tobacco control policies. WHO recommends that
such surveys be conducted regularly (at least once every five years), and such repetition would also
contribute to the creation WHO also recommends that such surveys be conducted regularly of tobacco-
related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart from the
repeatability and frequency of the survey, other criteria that characterize a good national surveillance
system include: comparability; validity and reliability; mechanisms to translate findings into action; and
sustainability (of financial and human resources). If data used for the calculations are collected regularly
(e.g. are available for each calendar year), such calculations can be repeated on an annual basis. Article
20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes for national,
regional and global surveillance of the magnitude, patterns, determinants and consequences of tobacco
consumption and exposure to tobacco smoke”, expecting data be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
26
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Global Infobase: https://apps.who.int/infobase/
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
27
2. PREVALENCE OF SMOKELESS TOBACCO USE IN THE ADULT POPULATION
28
2.1 Current smokeless tobacco users
INDICATOR NAME
Current smokeless tobacco users
DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of current use of any smokeless tobacco product among adults is an important indicator
to use when calculating the health and economic burden of tobacco on society, and is also important for
informing policy-making and substantiating the need for action.
Routine and regular monitoring of this indicator is necessary to enable accurate monitoring and
evaluation of the impact of implementation of the WHO FCTC over time.
DEFINITION
The definition of "current smokeless tobacco user" varies between surveys, but often means someone
who uses any smokeless tobacco product at least once during a defined period leading up to the survey
date.
The crude rate, expressed as a percentage of the total adult population, refers to the number of adults
who are current users of any smokeless tobacco product per 100 of the adult population of the country,
resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions). The age
range to which the prevalence data for the entire adult population refer should be, for example, 15
years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s methodology.
When this crude prevalence rate is multiplied by the country’s adult population, the result is the number
of adults who are current users of any smokeless tobacco product in the country.
"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red
tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway,
naas/naswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any
other tobacco product that is sniffed, held in the mouth, or chewed.
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
29
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys, and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted by the
country’s national statistical office, or any other relevant agency, or by national or international research
groups (and include academic research or studies implemented by nongovernmental organizations). If
no recent national data are available, country estimates may be found in the WHO Global Health
Observatory Data Repository.
METHOD OF MEASUREMENT
( )
( )
( )
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age, taking into account the age range selected for the relevant survey, data on smokeless
tobacco use prevalence should be broken down by age group (preferably by 10-year category, e.g.
25−34, 35−44)
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of current users of any smokeless tobacco product
contributes to effective monitoring and evaluation of the impact of tobacco control policies. WHO
recommends that such surveys be conducted regularly (at least once every five years), and such
repetition would also contribute to the creation of tobacco-related national surveillance systems as
envisaged in Article 20.3(a) of the Convention. Apart from the repeatability and frequency of the survey,
other criteria that characterize a good national surveillance system include: comparability; validity and
reliability; mechanisms to translate findings into action; and sustainability (of financial and human
30
resources). Article 20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes
for national, regional and global surveillance of the magnitude, patterns, determinants and
consequences of tobacco consumption and exposure to tobacco smoke” , expecting data be collected
with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data maybe reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO Global Health Observatory: http://apps.who.int/gho/data/node.main.1257?lang=en
- WHO Indicator Code Book Tobacco Control
http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=364
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
31
2.2 Daily smokeless tobacco users
INDICATOR NAME
Daily smokeless tobacco users
DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of daily use of any smokeless tobacco product among adults is an important indicator to
use when calculating the health and economic burden of tobacco on society, and is also important for
informing policy-making and substantiating the need for action. Routine and regular monitoring of this
indicator is necessary to enable accurate monitoring and evaluation of the impact of implementation of
the WHO FCTC over time.
DEFINITION
The definition of "daily user" varies between surveys, but often means someone who currently uses any
smokeless tobacco product at least once a day during a defined period leading up to the survey date.
The crude rate, expressed as a percentage of the total adult population, refers to the number of adults
who are daily users of any smokeless tobacco product per 100 of the adult population of the country,
resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions). The age
range to which the prevalence data for the entire adult population refer should be, for example, 15
years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s methodology.
When this crude prevalence rate is multiplied by the country’s adult population, the result is the number
of adults who are daily users of any smokeless tobacco product in the country.
"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red
tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway,
naas/naswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any
other tobacco product that is sniffed, held in the mouth, or chewed.
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
32
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys; and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted by the
countries’ national statistical offices or any other relevant agency, or by national or international
research groups (and include academic research or studies implemented by nongovernmental
organizations). If no recent national data are available, country estimates may be found in the WHO
Global Health Observatory Data Repository.
METHOD OF MEASUREMENT
( )
( )
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age, taking into account the age range selected to be applied for the relevant survey data
on smokeless tobacco use prevalence should be broken down by age group (preferably by 10-year
category, e.g. 25−34, 35−44).
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of daily users of any smokeless tobacco product contributes
to effective monitoring and evaluation of the impact of tobacco control policies. WHO recommends that
such surveys be conducted regularly (at least once every five years) and such repetition would also
contribute to the creation of tobacco-related national surveillance systems as envisaged in Article 20.3(a)
of the Convention. Apart from the repeatability and frequency of the survey, other criteria that
characterize a good national surveillance system include: comparability; validity and reliability;
mechanisms to translate findings into action; and sustainability (of financial and human resources).
33
Article 20.2 of the Convention calls upon Parties to “establish, as appropriate, programmes for national,
regional and global surveillance of the magnitude, patterns, determinants and consequences of tobacco
consumption and exposure to tobacco smoke”, expecting data be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
34
2.3 Occasional smokeless tobacco users
INDICATOR NAME
Occasional smokeless tobacco users
DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of occasional or non-daily use of smokeless tobacco among adults is an important
measure of the health and economic burden of tobacco. Routine and regular monitoring of this indicator
is necessary to enable accurate monitoring and evaluation of the impact of implementation of the WHO
FCTC over time.
Crude prevalence rates can be used to assess the actual use of smokeless tobacco in a country and to
generate an estimate of the number of users for the relevant indicator (e.g. occasional users) in the
population.
DEFINITION
An “occasional smokeless tobacco user" is someone who uses any smokeless tobacco product non-daily
during a defined period leading up to the survey date.
The crude rate, expressed as a percentage of the total adult population, refers to the number of adults
who are occasional or non-daily users of any smokeless tobacco product per 100 of the adult population
of the country, resulting from the latest adult tobacco use survey (or survey which asks tobacco use
questions). The age range to which the prevalence data for the entire adult population refer should be,
for example, 15 years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s
methodology.
When this crude prevalence rate is multiplied by the country’s adult population, the result is the number
of adults who are occasional or non-daily users of any smokeless tobacco product in the country.
"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red
tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway,
naas/naswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any
other tobacco product that is sniffed, held in the mouth, or chewed.
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys include:
35
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys; and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted by the
country’s national statistical office or any other relevant agency, or by national or international research
groups (and include academic research or studies implemented by nongovernmental organizations). If
no recent national data are available, country estimates may be found in the WHO Global Health
Observatory Data Repository.
METHOD OF MEASUREMENT
( )
( )
In the numerator the number of occasional smokeless tobacco users includes formerly daily and never
daily users of any smokeless tobacco product in the adult population.
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age: taking into account the age range selected for the relevant survey, data on smokeless
tobacco use prevalence should be broken down by age group (preferably by 10-year category, e.g.
25−34, 35−44)
36
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of occasional smokeless tobacco users contributes to
effective monitoring and evaluation of the impact of tobacco control policies. WHO recommends that
such surveys be conducted regularly (at least once every five years), and such repetition would also
contribute to the creation of tobacco-related national surveillance systems as envisaged in Article 20.3(a)
of the Convention. Apart from the repeatability and frequency of the survey, other criteria that
characterize a good national surveillance system include: comparability; validity and reliability;
mechanisms to translate findings into action; and sustainability (of financial and human resources).
Article 20.2 of the Convention calls upon Parties to “establish, as appropriate, programmes for national,
regional and global surveillance of the magnitude, patterns, determinants and consequences of tobacco
consumption and exposure to tobacco smoke”, expecting data be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
37
2.4 Former smokeless tobacco users
INDICATOR NAME
Former smokeless tobacco users
DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of former smokeless tobacco users among adults is an important measure of cessation
of smokeless tobacco use, and routine and regular monitoring of this indicator is necessary to enable
accurate monitoring and evaluation of the impact of implementation of the WHO FCTC over time.
DEFINITION
“Former smokeless tobacco users" are people who have ever used any smokeless tobacco product, and
who currently does not use any smokeless tobacco product during a defined period leading up to the
survey date.
Rare instances of smokeless tobacco use or experimental use of such products can be discounted, and
the individuals concerned taken as having used smokeless tobacco products ”not at all”. Accordingly, a
“former user” or “ex-user” may be defined as “a person who has consumed the tobacco equivalent of
fewer than 100 cigarettes or in his or her lifetime, and does not use smokeless tobacco at all now”.
The crude rate, expressed as a percentage of the total adult population, refers to the number of adults
who are former users of any smokeless tobacco product per 100 of the adult population of the country,
resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions). The age
range to which the prevalence data for the entire adult population refer should be, for example, 15
years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s methodology.
When this crude prevalence rate is multiplied by the country’s adult population, the result is the number
of adults who are former users of any smokeless tobacco product in the country.
"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red
tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway,
naas/naswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any
other tobacco product that is sniffed, held in the mouth, or chewed.
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys, which may have been implemented by the Parties, include:
38
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys; and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted either by the
countries’ national statistical office, or any other relevant agency, or by national or international
research groups (and include academic research or studies implemented by nongovernmental
organizations). If no recent national data are available, country estimates may be found in the WHO
Global Health Observatory Data Repository.
METHOD OF MEASUREMENT
( )
In the numerator the number of former smokeless tobacco users includes respondents who are ever
daily and non-daily users of any smokeless tobacco product, and who currently do not use any
smokeless tobacco product.
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age, taking into account the age range selected for the relevant survey, data on smokeless
tobacco use prevalence should be broken down by age group (preferably by 10-year category, e.g.
25−34, 35−44).
39
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of former users of any smokeless tobacco product
contributes to effective monitoring and evaluation of the impact of tobacco control policies. WHO
recommends that such surveys be conducted regularly (at least once every five years), and such
repetition would also contribute to the creation of tobacco-related national surveillance systems as
envisaged in Article 20.3(a) of the Convention. Apart from the repeatability and frequency of the survey,
other criteria that characterize a good national surveillance system include: comparability; validity and
reliability; mechanisms to translate findings into action; and sustainability (of financial and human
resources). Article 20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes
for national, regional and global surveillance of the magnitude, patterns, determinants and
consequences of tobacco consumption and exposure to tobacco smoke”, expecting data be collected
with some regularity.
Once Parties reported on such surveys to the Conference of the Parties as part of their regular
implementation reports, the Secretariat analyses them by preparing regional and global comparisons.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
40
2.5 Never users of smokeless tobacco
INDICATOR NAME
Never users of smokeless tobacco
DATA TYPE REPRESENTATION
Percent
RATIONALE
The prevalence of never users of smokeless tobacco products among adults is an important measure of
non-initiation of smokeless tobacco use, and provides a baseline for evaluating the effectiveness of
tobacco control programmes over time.
Routine and regular monitoring of this indicator is necessary to enable accurate monitoring and
evaluation of the impact of implementation of the WHO FCTC over time.
DEFINITION
“Never smokeless tobacco users" includes people who have never used any smokeless tobacco product
in their lives.
Rare instances of smokeless tobacco use or experimental use of such products can be discounted, and
the individuals concerned taken as having used smokeless tobacco products “not at all”. Accordingly, a
“never user of smokeless tobacco” or “non-user of smokeless tobacco” may be defined as “a person
who does not use smokeless tobacco now and has consumed the tobacco equivalent of fewer than 100
cigarettes or in his or her lifetime”.
The crude rate, expressed as a percentage of the total adult population, refers to the number of adults
who have never used any smokeless tobacco product in their life per 100 of the adult population of the
country, resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions).
The age range to which the prevalence data for the entire adult population refer should be, for example,
15 years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s
methodology.
When this crude prevalence rate is multiplied by the country’s adult population, the result is the number
of adults who have never used any smokeless tobacco product in the country.
"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red
tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway,
naas/naswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any
other tobacco product that is sniffed, held in the mouth, or chewed.
41
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys, which may have been implemented by the Parties, include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys; and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted either by the
countries’ national statistical office, or any other relevant agency, or by national or international
research groups (including academic research or studies implemented by nongovernmental
organizations). If no recent national data are available, country estimates may be found in the WHO
Global Health Observatory Data Repository.
METHOD OF MEASUREMENT
( )
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age: taking into account the age range selected for the relevant survey, data on smokeless
tobacco use prevalence should be broken down by age group (preferably by 10-year category, e.g.
25−34, 35−44).
42
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of never users of smokeless tobacco products contributes
to effective monitoring and evaluation of the impact of tobacco control policies. WHO recommends that
such surveys be conducted regularly (at least once every five years), and such repetition would also
contribute to the creation of tobacco-related national surveillance systems as envisaged in Article 20.3(a)
of the Convention. Apart from the repeatability and frequency of the survey, other criteria that
characterize a good national surveillance system include: comparability; validity and reliability;
mechanisms to translate findings into action; and sustainability (of financial and human resources).
Article 20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes for national,
regional and global surveillance of the magnitude, patterns, determinants and consequences of tobacco
consumption and exposure to tobacco smoke”, expecting data to be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
43
2.6 Average number of the most-consumed smokeless tobacco product used per day among daily
users
INDICATOR NAME
Average number of the most-consumed smokeless tobacco product used per day among daily users
DATA TYPE REPRESENTATION
Count
RATIONALE
This information can be used to assess the quantity of the most-consumed smokeless tobacco product,
as well as to indirectly calculate sales of the most-consumed smokeless tobacco product, individual
average and country per capita consumption of the most-consumed smokeless tobacco product.(This
information will pertain to consumption by daily smokeless tobacco users only; contribution of
occasional smokeless tobacco users to the overall per capita consumption will need to be assessed
separately.)
DEFINITION
The “average number of the most-consumed smokeless tobacco product used per day among daily
users” means the number of the most widely consumed smokeless tobacco product used per day on
average during a defined period leading up to the survey date.
"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red
tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway,
naas/naswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any
other tobacco product that is sniffed, held in the mouth, or chewed.
PREFERRED DATA SOURCES
National household surveys using standard methods across time, so that changes over time can be
measured. Examples of such surveys include:
- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International
Tobacco Control Policy Evaluation Project (ITC Project);
- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to
Surveillance (WHO STEPS);
- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic
and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.
44
OTHER POSSIBLE DATA SOURCES
These include: national censuses, national health surveys, and other national household surveys that
may be about other topics such as household expenditure. Such surveys may be conducted by the
countries’ national statistical office, or any other relevant agency, or national or international research
groups (and include academic research or studies implemented by nongovernmental organizations). If
no recent national data are available, country estimates may be found in the WHO Global Health
Observatory Data Repository.
METHOD OF MEASUREMENT
DISAGGREGATION
Disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age, taking into account the age range selected for the relevant survey, data on average
number of smokeless tobacco product used per day should be broken down by age group (preferably by
10-year category, e.g. 25−34, 35−44).
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the average number of the most consumed smokeless tobacco product
contributes to effective monitoring and evaluation of the impact of tobacco control policies. WHO
recommends that such surveys be conducted regularly (at least once every five years), and such
repetition would also contribute to the creation of tobacco-related national surveillance systems as
envisaged in Article 20.3(a) of the Convention. Apart from the repeatability and frequency of the survey,
other criteria that characterize a good national surveillance system include: comparability; validity and
reliability; mechanisms to translate findings into action; and sustainability (of financial and human
resources). Article 20.2 of the Convention calls upon Parties to “establish, as appropriate, programmes
for national, regional and global surveillance of the magnitude, patterns, determinants and
45
consequences of tobacco consumption and exposure to tobacco smoke”, expecting data be collected
with some regularity.
Once Parties reported on such surveys to the Conference of the Parties as part of their regular
implementation reports, the Secretariat analyses them by preparing regional and international
comparisons.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
46
3. PREVALENCE OF TOBACCO USE BY YOUTH
47
3.1 Current youth smokers
INDICATOR NAME
Current youth smokers
DATA TYPE REPRESENTATION
Percent
RATIONALE
Risky behaviour which starts in childhood often continues into adulthood. Tobacco is an addictive
substance and smoking often starts in adolescence, before the development of risk perception. By the
time the risk to health is recognized, addicted individuals find it difficult to stop tobacco use.
Prevalence rates from youth surveys can be used to gauge the future prospects for smoking tobacco use
in a country.
DEFINITION
The youth prevalence rate, expressed as a percentage of the total youth population, refers to the
number of current smokers of any tobacco product per 100 of the youth population in the country,
resulting from the latest youth tobacco use survey (or survey which asks tobacco use questions).
When this prevalence rate is multiplied by the country's youth population, the result is an estimate of
the number of current smokers of any tobacco product in the country. The age range to which the
prevalence data for the youth refer could be, for example, 12 to 17 years; less than 18 years of age; or as
determined in the survey’s methodology. The upper age limit of “youth” may also be defined by age of
maturity as per individual countries’ laws legislative framework.
The definition of "current smoker" varies between surveys, but often means someone who smokes any
tobacco product either daily or occasionally at least once during a defined period leading up to the
survey date.
"Tobacco smoking" includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water
pipes), fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.
PREFERRED DATA SOURCES
National surveys implemented as part of international data collection initiatives, such as:
- Tobacco-specific surveys: Global Youth Tobacco Survey (GYTS);
- Non-tobacco-specific surveys: Global School-based Student Health Survey (GSHS), European School
Survey Project on Alcohol and Other Drugs (ESPAD), Health Behaviour of School-aged Children (HBSC),
Youth Risk Behaviour Surveillance System (YRBSS).
48
OTHER POSSIBLE DATA SOURCES
These include: national specific population surveys conducted by the country’s national surveillance
system, national statistical office, or any other relevant agency, or by research groups (and include
academic research or studies implemented by nongovernmental organizations).
If no national data are available, country estimates may be found in the WHO Global Health Observatory
Data Repository.
METHOD OF MEASUREMENT
( )
( )
( )
DISAGGREGATION
Wherever possible, prevalence data should be separated for boys and girls, and combined (total)
prevalence should also be provided.
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of current smokers of any tobacco product among youth
contributes to effective monitoring and evaluation of the impact of tobacco control policies. WHO also
recommends that such surveys be conducted regularly (at least once every five years), and such
repetition would also contribute to the creation of tobacco-related national surveillance systems as
envisaged in Article 20.3(a) of the Convention. Apart from the repeatability and frequency of the survey,
other criteria that characterize a good national surveillance system include: comparability; validity and
reliability; mechanisms to translate findings into action; and sustainability (of financial and human
resources). Article 20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes
for national, regional and global surveillance of the magnitude, patterns, determinants and
consequences of tobacco consumption and exposure to tobacco smoke", expecting data to be collected
with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, Parties are required to provide information about the study (e.g.
year, source, name of the region concerned).
49
USEFUL LINKS AND SOURCES
Global:
- GSHS: http://www.who.int/chp/gshs
- GYTS: http://www.who.int/tobacco/surveillance/gyts/en/index.html
- WHO Global Health Observatory: http://apps.who.int/gho/data/view.main
- WHO Indicator Code Book Tobacco Control:
http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=1297
- YRBSS:http://www.cdc.gov/HealthyYouth/yrbs/index.htm
Regional:
- ESPAD: http://www.espad.org
- HSBC: http://www.hbsc.org
50
3.2 Current youth smokeless tobacco users
INDICATOR NAME
Current youth smokeless tobacco users
DATA TYPE REPRESENTATION
Percent
RATIONALE
Risky behaviour which starts in childhood often Tobacco is an addictive substance and smokeless
tobacco use often starts in adolescence, before the development of risk perception. By the time the risk
to health is recognized, addicted individuals find it difficult to stop smokeless tobacco use.
Prevalence rates from youth surveys can be used to gauge the future prospects for smokeless tobacco
use in a country.
DEFINITION
The definition of "current smokeless tobacco user" varies between surveys, but often means someone
who uses any smokeless tobacco product at least once during a defined period leading up to the survey
date.
The youth prevalence rate, expressed as a percentage of the total youth population, refers to the
number of current users of any smokeless tobacco product per 100 of the youth population in the
country, resulting from the latest youth tobacco use survey (or survey which asks tobacco use questions).
When this prevalence rate is multiplied by the country's youth population, the result is an estimate of
the number of current users of any smokeless tobacco product in the country.
The age range to which the prevalence data for the youth refer could be, for example, 12 to 17 years;
less than 18 years of age; or as determined in the survey’s methodology. The upper age limit of “youth”
may also be defined by age of maturity as per individual countries’ laws legislative framework.
"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red
tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway,
naas/naswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any
other tobacco product that is sniffed, held in the mouth, or chewed.
51
PREFERRED DATA SOURCES
National surveys implemented as part of international data collection initiatives, such as:
- Tobacco-specific surveys: Global Youth Tobacco Survey (GYTS);
- Non-tobacco-specific surveys: the Global School-based Student Health Survey (GSHS), the European
School Survey Project on Alcohol and Other Drugs (ESPAD), the Health Behaviour of School-aged
Children (HBSC), and the Youth Risk Behaviour Surveillance System (YRBSS).
OTHER POSSIBLE DATA SOURCES
These include: national specific population surveys conducted by the country’s national surveillance
system, national statistical office, or by any other relevant agency or research groups (and include
academic research or studies implemented by nongovernmental organizations). If no national data are
available, country estimates may be found in the WHO Global Health Observatory Data Repository.
METHOD OF MEASUREMENT
( )
( )
( )
DISAGGREGATION
Wherever possible, prevalence data should be separated for boys and girls, and combined (total)
prevalence should also be provided.
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of current youth users of smokeless tobacco products
contributes to effective monitoring and evaluation of the impact of tobacco control policies. WHO
recommends that such surveys be conducted regularly (at least once every five years), and such
repetition would also contribute to the creation of tobacco-related national surveillance systems as
envisaged in Article 20.3(a) of the Convention. Apart from the repeatability and frequency of the survey,
other criteria that characterize a good national surveillance system include: comparability; validity and
reliability; mechanisms to translate findings into action; and sustainability (of financial and human
resources). Article 20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes
52
for national, regional and global surveillance of the magnitude, patterns, determinants and
consequences of tobacco consumption and exposure to tobacco smoke", expecting data be collected
with some regularity.
COMMENTS
If national data are not available at the time of preparation of the report, subnational data may be
reported. In these cases, please provide information about the study (e.g. year, source, name of the
region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- GSHS: http://www.who.int/chp/gshs
- GYTS: http://www.who.int/tobacco/surveillance/gyts/en/index.html
- WHO Global Health Observatory: http://apps.who.int/gho/data/view.main
- WHO Indicator Code Book Tobacco Control:
http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=1297
- YRBSS: http://www.cdc.gov/HealthyYouth/yrbs/index.htm
53
4. EXPOSURE TO TOBACCO SMOKE IN THE ADULT POPULATION
54
4.1 Percentage of adults exposed to tobacco smoke3 at home
INDICATOR NAME
Percentage of adults exposed to tobacco smoke at home
DATA TYPE REPRESENTATION
Percent
RATIONALE
The adult exposure rate indicates how widespread exposure to second-hand smoke is in a country and
can be used to estimate the number of adults exposed to second-hand smoke at home) in the
population. It can also be used to estimate the health impacts attributable to this exposure.
Some of the health conditions caused by second-hand smoke in adults include heart disease and lung
cancer. People who already have heart disease are at especially high risk of suffering adverse effects
from breathing second-hand smoke and should take special precautions to avoid even brief exposure.
DEFINITION
The rate of adult exposure at home, expressed as a percentage of the total adult population, refers to
the number of adults who were exposed to tobacco smoke in their homes per 100 of the adult
population. Multiplying this rate by the adult population results in the number of adults exposed to
second-hand smoke at home. The age range to which the prevalence data for the entire adult
population refer should be, for example, 15 years and over, 18 years and over, 18–64 years, or similar,
as determined in the survey’s methodology.
"Exposure at home" is defined as respondents reporting another person smoking in respondent’s home
at least once during a defined period leading up to the survey date.
Second-hand tobacco smoke can be defined as “the smoke emitted from the burning end of a cigarette
or from other tobacco products usually in combination with the smoke exhaled by the smoker”
(guidelines for implementation of Article 8 of the Convention).
PREFERRED DATA SOURCES
National surveys implemented as part of international data collection initiatives, such as:
3 Several alternative terms are commonly used to describe the type of smoke addressed by Article 8 of the WHO
Framework Convention. These include “second-hand smoke”, “environmental tobacco smoke”, and “other people’s smoke”. Terms such as “passive smoking” and “involuntary exposure to tobacco smoke” should be avoided, as experience in France and elsewhere suggests that the tobacco industry may use these terms to support a position that “voluntary” exposure is acceptable. “Second-hand tobacco smoke”, sometimes abbreviated as “SHS”, and “environmental tobacco smoke”, sometimes abbreviated “ETS”, are the preferable terms; this Compendium uses the term “second-hand tobacco smoke”.
55
- Tobacco-specific surveys: the Global Adult Tobacco Survey (GATS) and the International Tobacco
Control Policy Evaluation Project (ITC Project).
- Non-tobacco-specific surveys: the WHO STEPwise Approach to Surveillance (STEPS), the WHO Study
on Global Ageing and Adult Health (SAGE), Demographic and Health Surveys (DHS), Eurobarometer
and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national health surveys, national household surveys, and national specific population
surveys. Such surveys may be conducted by the country’s national surveillance system, or national
statistical office, or by any other relevant agency or research groups (and include academic research or
studies carried out by nongovernmental organizations).
METHOD OF MEASUREMENT
( )
DISAGGREGATION
Wherever possible, disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age, taking into account the age range selected to be applied for the relevant survey, data
on second-hand smoke exposure at home should be broken down by age groups (preferably by 10-year
category, e.g. 25−34, 35−44).
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of adults exposed to tobacco smoke in their homes
contributes to effective monitoring and evaluation of the impact of tobacco control policies. WHO also
recommends that such surveys be conducted regularly (at least once every five years) so that their
repetition contributes to the creation of tobacco-related national surveillance systems as envisaged in
Article 20.3(a) of the Convention. Apart from the repeatability and frequency of the survey, other
56
criteria that characterize a good national surveillance system include: comparability; validity and
reliability; mechanisms to translate findings into action; and sustainability (of financial and human
resources). Article 20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes
for national, regional and global surveillance of the magnitude, patterns, determinants and
consequences of tobacco consumption and exposure to tobacco smoke" , expecting data be collected
with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
57
4.2 Percentage of adults exposed to tobacco smoke in the workplace
INDICATOR NAME
Percentage of adults exposed to tobacco smoke in the workplace
DATA TYPE REPRESENTATION
Percent
RATIONALE
The adult exposure rate indicates how widespread exposure to second-hand smoke is in a country and
can be used to estimate the number of adults exposed to second-hand smoke in their work places in the
population. It can also be used to estimate the health impacts attributable to this exposure.
Some of the health conditions caused by second-hand smoke in adults include heart disease and lung
cancer. People who already have heart disease are at especially high risk of suffering adverse effects
from breathing second-hand smoke and should take special precautions to avoid even brief exposure.
DEFINITION
The adult second-hand smoke exposure rate at work, expressed as a percentage of the total adult
population, refers to the number of adults who were exposed to tobacco smoke in their workplaces per
100 of the adult population. Multiplying this rate by the adult population results in the number of adults
exposed to second-hand smoke in the workplace. The age range to which the prevalence data for the
entire adult population refer should be, for example, 15 years and over, 18 years and over, 18–64 years,
or similar, as determined in the survey’s methodology.
"Exposure in the workplace" is defined as other people smoking in the workplace in the presence of the
respondent at least once during a defined period leading up to the survey date.
In line with the recommendation of the guidelines for implementation of Article 8 of the Convention, a
“workplace” should be defined broadly as “any place used by people during their employment or work”.
This should include not only work done for compensation, but also voluntary work, if it is of the type for
which compensation is normally paid. In addition, “workplaces” include not only those places at which
work is performed, but also all attached or associated places commonly used by the workers in the
course of their employment, including, for example, corridors, lifts, stairwells, lobbies, joint facilities,
cafeterias, toilets, lounges, lunchrooms and also outbuildings such as sheds and huts. Vehicles used in
the course of work are workplaces and should be specifically identified as such.
PREFERRED DATA SOURCES
National surveys implemented as part of international data collection initiatives, such as:
- Tobacco-specific surveys: the Global Adult Tobacco Survey (GATS) and the International Tobacco
Control Policy Evaluation Project (ITC Project).
58
- Non-tobacco-specific surveys: the WHO STEPwise Approach to Surveillance (STEPS), the WHO Study
on Global Ageing and Adult Health (SAGE), Demographic and Health Surveys (DHS), Eurobarometer
and the European Health Interview Survey.
OTHER POSSIBLE DATA SOURCES
These include: national health surveys, national household surveys, and national specific population
surveys. Such surveys may be conducted by the country’s national surveillance system, or national
statistical office, or by any other relevant agency or research groups (and include academic research or
studies implemented by nongovernmental organizations).
METHOD OF MEASUREMENT
( )
DISAGGREGATION
Wherever possible, disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age: taking into account the age range selected to be applied for the relevant survey, data
on SHS exposure at work should be broken down by age group (preferably by 10-year category, e.g.
25−34, 35−44)
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of adults exposed to tobacco smoke in the workplace
contributes to effective tobacco control policies. WHO also recommends that such surveys be conducted
regularly (at least once every five years) so that their repetition contributes to the creation of tobacco-
related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart from the
repeatability and frequency of the survey, other criteria that characterize a good national surveillance
system include: comparability; validity and reliability; mechanisms to translate findings into action; and
sustainability (of financial and human resources). Article 20.2 of the Convention calls upon Parties to
"establish, as appropriate, programmes for national, regional and global surveillance of the magnitude,
patterns, determinants and consequences of tobacco consumption and exposure to tobacco smoke",
expecting data be collected with some regularity.
59
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO STEPS: http://www.who.int/chp/steps/en/
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
60
4.3 Percentage of adults exposed to tobacco smoke in public transport
INDICATOR NAME
Percentage of adults exposed to tobacco smoke in public transport
DATA TYPE REPRESENTATION
Percent
RATIONALE
The adult exposure rate indicates how widespread exposure to second-hand smoke is in a country and
can be used to estimate the number of adults exposed to second-hand smoke in public transport in the
population. It can also be used to estimate the health impacts attributable to this exposure.
Some of the health conditions caused by second-hand smoke in adults include heart disease and lung
cancer. People who already have heart disease are at especially high risk of suffering adverse effects
from breathing second-hand smoke and should take special precautions to avoid even brief exposure.
DEFINITION
The adult exposure rate, expressed as a percentage of the total adult population, refers to the number
of adults who were exposed to tobacco smoke in public transport per 100 of the adult population.
Multiplying this rate by the adult population results in the number of adults exposed to second-hand
smoke in public transport. The age range to which the prevalence data for the entire adult population
refer should be, for example, 15 years and over, 18 years and over, 18–64 years, or similar, as
determined in the survey’s methodology.
"Exposure in public transport" is defined as other people smoking in the presence of the respondent in
public transport at least once during a defined period leading up to the survey date.
In line with the recommendation of the guidelines for implementation of Article 8 of the Convention,
“public transport” should be defined as any vehicle used for the carriage of members of the public,
usually for reward or commercial gain. This includes taxis.
PREFERRED DATA SOURCES
National surveys implemented as part of international data collection initiatives, such as:
- Tobacco-specific surveys: the Global Adult Tobacco Survey (GATS) and the International Tobacco
Control Policy Evaluation Project (ITC Project).
- Non-tobacco-specific surveys: the WHO STEPwise Approach to Surveillance (STEPS), the WHO Study
on Global Ageing and Adult Health (SAGE), Demographic and Health Surveys (DHS), Eurobarometer
and the European Health Interview Survey.
61
OTHER POSSIBLE DATA SOURCES
These include: national health surveys, national household surveys, and national specific population
surveys. Such surveys may be conducted by the country’s national surveillance system, or national
statistical office, or by any other relevant agency or research groups (and include academic research or
studies implemented by nongovernmental organizations).
METHOD OF MEASUREMENT
( )
DISAGGREGATION
Wherever possible, disaggregation should be made by gender and age.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age: taking into account the age range selected to be applied for the relevant survey, data
on SHS exposure in Public transport should be broken down by age group (preferably by 10-year
category, e.g. 25−34, 35−44)
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of adults exposed to tobacco smoke in public transport
contributes to effective tobacco control policies. WHO also recommends that such surveys be conducted
regularly (at least once every five years) so that their repetition contributes to the creation of tobacco-
related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart from the
repeatability and frequency of the survey, other criteria that characterize a good national surveillance
system include: comparability; validity and reliability; mechanisms to translate findings into action; and
sustainability (of financial and human resources). Article 20.2 of the Convention calls upon Parties to
"establish, as appropriate, programmes for national, regional and global surveillance of the magnitude,
patterns, determinants and consequences of tobacco consumption and exposure to tobacco smoke",
expecting data be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
62
USEFUL LINKS AND SOURCES
Global:
- DHS: http://www.measuredhs.com/What-We-Do/
- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html
- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html
- WHO Global Health Observatory: http://apps.who.int/gho/data/view.main
Regional:
- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm
Other sources:
- ITC Project: http://www.itcproject.org/
63
5. EXPOSURE TO TOBACCO SMOKE IN YOUTH
64
5.1 Percentage of youth exposed to tobacco smoke at home
INDICATOR NAME
Percentage of youth exposed to tobacco smoke at home
DATA TYPE REPRESENTATION
Percent
RATIONALE
Children are at particular risk from adults’ smoking. Adverse health effects include pneumonia and
bronchitis, coughing and wheezing, worsening of asthma, middle ear disease, and possibly neuro-
behavioural impairment and cardiovascular disease in adulthood. In addition, many studies show that
parental smoking is associated with higher youth smoking.
The youth exposure rates reflect the exposure to second-hand smoke among youth in a country and can
be used to estimate of the number of youth exposed in the population.
DEFINITION
The youth second-hand smoke exposure rate, expressed as a percentage of the total youth population,
refers to the number of youth exposed to second-hand smoke at home per 100 of the youth population
in the country, resulting from the latest youth tobacco use survey (or survey which asks tobacco use
questions). When this rate is multiplied by the country's youth population, the result is an estimate of
the number of youth currently exposed to second-hand smoke at home in the country.
The age range to which the prevalence data for the youth refer could be, for example, 12 to 17 years;
less than 18 years of age; or as determined in the survey’s methodology. The upper age limit of “youth”
may also be defined by age of maturity as per individual countries’ laws legislative framework.
"Exposure at home" is defined as other people smoking in the presence of the respondent in the
respondent’s home at least once during a defined period leading up to the survey date.
PREFERRED DATA SOURCES
National surveys implemented as part of international data collection initiatives, such as:
- Tobacco-specific surveys: Global Youth Tobacco Survey (GYTS).
- Non-tobacco-specific surveys: Global School-based Student Health Survey (GSHS), European School
Survey Project on Alcohol and Other Drugs (ESPAD), Health Behaviour of School-aged Children (HBSC).
65
OTHER POSSIBLE DATA SOURCES
These include national specific population surveys. Such surveys may be conducted by the country’s
national surveillance system, or national statistical office, or by any other relevant agency or research
groups (and include academic research or studies implemented by nongovernmental organizations).
Youth exposure rates for selected countries can be found in the WHO Global Health Observatory Data
Repository.
METHOD OF MEASUREMENT
( )
( )
DISAGGREGATION
Wherever possible, data should be separated for boys and girls, and combined (total) prevalence should
be provided.
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of youth exposed to tobacco smoke at home contributes to
effective tobacco control policies. WHO also recommends that such surveys be conducted regularly (at
least once every five years) so that their repetition contributes to the creation of tobacco-related
national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart from the
repeatability and frequency of the survey, other criteria that characterize a good national surveillance
system include: comparability; validity and reliability; mechanisms to translate findings into action; and
sustainability (of financial and human resources). Article 20.2 of the Convention calls upon Parties to
"establish, as appropriate, programmes for national, regional and global surveillance of the magnitude,
patterns, determinants and consequences of tobacco consumption and exposure to tobacco smoke",
expecting data be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
66
USEFUL LINKS AND SOURCES
Global:
- Global Youth Tobacco Survey: http://www.who.int/tobacco/surveillance/gyts/en/index.html
- GSHS: http://www.who.int/chp/gshs
- WHO Global Health Observatory Data Repository:
http://apps.who.int/gho/data/node.main.1259?lang=en
67
5.2 Percentage of youth exposed to tobacco smoke in public places or public transport
INDICATOR NAME
Percentage of youth exposed to tobacco smoke in public places
DATA TYPE REPRESENTATION
Percent
RATIONALE
Children are at particular risk from adults’ smoking. Adverse health effects include pneumonia and
bronchitis, coughing and wheezing, worsening of asthma, middle ear disease, and possibly neuro-
behavioural impairment and cardiovascular disease in adulthood. In addition, many studies show that
parental smoking is associated with higher youth smoking.
The youth exposure rates reflect the exposure to second-hand smoke among youth in a country and can
be used to estimate the number of youth exposed to tobacco smoke in public places in the population.
DEFINITION
The youth exposure rate, expressed as a percentage of the total youth population, refers to the number
of youth exposed to other people’s tobacco smoke in public places per 100 of the youth population in
the country, resulting from the latest youth tobacco use survey (or survey which asks tobacco use
questions). When this rate is multiplied by the country's youth population, the result is an estimate of
the number of youth currently exposed to smoke in public places in the country.
The age range to which the prevalence data for the youth refer could be, for example, 12 to 17 years;
less than 18 years of age; or as determined in the survey’s methodology. The upper age limit of “youth”
may also be defined by age of maturity as per individual countries’ laws legislative framework.
"Exposure in public places" is defined as youth reporting other people smoking in public places at least
once in the presence of the respondent during a defined period leading up to the survey date.
While the precise definition of “public places” will vary between jurisdictions, it is important for the
legislation in force to define this term as broadly as possible. The definition used should cover all places
accessible to the general public or places for collective use, regardless of ownership or right to access.
(in line with the guidelines for implementation of Article 8 of the Convention)
PREFERRED DATA SOURCES
National surveys implemented as part of international data collection initiatives, such as:
- Tobacco-specific surveys: Global Youth Tobacco Survey (GYTS);
68
- Non-tobacco-specific surveys: Global School-based Student Health Survey (GSHS), European School
Survey Project on Alcohol and Other Drugs (ESPAD), Health Behaviour of School-aged Children (HBSC).
OTHER POSSIBLE DATA SOURCES
These include national specific population surveys. Such surveys may be conducted by the country’s
national surveillance system, or national statistical office, or by any other relevant agency or research
groups (including academic research or studies implemented by nongovernmental organizations). Data
on youth exposure to tobacco smoke outside home for selected countries can be found in the WHO
Global Health Observatory Data Repository.
METHOD OF MEASUREMENT
( )
( )
DISAGGREGATION
Wherever possible, disaggregation should be made by gender, data should be separated for boys, girls,
and combined (total) prevalence should also be provided.
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the prevalence of youth exposed to tobacco smoke in public places
contributes to effective tobacco control policies. WHO also recommends that such surveys be conducted
regularly (at least once every five years) so that their repetition contributes to the creation of tobacco-
related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart from the
repeatability and frequency of the survey, other criteria that characterize a good national surveillance
system include: comparability; validity and reliability; mechanisms to translate findings into action; and
sustainability (of financial and human resources). Article 20.2 of the Convention calls upon Parties to
"establish, as appropriate, programmes for national, regional and global surveillance of the magnitude,
patterns, determinants and consequences of tobacco consumption and exposure to tobacco smoke”,
expecting data be collected with some regularity.
COMMENTS
If national data are not available at the time of preparation of the implementation report, subnational
data may be reported. In these cases, please provide information about the study (e.g. year, source,
name of the region concerned and referred adult population group).
69
USEFUL LINKS AND SOURCES
Global:
- Global Youth Tobacco Survey: http://www.who.int/tobacco/surveillance/gyts/en/index.html
- GSHS: http://www.who.int/chp/gshs
- WHO Global Health Observatory Data Repository:
http://apps.who.int/gho/data/node.main.1259?lang=en
70
6. TOBACCO-RELATED MORTALITY
71
6.1 Estimated total number of deaths attributable to tobacco use
INDICATOR NAME
Estimated total number of deaths attributable to tobacco use
DATA TYPE REPRESENTATION
Count
RATIONALE
Almost 6 million people die from tobacco use each year, both from direct tobacco use and from
exposure to second-hand smoke. By 2020, this number will increase to 7.5 million, accounting for 10% of
all deaths. Smoking is estimated to cause about 71% of lung cancer, 42% of chronic respiratory disease
and nearly 10% of cardiovascular disease. (Global status report on noncommunicable diseases 2010)
DEFINITION
Proportion of adult (age 30 years and above) deaths attributable to tobacco use by major communicable
and noncommunicable causes.
A list of the main smoking-related causes of death (which can be taken into account when calculating
the estimated total number of deaths attributable to tobacco use) is provided is provided for reference
in Appendix 1.
PREFERRED DATA SOURCES
Estimates produced by various research groups, using information from sources such as: national civil
registration with complete coverage and medical certification of cause of death; household surveys;
population census; sample or sentinel registration systems; national cancer registries; and special
studies.
OTHER POSSIBLE DATA SOURCES
If no national data are available, country estimates may be found at the WHO Global Health Observatory
Data Repository.
METHOD OF MEASUREMENT
The contribution of a risk factor (e.g. tobacco) to a disease or a death is quantified using the Population
Attributable Fraction (PAF). PAF is the proportional reduction in population disease or mortality that
would occur if exposure to a risk factor were reduced to an alternative ideal exposure scenario (e.g. no
tobacco use). To enable the calculation of mortality attributable to tobacco use using PAF method, three
pieces of information are needed:
- the prevalence of tobacco use;
72
- the risk of death related to specific causes among tobacco users compared with the risk of death of
these same causes among non-users; and
- vital statistics information on the number of deaths in a population by cause of death, age at death and
gender of the deceased.
The population attributable fraction (PAF) formula is made up of two factors: (i) the prevalence (P) of
tobacco use in the population in question; and (ii) the relative risk (RR) of developing a disease among
those who smoke tobacco or consume smokeless tobacco compared with those who do not smoke
tobacco.
PAF = P(RR-1)/[P(RR-1)+1]
The PAF can range from zero to one. It can only take the value zero when either the relative risk is
exactly equal to 1 or prevalence of tobacco use is zero (i.e. nobody uses tobacco). Otherwise, the higher
the prevalence (P) the higher the PAF as long as RR is not equal to 1; and conversely, the higher the
measure of relative risk (RR), the higher the PAF as long as prevalence of tobacco use is not zero.
Multiplying the number of cause specific deaths by the PAF results in the number of deaths attributable
to tobacco use.
If relative risk is not available from local sources, the estimated relative risk (RR) of mortality for current
and former cigarette smokers compared to never smokers can be obtained from the following source:
WHO economics of tobacco toolkit: assessment of the economic costs of smoking (available at
http://whqlibdoc.who.int/publications/2011/9789241501576_eng.pdf).
DISAGGREGATION
Wherever possible, disaggregation should be made by gender and age and cause of death.
In the case of gender, data should be separated for males and females, and combined (total) prevalence
should also be provided.
In the case of age, taking into account the age range selected to be applied for the relevant survey, data
on tobacco-attributable mortality should be broken down by age group (preferably by 10-year category,
e.g. 25−34, 35−44)
In the case of cause of death, if available, provide data by each separate tobacco-related cause of death
provided in Annex 1.
EXPECTED FREQUENCY OF DATA COLLECTION
Regular collection of data on the overall tobacco-attributable mortality contributes to effective
monitoring and evaluation of the impact tobacco control policies. WHO also recommends that such
surveys be conducted regularly so that their repetition contributes to the creation of tobacco-related
national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart from the
73
repeatability and frequency of the survey, other criteria that characterize a good national surveillance
system include: comparability; validity and reliability; mechanisms to translate findings into action; and
sustainability (of financial and human resources). Article 20.2 of the Convention calls upon Parties to
"establish, as appropriate, programmes for national, regional and global surveillance of the magnitude,
patterns, determinants and consequences of tobacco consumption and exposure to tobacco smoke",
expecting data be collected with some regularity.
COMMENTS
None
USEFUL LINKS AND SOURCES
Global:
- CANCERmondial: http://www-dep.iarc.fr/
- WHO Global Health Observatory (Mortality and global health
estimates):http://www.who.int/gho/mortality_burden_disease/en/
- WHO global report: mortality attributable to tobacco (WHO, 2012)
http://www.who.int/tobacco/publications/surveillance/rep_mortality_attibutable/en/
Other sources:
- Bulletin of the World Health Organization: Counting the dead and what they died from: an
assessment of the global status of cause of death data (Mathers CD et al. Bulletin of the World Health
Organization, 2005, 83:171–177)
http://www.who.int/bulletin/volumes/83/3/mathers0305abstract/en/
74
7. TOBACCO-RELATED COSTS
75
7.1 Overall cost of tobacco use imposed on society
INDICATOR NAME
Overall cost of tobacco use imposed on society
DATA TYPE REPRESENTATION
Local currency unit
RATIONALE
Tobacco use creates a significant economic burden on society. Higher direct health costs associated with
tobacco-related disease, and higher indirect costs associated with premature loss of life, disability due
to tobacco-related disease and productivity losses create significant negative externalities of tobacco
use.
Measuring the cost of tobacco use translates the adverse health effects of tobacco use into monetary
terms. Information on the overall cost of tobacco use imposed on society is useful for a number of
purposes:
• to measure the impact of tobacco use on health-care delivery and financing, and the productivity of
the population;
• to inform the adoption of economic interventions, such as increases in taxes applied to tobacco
products and financial incentives for not using such products;
• to determine damages in court cases/litigation related to tobacco use;
• to advocate for and to guide the development of public health policies with respect to tobacco control;
• to inform decision-makers at both national and subnational levels;
• to provide an economic framework for tobacco control programme evaluation.
DEFINITION
The term ”costs of tobacco use” is defined as the difference between overall (health-care and other)
costs that actually occur due to tobacco use, and the costs that would have occurred had there been no
tobacco use. That is, the cost of tobacco use is based on an excess cost approach. Tobacco use includes
the use of smoking tobacco products, smokeless tobacco products, and other tobacco products.
Based on the conventional cost of illness approach, the economic costs of tobacco use distinguish
between direct and indirect costs.
Direct costs consist of goods or services which involve a monetary exchange in the market place.
76
Indirect costs represent losses for which no money changes hands, but nonetheless involve a loss of
resources. Indirect costs include the value of time lost from activities due to illness and disability, and
the value of lives lost prematurely from tobacco-related illnesses.
PREFERRED DATA SOURCES
Cost calculations are usually carried out by research that has been given the task of translating the
health effects of tobacco use into monetary terms. Such groups may have been constituted by health,
finance and other relevant departments of government or other relevant -agencies and institutions
affiliated to the government.
Such cost calculations can be based on information available on the public domain, i.e. government
statistics. These sources can include, but may not be limited to, public expenditure reports, statistical
yearbooks and other periodicals, budgetary documents, national account reports, statistical data on
official web sites, and data provided by government ministries and offices.
OTHER POSSIBLE DATA SOURCES
Reports of studies and analyses undertaken by research groups not affiliated to any government
department or agency. Other such sources may include academic studies and reports, or research done
by nongovernmental organizations not affiliated with the tobacco industry and any other public and
private agency. It should be ensured that, in the context of Article 5.3 of the Convention, such research
is protected from the commercial and other vested interests of the tobacco industry, including
resources provided for such research by the tobacco industry or by organizations and individuals that
work to further the interests of the tobacco industry.
METHOD OF MEASUREMENT
Different research groups may apply various formulae for the calculation of costs attributable to tobacco
use. First and foremost, the decision needs to be taken as to which (or all) of the diseases attributable to
tobacco use and/or exposure to tobacco smoke will be included in the calculations. The most
comprehensive studies include diseases occurring in both children and adults, and are related to either
tobacco use or exposure to tobacco smoke. Once the nature of diseases to be included in the calculation
has been decided upon, the tobacco-attributable fraction (TAF) will need to be calculated.
Tobacco-attributable fraction
The TAF is the proportion of health services utilization, health-care costs, deaths, or other health
outcome measures that can be attributed to tobacco use. This fraction is also known as the population
attributable risk (PAR).
Once the TAF is determined, it can be multiplied by the corresponding total measure of interest to
derive the tobacco-attributable measure. For example, the product of the TAF and total number of
inpatient days in a country is the tobacco-attributable inpatient days; the product of the TAF and total
national outpatient cost is the tobacco-attributable outpatient cost. Similarly, the product of the TAF for
77
lung cancer deaths and the total number of lung cancer deaths gives the number of tobacco-attributable
lung cancer deaths.
To calculate the TAF using the epidemiological approach,4 two fundamental data elements need to be
estimated first: (1) tobacco use prevalence, and (2) relative risk.
(1) Pe = Ne / (total population) x 100%
(2) RRie = [Incident cases for disease i or incident i among tobacco users/Ne] / [Incident cases for disease
i or incident i among non-tobacco users/Nn]
(3) TAFi = [Pe * (RRie – 1)/Pe * (RRie – 1) + 1] x 100%
= [(Pn + Pe * RRie) – 1]/(Pn + Pe * RRie)]x 100%
where the subscript i = a particular tobacco-related disease i (e.g.lung cancer)
Pe = percentage of ever tobacco users (current plus former users)
Pn = percentage of never tobacco users which equals (1 – Pe)
Ne = number of ever tobacco users (current plus former users)
Nn = number of never tobacco users
The total economic cost of tobacco use is the sum of the estimated tobacco-attributable health-care
expenditures, tobacco-attributable indirect morbidity cost, and tobacco-attributable mortality cost
across all tobacco-attributable diseases. For cross-country comparison, the total cost of tobacco use is
often expressed as a percentage of the gross domestic product (GDP). Although this proportion provides
convenient comparison for the relative scale of tobacco-attributable burden on society across countries,
it does not measure the impact of tobacco use on economic growth.
For more technical information, please refer to the useful links and information below.
DISAGGREGATION
As a minimum, calculations need to be made separately for direct and indirect costs. If resources are
available, disaggregated figures may also be provided by tobacco product (e.g. smoking, smokeless and
other tobacco products); gender; and for children and adults. As a minimum, such calculation needs to
be conducted for the adults where most of the costs related to tobacco use occur.
4WHO’sEconomics of tobacco toolkitalso describes the econometric approach to estimate the smoking-attributable
fraction. However, the econometric approach is not as straightforward as the epidemiological approach and is also very data intensive. For example, data from a household health and demographic survey may not be readily available in most countries. In practice, researchers mostly rely on the epidemiological approach when estimating the tobacco-attributable fraction, which is why the epidemiological approach is presented in this Compendium. For more information and the description of other approaches please refer to the toolkit.
78
EXPECTED FREQUENCY OF DATA COLLECTION
To better contribute to the substantiation of tobacco control policies, the overall cost of tobacco use
imposed on society need to be recalculated regularly. If data used for the calculations are collected
regularly (e.g. are available for each calendar year), such calculations can be repeated on an annual basis.
Article 20.3(a) of the Convention calls upon Parties to "establish progressively a national system for the
epidemiological surveillance of tobacco consumption and related social, economic and health indicators".
COMMENTS
It is useful to present the estimated total economic cost of tobacco use in the following ways:
• by the component of the economic costs (e.g. health-care costs, mortality cost, etc.);
• by type of tobacco use-related diseases (e.g. heart diseases, cancer, etc.);
• by demographic subgroups (e.g. gender);
• in terms of cost per person or per tobacco user;
• in terms of cost per pack of cigarettes sold or per unit of other tobacco product sold.
USEFUL INFORMATION AND LINKS
Global:
- OECD (data on health expenditure): http://www.oecd-ilibrary.org/social-issues-migration-
health/health-key-tables-from-oecd_20758480
- United Nations Statistical Division, UNdata (government expenditure allocated to health):
http://data.un.org/Data.aspx?q=health+expenditure&d=SOWC&f=inID%3a85
- The World Bank (health expenditure as % of GDP):
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
- World Health Organization, economics of tobacco toolkit: assessment of the economic costs of
smoking. http://apps.who.int/iris/bitstream/10665/44596/1/9789241501576_eng.pdf
- WHO Global Health Observatory Data Repository (health financing):
http://apps.who.int/gho/data/node.main.75?lang=en
Regional:
- Eurostat (health care expenditure):
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/data
base
79
7.2 Direct (health-care related) costs of tobacco use
INDICATOR NAME
Direct costs of tobacco use
DATA TYPE REPRESENTATION
Local currency unit
RATIONALE
Tobacco use creates a significant economic burden on society. Higher direct health costs associated with
tobacco-related disease, and higher indirect costs associated with premature loss of life, disability due
to tobacco-related disease and productivity losses create significant negative externalities of tobacco
use.
The direct cost of tobacco-related illnesses is determined by both the number of persons being treated
and the cost of treatment. The number of patients depends on a country’s population and stage in the
tobacco epidemic, whereas cost of treatment depends on the country’s health system. Estimates may
also vary depending on the research method used. Tobacco-related health-care costs have only been
calculated in a few countries, primarily due to limited or poor-quality data, dearth of research funding,
and absence of research capacity. As health systems of low- and middle-income countries develop along
with their economies, the medical costs of tobacco-related diseases will continue to grow along with the
need to evaluate these costs.
DEFINITION
“Direct costs” represent the monetary value of goods and services consumed as a result of tobacco use
and tobacco-related illness, and for which a payment is made. Some direct costs result from the use of
health-care services, while other are related to non-health-care costs. Direct costs include payments
made out-of-pocket on health-care benefits, disability, and workers' compensation. (Note that there are
two approaches which can be used to estimate the direct costs of tobacco use – annual cost approach
and lifetime cost approach.)
Direct costs include the following types of costs:
Health-care costs include hospitalizations, physician services, nursing home care, home health-care,
medications, and services of other health-care providers in the treatment of tobacco-related diseases. It
also includes the costs of transportation to health-care providers, and care giving by non-health-care
providers, such as family members, to tobacco users who are ill. Costs for herbal treatments,
complementary and alternative medicine, and traditional healers might also be included. Other related
costs include medical supplies and equipment.
80
Non-health-care costs of tobacco use, include property losses from fires caused by smoking, cleaning of
clothes and air to remove smoke and odours, business expenses to hire and train replacements for
tobacco users who are ill, and insurance premiums for fire and accident insurance.
PREFERRED DATA SOURCES
Cost calculations are usually carried out by research that have been given the task of translating the
health effects of tobacco use into monetary terms. Such groups may have been constituted by health,
finance and other relevant departments of government or other relevant agencies and institutions
affiliated to the government.
Such cost calculations can be based on information available on the public domain, i.e. government
statistics. These sources may include public expenditure reports (e.g. those concerning health care
funding, health insurance companies’ reports), statistical yearbooks and other periodicals, budgetary
documents, national account reports, statistical data available on official web sites, and other data
provided by government departments or agencies.
OTHER POSSIBLE DATA SOURCES
Reports of studies and analyses implemented by various other research groups, not affiliated to any
government department or agency. Other such sources may include academic studies and reports, or
research done by nongovernmental organizations not affiliated with the tobacco industry and any other
public and private agency or organization. It should be ensured that, in the context of Article 5.3 of the
Convention, such research is protected from commercial and other vested interests of the tobacco
industry, including resources provided for such research by the tobacco industry or by organizations and
individuals that work to further the interests of the tobacco industry.
METHOD OF MEASURMENT
The direct costs of tobacco use, also called tobacco-attributable health-care expenditures (TAE), are
those health-care expenditures resulting from the treatment of tobacco-related diseases. The key step
in estimating the costs of tobacco use is to determine the TAF. Once the TAF is determined, the product
of the TAF and the total national health-care expenditures gives the TAE.
Estimating the TAE consists of four steps:
1. Determine the tobacco-related diseases, the types of health-care services to be included, and the
appropriate classification of population subgroups.
2. Estimate the TAF of health-care expenditures using the epidemiological approach.
3. Estimate total national health-care expenditures (THE) by population groups.
4. Estimate the TAE as the product of the TAF and the THE according to Equation below.
81
The formula to calculate the tobacco-attributable health-care expenditures for treating disease i using
health-care service type k among population subgroup j (TAEikj) is specified as:
TAEikj = TAFikj x THEikj
where TAFikj = tobacco-attributable fraction for treating disease i using health-care service type k
among population subgroup j
THEikj = total national annual expenditures in the country for treating disease i using health-care service
type k among population subgroup j
If the TAF estimates are not available by type of health-care services, the above formula is approximated
to be:
TAEikj = TAFij x THEikj
where TAFij = tobacco-attributable fraction for disease i among population subgroup j
The value of the total national health-care expenditures can be estimated from the total health
expenditure as a % of GDP.
For more technical information, please refer to the useful links and information below.
DISAGGREGATION
As a minimum, such calculation needs to be conducted for the adults, where most of the costs related to
tobacco use occur. Taking into account local needs and availability of resources, disaggregated figures
can also be provided by tobacco products (e.g. smoking, smokeless, or other tobacco products); types of
health-care services (e.g. inpatient/outpatient); gender (e.g. data separated for males and females and
total); and age (e.g. children and adults).
EXPECTED FREQUENCY OF DATA COLLECTION
To better contribute to the substantiation of tobacco control policies, the direct cost of tobacco use
imposed on society need to be recalculated regularly. If data used for the calculations are collected
regularly (e.g. are available for each calendar year), such calculations can be repeated on an annual basis.
Article 20.3(a) of the Convention calls upon Parties to "establish progressively a national system for the
epidemiological surveillance of tobacco consumption and related social, economic and health indicators".
COMMENTS
It is useful to present the estimated total smoking-attributable health-care cost in the following ways:
• by type of health-care services (e.g. inpatient hospitalizations, outpatient visits and etc.)
• by type of smoking-related diseases
• by demographic subgroups
82
• in terms of costs per person or per smoker
• in terms of cost per pack of cigarettes sold
For cross-country comparison, the total smoking-attributable health-care cost is commonly expressed as
the percentage of the national total health-care expenditures or the national gross domestic product.
The estimated costs related to tobacco use vary considerably depending on the premises used and the
items included in the cost analysis. Therefore, careful consideration should be given when providing
cross-country comparisons of the cost estimates. [JAPAN]
USEFUL INFORMATION AND LINKS
Global:
- OECD (data on health expenditure): http://www.oecd-ilibrary.org/social-issues-migration-
health/health-key-tables-from-oecd_20758480
- United Nations Statistical Division, UNdata (government expenditure allocated to health):
http://data.un.org/Data.aspx?q=health+expenditure&d=SOWC&f=inID%3a85
- The World Bank (health expenditure as % of GDP):
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
- World Health Organization, economics of tobacco toolkit: assessment of the economic costs of
smoking. http://apps.who.int/iris/bitstream/10665/44596/1/9789241501576_eng.pdf
- WHO Global Health Observatory Data Repository (health financing):
http://apps.who.int/gho/data/node.main.75?lang=en
Regional:
- Eurostat (health care expenditure):
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/data
base
83
7.3 Indirect costs of tobacco use
INDICATOR NAME
Indirect costs of tobacco use
DATA TYPE REPRESENTATION
Local currency unit
RATIONALE
Tobacco use creates a significant economic burden on society. Higher direct health costs associated with
tobacco-related disease, and higher indirect costs associated with premature loss of life, disability due
to tobacco-related disease and productivity losses create significant negative externalities of tobacco
use.
Indirect costs of tobacco use are expenses not immediately related to treatment of disease. These non-
medical expenditures include lost wages, lost workdays, costs related to using replacement workers,
overtime premiums, productivity losses related to unscheduled absences, and productivity losses of
workers on the job.
DEFINITION
Indirect costs include the following:
Morbidity costs are an indirect cost representing the value of lost productivity by persons who are ill or
disabled as a result of a tobacco-related disease. An ill person may be unable to work at their usual job
or perform their usual housekeeping and childcare activities. Morbidity costs are estimated by
determining what a person would have been able to earn performing paid labour, and also by
estimating an imputed value for lost household production services.
Mortality costs: tobacco users have an increased probability of dying from a number of diseases that
have been causally linked to tobacco use. The value of the lives lost is known as the mortality cost. One
measure of the value of life is based on assigning a monetary value to a life. This can be done using the
human capital approach, which values life according to what an individual produces, or the willingness-
to-pay approach, which values life according to what someone would pay to avoid illness or death.
Another measure of the value of lives lost prematurely is the number of years of potential life lost (YPLL).
YPLL denotes the number of years an individual would have lived had they not died of a tobacco-
attributable disease. The YPLL is determined by the number of years of life expectancy remaining at the
age of death.
Disability adjusted life years (DALYs) incorporate both the impact of tobacco-related illness on disability
and premature death, i.e. the qualitative and quantitative aspects of illness, by combining them into one
measure. The DALY was first conceptualized by Murray and Lopez in work carried out with WHO and the
84
World Bank (Murray and Lopez, 1996)5. Years of life lost due to living with a disability is the product of
number of incident cases of disease, duration of each case, and a disability weight which reflects the
degree of disability. Disability weights to be used with years lived with a specific illness have been
developed, and years of life lost from premature death are determined by comparing age at death with
the greatest life expectancy – that of Japanese women. The mortality component of the DALYs is similar
to the YPLLs. Disability weights for specific illnesses are found in the Global Burden of Disease Study
(Murray and Lopez, 1997).6
PREFERRED DATA SOURCES
Calculation of these costs is usually carried out by research groups given the task of translating the
health effects of tobacco use into monetary terms. Such groups may have been constituted by health,
finance and other relevant departments of government, as well as by other relevant agencies and
institutions affiliated to the government.
Such cost calculations can be based on information available on the public domain, for example from
various government statistics. These sources can include, but may not be limited to, public expenditure
reports (e.g. those concerning health care funding, health insurance companies’ reports), statistical
yearbooks and other periodicals, budgetary documents, national account reports, statistical data
available on official web sites, and other data provided by government departments or agencies.
OTHER POSSIBLE DATA SOURCES
Reports of studies and analyses carried out by other research groups not affiliated to any government
department or agency. Other such sources may include academic studies and reports, or research done
by nongovernmental organizations not affiliated with the tobacco industry and any other public and
private agency or organization. It should be ensured that, in the context of Article 5.3 of the Convention,
such research is protected from commercial and other vested interests of the tobacco industry,
including resources provided for such research by the tobacco industry or by organizations and
individuals that work to further the interests of the tobacco industry.
METHOD OF MEASURMENT
The indirect morbidity costs of tobacco use, also called tobacco-attributable indirect morbidity costs
(TAI), are the economic value of lost productivity by persons who are sick or disabled due to tobacco-
related diseases. The lost productivity is measured by work-loss days and/or disability days.
In the epidemiological approach, the TAF is calculated for each tobacco-related disease of interest;
similarly, the TAI need to be estimated for each particular tobacco-related disease.
5. Murray CJL, Lopez AD, eds. The Global Burden of Disease: a comprehensive assessment of mortality and disability
from diseases, injuries and risk factors in 1990 and projected to 2020. Harvard, MA, Harvard School of Public Health, 1996. 6Murray CJL, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease
Study. Lancet, 1997, 349:1436–1442
85
Estimating the TAI comprises five steps:
1. Determine the tobacco-related diseases, the type of health-care services to be included, and the
appropriate classification of population subgroups.
2. Estimate the TAF of work-loss days and non-health-care costs using the epidemiological approach.
3. Estimate total national work-loss days (TWLD) and total national non-health-care costs (TNHC) by
population groups.
4. Estimate the mean daily earnings or salary.
5. Estimate the TAI by adding the product of the TAF, TWLD, and mean daily earnings to the product of
the TAF and the TNHC for each type of health-care services.
The indirect mortality costs of tobacco use, also called tobacco-attributable indirect mortality costs
(TAMC), are defined as the value of lives lost due to tobacco-caused premature death. Another way to
measure the value of lives is in terms of the number of years of potential life lost (YPLL), which indicates
how many more years an individual would have lived had they not died prematurely from a tobacco-
related disease. The YPLL is determined by the number of years of life expectancy remaining at the age
of death.
Estimating the TAMC and TAYPLL involves six steps:
1. Determine the tobacco-related diseases, and the appropriate classification of population subgroups.
2. Estimate the TAF of mortality.
3. Estimate the total number of deaths in the country for the disease of interest (TDEATH).
4. Estimate the present value of lifetime earnings (PVLE).
5. Determine the years of remaining life expectancy (YLIFE).
6. Estimate the TAMC as the product of the TAF, TDEATH, and PVLE. Similarly, estimate TAYPLL as the
product of TAF, TDEATH, and YLIFE.
DISAGGREGATION
As a minimum, such calculations need to be conducted for the adults, the group in which most of the
costs related to tobacco use occur. Taking into account local needs and availability of resources,
disaggregated figures can also be provided by tobacco products (e.g. smoking, smokeless, or other
tobacco products); types of health-care services (e.g.. inpatient/outpatient); gender (e.g.. data
separated for males and females and total); and age (e.g.. children and adults).
86
EXPECTED FREQUENCY OF DATA COLLECTION
To better contribute to the substantiation of tobacco control policies, the indirect cost of tobacco use
imposed on society need to be recalculated regularly. If data used for the calculations are collected
regularly (e.g. are available for each calendar year), such calculations can be repeated on an annual basis.
Article 20.3(a) of the Convention calls upon Parties to "establish progressively a national system for the
epidemiological surveillance of tobacco consumption and related social, economic and health indicators".
COMMENTS
None
USEFUL INFORMATION AND LINKS
Global:
- OECD (data on health expenditure): http://www.oecd-ilibrary.org/social-issues-migration-
health/health-key-tables-from-oecd_20758480
- United Nations Statistical Division, UNdata (government expenditure allocated to health):
http://data.un.org/Data.aspx?q=health+expenditure&d=SOWC&f=inID%3a85
- The World Bank (health expenditure as % of GDP):
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
- World Health Organization, economics of tobacco toolkit: assessment of the economic costs of
smoking. http://apps.who.int/iris/bitstream/10665/44596/1/9789241501576_eng.pdf
- WHO Global Health Observatory Data Repository (health financing):
http://apps.who.int/gho/data/node.main.75?lang=en
Regional:
- Eurostat (health care expenditure):
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/data
base
87
8. SUPPLY OF TOBACCO AND TOBACCO PRODUCTS
88
8.1 Total volume of duty-free sales of tobacco products
INDICATOR NAME
Total volume of duty-free sales of tobacco products
DATA TYPE REPRESENTATION
Volume expressed in unit (e.g. pieces, millions of pieces, tonnes, thousands of packages)
RATIONALE
Tax avoidance by consumers involves legal activities such as purchases for personal consumption from a
lower-tax jurisdictions or duty-free shops. The extent of duty-free shopping and/or other tax avoidance
activities by individuals can be significant in some countries. This defeats the health purpose of taxation
and harms public health by encouraging personal consumption. Prohibiting or restricting duty-free sales
of tobacco products reduces opportunities for tax avoidance, and a number of Parties to the Convention
have already taken such measures.
In addition, there is some evidence that the availability of duty-free sales of tobacco products has
facilitated illicit trade in tobacco products in many countries.
DEFINITION
Duty-free tobacco products (cigarettes, smoking, smokeless and other tobacco products) are defined as
merchandise on which duty is not charged because it is sold only to departing passengers in an airport's
or port's departure lounge (which are bonded areas) upon presentation of valid travel documents (such
as a passport and travel ticket).
These tobacco products are treated for customs purposes as goods for duty-free shops and tax should
not be paid.
PREFERRED DATA SOURCES
Government departments, national statistical offices or agencies, or any other organization affiliated to
the government, which is responsible for collecting data on licit supply of tobacco products.
OTHER POSSIBLE DATA SOURCES
Any other relevant agency or research group, including academic research or studies implemented by
nongovernmental organizations.
METHOD OF MEASUREMENT
Duty-free sales can be reported by product and unit (e.g. pieces, millions of pieces, tonnes, thousands of
packages). In some cases, duty-free sales information is provided in value. The value of duty-free sales of
89
tobacco products is equal to the price per unit of tobacco product multiplied by the number of quantity
of units of tobacco products.
DISAGGREGATION
Data can be disaggregated by category of tobacco product - cigarettes, smoking tobacco products,
smokeless tobacco products and/or other tobacco products, as appropriate.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant government department, national statistical
offices or agency, or any other organization affiliated to the government that is responsible for
collecting data on licit supply of tobacco products in the country.
COMMENTS
Article 6.2(b) of the Convention not only requires Parties to prohibit or restrict sales to international
travellers of tax- and duty-free tobacco products, but also importations of tax- and duty-free tobacco
products by returning travellers.
USEFUL LINKS AND SOURCES
- Expert review on a possible ban on duty-free sales of tobacco products (document FCTC/COP/INB-
IT/3/INF.DOC./3, available at http://apps.who.int/gb/fctc/PDF/it3/FCTC_COP_INB_IT3_ID3-en.pdf)
90
8.2 Total volume of domestic production of tobacco and tobacco products
INDICATOR NAME
Total volume of domestic production of tobacco and tobacco products
DATA TYPE REPRESENTATION
Volume expressed in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco
(tobacco leaf) and unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of
manufactured tobacco products.
RATIONALE
Tobacco is produced and manufactured in many countries worldwide, including developing countries.
Tobacco is a cash crop that active industry intervention has made attractive to farmers. It is the largest
non-food crop by monetary value in the world. Nevertheless, many countries, including the world’s
largest producers, are taking steps to find alternatives to tobacco growing.
Unmanufactured tobacco is mostly used in the production of tobacco products. Cigarette production
has, until recently, been located largely in developed countries for various reasons. First, consumption
was concentrated in developed countries. Second, cigarette production is a capital intensive
manufacturing activity and requires specialized technology, supply of materials and considerable
research and development that were typically not available in developing countries.
The market for unmanufactured tobacco and tobacco products does not resemble a free market and
governmental interventions influence both the production and trade of tobacco in most countries.
Monitoring domestic production of tobacco and tobacco products facilitates the development of
sectoral policies, including transition to viable alternatives to tobacco growing, and an effective
administration of excise, respectively.
DEFINITION
Domestic tobacco and tobacco products include all tobacco grown or manufactured within a particular
territory rather than imported from outside that territory.
PREFERRED DATA SOURCES
Government departments (e.g. trade, industry, finance), national statistical offices or agencies, or any
other organization affiliated to the government that is responsible for collecting data on licit supply of
unmanufactured tobacco and tobacco products.
OTHER POSSIBLE DATA SOURCES
Any other relevant agency or research group, including academic research or studies implemented by
nongovernmental organizations.
91
METHOD OF MEASUREMENT
Domestic production of unmanufactured tobacco can be reported in dry weight (e.g. kilograms, tonnes).
Domestic production of manufactured tobacco can be reported by product and unit (e.g. pieces, millions
of pieces, tonnes, thousands of packages).
Licit supply is calculated, as appropriate, using the following formula: domestic production + (imports −
exports), where:
Domestic production = total licit supply - imports + exports
DISAGGREGATION
Data can be disaggregated by unmanufactured tobacco (tobacco leaf) and category of manufactured
tobacco product – e.g. cigarettes, smoking tobacco products, smokeless tobacco products and/ or other
tobacco products.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant government department, national statistical
offices or agencies, or any other organization affiliated to the government that is responsible for
collecting data on licit supply of tobacco products in the country at any time.
COMMENTS
In some cases, information on domestic production is available in the form of the value of tobacco leaf
or manufactured tobacco product.
USEFUL LINKS AND SOURCES
Information on the domestic production of tobacco and tobacco products are available on the following
sites:
- Food and Agriculture Organization of the United Nations:
http://faostat3.fao.org/home/index.html#DOWNLOAD (commodity code 2671)
- United Nations Commodity Trade Statistics Database (UN Comtrade): http://comtrade.un.org/db/
- United Nations Conference on Trade and Development (UNCTAD):
http://unctadstat.unctad.org/ReportFolders/reportFolders.aspx
- United Nations Statistical Division (UNSD-UN data): http://data.un.org/Default.aspx and
http://data.un.org/Data.aspx?q=TOBACCO&d=ICS&f=cmID%3a25090-0
- UNSD Industrial Commodity Production Statistics Dataset
http://unstats.un.org/unsd/industry/ics_intro.asp
92
- World Integrated Trade Solution (WITS)7: http://wits.worldbank.org/wits/
7 The World Integrated Trade Solution (WITS) is software developed by the World Bank, in collaboration with the
United Nations Conference on Trade and Development (UNCTAD), International Trade Center (ITC), United Nations Statistical Division (UNSD) and the World Trade Organization (WTO). WITS gives users access to major international merchandise trade, tariffs and non-tariff data compilations such as: the UN COMTRADE database maintained by the UNSD (containing merchandise trade exports and imports by detailed commodity and partner country); the TRAINS maintained by UNCTAD (imports, tariffs, para-tariffs and non-tariff measures at national tariff level); the IDB and CTS databases maintained by WTO (MFN applied, preferential & bound tariffs at national tariff level); the GPTAD database maintained by the World Bank and the Center for International Business, Tuck School of Business at Dartmouth College. WITS is free, but access to databases themselves may require payment of a fee or be limited, depending on the status of the user.
93
8.3 Volume of exports of tobacco and tobacco products
INDICATOR NAME
Volume of exports of tobacco and tobacco products
DATA TYPE REPRESENTATION
Volume expressed in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco
(tobacco leaf) and unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of
manufactured tobacco products.
RATIONALE
There are several basic reasons why international trade in tobacco and tobacco products has arisen,
including the following:
(1) a country’s inability to domestically produce tobacco and tobacco products in sufficient quantity to
satisfy domestic demand for these products;
(2) a country’s inability to domestically produce tobacco and tobacco products of sufficiently high quality
to satisfy domestic demand;
(3) differences in prices among countries for different types and qualities of tobacco and tobacco
products; and
(4) the importing of unmanufactured tobacco for use in production of tobacco products for export.
The recent liberalization of tobacco-related trade through bilateral, regional, and international trade
agreements has significantly reduced tariff and nontariff trade barriers. The elimination or reduction of
these barriers has almost certainly increased competition in tobacco-product markets leading to
reductions in the relative prices of these products and increases in their advertising and promotion.
Cross-country price comparisons of tobacco of the same type indicate that prices have been altered
significantly by trade restrictions and domestic tobacco policy in major producing and consuming
counties. Liberalization of tobacco-related trade has contributed to global increases in cigarette smoking
and other tobacco use, particularly in low- and middle-income countries.
DEFINITION
Tobacco and tobacco product exports are all tobacco which are subtracted from the stock of material
resources of the country by leaving its economic territory. In many cases, a country's economic territory
largely coincides with its customs territory, which is the territory in which the customs law of a country
applies in full. Unmanufactured tobacco and tobacco products simply being transported through a
country (in transit) or temporarily admitted or withdrawn (except for goods for inward or outward
processing) do not subtract from the stock of material resources of the country and are not included in
the definition.
94
PREFERRED DATA SOURCES
Government departments (e.g. trade, industry, and finance), national statistical offices or agencies, or
any other organization affiliated to the government that is responsible for collecting data on licit supply
of unmanufactured tobacco and tobacco products.
OTHER POSSIBLE DATA SOURCES
Any other relevant agency or research groups, including academic research or studies implemented by
nongovernmental organizations.
If such data are not available or not easily accessible within the country, the sources mentioned at the
end of this section provide information on exports/imports of unmanufactured tobacco and tobacco
products.
METHOD OF MEASUREMENT
Exports can be reported in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco,
and by product and unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of
manufactured tobacco.
Licit supply is calculated, as appropriate, from the following formula: domestic production + (imports –
exports), where:
Exports = domestic production + imports – total licit supply
DISAGGREGATION
Data can be disaggregated by unmanufactured tobacco (tobacco leaf) and category of manufactured
tobacco product – e.g. cigarettes, smoking tobacco products, smokeless tobacco products and/or other
tobacco products.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant government department, national statistical
offices or agencies, or any other organization affiliated to the government that is responsible for
collecting data on licit supply of unmanufactured tobacco and tobacco products in the country.
COMMENTS
In some cases, information on exports is available in form of the value of the exported quantity of
product.
USEFUL LINKS AND SOURCES
Information on tobacco exports/imports are available on the following sites:
95
- United Nations Commodity Trade Statistics Database (UN Comtrade): http://comtrade.un.org/db/
- United Nations Conference on Trade and Development (UNCTAD):
http://unctadstat.unctad.org/ReportFolders/reportFolders.aspx
- United Nations Statistical Division, UNdata (tobacco exports/imports):
http://data.un.org/Data.aspx?q=TOBACCO&d=ComTrade&f=_l1Code%3a25
96
8.4 Volume of imports of tobacco and tobacco products
INDICATOR NAME
Volume of imports of tobacco and tobacco products
DATA TYPE REPRESENTATION
Volume expressed in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco and in
unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of manufactured tobacco
products.
RATIONALE
There are several basic reasons why international trade in unmanufactured tobacco and tobacco
products has arisen, including the following:
(1) a country’s inability to domestically produce tobacco and tobacco products in sufficient quantity to
satisfy domestic demand for these products;
(2) a country’s inability to domestically produce tobacco and tobacco products of sufficiently high quality
to satisfy domestic demand;
(3) differences in prices among countries for different types and qualities of tobacco and tobacco
products; and
(4) the importing of unmanufactured tobacco for use in production of tobacco products for export.
The recent liberalization of tobacco-related trade through bilateral, regional, and international trade
agreements has significantly reduced tariff and nontariff trade barriers. The elimination or reduction of
these barriers has almost certainly increased competition in tobacco-product markets leading to
reductions in the relative prices of these products and increases in their advertising and promotion.
Cross-country price comparisons of tobacco of the same type indicate that prices have been altered
significantly by trade restrictions and domestic tobacco policy in major producing and consuming
counties. Liberalization of tobacco-related trade has contributed to global increases in cigarette smoking
and other tobacco use, particularly in low- and middle-income countries.
In addition, many countries are net importers of tobacco leaf and tobacco products, and lose millions of
dollars each year in foreign exchange as a result.
DEFINITION
Tobacco and tobacco product imports are all products which add to the stock of material resources of
the country by entering its economic territory. In many cases, a country's economic territory largely
coincides with its customs territory, which is the territory in which the customs law of a country applies
in full. Unmanufactured tobacco and tobacco products simply being transported through a country (in
97
transit) or temporarily admitted or withdrawn (except for goods for inward or outward processing) do
not add to the stock of material resources of the country and are not included in the definition.
PREFERRED DATA SOURCES
Government departments (e.g. trade, industry, and finance), national statistical offices or agencies, or
any other organization affiliated to the government that is responsible for collecting data on licit supply
of unmanufactured tobacco and tobacco products.
OTHER POSSIBLE DATA SOURCES
Any other relevant agency or research groups, including academic research or studies implemented by
nongovernmental organizations.
If such data are not available or not easily accessible within the country, the sources mentioned at the
end of this section provide information on exports/imports of unmanufactured tobacco and tobacco
products.
METHOD OF MEASUREMENT
Imports can be reported in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco,
and by product and unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of
manufactured tobacco.
Licit supply is calculated, as appropriate, from the following formula: domestic production + (imports −
exports), where:
Imports = total licit supply – (domestic production - exports)
DISAGGREGATION
Data can be disaggregated by unmanufactured tobacco (tobacco leaf) and category of manufactured
tobacco product – e.g. cigarettes, smoking tobacco products, smokeless tobacco products and/or other
tobacco products.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant government department, national statistical
offices or agencies, or any other organization affiliated to the government that is responsible for
collecting data on licit supply of tobacco products in the country at any time.
COMMENTS
In some cases, information on imports is available in form of the value of the imported quantity of
product.
98
USEFUL LINKS AND SOURCES
Information on tobacco exports/imports are available on the following sites:
- United Nations Commodity Trade Statistics Database (UN Comtrade): http://comtrade.un.org/db/
- United Nations Conference on Trade and Development (UNCTAD):
http://unctadstat.unctad.org/ReportFolders/reportFolders.aspx
- United Nations Statistical Division, UNdata:
http://data.un.org/Data.aspx?q=TOBACCO&d=ComTrade&f=_l1Code%3a25
99
9. SEIZURES OF TOBACCO PRODUCTS
100
9.1 Quantity of seized illicit tobacco products
INDICATOR NAME
Quantity of seized illicit tobacco products
DATA TYPE REPRESENTATION
Count
RATIONALE
Tobacco products are particularly attractive to smugglers because tax represents a high proportion of
their price, and evading tax by diverting tobacco products into the illicit market (where sales are largely
tax free) generates a considerable profit margin for the smugglers. The availability of cheap tobacco
products increases consumption and thus tobacco-related deaths in the future. Eliminating or reducing
the illicit trade in tobacco products will reduce consumption (by reinforcing and facilitating the impact of
taxation and price increases), save lives, and increase tax revenue to governments.
The quantity of seized illicit tobacco products gives an indication of the size of the illicit trade problem; it
is also important to analyse the seized tobacco products, disaggregating by brand and origin, to better
understand details and monitor trends.
Evidence that higher-income countries, where tobacco products are more expensive, have lower levels
of illicit trade than lower-income countries, is contrary to the claim of the tobacco industry that the
overall level of illicit trade is dependent (solely) on the price of tobacco products.
DEFINITION
Seizure of illicit tobacco products is the action of confiscating such products by warrant of legal right.
“Illicit trade” is defined in Article 1 of the WHO FCTC as any practice or conduct prohibited by law and
which relates to production, shipment, receipt, possession, distribution, sale or purchase including any
practice or conduct intended to facilitate such activity.
PREFERRED DATA SOURCES
National customs offices, government departments, national statistical offices or agencies, or any other
organization affiliated to the government that is responsible for collecting data on illicit supply of
tobacco products.
Such data may be available on the Internet in the public domain, or on websites maintained by national
customs offices.
Collection and analysis of data should be protected from any interference by the tobacco industry.
101
OTHER POSSIBLE DATA SOURCES
Any other relevant agency or research groups, including academic research or studies implemented by
nongovernmental organizations.
Information on seizures can be available in publications of the World Customs Organization.
METHOD OF MEASUREMENT
Seizures can be reported by product and unit (e.g. millions of pieces, thousands of packages). Following
conventional standards, one cigarette or stick weighs one gram, considering all the packaging, and 1
kilogram therefore represents 1000 sticks.
DISAGGREGATION
Data can be disaggregated by category of tobacco product (e.g. cigarettes, smoking tobacco products,
smokeless tobacco products and/or other tobacco products), as appropriate.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant national customs offices, government
departments, national statistical offices or agencies, or any other organization affiliated to the
government that is responsible for collecting data on illicit supply of tobacco products in the country at
any time.
COMMENTS
The tobacco industry may present its own data or estimates concerning any indicator on illicit trade in
tobacco products. It is important to note that such information needs to be viewed with caution,
because the aim of the tobacco industry is to promote its interests and agenda, and there is a
fundamental and irreconcilable conflict between the tobacco industry’s interests and public health
policy interests. The industry promotes such information with a view to interfering with the
development of public health policies with respect to tobacco control. The guidelines for
implementation of Article 5.3 of the Convention require Parties not to accept support or endorse any
offer of assistance or any proposed tobacco control legislation or policy drafted by or in collaboration
with the tobacco industry.
USEFUL LINKS AND SOURCES
Global:
- OLAF: http://ec.europa.eu/anti_fraud/index_en.htm
http://ec.europa.eu/atwork/synthesis/amp/doc/olaf_mp_en.pdf
- World Customs Organization: http://www.wcoomd.org/
102
(Customs and Tobacco Report of the World Customs Organization are available for the years 2008,
2009, 2010 and 2011.) http://www.wcoomd.org/en/topics/enforcement-and-compliance/activities-
and-programmes/ef_tobaccoandcigarettesmuggling.aspx
Other sources:
- Joossens L. Illicit tobacco trade in Europe: issues and solutions.
In:http://www.ppacte.eu/index.php?option=com_docman&task=doc_download&gid=187&Itemid=2
9.
- Joossens L, et al. How eliminating the global illicit cigarette trade would increase tax revenue and
save lives. Paris, International Union Against Tuberculosis and Lung Disease, 2009.
http://www.worldlungfoundation.org/ht/display/ContentDetails/i/6589/pid/6512
103
9.2 Percentage of illicit tobacco products on the national tobacco market
INDICATOR NAME
Percentage of illicit tobacco products on the national tobacco market
DATA TYPE REPRESENTATION
Percent
RATIONALE
Tobacco products are particularly attractive to smugglers because tax represents a high proportion of
their price, and evading tax by diverting tobacco products into the illicit market (where sales are largely
tax free) generates a considerable profit margin for the smugglers. The availability of cheap tobacco
products increases consumption and thus tobacco-related deaths in the future. Eliminating or reducing
the illicit trade in tobacco products will reduce consumption (by reinforcing and facilitating the impact of
taxation and price increases), save lives, and increase tax revenue to governments.
DEFINITION
This indicator refers to the proportion of the national tobacco market represented by illicit tobacco
products.
Since there is no direct measure of the percentage of illicit tobacco products on the national tobacco
market, the value of this indicator is based on estimates.
Estimates of illicit trade do not always refer to illicit trade in the same way. Sometimes they refer to tax
evasion or to large-scale smuggling, sometimes to smuggling, sometimes to illicit trade (smuggling and
domestic illicit manufacturing combined). An additional problem is that the estimates of illicit cigarette
trade are expressed in different ways, sometimes as a percentage of cigarette sales based on tax records,
sometimes as a percentage of cigarette consumption or sometimes as a percentage of the cigarette
market. However, there is no standard way to define cigarette consumption or cigarette market and the
terms have been used to refer to different data sets, including tax recorded sales, tax recorded sales
plus illegal sales, tax recorded sales and legal cross-border sales in neighbouring countries, tax recorded
sales, illegal sales and legal cross border shopping sales.
The "national market" refers to sales of tobacco products in a country. The legal market refers to legal
sales. The illegal market refers to illegal (or illicit) sales. The total market refers to legal and illegal sales
in a country.
Sales data are based on sales to those who live in a country and to those who visit the country (tourist
shopping).
104
Consumption data are based on survey data among the population and reflect the use of all legal and
illegal tobacco products by those who live in the country, but not by non-residents passing through the
country.
Total consumption data for a country include: the legal sales in the country + the illegal sales to its
inhabitants + the legal sales to its inhabitants visiting other countries or duty-free shops (in amounts
allowable under customs regulations), minus legal sales to non-residents passing through the country.
PREFERRED DATA SOURCES
National customs office, government departments, national statistical offices or agency, or any other
organization affiliated to the government that is responsible for collecting data on illicit supply of
tobacco products.
OTHER POSSIBLE DATA SOURCES
Research undertaken by any other relevant agency or research group, including academic research or
studies implemented by nongovernmental organizations.
A World Bank guide to understanding and measuring illicit trade in tobacco products within national
markets suggests that a range of different approaches are needed to obtain estimates. These
approaches include interviews with customs officials or law enforcement personnel, surveys of smokers
about their sources and buying habits, measures of tobacco trade figures, comparisons of tobacco sales
with tobacco consumption and empirical modelling of tobacco sales and consumption.
METHOD OF MEASUREMENT
The difference between tax paid sales and individually reported consumption should reflect the extent
of overall tax avoidance and evasion – if there are no reporting biases in measures of tax paid sales and
measures of average consumption and prevalence obtained from representative population surveys.
Measuring illicit tobacco trade is methodologically challenging for many reasons. First, smuggling is an
illegal activity, and illegal traders are unlikely to record their activity. Similarly, for security reasons, data
on illicit trade are usually difficult to collect, as law enforcement agencies often prefer not to publicize
the scope of the activity. In addition, the data source may bias the estimate.
DISAGGREGATION
Data can be disaggregated by category of tobacco product (e.g. cigarettes, smoking tobacco products,
smokeless tobacco products and/or other tobacco products), as appropriate.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant national customs offices, government
departments, national statistical offices or agencies, or any other organization affiliated to the
105
government that is responsible for collecting data on illicit supply of tobacco products in the country at
any time or estimates can be provided by any such agency upon request.
If estimates are not available at any time, as a minimum the relevant agencies should provide such
information regularly, in relation to the Party’s obligation under the Convention (Article 15.5 and Article
21.1).
COMMENTS
The tobacco industry may present its own data or estimates concerning any indicator on illicit trade in
tobacco products. It is important to note that such information needs to be viewed with caution,
because the aim of the tobacco industry is to promote its interests and agenda, and there is a
fundamental and irreconcilable conflict between the tobacco industry’s interests and public health
policy interests. The industry promotes such information with a view to interfering with the
development of public health policies with respect to tobacco control The guidelines for implementation
of Article 5.3 of the Convention require Parties not to accept, support or endorse any offer of assistance
or any proposed tobacco control legislation or policy drafted by or in collaboration with the tobacco
industry.
USEFUL LINKS AND SOURCES
Global:
- OLAF: http://ec.europa.eu/anti_fraud/index_en.htm
- World Customs Organization:
http://www.wcoomd.org/andhttp://www.wcoomd.org/en/topics/enforcement-and-
compliance/activities-and-programmes/ef_tobaccoandcigarettesmuggling.aspx
Other sources:
- Joossens L. Illicit tobacco trade in Europe: issues and solutions. In:
http://www.ppacte.eu/index.php?option=com_docman&task=doc_download&gid=187&Itemid=29
- Measuring Tax Gaps (estimating the illicit tobacco market): http://www.hmrc.gov.uk/statistics/tax-
gaps/mtg-2009.pdf
- Merriman D. Tool 7. Smuggling: Understand, measure and combat tobacco smuggling. In: Yurekli A,
De Beyer J, eds. World Bank economics of tobacco toolkit. Washington, DC, World Bank, 2003.
http://siteresources.worldbank.org/INTPH/Resources/7Smuggling.pdf
106
10. TOBACCO GROWING
107
10.1 Number of workers involved in tobacco growing
INDICATOR NAME
Number of workers involved in tobacco growing
DATA TYPE REPRESENTATION
Count/Percent/Full time job equivalents (FTE)
RATIONALE
Article 17 of the Convention concerns the provision of support for economically viable alternatives to
tobacco growing, while under Article 18 Parties agree to have due regard to the protection of health of
persons working in tobacco cultivation (and manufacture).
Tobacco farmers are engaged in the preparation of farms, nursery establishment, planting, farm/crop
management, harvesting, curing, sorting and leaf grading, and transportation from their homes to leaf
buying centres.
The agricultural sector is composed of tobacco farmers and contractual or non-contractual workers
employed by the farmers. The exact number of tobacco farmers is difficult to estimate due to a lack of
reliable statistics for the tobacco sector. There is also controversy over how the workforce should be
counted. The tobacco industry favours “head counts”. Another method uses the concept of “annual
working units”. Applying the latter method produces a lower number than the former, because the
number of theoretically fully employed persons is much lower than that produced by the head count
method. Both concepts have their rationale.
Nearly 1.2 million workers operate in the organized tobacco manufacturing industry worldwide for the
processing of tobacco leaves and manufacturing of cigarettes. An additional 4 million people work in the
unorganized sector, for example bidi rolling in India. Jobs in the tobacco industry have been declining in
recent decades owing to the mechanization of cigarette production plants, in which technology
supplants factory workers, and changes in tobacco demand, rather than as a result of national and
international tobacco control policies targeting consumption.8
DEFINITION
Direct tobacco-growing employment is defined as paid employment directly related to the production,
distribution, and retailing of tobacco leaf.
In general, tobacco farming includes all aspects of tobacco-related work on the farm, from initial land
preparation to the delivery of cured tobacco at the place where the leaf buyer takes physical charge of it.
Tobacco leaf marketing and processing consists of all activities after tobacco departs the farm but prior
to the ageing process. Major activities include leaf auctioning and warehousing (a central place for leaf 8Document FCTC/COP/5/10 (available at http://apps.who.int/gb/fctc/PDF/cop5/FCTC_COP5_10-en.pdf).
108
trade and temporary leaf storage), and leaf processing (the name given to a series of treatments to
separate the midrib or stems of each leaf from the lamina, thresh the tobacco, and dry it with uniform
moisture content for storage and ageing).
PREFERRED DATA SOURCES
National agricultural statistics of individual countries, national accounts, national labour force surveys,
establishment censuses, establishment surveys, administrative records and official estimates.
According to the International Labour Organization, national/central statistical offices are usually the
point of call when collecting such information on countries.
OTHER POSSIBLE DATA SOURCES
Any other relevant agency or research groups, including academic research or studies implemented by
nongovernmental organizations.
METHOD OF MEASUREMENT
Information on the number of jobs related to tobacco farming is normally not available directly from
government statistical resources. Thus, this information may be derived or estimated using other
relevant resources and by following one or both of two methods. The procedure involved in the two
methods is similar: first estimate the total hours of labour used, and then convert this number into a
full-time employee base. The difference between the two methods lies in the way in which the number
of hours of labour used is estimated. In the first method, the number of hours is calculated as the
product of the amount of tobacco produced and hours of labour required per production unit. In the
second method, the total number of hours of labour is the product of acres of tobacco planted and
hours of labour required per acre.
In many countries, information on the number of tobacco farms is available in governmental agricultural
statistics. However, the number of tobacco farmers is not equal to the number of jobs related to
tobacco farming for several reasons: there may be more than one person working on a tobacco farm;
although tobacco may be the major source of income, it is very likely that tobacco farmers also grow
other crops or engage in other economic activities; and the number of tobacco farms may not include
those where the amount of tobacco harvested falls below a certain crop percentage or threshold,
depending on how a tobacco farm is defined in the statistical data
DISAGGREGATION
If possible, the data should be broken down into full-time, part-time and seasonal workers, and by
gender.
109
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available in the national agricultural statistics, or by organizations affiliated
to the government that are responsible for collecting data on the agricultural sector or workforce; or
estimates can be provided by such an agency upon request.
If estimates are not available at any time, as a minimum the relevant agencies should provide such
information regularly, in relation to the Party’s reporting obligations under the Convention (Article 21),
to the agency responsible for the preparation and submission of implementation reports.
COMMENTS
None
USEFUL LINKS AND SOURCES
Global:
- The World Bank (employment in agriculture): http://data.worldbank.org/indicator/SL.AGR.EMPL.ZS
110
10.2 Share of the value of tobacco leaf production in the national gross domestic product
INDICATOR NAME
Share of the value of tobacco leaf production in the national gross domestic product
DATA TYPE REPRESENTATION
Percent
RATIONALE
This indicator promotes a better understanding of the economic importance and contribution of
tobacco leaf production to the national gross domestic product.
DEFINITION
The proportion of the national gross domestic product represented by tobacco leaf-growing or
production.
Gross domestic product at purchaser's prices is the sum of gross value added by all resident producers in
the economy plus any product taxes and minus any subsidies not included in the value of the products.
PREFERRED DATA SOURCES
National agricultural statistics of individual countries, national accounts, national labour force surveys,
establishment censuses, establishment surveys, administrative records and official estimates.
OTHER POSSIBLE DATA SOURCES
These include any other relevant agency or research groups, including academic research or studies
implemented by nongovernmental organizations.
The Food and Agriculture Organization’s statistical database contains information on the share of the
value of tobacco leaf production in the national gross domestic product.
METHOD OF MEASUREMENT
Value of tobacco leaf production expressed as a percentage of the national gross domestic product.
Dollar figures for gross domestic product need to be calculated from domestic currencies using single
year official exchange rates.
DISAGGREGATION
Not applicable
EXPECTED FREQUENCY OF DATA COLLECTION
111
Such information is usually available in national agricultural statistics, or through other organizations
affiliated to the government that are responsible for collecting data on the agricultural sector or
workforce, at any time or estimates can be provided by any such agency upon request.
If estimates are not available at any time, as a minimum the relevant agencies should provide such
information regularly, in relation to the Party’s reporting obligations under the Convention (Article 21),
to the agency responsible for the preparation and submission of implementation reports.
COMMENTS
None
USEFUL LINKS AND SOURCES
Global:
- Food and Agriculture Organization of the United Nations:
http://faostat3.fao.org/home/index.html#SEARCH_DATA (enter the word “tobacco”; information will
be found on tobacco (products nes) or tobacco (unmanufactured))
- The World Bank (net output of the agriculture sector, % of GDP):
http://data.worldbank.org/indicator/NV.AGR.TOTL.ZS(GDP values can be found at:
http://data.worldbank.org/indicator/NY.GDP.MKTP.CD/countries)
- UN National Accounts: http://unstats.un.org/unsd/nationalaccount/madt.asp
112
11. TAXATION OF TOBACCO PRODUCTS
113
11.1 Proportion of the retail price of the most widely sold brand of tobacco product consisting of taxes
INDICATOR NAME
Proportion of the retail price of the most widely sold brand of tobacco product consisting of taxes
DATA TYPE REPRESENTATION
Percent
RATIONALE
Tax and price policies are widely recognized to be one of the most effective means of influencing the
demand for and thus the consumption of tobacco products. Consequently, implementation of Article 6
of the WHO FCTC is an essential element of tobacco control policies and thereby efforts to improve
public health.
Taxes are a very effective tool for policy-makers to influence the price of tobacco products. In most
cases, higher taxes on tobacco products lead to higher prices which, in turn, lead to lower consumption
and prevalence and result in a reduction of mortality and morbidity and thus in the improved health of
the population.
Parties have the sovereign right to determine and establish their taxation policies, including the level of
tax rates to apply. There is no single optimal level of tobacco taxes that applies to all countries because
of differences in tax systems, in geographical and economic circumstances, and in national public health
and fiscal objectives. In setting tobacco tax levels, consideration could be given to final retail prices
rather than individual tax rates. In this regard, the WHO technical manual on tobacco tax administration
recommends that tobacco excise taxes account for at least 70% of the retail prices of tobacco products.
This indicator takes into account the exact contribution of all taxes in the price of the most popular price
category of tobacco product and therefore represents a good comparable measure of the magnitude of
tobacco taxes by also indicating the likelihood that such rates are of a level that may contribute to the
health objectives aimed at reducing tobacco consumption. The use of this indicator can provide for
cross-country comparisons between overall tax rates.
DEFINITION
This indicator refers to the proportion (in percentage terms) of the retail price of a unit pack and/or
package of tobacco product, of the most popular price category that consists of taxes, including the sum
of all taxes levied on tobacco products, such as excise tax, import taxes, value added tax and sales taxes
(VAT/GST), if applicable.
PREFERRED DATA SOURCES
Finance or other relevant government departments that are in the possession of the latest available
information concerning all types of taxes applied to the most widely sold brand of tobacco product in
114
the country. Information on this indicator is usually made available by these relevant departments at
regular intervals.
Calculation of this indicator can also be done on an ad-hoc basis, using normative documents containing
the latest tax rates (e.g. budget laws, relevant regulations) as well as other sources (e.g. statistical or
trade reports or any other relevant documents).
OTHER POSSIBLE DATA SOURCES
If such data are not available in the country, estimates produced WHO may be used. WHO’s country
reports contain comparable estimates for more than 180 countries concerning the total taxes as
percentage of retail price of 20 cigarettes of the most sold brand in the country. Such estimates are
available at: http://www.who.int/tobacco/surveillance/policy/country_profile/.
METHOD OF MEASUREMENT
Information provided on tax policy can be used to calculate the share of tobacco taxes in the retail price
of the most widely sold brand of tobacco product in the country.
Total tax share includes specific excise tax, ad valorem excise tax, VAT, import duty (if the most popular
brand in the country is imported), and others (if applicable).
Only the price of the most popular brand of tobacco products is considered in the calculation of tax as a
share of retail price. In the case of countries in which different levels of taxes are applied, only the rate
that applies to the most-sold brand should be used in the calculation.
For more technical information, please refer to the useful links and information below.
DISAGGREGATION
Data on taxation can be provided by category of tobacco product, e.g. smoking, smokeless or other
tobacco products.
EXPECTED FREQUENCY OF DATA COLLECTION
Since all information for the calculation of this indicator is available in a country at any time, the
calculation can be repeated on a regular basis, thus contributing to the Party’s compliance with the
requirements of Article 20.3(a) of the Convention.
Information on the trend over time can contribute to assessment of how price and tax measures to
reduce the demand for tobacco are being used in the country and could serve the purposes of cross-
country comparisons.
COMMENTS
None
115
USEFUL LINKS AND SOURCES
Global:
- WHO: http://www.who.int/tobacco/economics/prices/en/
- WHO Global Health Observatory: http://apps.who.int/gho/data/node.main.1309?lang=en
- WHO technical manual on tobacco tax administration. Geneva, World Health Organization, 2010.
http://www.who.int/tobacco/publications/economics/tax_administration/
- Technical note III: Tobacco taxes in WHO Member States. In: WHO report on the global tobacco
epidemic, 2011.Geneva, World Health Organization, 2011.
http://www.who.int/tobacco/global_report/2011/en_tfi_global_report_2011_techincal_note_iii.pdf
Regional: - European Union Taxation and Customs Commission
http://ec.europa.eu/taxation_customs/taxation/gen_info/index_en.htm and
http://ec.europa.eu/taxation_customs/taxation/excise_duties/tobacco_products/rates/index_en.ht
m
116
11.2 Specific excise tax
INDICATOR NAME
Specific excise tax
DATA TYPE REPRESENTATION
Amount
RATIONALE
This indicator provides information that can be used to assess the affordability9 of tobacco products. It
also needs to be taken into account when calculating the share of taxes in the price of a pack and/or
package of tobacco product.
Excise taxes are imposed on selected nonessential or luxury goods, such as tobacco products, alcoholic
beverages and energy products. In the case of tobacco products, they are the primary tool for increasing
the price of tobacco products relative to the prices of other goods or services.
An excise tax is a tax levied on the sale or production for sale of a specific product within a country but
normally not on products produced in a country for sale abroad (exported).
DEFINITION
A specific excise tax is a tax levied on quantity of a tobacco product (e.g. piece, pack, carton, weight). In
general, the tax is collected from the manufacturer/wholesaler or at the point of entry into the country
by the importer, in addition to import duties. These taxes come in the form of an amount per pack, per
1000 sticks or per kilogram. Example: US$ 1.50 per pack of 20 cigarettes.
The most common base for a specific excise is a pack of 20 cigarettes or a tax per 1000 cigarettes, but
there are exceptions such as a carton of 5 packs of 25 cigarettes (e.g. Canada), a cigarette stick not
exceeding in weight 0.8 grams of actual tobacco content or kilogram of loose pouch for roll-your-own
tobacco (e.g. Australia), a metre (e.g. Nepal), the weight (e.g. New Zealand), or the weighted average
price10 (e.g. European Union).
PREFERRED DATA SOURCES
Finance or other relevant departments of the government or normative documents containing the latest
tax rates (e.g. budget laws, relevant regulations) as well as other sources (e.g. statistical or trade reports
or any other relevant documents).
9Price relative to per capita income.
10 The weighted average price is the average consumer price of a tobacco product based on the prices of individual
brands and weighted by sales of each brand.
117
OTHER POSSIBLE DATA SOURCES
If such data are not available in the country or they cannot be obtained, estimates produced by the
tobacco economics team of WHO are also available at:
http://www.who.int/tobacco/surveillance/policy/country_profile/.
METHOD OF MEASUREMENT
For specific excise tax, the tax base is the quantity of the tobacco product (e.g. piece, pack, carton,
weight). For example, if a tax is US$ 5 per 100 cigarettes, the amount of tax is US$ 5 and the base of the
tax is 100 cigarettes.
For more technical information, please refer to the useful links and information below.
DISAGGREGATION
Data on taxation can be provided by category of tobacco product, e.g. smoking, smokeless or other
tobacco products.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant government agency (most often ministry of
finance) in the country at any time.
COMMENTS
Specific taxes can either be uniform or tiered. Uniform specific taxes create a price floor (minimum
price). Furthermore, uniform specific taxes tend to lead to relatively higher prices, even on low-priced
brands. Uniform specific taxes compared to ad valorem taxes may reduce incentives for consumers to
switch to lower-priced brands because they generate smaller price differences between lower- and
higher-priced brands.
Mixed (or hybrid) excise tax structures apply both specific and ad valorem excise taxes and seek to
combine the advantages of pure specific and pure ad valorem taxes. Mixed systems usually combine a
uniform specific tax (which has relatively more impact on less expensive brands) and an ad valorem tax
(which has a greater absolute impact on more expensive brands). In a mixed system, the emphasis
placed on either the ad valorem or the specific element depends on national circumstances and the
policy objectives being pursued.
USEFUL LINKS AND SOURCES
Global:
- WHO: http://www.who.int/tobacco/economics/prices/en/
- WHO Global Health Observatory: http://apps.who.int/gho/data/node.main.1309?lang=en
- WHO technical manual on tobacco tax administration. Geneva, World Health Organization, 2010.
http://www.who.int/tobacco/publications/economics/tax_administration/
118
- Technical note III: Tobacco taxes in WHO Member States. In: WHO report on the global tobacco
epidemic, 2011.Geneva, World Health Organization, 2011.
http://www.who.int/tobacco/global_report/2011/en_tfi_global_report_2011_techincal_note_iii.pdf
Regional: - European Union Taxation and Customs Commission
http://ec.europa.eu/taxation_customs/taxation/gen_info/index_en.htm and
http://ec.europa.eu/taxation_customs/taxation/excise_duties/tobacco_products/rates/index_en.ht
m
119
11.3 Ad valorem excise tax
INDICATOR NAME
Ad valorem excise tax
DATA TYPE REPRESENTATION
Percent
RATIONALE
This indicator provides information that can be used to assess the affordability of tobacco products. It
also needs to be taken into account when calculating the share of taxes in the price of a pack and/or
package of tobacco product.
Excise taxes are imposed on selected nonessential or luxury goods, such as tobacco products, alcoholic
beverages and energy products. In the case of tobacco products, they are the primary tool for increasing
the price of tobacco products relative to the prices of other goods or services.
An excise tax is a tax levied on the sale or production for sale of a specific product within a country but
normally not on products produced in a country for sale abroad (exported).
DEFINITION
Ad valorem taxes are expressed as a percentage of a certain base value, which can be the retail selling
price (containing all applicable taxes), the manufacturer’s (or ex-factory) price, or the cost insurance
freight (CIF) price. Example: 30% of the retail selling price.
In general, the tax is collected from the manufacturer/wholesaler or at the point of entry into the
country by the importer, in addition to import duties. These taxes are in the form of a percentage of the
value of a transaction between two independent entities at some point of the production/distribution
chain; ad valorem taxes are generally applied to the value of the transactions between the manufacturer
and the retailer/wholesaler.
PREFERRED DATA SOURCES
Finance or other relevant departments of the government or normative documents containing the latest
tax rates (e.g. budget laws, relevant regulations) as well as other sources (e.g. statistical or trade reports
or any other relevant documents).
OTHER POSSIBLE DATA SOURCES
If such data are not available in the country or they cannot be obtained, estimates produced by the
tobacco economics team of WHO are also available at:
http://www.who.int/tobacco/surveillance/policy/country_profile/.
120
METHOD OF MEASUREMENT
The calculation of the ad valorem tax as a proportion of the retail price will depend on the stage and the
base on when the tax is imposed. Comparing reported ad valorem tax rates without taking into account
the stage at which the tax is applied could lead to biased results. All tax rates should be recalculated to
the same base: the tax inclusive retail sales price. If the tax is expressed as a percentage (e.g. ad valorem
tax), the base of the tax is the actual value of the good that is taxed; for example, 30% of the retail
selling price.
For more technical information, please refer to the useful links and information below.
DISAGGREGATION
Data on taxation can be provided by category of tobacco product, e.g. smoking, smokeless or other
tobacco products.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant government agency (most often ministry of
finance) in the country at any time.
COMMENTS
Compared to a uniform specific tax, an ad valorem tax leads to larger differences in price between lower
and higher-priced brands and increases incentives for consumers to switch to cheaper brands. Used
alone, ad valorem taxes can lead to more price competition, and consequently to a lower average price.
Mixed (or hybrid) excise tax structures apply both specific and ad valorem excise taxes and they seek to
combine the advantages of pure specific and pure ad valorem taxes. Mixed systems usually combine a
uniform specific tax (which has relatively more impact on less expensive brands) and an ad valorem tax
(which has a greater absolute impact on more expensive brands). In a mixed system, the emphasis
placed on either the ad valorem or the specific element depends on national circumstances and the
policy objectives being pursued.
USEFUL LINKS AND SOURCES
Global:
- Technical note III: Tobacco taxes in WHO Member States. In: WHO report on the global tobacco
epidemic, 2011.Geneva, World Health Organization,
2011.http://www.who.int/tobacco/global_report/2011/en_tfi_global_report_2011_techincal_note_i
ii.pdf
- WHO technical manual on tobacco tax administration. Geneva, World Health Organization, 2010.
http://www.who.int/tobacco/publications/economics/tax_administration/
- WHO Global Health Observatory:
http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=386
121
Regional:
- European Union Taxation and Customs Commission
http://ec.europa.eu/taxation_customs/taxation/gen_info/index_en.htmand
http://ec.europa.eu/taxation_customs/taxation/excise_duties/tobacco_products/rates/index_en.ht
m
122
11.4 Import duty
INDICATOR NAME
Import duty
DATA TYPE REPRESENTATION
Percent
RATIONALE
Taxes on international trade and transactions are taxes that become payable when goods cross the
national or customs frontiers of the economic territory, or when transactions in services exchange
between residents and non-residents. These taxes are classified into various subcategories according to
the nature of the exchange and whether the exchange is related to imports or exports.
This item covers revenue from all levies and duties payable on goods of a particular kind when they
enter the country from abroad. It includes duties levied under the customs tariff schedule and its
annexes, including surtaxes that are based on the tariff schedule, consular fees, tonnage charges,
statistical taxes, fiscal duties, and surtaxes not based on the customs tariff schedule. This category
covers taxes that fall on imports only.
In the past, many countries levied a tariff on imported tobacco products. In recent years, given bilateral,
regional and global trade agreements, import duty rates have been reduced dramatically in many
countries. Import duties discriminate against imported products and free trade agreements usually
require participating countries to gradually phase them out. As import duties are phased out, the
government loses the revenues they generated. Replacing import duties with excise taxes or increasing
excise taxes can compensate for these revenue losses.
DEFINITION
An import duty is a tax on a selected good imported into a country to be consumed in that country (i.e.
the goods are not in transit to another country). In general, the import duties are collected from the
importer at the point of entry into the country. These taxes can be either amount-specific or ad valorem.
PREFERRED DATA SOURCES
Customs, finance or other relevant departments of the government or normative documents containing
the latest tax rates (e.g. budget laws, relevant regulations) as well as other sources (e.g. statistical or
trade reports or any other relevant documents).
OTHER POSSIBLE DATA SOURCES
If such data are not available in the country or they cannot be obtained, estimates produced by WHO
are also available at: http://www.who.int/tobacco/surveillance/policy/country_profile/.
123
METHOD OF MEASUREMENT
Amount-specific import duties are applied in the same fashion as amount-specific excise taxes. Ad
valorem import duties are generally applied to the cost, insurance, freight (CIF) value (i.e. the value of
the unloaded consignment that includes the cost of the product itself, insurance and transport and
unloading). Example: 50% import duty levied on CIF.
For more technical information, please refer to the links and resources given below.
DISAGGREGATION
Data on taxation can be provided by category of tobacco product, e.g. smoking, smokeless or other
tobacco products.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant government agency (most often ministry of
finance) in the country at any time.
COMMENTS
None
USEFUL LINKS AND SOURCES
Global:
- WHO Global Health Observatory:
http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=387
- International Customs Tariff Bureau (BITD): http://www.bitd.org/
- International Trade Centre (ITC)(import tariffs are available per country upon registration on the site):
http://www.intracen.org/
- WTO World Tariff Profiles 2012:
http://www.wto.org/english/res_e/publications_e/world_tariff_profiles12_e.htm
- World Integrated Trade Solution (WITS):http://wits.worldbank.org/wits/
124
11.5 VAT/GST/sales tax
INDICATOR NAME
VAT/GST/sales tax
DATA TYPE REPRESENTATION
Percent
RATIONALE
The value added tax (VAT), goods and services tax (GST) and other sales taxes are general taxes applied
on goods and services, and have great practical appeal for revenue generation. Although they are also
applied to tobacco products and have a significant impact on the retail prices of tobacco products, they
do not generally affect the prices of tobacco products relative to the prices of other goods and services
and, consequently, have less impact on public health.
DEFINITION
VAT or GST is a tax imposed on a wide variety of products, based on the value added at each stage of
production or distribution. Sales taxes are also taxes imposed on a wide variety of products, typically
based on the retail price.
VAT is a “multi-stage” tax described as a deductible tax, because producers are not usually required to
pay the government the full amount of the tax they invoice to their customers, as they are permitted to
deduct the amount of tax they have been invoiced on their own purchases of goods or services intended
for intermediate consumption or fixed capital formation.
PREFERRED DATA SOURCES
Finance or other relevant departments of the government or normative documents containing the latest
tax rates (e.g. budget laws, relevant regulations) as well as other sources (e.g. statistical or trade reports
or any other relevant documents).
OTHER POSSIBLE DATA SOURCES
If such data are not available in the country or they cannot be obtained, estimates produced by WHO
are also available at: http://www.who.int/tobacco/surveillance/policy/country_profile/.
METHOD OF MEASUREMENT
VAT or similar taxes are calculated on the price of the good or service, including any other tax on the
product. VAT may also be payable on imports of goods or services in addition to any import duties or
other taxes on the imports. Most countries that impose VAT do so on a base that already includes any
excise tax and customs duty. Example: VAT representing 10% of the retail price.
125
For more technical information, please refer to the useful links and information below.
DISAGGREGATION
Data on taxation can be provided by category of tobacco product, e.g. smoking, smokeless or other
tobacco products.
EXPECTED FREQUENCY OF DATA COLLECTION
Such information is usually available with the relevant government agency (most often ministry of
finance) in the country at any time.
COMMENTS
None
USEFUL LINKS AND SOURCES
Global:
- Technical note III: Tobacco taxes in WHO Member States. In: WHO report on the global tobacco
epidemic, 2011.Geneva, World Health Organization, 2011.
http://www.who.int/tobacco/global_report/2011/en_tfi_global_report_2011_techincal_note_iii.pdf
- WHO technical manual on tobacco tax administration. Geneva, World Health Organization, 2010.
http://www.who.int/tobacco/publications/economics/tax_administration/
- WHO Global Health Observatory:
http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=1220
Regional:
- European Union Taxation and Customs Commission
http://ec.europa.eu/taxation_customs/taxation/gen_info/index_en.htm and
http://ec.europa.eu/taxation_customs/taxation/excise_duties/tobacco_products/rates/index_en.ht
m
126
11.6 Earmarking of any percentage of taxation income for tobacco control
INDICATOR NAME
Earmarking of any percentage of taxation income for tobacco control
DATA TYPE REPRESENTATION
Percent
RATIONALE
According to Article 6.2 of the WHO FCTC, Parties retain their sovereign right to determine and establish
their taxation policies, including decisions on how the revenue stemming from tobacco taxation is used.
The guidelines for implementation of Articles 8, 9 and 10, 12, and 14 of the Convention note that
tobacco excise taxes provide a potential source of financing for tobacco control.
While bearing in mind Article 26.2 of the Convention, and in accordance with national law, some Parties
dedicate tobacco tax revenues to tobacco control programmes, while others do not. Parties’ reports
indicate that some of them add a given percentage or an amount to the excise tax in order to collect
revenues for special purposes, including health, while others earmark a given share of collected tobacco
taxes.
DEFINITION
Earmarking of any percentage of taxation income for tobacco control indicates whether or not the
country has dedicated taxes from any fiscal interventions to influence behaviour change through
funding awareness raising, health promotion and disease prevention programmes, cessation services,
economically viable alternative activities to tobacco growing and financing appropriate structures for
tobacco control.
PREFERRED DATA SOURCES
Finance or other relevant departments of the government should have the latest information
concerning all taxes applied on tobacco products. There may be specific normative documents referring
to this type of additional tax on tobacco products, for example, national tobacco control legislation.
OTHER POSSIBLE DATA SOURCES
If such data are not available in the country or they cannot be obtained, estimates produced by WHO
are also available at: http://www.who.int/tobacco/surveillance/policy/country_profile/.
127
METHOD OF MEASUREMENT
The earmarked percentage is given in the normative document (e.g. national tobacco control legislation)
mandating its introduction.
DISAGGREGATION
Information on earmarking may be provided, if applicable, by category of tobacco product, e.g. smoking,
smokeless or other tobacco products.
EXPECTED FREQUENCY OF DATA COLLECTION
Information on earmarking is usually available with the relevant government agency (most often
ministry of finance) in the country at any time. In addition, information on the spending of the total
earmarked amount may be available in statistical yearbooks, budgetary documents, national account
reports, data available with government ministries and agencies that are concerned with its spending,
etc.
COMMENTS
The reporting instrument of the WHO FCTC contains a question aimed at collecting information on this
indicator (“Do you earmark any percentage of your taxation income for funding any national plan or
strategy on tobacco control in your jurisdiction?”) Parties may also provide details on how they apply
this approach. Fourteen Parties provided information on earmarking in their 2012 implementation
reports.
USEFUL LINKS AND SOURCES
Global:
- WHO technical manual on tobacco tax administration. Geneva, World Health Organization, 2010.
http://www.who.int/tobacco/publications/economics/tax_administration/
- The WHO Global Health Observatory includes a similar indicator named “Earmarking of taxes from
fiscal interventions to influence behaviour change used to fund health promotion programmes or a
health promotion foundation”. Available at
http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=2440
128
12. PRICE OF TOBACCO PRODUCTS
129
12.1 Most widely sold brand of smoking or smokeless tobacco product
INDICATOR NAME
Most widely sold brand of smoking or smokeless tobacco product
DATA TYPE REPRESENTATION
Categorical
RATIONALE
Identification of the most widely sold brand of smoking or smokeless tobacco product can be used to
assess the affordability of smoking and smokeless tobacco products, as well as to calculate the share of
taxes in the price of the most widely sold brand of smoking and smokeless tobacco product.
DEFINITION
The most sold brand of smoking and smokeless tobacco product nationally determined by national
market share information.
PREFERRED DATA SOURCES
Finance, trade, economy or other relevant departments of the government usually have this information
along with any other national market share information. Such information may also be collected by
national statistical offices.
OTHER POSSIBLE DATA SOURCES
Statistical yearbooks and other periodicals, budgetary documents, national account reports, data
provided by government ministries and offices, nongovernmental organization reports, academic
studies and reports, etc.
METHOD OF MEASUREMENT
The most widely sold brand of smoking and smokeless tobacco product is determined based on national
market share information. Where this is not available, in-country tobacco focal points are asked to
determine the most popular brand by consulting vendors, preferably in the capital city, in a retail outlet
widely used by the local population.
DISAGGREGATION
Information on the most widely sold brand may be provided, if applicable, by category of tobacco
product, e.g. smoking, smokeless or other tobacco products.
130
EXPECTED FREQUENCY OF DATA COLLECTION
The relevant government department or the agency which follows trends in national market share,
including national statistical offices, when relevant, usually have this information available at any time.
COMMENTS
When reporting on the prices of the most widely sold brand of smoking and smokeless tobacco products
Parties should provide price information for a brand (e.g. Marlboro), not a product group (e.g. cigarettes,
snus).
USEFUL LINKS AND SOURCES
Global:
- WHO Global Health Observatory:
http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=376
- WHO technical manual on tobacco tax administration. Geneva, World Health Organization, 2010.
http://www.who.int/tobacco/publications/economics/tax_administration/
131
12.2 Retail price of a pack of the most widely sold brand of tobacco product
INDICATOR NAME
Retail price of a pack of the most widely sold brand of tobacco product
DATA TYPE REPRESENTATION
Standard local currency unit
RATIONALE
This information can be used to assess the affordability of tobacco products, as well as to calculate the
share of taxes in the price of the most popular price category of tobacco product.
Monitoring the trends in tobacco prices will help in assessing the impact of tobacco tax increases (if
these have been reflected in the prices of products by the tobacco companies or not) and could help in
projecting the possible health impact of tobacco tax increases.
DEFINITION
Retail price (inclusive of all taxes and in local currency where possible) is the price of the product
purchased at a convenience store or supermarket in the capital city. Popularity is determined based on
national market share information or by consulting with vendors in at least three stores.
With reference to the word “retail”, retail trade is a form of trade in which goods are mainly purchased
and resold to the consumer or end-user, generally in small quantities and in the state in which they were
purchased (or following minor transformations).
PREFERRED DATA SOURCES
Finance, trade, economy or other relevant departments of the government usually have this information
along with any other national market share information. Such information may also be collected by the
national statistical offices.
OTHER POSSIBLE DATA SOURCES
Statistical yearbooks and other periodicals, budgetary documents, national account reports, data
provided by government ministries and offices, nongovernmental organization reports, academic
studies and reports, and any other agency or organization, etc.
METHOD OF MEASUREMENT
The price of the most widely sold tobacco product for a unit retail pack, in local currency unit, in the
latest available year, preferably in the capital city, from a retail outlet widely used by the local
population. Where this information is not collected regularly, the relevant tobacco focal points are
132
required to determine the retail price of a pack of the most popular brand of tobacco product by
consulting vendors, preferably in the capital city, in a retail outlet widely used by the local population.
When information on the retail price is collected, attention should be given to the number of units (e.g.
pieces) or amount (e.g. weight in grams) per package. For cigarettes, if Parties have 20-piece cigarette
packs on the market, they should determine the price of this retail pack. (Small packets, tins, sachets,
metal or glass containers of various sizes, toothpaste-like tubes and candy-like wrapped cylinders are
examples of packages in which smokeless tobacco products can be sold. In these cases, the unit can be
the weight of the packaged product.)
DISAGGREGATION
Data on taxation can be provided by category of tobacco product, e.g. smoking, smokeless or other
tobacco products.
If applicable, data should be provided separately for domestic and imported brands.
EXPECTED FREQUENCY OF DATA COLLECTION
The relevant government department or the agency which follows trends in national market share,
including national statistical offices, when relevant usually have this information available at any time.
COMMENTS
For standard local currency unit, please refer to the International Organization for Standardization ISO
4217 Codes for the representation of currencies and funds.
The price of the most widely sold brand of tobacco product can be converted from local currency to
Purchasing Power Parity (PPP) adjusted dollars or international dollars to account for differences in
purchasing power across countries, using the conversion rate published by the International Monetary
Fund.
USEFUL LINKS AND SOURCES
Global:
- Standard local currency units: http://www.iso.org/iso/home/standards/currency_codes.htm
- WHO Global health Observatory:
http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=377
- WHO technical manual on tobacco tax administration. Geneva, World Health Organization, 2010.
http://www.who.int/tobacco/publications/economics/tax_administration/
133
Appendix 1. Smoking-related causes of death11
Disease categories ICD-9 Codes ICD-10 Codes
Malignant neoplasms:
Lip, oral cavity, pharynx 140-141, 143-149 C00-C14
Oesophagus 150 C15
Stomach (gastric) 151 C16
Pancreas 157 C25
Larynx 161 C32
Trachea, lung, bronchus 162 C33-C34
Cervix, uteri 180 C53
Kidney and renal pelvis 189 C64-C65
Urinary bladder 188 C67
Acute myeloid leukaemia 205 C92.0
Cardiovascular diseases:
Ischaemic heart disease 410-414,429.2 I20-I25
Cerebrovascular disease (stroke) 430-438 I60-I69
Atherosclerosis 440 I70
Aortic aneurysm 441 I71
Peripheral vascular disease 443.1-443.9 I73
Arterial embolism and thrombosis 444 I74
Respiratory diseases:
Chronic bronchitis, emphysema 491-492 J41-J43
Chronic airways obstruction 496 J44
11
Published in: WHO Economics of tobacco toolkit: assessment of the economic costs of smoking, Geneva, World Health Organization, 2011 (available at: http://whqlibdoc.who.int/publications/2011/9789241501576_eng.pdf).
134
Reproductive effects:
Low birth weight 765 P07
Respiratory distress syndrome -
Newborn
769 P22
Other respiratory conditions -Newborn 770 P23-P28
Sudden Infant Death Syndrome 798 R95