A Cross-Country Comparison of Knowledge, Attitudes and Practices about Tobacco Use: Findings from the Global Adult Tobacco Survey

  • Gupta, Bhawna (Griffith Health Institute, School of Dentistry and Oral Health, Griffith University) ;
  • Kumar, Narinder (Department of Orthopaedics, Military Hospital)
  • Published : 2014.06.30


Background: Knowledge and individual perceptions about adverse effects of all forms of tobacco exert direct influence on the level of tobacco consumption in various socio-demographic groups. The objective of this study was to determine the nature, extent and demographic correlates of knowledge, attitudes and perceptions of use of tobacco among adults in low and middle income countries. Materials and Methods: The Global Adult Tobacco Survey, conducted in fourteen different countries from 2008-2010, was sourced for the data analyzed in this study. Descriptive statistical analyses were conducted to determine the prevalent knowledge and individual perceptions amongst adults about all forms of tobacco consumption. Results: There was relatively high awareness about the harmful effects of smoking tobacco with main awareness being about its relationship with lung cancer (>90% in most countries). In contrast, there was relatively low awareness about harmful effects of smokeless tobacco (< 90% in all countries except India and Bangladesh), and observed correlation of smoking tobacco with heart attack (40.6% in China, 65.1% in India) and stroke (28.2% in China, 50.5% in India). Conclusions: A large proportion of adults living in low and middle income countries possess adequate knowledge about smoking tobacco but have inadequate awareness as well as false perceptions about smokeless forms of tobacco. Popular beliefs of inverse relationships of tobacco consumption with knowledge, attitudes and perception of populations towards tobacco are challenged by the findings of this study.


  1. Gupta B, Ariyawardana A, Johnson NW (2013). Oral cancer in India continues in epidemic proportions: evidence base and policy initiatives. Int Dent J, 63, 12-25.
  2. Flay BR, Petraitis J, Hu FB (1999). Psychosocial risk and protective factors for adolescent tobacco use. Nicotine Tob Res, S59-65.
  3. Goebel LJ, Crespo RD, Abraham RT, Masho SW, Glover ED (2000). Correlates of youth smokeless tobacco use. Nicotine Tob Res, 2, 319-325.
  4. Global Adult Tobacco Survey. Centers for Disease Control and Prevention, 2011.
  5. Gupta PC, Ray CS (2003). Smokeless tobacco and health in India and South Asia. Respirology, 8, 419-431.
  6. Gupta R, Gupta N, Khedar RS (2013). Smokeless tobacco and cardiovascular disease in low and middle income countries. Indian Heart J, 65, 369-377.
  7. Honjo K, Siegel M (2003). Perceived importance of being thin and smoking initiation among young girls. Tob Control, 12, 289-295.
  8. Jena PK, Kishore J, Pati S, Sarkar BK, Das S (2013). Tobacco use and quit behaviour assessment in the Global Adult Tobacco Survey (GATS): invalid responses and implications. Asian Pac J Cancer Prev, 14, 6563-8.
  9. Johnson NW, Warnakulasuriya S, Gupta PC, et al (2011). Global oral health inequalities in incidence and outcomes for oral cancer: causes and solutions. Adv Dent Res, 23, 237-46.
  10. Krishna Rao SV, Mejia G, Roberts-Thomson K, Logan R (2013). Epidemiology of oral cancer in Asia in the past decade--an update (2000-2012). Asian Pac J Cancer Prev, 14, 5567-77.
  11. Lim KH, Sumarni MG, Amal NM, et al (2009). Tobacco use, knowledge and attitude among Malaysians age 18 and above. Trop Biomed, 26, 92-99.
  12. Charlton A and Blair V (1989). Predicting the onset of smoking in boys and girls. Soc Sci Med, 29, 813-8.
  13. Warnakulasuriya S, Johnson NW, van der Waal I (2007). Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathology Med, 36, 575-80.
  14. Wisborg K, Kesmodel U, Henriksen TB, Olsen SF, Secher NJ (2001). Exposure to tobacco smoke in utero and the risk of stillbirth and death in the first year of life. Am J Epidemiol, 154, 322-27.
  15. World Health Organization. (2002). "Quantifying selected major risks to health. The World Health report 2002-Reducing risks, promoting healthy life.
  16. Cooper J (2007). Cognitive Dissonance: Fifty Years Of A Classic Theory. London, SAGE Publications Ltd.
  17. Critchley JA and Unal B (2003). Health effects associated with smokeless tobacco: a systematic review. Thorax, 58, 435-43.
  18. Cutress TW (2003). Periodontal health in South Pacific populations: A review. Pac Health Dialog, 10, 68-75.
  19. Dey SK, Jha S, Ghosh I, et al (2012). Knowledge, attitude and practice of smoking in subjects of lung cancer. J Indian Med Assoc, 110, 880-4.
  20. England LJ, Kim SY, Tomar SL, Ray CS, Gupta PC, Eissenberg T, et al. (2010). Non-cigarette tobacco use among women and adverse pregnancy outcomes. Acta Obstet Gynecol Scand, 89, 454-64.
  21. Bhawna G (2013). Burden of smoked and smokeless tobacco consumption in India - Results from the Global adult Tobacco Survey India (GATS-India)- 2009-201. Asian Pac J Cancer Prev, 14, 3323-9.
  22. Bien TH, Miller WR and Tonigan JS (1993). Brief interventions for alcohol problems: a review. Addiction, 88, 315-35.
  23. Rosendahl KI, Galanti MR, Gilljam H, Ahlbom A (2005). Knowledge about tobacco and subsequent use of cigarettes and smokeless tobacco among Swedish adolescents. J Adolesc Health, 37, 224-8.
  24. Panda R, Mathur MR, Divya P, Srivastava S, Ramachandra SS (2012). Health system preparedness for tobacco control: situational analysis of existing health programs in andhra pradesh, India. Asian Pac J Cancer Prev, 13, 5969-73.
  25. Prochaska JO, DiClemente CC, Norcross JC (1992). In search of how people change. Applications to addictive behaviors. Am Psychol, 47, 1102-14.
  26. Radoi L, Luce D (2013). A review of risk factors for oral cavity cancer: the importance of a standardized case definition. Community Dent Oral Epidemiol, 41, 97-109, e178-91.
  27. Shiffman F (1986). Psychosocial factors in smoking and quitting belief, self efficacy and stress. The Pharmacologic Treatment of tobacco dependence. J. D. Ockene. Proceedings of the world congress (Cambridge MA, Institute for the study of smoking behavior and policy).
  28. Strecher. VJ and Rosenstock. IM (1997). The Health Belief Model. Health behavior and health education:Theory, research and practice. K. Glanz, F. M. Lewis and B. K. Rimer. San Fransisco, Jossey-Bass: 41-59.
  29. Thun MJ, DeLancey JO, Center MM, Jemal A, Ward EM (2010). The global burden of cancer: priorities for prevention. Carcinogenesis, 31, 100-10.
  30. van Zyl MA, Rodu B, Antle BF, Bledsoe LK, Sullivan DJ (2013). Exploring attitudes regarding smokeless tobacco products for risk reduction. Soc Work Public Health, 28, 477-95.
  31. Wang W, Yang X, Liang J, et al. (2013). Cigarette smoking has a positive and independent effect on testosterone levels. Hormones, 12, 567-77.
  32. Ma GX, Fang CY, Tan Y, Feeley RM (2003). Perceptions of risks of smoking among Asian Americans. Prev Med, 37, 349-355.
  33. Nair U, Bartsch H, Nair J (2004). Alert for an epidemic of oral cancer due to use of the betel quid substitutes gutkha and pan masala: a review of agents and causative mechanisms. Mutagenesis, 19, 251-262.
  34. Nobile CG, Anfosso R, Pavia M, Angelillo IF (2000). Cigarette smoking: knowledge, attitudes and behaviour in an adult population in Italy. Public Health, 114, 348-52.

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