Objectives To determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and frequency of use vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and frequency of use within countries. Design Secondary analysis of nationally representative, cross-sectional, household survey data from 82 low and middle income countries collected between 1 January 2015 and 31 December 2020. Setting Population based survey data. Participants 1 231 068 individuals aged 15 years and older. Main outcome measures Self-reported current smoking, current daily smoking, current smokeless tobacco use, current daily smokeless tobacco use, pack years, and current use and use frequencies of each tobacco product. Products were any type of cigarette, manufactured cigarette, hand rolled cigarette, water pipe, cigar, oral snuff, nasal snuff, chewing tobacco, and betel nut (with and without tobacco). Results The smoking prevalence in the study sample was 16.5% (95% confidence interval 16.1% to 16.9%) and ranged from 1.1% (0.9% to 1.3%) in Ghana to 50.6% (45.2% to 56.1%) in Kiribati. The user prevalence of smokeless tobacco was 7.7% (7.5% to 8.0%) and prevalence was highest in Papua New Guinea (daily user prevalence of 65.4% (63.3% to 67.5%)). Although variation was wide between countries and by tobacco product, for many low and middle income countries, the highest prevalence and cigarette smoking frequency was reported in men, those with lower education, less household wealth, living in rural areas, and higher age. Conclusions Both smoked and smokeless tobacco use and frequency of use vary widely across tobacco products in low and middle income countries. This study can inform the design and targeting of efforts to reduce tobacco use in low and middle income countries and serve as a benchmark for monitoring progress towards national and international goals. All data cleaning and analysis code will be made publicly available on the Harvard Dataverse repository on publication of the paper. A description of each included survey’s sampling design is provided in the supplementary text S1 and response rates and sampled age ranges in supplementary table S2. Supplementary table S3 displays low and middle income countries for which no eligible survey data were available. De-identified data from the Global Adult Tobacco Surveys are publicly available on the Centers for Disease Control and Prevention’s Global Tobacco Surveillance System (). Data from all WHO-STEPwise Approach to Surveillance surveys but Iran are available on the WHO NCD Micro Data Repository (). All Demographic and Health Survey data are publicly available at and all Multiple Indicator Cluster Surveys data at . Data from the Bolivian Encuesta de Hogares are available at , from the Brazilian Pesquisa Nacional de Saúde at . from the Mexican Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco at . Data from the Iranian WHO-STEPwise Approach to Surveillance have been shared upon request by the national data owner and are not publicly accessible. Data are, however, available from the authors on reasonable request and with permission of the data owners.

中文翻译：

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按烟草产品和社会人口特征划分的中低收入国家烟草使用模式：来自 82 个国家的全国代表性调查数据


目标 确定使用任何烟草产品和每一种详细烟草产品的流行率和频率，烟草使用和使用频率在不同国家、世界地区和世界银行国家收入群体之间有何差异，以及不同国家和地区的社会经济和人口梯度国家内的烟草使用和使用频率。设计 对 2015 年 1 月 1 日至 2020 年 12 月 31 日期间收集的 82 个低收入和中等收入国家具有全国代表性的横断面家庭调查数据进行二次分析。设置基于人口的调查数据。参与者 1 231 068 名 15 岁及以上的人。主要结果测量自我报告的当前吸烟情况、当前每日吸烟情况、当前无烟烟草使用情况、当前每日无烟烟草使用情况、包年数以及每种烟草产品的当前使用情况和使用频率。产品包括任何类型的香烟、制成品香烟、手卷烟、水烟、雪茄、口鼻烟、鼻烟、咀嚼烟草和槟榔（含或不含烟草）。结果 研究样本中的吸烟率为 16.5%（95% 置信区间为 16.1% 至 16.9%），范围从加纳的 1.1%（0.9% 至 1.3%）到基里巴斯的 50.6%（45.2% 至 56.1%）。无烟烟草的使用者流行率为 7.7%（7.5% 至 8.0%），流行率最高的是巴布亚新几内亚（每日使用者流行率为 65.4%（63.3% 至 67.5%））。尽管各国之间和烟草产品的差异很大，但对于许多低收入和中等收入国家来说，据报道，男性、教育程度较低、家庭财富较少、生活在农村地区和年龄较大的人的患病率和吸烟频率最高。 结论 在低收入和中等收入国家，吸烟和无烟烟草的使用以及使用烟草产品的频率差异很大。这项研究可以为低收入和中等收入国家减少烟草使用的努力的设计和目标提供信息，并作为监测国家和国际目标进展情况的基准。所有数据清理和分析代码将在论文发表后在哈佛 Dataverse 存储库上公开。补充文本 S1 中提供了对所包含的每项调查的抽样设计的描述，补充表 S2 中提供了答复率和抽样年龄范围。补充表 S3 显示了没有合格调查数据的低收入和中等收入国家。全球成人烟草调查的去识别化数据可在疾病控制和预防中心的全球烟草监测系统 () 上公开获取。除伊朗外，所有世卫组织逐步监测方法的数据均可在世卫组织非传染性疾病微观数据存储库 () 上获取。所有人口和健康调查数据均可在 上公开获取，所有多指标类集调查数据可在 上公开获取。玻利维亚 Encuesta de Hogares 的数据可从巴西 Pesquisa Nacional de Saúde 获取。来自墨西哥 Encuesta Nacional de Consumo de Drogas、Alcohol y Tabaco，网址为 。伊朗世卫组织逐步监测方法的数据已应国家数据所有者的要求进行共享，且不公开。但是，可根据合理请求并在数据所有者许可的情况下从作者处获取数据。