Nearly half of all men and more than 1 in 10 women use tobacco in many developing countries, and women are starting to smoke at earlier ages, according to the largest survey to date on international tobacco use. If current trends continue, warns the World Health Organization, tobacco could kill a billion people around the world in this century.

The authors of the study say the numbers call for urgent changes in tobacco policy and regulation in developing nations. While tobacco use is declining in industrialized countries, it remains strong — or is even increasing — in low- and middle-income countries, a trend the authors attribute to powerful pro-tobacco forces worldwide.

The study, the Global Adult Tobacco Survey, looked at smoking trends among people ages 15 and older from 16 countries, estimating 852 million tobacco users.

Some key findings:

  • China has the most tobacco users (300.8 million), followed by India (274.9 million). China has the most smokers (300.7 million), while India has the most smokeless tobacco users (205.9 million).
  • Russia has the highest smoking rate among men (60.2 percent). Particularly alarming is the fact that the percentage of Russian youth who smoke (both male and female, ages 15 to 19) is higher than in any other country in the study.
  • India and Bangladesh face unique risks because of high rates of smokeless tobacco use, having a combined 94 percent of the smokeless tobacco users in the survey. Just over 25 percent of Indians use smokeless tobacco. Bangladesh has the highest smokeless tobacco rate in the survey (27.9 percent) and the highest rate among women. India and Bangladesh have the highest rates of oral cancer in the world.

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