Growing Up Global The Changing Transitions to Adulthood in Developing Countries (2005) / Chapter Skim
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168 4 Health INTRODUCTION The physical changes that signal the transition from childhood to adulthood are accompanied by changes in opportunities and risks that can profoundly affect health and well-being during adolescence and beyond. Habits acquired during these years can enhance or compromise future health, and choices made about health-related behavior have implications for the entire life course.
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HEALTH 169 identity, become more independent and emotionally mature. The "cascade of hormonal, physical, psychological, and behavioral changes" (Cameron, 2003)
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170 GROWING UP GLOBAL The health environment in which young people are making the transition to adulthood has been dramatically altered by global epidemiological shifts as well as many other important changes, such as the rising percentage of young people attending school, changes in poverty rates, rapid urban growth, the growing presence of multinational corporations, the spread of global youth culture, technological change and medical advances, greater access to basic health care and family planning services, and growing acceptance of international norms relating to reproductive rights. Many of these changes have brought improvements in the health environment for young people; others have brought new challenges, and some have created greater risks for young people.
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HEALTH 171 come significant actors in determining their own health. Choices about behaviors that affect health and about the use of health services and technologies are increasingly made by individual young people during this phase of life rather than by parents or other adults.1 The design and implementation of health programs and services for young people can thus have a considerable effect on their health.
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172 GROWING UP GLOBAL age 10 (i.e., among those who survive to age 10) in developing countries also rose by about one year during the 1990s and is projected to continue increasing (United Nations, 2003a)
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HEALTH 173 0.00 0.02 0.04 0.06 0.08 0.10 0.12 0.14 0 10 20 30 40 50 60 Age Qx Least developed 1990-1995 Least developed 2000-2005 Developing 1990-1995 Developing 2000-2005 Developed 1990-1995 Developed 2000-2005 FIGURE 4-1 Probability of dying by age, according to type of country, 1990-1995 and 2000-2005. SOURCE: United Nations (2001)
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174 GROWING UP GLOBAL TABLE 4-1 Probability of Dying Between Age 10 and Age 25 by Country Group, Years, and Sex 1990-1995 2000-2005 Region Males Females Males Females WORLD 0.028 0.024 0.025 0.021 Developed regions 0.014 0.005 0.012 0.005 Developing regions 0.031 0.028 0.027 0.024 Least developed countries 0.074 0.070 0.064 0.059 Sub-Saharan Africa 0.079 0.070 0.075 0.068 SOURCE: Estimated from United Nations (2003a)
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HEALTH 175 Males Females World Low Medium High Low Medium High Females Males M or ta lit y Le ve l 0.0 0.2 0.4 0.6 0.8 1.0 Proportion of Deaths Communicable Maternal HIV Noncommunicable Unintentional injuries Intentional injuries FIGURE 4-2 Percentage distribution of deaths at ages 15-29 by cause for the world as a whole, according to sex and mortality. NOTES: Low = all developed countries (exclusively)
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176 GROWING UP GLOBAL TABLE 4-2 Percentage Distribution of Deaths at Ages 15-29 by Cause, According to Sex and Region Cause of Death Communicable Maternal Region Sex Diseases Mortality WORLD Females 14.6 15.4 Males 14.1 0.0 Sub-Saharan Africa Females 12.0 16.6 Males 19.8 0.0 Southeast/Southwest Asia Females 20.3 16.7 Males 15.6 0.0 North Africa and Middle East Females 16.2 25.4 Males 20.2 0.0 Latin America Females 14.0 16.4 Males 8.7 0.0 East Asia Females 11.3 6.1 Males 7.5 0.0 SOURCE: World Health Organization (2001a)
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HEALTH 177 young men (Gureje, 1991; Lewinsohn et al., 1993; Sorenson, Rutter, and Aneshensel, 1991)
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178 GROWING UP GLOBAL score of 4 represents "quite unhappy" and a score of 2 represents "quite happy." This was not as positive a rating as that of their counterparts in 21 countries covering Australia, Canada, Japan, the United States, and Western Europe, but clearly more positive than ratings in 24 Eastern European countries. In a recent study of nine Caribbean countries, 83 percent of inschool young people attending school reported being generally happy and 88 percent were satisfied with their appearance (Halcón et al., 2003)
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HEALTH 179 better or much better than their parents' lives (UNICEF, 2001a)
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180 GROWING UP GLOBAL TABLE 4-3 HIV Prevalence at Ages 15-24 and 15-49, by World Region Males Females Adults 15-24 15-24 15-49 Region 2001 2001 1997 1999 2001 WORLD 0.8 1.4 1.0 1.1 1.2 Eastern and Southern Africa 5.9 13.7 11.1 13.0 12.3 Western/Middle Africa 2.9 6.0 4.2 4.9 5.4 North Africa/Middle East 0.1 0.3 0.1 0.1 0.3 Caribbean 1.9 2.5 1.8 2.1 2.3 Latin America 0.5 0.4 0.5 0.5 0.5 South/Southeast Asia 0.3 0.5 0.6 0.5 0.6 East Asia/Pacific 0.2 0.1 0.1 0.1 0.1 Australia/New Zealand <0.1 <0.1 0.1 0.1 0.1 Eastern Europe/Central 1.0 0.3 0.1 0.2 0.5 Asia n.a.
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HEALTH 181 males, as they also do in developed regions. The ratio of female to male prevalence generally rose in 2000-2001 worldwide (the major exception being Eastern Europe and Central Asia)
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182 GROWING UP GLOBAL enhances the probability that HIV infection will be passed between sexual partners (Cohen, 1998)
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HEALTH 183 in 55 countries, only 40 percent on average are aware that mosquitoes cannot transmit HIV (UNICEF, 2002)
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184 GROWING UP GLOBAL BOX 4-1 Young People Facing a Different World: The Future Impact of HIV/AIDS The HIV/AIDS pandemic has profoundly affected the world for over two decades and its continued and rapid progress will have far-reaching impacts on the kind of world young people inherit. The United Nations (2003b)
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HEALTH 185 Kenya is expected to be 12.1 percent less than required to meet food needs in 2010. Food shortages, more malnutrition, and increased dependence on food imports are expected.
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186 T A B L E 4 -4 P er ce nt ag e of Y ou ng W om en C ur re nt ly U si ng C on do m s in S uc ce ss iv e D em og ra ph ic an d H ea lt h Su rv ey s A bo ut T en Y ea rs A pa rt N ev er M ar ri ed a nd Y ea r of S ur ve y A ll S ex ua ll y A ct iv e Se xu al ly A ct iv e A ge G ro up a nd C ou nt ry 1s t 2 nd 1s t 2 nd 1s t 2n d 15 -1 9Y ea rO ld s G ha na 19 88 19 98 -1 99 9 0.
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HEALTH 187 far higher than in any other country in the table. Although the magnitude of the change varies, increases over time appear in all countries surveyed.
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188 GROWING UP GLOBAL 0.00 0.02 0.04 0.06 0.08 0.10 0.12 0.14 0.16 0.18 1989-1999 1999-2000 None Primary Secondary H I V P r e v a l e n c e Years FIGURE 4-4 HIV prevalence among individuals ages 18-29 by level of education, rural Uganda (MRC General Population Cohort)
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HEALTH 189 veloping countries, by contrast, a much higher proportion of fatalities involve pedestrians, bicyclists, motorcyclists, and moped riders or passengers on buses and trucks (Nantulya and Reich, 2002)
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190 GROWING UP GLOBAL in virtually every country with reasonable data (Krug et al., 2002)
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HEALTH 191 alcohol and drug abuse and mental illness, have been cited as important factors (Brown, 2001)
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192 GROWING UP GLOBAL report released in 2003 states that "it does appear that globally, levels of maternal mortality remained stable between 1995 and 2000" (World Health Organization/UNICEF/United Nations Population Fund, 2003:15)
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HEALTH 193 be well nourished than older mothers. In spite of a widespread assumption that young mothers are less likely to get adequate prenatal and obstetric care, recent evidence suggests that this is not the case (Abou-Zahr and Wardlaw, 2003)
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194 GROWING UP GLOBAL ing local support for ending the practice (Masterson and Swanson, 2000)
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HEALTH 195 berty provide an important context in which to assess changes in sexual and reproductive behavior. The literature on young people's sexual and reproductive behavior in developing countries is vast.
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196 GROWING UP GLOBAL BOX 4-2 Improving Reporting of Sexual Behavior Among Young People Using Alternative Interviewing Methods Obtaining accurate information on sexual activity and risk behaviors among young people, particularly teens, is crucial for monitoring exposure to sexually transmitted infections and effectively addressing the reproductive health needs of young people. Reliable estimates of sexual behavior among teens are particularly important given rising rates of HIV infection and STIs in many developing countries.
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HEALTH 197 The age at which the sexual initiation of young women and men is reported to occur varies widely across regions in which recent survey data are available (Table 4-5)
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198 GROWING UP GLOBAL TABLE 4-5 Percentage of Females and Males Ages 20-24 Who First Had Sex by Specific Ages, Demographic and Health Surveys 1996-2001 and Young Adult Reproductive Health Surveys (YARHS) Females Males Region First Had Sex by Age First Had Sex by Age (Number of Countries for Females/Males)
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HEALTH 199 women married before the age of 18 (see further discussion in Chapter 7) , counteracting the effect of a rise in the percentage reporting premarital sex by the age of 18.
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200 GROWING UP GLOBAL sex early would be those most likely to develop AIDS. It is also worth noting that results from a study of Colombia and Peru using the same data sets but different methodology show the same patterns as this analysis (Ali, Cleland, and Shah, 2003)
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HEALTH 201 slums of Nairobi, Christian women started sexual activity significantly earlier than Muslim women or those who practice traditional religions. Gupta (2000)
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202 GROWING UP GLOBAL 0 1 2 3 4 5 6 7 8 9 0.0 0.2 0.4 0.6 0.8 Proportion in School South America Western Africa Eastern/Southern Africa Central America Pr op or tio n of 1 517 -Y ea r-O ld s W ho E ve r H ad S ex (N ot in sc ho ol/ in sc ho ol) FIGURE 4-5 Ratio of proportion of unmarried women ages 15-17 who ever had sex among those not currently enrolled vs.
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HEALTH 203 greater or lesser extent in different families, different schools, and different communities. This is a relatively underresearched area, one that holds future promise given the descriptive findings highlighted above.
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204 GROWING UP GLOBAL the proportion reporting multiple partners is much lower among women than among men. However, in these 12 countries, 10-30 percent of unmarried women ages 15-19, who have been sexually active in the past year, report having two or more sexual partners over the recent one-year period.
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HEALTH 205 tions, evidence on the wantedness of sexual activity among them is sparse. There is some evidence, however, based on findings from a few small-scale studies and from anecdotal evidence, that coercion plays a considerable role in the sexual relations of young people -- not only young women but also young men.
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206 GROWING UP GLOBAL concerning reliability of responses. Studies from other settings in Africa report considerable variation in the prevalence of reported coerced sexual relations of young women.
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207 T A B L E 4 -7 P er ce nt ag e of Y ou ng P eo pl e R ep or ti ng F or ce d Se xu al I ni ti at io n in S el ec te d D ev el op in g C ou nt ri es C ou nt ry St ud y Si te Y ea ra A ge G ro up Sa m pl e Si ze Fe m al es M al es St ud ie s R ep or te d in K ru g et a l.
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208 GROWING UP GLOBAL them than other young people (Heise, Moore, and Toubia, 1995; Luster and Small, 1997; Stewart et al., 1996; Stock et al., 1997)
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HEALTH 209 Contraceptive Knowledge and Use The current generation of young people in the developing world is the first to grow up with nearly universal knowledge of modern contraceptive methods, at least partly as a result of the efforts of organized family planning programs. DHS data show that, in the vast majority of surveys conducted in the last five years or so, more than 9 in 10 women ages 15-24 know about at least one contraceptive method and most know more than one (ORC Macro, 2004)
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210 GROWING UP GLOBAL 0.02 0.00 0.04 0.06 0.08 0.10 0.12 0.14 0.16 0.18 0.20 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year of Survey Pe rc en ta ge U sin g An y Co nt ra ce pt ive M et ho d Kenya Madagascar Malawi Tanzania Uganda Zambia Zimbabwe FIGURE 4-6a Percentage of females ages 15-19 using any contraceptive method, Eastern and Southern Africa. SOURCE: DHS data, 1986-2000.
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HEALTH 211 0.02 0.00 0.04 0.06 0.08 0.10 0.12 0.14 0.16 0.18 0.20 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year of Survey Pe rc en ta ge U sin g An y Co nt ra ce pt ive M et ho d Bolivia Colombia Peru Dominican Republic Haiti FIGURE 4-6c Percentage of females ages 15-19 using any contraceptive method, Latin America and Carribean. SOURCE: DHS data, 1986-2000.
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212 GROWING UP GLOBAL TABLE 4-8 Percentage of Women Ages 15-19 and 20-24 Currently Using Contraception by Region (Weighted Averages) , Demographic and Health Surveys Ages 15-19 Sexually Active, Region or Income Level Sexually Never Never (Number of countries)
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HEALTH 213 not expecting to have sex. Once they start to use contraception, girls are more likely to discontinue contraceptive use than older women and more likely to experience a contraceptive failure (Blanc and Way, 1998)
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214 GROWING UP GLOBAL TABLE 4-9 Percentage of Women Ages 15-19 and 20-24 Currently Using Contraception by Region and Years of Education (Weighted Averages) , Demographic and Health Surveys Ages 15-19 Ages 20-24 Region/Years of Education Sexually Sexually (# of Countries)
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HEALTH 215 Abortion Performed in safe conditions with modern methods, induced abortion carries little risk to women's health or mortality. In representative developed countries, the risk of dying is no more than 1 in 100,000 procedures, lower than the relatively low risks associated with pregnancy and childbirth in these countries (The Alan Guttmacher Institute, 1999)
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216 GROWING UP GLOBAL people in Uganda reported that 17 percent of 15-19-year-olds previously had an abortion and 53 percent of 20-24-year-olds had done so (Agyei and Epema, 1992)
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HEALTH 217 (52 percent) sought abortion in the first 10 weeks, 37 percent sought it between 10 and 16 weeks of pregnancy and 11 percent sought it between 16 and 20 weeks (Mpangile, Leshabari, and Kihwele, 1999)
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218 GROWING UP GLOBAL from private facilities because they felt their privacy would be better protected there (Zheng et al., 2001)
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HEALTH 219 OTHER RISK BEHAVIORS AND THEIR HEALTH CONSEQUENCES Some health behaviors that typically are initiated during the transition to adulthood can compromise current health and reduce life expectancy and well-being. WHO estimates that 70 percent of premature deaths among adults are largely due to behavior initiated during adolescence (World Health Organization, 1995)
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220 GROWING UP GLOBAL BOX 4-3 The Nutrition Transition: Increasing Obesity and Overweight Among Young People The nutrition transition is defined as the shift in dietary and physical activity patterns from high activity levels and diets relatively low in fat and sugar and relatively high in carbohydrates and fiber that are typical of poor rural populations to low activity levels and diets relatively high in saturated fat, sugar, and refined foods and low in fiber that are typical of wealthier, urban populations (Popkin, 2002)
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HEALTH 221 Prevention, 2002)
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222 GROWING UP GLOBAL TABLE 4-10 Percentage of Young People Currently Smoking by Sex % Currently Smoking Age Group and Region or Country Males Females In-School Ages 13-15 (GYTS) , 1999-2003 Eastern and Southern Africa (16)
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HEALTH 223 oping countries. We found only a few examples of multivariate studies of the determinants of smoking and even fewer that were methodologically sound.
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224 GROWING UP GLOBAL BOX 4-4 A Syndrome of Problem Behavior? Experimenting with tobacco, alcohol, and illicit drugs would seem to involve interdependent decisions.
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HEALTH 225 FIGURE 4-7 Percentage of student smokers ages 13-15 wanting to stop, by per capita national income and region. SOURCES: Global Youth Tobacco Survey Collaborating Group (2002)
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226 GROWING UP GLOBAL juana, however, the prevalence of drug use in the developing regions is still mostly well below Europe, North America, Australia, and New Zealand. Research suggests that, unlike smoking, many young people who experiment with illicit drugs do not become addicted and do not continue to use when they become adults (United Nations, 1999b)
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HEALTH 227 18 reported heavy use of alcohol (Jernigan, 2001)
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228 GROWING UP GLOBAL empirical evidence on the impact of relevant health policy and program initiatives remains thin. Careful studies of the impact of health-related policies are particularly lacking, and cost-effectiveness studies are virtually nonexistent.
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HEALTH 229 grams be developed to address those needs (United Nations, 1994)
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230 GROWING UP GLOBAL ized or matched control designs, some with pretest and posttest measurements and some with posttest-only measurements. Studies with less rigorous designs are not included in the discussion.
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HEALTH 231 tude of impact has generally been modest and limited to a subset of the behavioral outcomes targeted. Examples of the results achieved by some of these school-based interventions include: • A randomized control trial of an after-school intervention (14 sessions)
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232 GROWING UP GLOBAL intervention resulted in a greater increase in contraceptive use among girls from program schools than among those from nonprogram schools. Overall, however, use of contraceptives at last sex remained low in both groups, and no significant increase in the volume of young clients at health facilities over the 2-year follow-up period was observed.
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HEALTH 233 issues, as well as workshops conducted in schools (Magnani et al., 2000)
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234 GROWING UP GLOBAL ings indicated broad reach of the radio program, especially in rural areas. Young people exposed to the intervention also reported being more likely to abstain from sex and have fewer recent sexual partners, and use of contraceptives and clinic services increased significantly in campaign sites between the surveys.
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HEALTH 235 family planning workers, village doctors, and women's leaders in 20 townships in Jiangsu Province, China, observed significant increases at the 12month follow-up in condom use at last sex among villages participating in the project versus no change in condom use in control villages (Xiaoming et al., 2000)
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236 GROWING UP GLOBAL STI/HIV Counseling and Testing Evidence from the United States indicates that HIV counseling and testing can be effective in changing high-risk sexual behaviors and reducing new STIs among both adults and young people (Bolu et al., 2002; Kamb et al., 1998)
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HEALTH 237 Programs Targeting Parents Recognizing that parents play a key role in shaping young people's behaviors and that parents in many settings are uncomfortable counseling their children on matters related to sex and contraception, a number of sexual and reproductive health and HIV/AIDS education programs for parents have been designed both as stand-alone efforts and as components of larger programs directed to young people. The impact of such programs in developing country settings has yet to be rigorously measured.
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238 GROWING UP GLOBAL the impact of the Thai army program from other activities under way in Thailand given the intensity of efforts to reduce STI/HIV at the national level in Thailand in the early 1990s. The second was an STI/HIV intervention undertaken among commercial sex workers and madams in the red light district of Bombay (Bhave et al., 1995)
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HEALTH 239 Mwanza region of Tanzania is unique because the evaluation incorporated the measurement of biological markers as outcome measures: HIV incidence, genital herpes, other STIs, and pregnancy rates (YouthNet/Family Health International, 2003)
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240 GROWING UP GLOBAL vision of a range of development activities in one program that address a wide range of needs of young people during the transition from adolescence to adulthood. These projects go beyond simply providing sexual and reproductive health education to also focusing on life options, educational aspirations, employment considerations, and psychosocial development needs.
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HEALTH 241 the tobacco litigation trials in the United States show that the tobacco industry is intensely interested in trends in the attitudes and smoking habits of young people (World Health Organization, 1999b)
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242 GROWING UP GLOBAL tries in recent years, increases in mortality among 25-35-year-olds are evident in the least developed countries, raising cause for some concern. Continued reductions in mortality seem likely, with the major exception of countries strongly affected by the HIV/AIDS pandemic.
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HEALTH 243 Mental health problems account for a substantial and possibly increasing share of illness among young people. This finding is significant not only because it directs increasing attention to the problems of young people who suffer from mental health problems but also because mental health problems are associated with various other behaviors, including alcohol and drug use and risky sexual behavior.
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244 GROWING UP GLOBAL in condom use varies, increasing trends are evidenced in all countries with data. Although young women are generally less likely than older women to obtain an abortion, they are more likely to have the abortion later in pregnancy and to choose an unsafe provider, thus putting themselves at greater risk.
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HEALTH 245 status are associated with delayed sexual initiation among young women and men and a greater likelihood of contraceptive use. Recent evidence shows that, in contrast to earlier patterns, progressively higher levels of schooling completed are linked with higher rates of condom use and lower rates of HIV infection.
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246 GROWING UP GLOBAL health interventions. The years between roughly ages 10 and 14 are a window of opportunity to reach young people before they become sexually active (or start injecting drugs or become involved in sex work)
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HEALTH 247 HIV/AIDS are becoming apparent, many national governments and international organizations have turned their attention to young people as key to defeating the pandemic. Because the issues surrounding HIV/AIDS deal with sensitive issues about what is appropriate for young people to know and to do, interventions are often highly controversial.
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248 GROWING UP GLOBAL Research Recommendations Throughout this chapter, the lack of data on some topics has hampered our ability to describe the current health situation of young people and, more often, trends in health indicators. A key recommendation is therefore that improvements need to be made in both the coverage and quality of data collection on health among young people.
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HEALTH 249 • What is the abortion rate among young women, and what factors determine their decision to terminate a pregnancy and their choice of provider? What are the consequences of unsafe abortion?
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250 GROWING UP GLOBAL • Which combination of interventions is most cost-effective and sustainable for delaying the age at sexual initiation? • What aspects of school quality are most salient for young people's reproductive health?
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252 GROWING UP GLOBAL APPENDIX TABLE 4-1 Smoking Among Students Ages 13-15, Global Youth Tobacco Survey, 1999-2003 (Percentage) Ever Smoked Currently Smoke Cigarettes Cigarettes Region and Country Male Female Male Female Eastern and Southern Africa Botswana 2001 24.1 10.0 8.7 2.6 Kenya 2001 21.0 8.5 10.1 4.2 Lesotho 2002 40.0 15.1 23.0 6.0 Seychelles 2002 56.4 42.9 31.3 21.7 Swaziland 2001 27.5 10.6 14.6 4.6 Malawi: Blantyre 2001 22.3 7.8 4.1 1.6 Malawi: Lilongwe 2001 28.6 10.1 9.1 2.8 Mozambique: Gaza Inhambe 2002 12.7 7.2 4.3 3.3 Mozambique: Maputo City 2002 23.9 10.7 5.9 2.6 Uganda: Arua 2002 38.2 21.7 24.3 15.7 Uganda: Kampala 2002 22.8 11.5 6.7 3.3 Uganda: Mpigi 2002 23.7 14.2 11.5 3.3 Zambia: Chongwe / Luangwa 2002 30.5 28.1 14.9 12.4 Zambia: Kafue 2002 23.4 15.3 12.2 8.2 Zambia: Lusaka 2002 36.0 22.3 10.8 8.3 Zimbabwe: Harare 1999 30.1 21.5 11.4 10.1 Zimbabwe: Manicaland 1999 29.0 16.3 12.6 9.7 Central and Western Africa Ghana 2000 14.7 13.0 5.3 3.8 Mauritania 2001 38.9 22.9 24.1 10.6 Niger 2002 43.2 11.9 24.8 6.5 Togo 2002 31.8 10.0 14.9 4.0 Burkina Faso: B
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HEALTH 253 Currently Use Any Tobacco Products Never Smokers Smokers Smokers Who Likely to Initiate Wanting to Have Tried Male Female Smoking Next Year Stop to Stop 17.0 11.6 8.1 63.5 68.3 15.8 10.0 19.7 73.5 70.2 31.6 19.7 35.1 80.1 73.5 36.0 24.5 16.4 76.1 76.4 20.7 10.0 17.4 76.3 75.3 17.9 15.3 15.3 91.4 61.0 21.1 14.7 17.1 82.0 92.1 10.0 10.5 28.6 n.a.
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254 GROWING UP GLOBAL India: Bihar 2000 23.3 8.1 16.5 4.6 India: Calcutta 2000 15.4 9.5 8.8 2.6 India: Central Bihar 2001 9.6 3.1 4.6 1.1 India: Delhi 2001 5.7 2.2 1.5 0.7 India: Goa 2000 5.0 2.5 1.0 0.6 India: Hyderabad 2001 6.2 5.8 2.4 0.2 India: Maharashtra 2000 10.2 9.6 3.0 4.2 India: Manipur 2001 31.8 9.8 24.9 5.6 India: Meghalay 2001 22.8 14.2 16.5 6.5 India: Mizoram 2001 38.9 21.5 32.8 13.4 India: Mumbai 2000 5.9 1.7 2.4 0.2 India: Nagaland 2001 37.0 20.3 25.7 12.9 India: Navoday 2001 8.2 2.0 1.0 0.2 India: Orissa 2002 8.4 3.5 2.8 0.6 India: Rajasthan 2002 18.1 7.7 3.9 1.8 India: Sikkim 2001 31.9 15.5 24.1 10.5 India: Tamil Nadu 2000 6.3 4.1 2.3 1.0 India: Tripura 2001 16.0 8.0 13.4 6.6 India: Uttar Pradesh 2002 14.8 10.2 8.3 6.4 India: West Bengal 2000 14.1 6.3 6.1 1.4 Indonesia: Jakarta 2000 69.3 18.8 37.1 4.4 Eastern Asia China: Chongqing 1999 42.4 18.5 11.5 1.8 China: Guangdong 1999 27.1 17.4 7.3 2.3 China: Shandong 1999 26.5 7.6 4.9 0.2 China: Tianjin 1999 36.5 11.0 12.0 1.5 Macau 2001 33.0 23.4 8.5 6.0 Russia/Former Soviet Asia Russian Fed.: Moscow 1999 71.4 61.7 38.3 28.7 Russian Fed.: Sarov 2002 70.1 51.7 40.8 25.0 Ukraine: Kiev City 1999 84.0 69.1 46.8 33.8 Western Asia/Northern Africa Bahrain 2001 41.5 14.1 23.1 4.6 Gaza Strip 2001 56.2 24.4 18.5 3.8 Georgia 2002 55.5 32.7 32.6 12.1 Jordan 1999 44.1 25.8 22.6 11.4 Kuwait 2002 37.6 17.6 21.1 6.7 Lebanon 2001 39.9 27.1 16.1 7.4 Libya 2003 22.0 6.7 9.4 1.7 Morocco 2001 19.4 5.9 6.3 1.5 Oman 2003 31.4 6.8 16.2 1.8 APPENDIX TABLE 4-1 Continued Ever Smoked Currently Smoke Cigarettes Cigarettes Region and Country Male Female Male Female
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256 GROWING UP GLOBAL Sudan 2001 30.0 10.0 14.1 2.1 Syrian Arab Republic 2002 15.4 6.1 8.4 3.8 Tunisia 2001 39.0 11.8 23.1 4.2 United Arab Emirates 2002 29.5 10.9 14.3 2.9 West Bank 2001 70.4 41.4 29.4 5.9 Saudi Arabia: Riyadh 2001 34.5 n.a.
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From page 258... ...
258 GROWING UP GLOBAL Bolivia: Cochabamba 2000 61.2 45.7 29.7 17.7 Bolivia: La Paz 2000 63.5 47.5 32.2 22.4 Bolivia: Santa Cruz 2000 60.7 49.7 29.5 20.8 Brazil: Goiania 2002 48.2 46.5 16.0 23.5 Brazil: Matto Grosso do Sul 2002 48.9 48.1 20.6 18.3 Brazil: Paraiba 2002 45.3 42.2 14.4 12.4 Brazil: Rio Grande do Norte 2002 40.1 38.7 14.5 13.1 Chile: Coquimbo 2000 65.1 69.7 35.4 40.8 Chile: Santiago 2000 67.4 74.7 30.9 43.8 Chile: Valparaiso V del Mar 2000 61.7 71.6 31.3 40.6 Colombia: Bogota 2001 63.4 58.7 28.4 27.2 Ecuador: Guayaquil 2001 31.1 26.9 9.2 7.5 Ecuador: Quito 2001 62.1 40.4 23.8 11.1 Ecuador: Zamora 2002 64.0 46.8 26.6 17.4 Paraguay: Altoparana Ituapua 2003 36.8 30.1 15.4 12.3 Paraguay: Amambay Caaguazu 2003 30.0 27.1 14.1 13.3 Paraguay: Asuncion 2003 36.0 37.0 18.4 17.0 Paraguay: Central 2003 26.0 25.1 11.7 12.2 Peru: Huancayo 2000 60.0 37.9 22.7 10.8 Peru: Ica City 2002 48.6 37.5 19.6 11.8 Peru: Lima 2000 63.1 48.9 23.6 17.4 Peru: Tarapoto 2000 56.2 32.2 21.7 10.1 Peru: Trujillo 2000 59.9 38.2 27.1 10.5 Uruguay: Colonia 2001 32.4 41.2 15.1 17.1 Uruguay: Maldonado 2001 49.4 51.8 15.7 24.6 Uruguay: Montevideo 2001 52.2 52.3 20.5 26.5 Uruguay: Rivera 2001 42.7 48.7 18.1 21.0 Venezuela: Tachira State 2001 23.8 21.2 7.8 6.5 Venezuela: Yaracuy State 2001 14.5 10.0 4.4 3.5 Venezuela: Zulia State 2001 24.2 17.2 11.3 5.9 Oceania Fiji 1999 47.4 27.2 18.8 9.6 Northern Marianas 2000 78.2 81.3 37.5 40.7 Palau 2000 63.0 60.1 23.3 20.0 Europe Bosnia and Herzegovina 2003 45.5 38.5 16.8 10.0 Bulgaria 2002 64.4 73.4 31.3 42.7 Croatia 2002 62.5 56.3 18.5 14.3 Czech Republic 2002 75.0 71.2 34.4 34.9 Estonia 2002 82.4 73.8 33.9 29.8 FYR Macedonia 2002 25.8 19.5 9.3 6.7 APPENDIX TABLE 4-1 Continued Ever Smoked Currently Smoke Cigarettes Cigarettes Region and Country Male Female Male Female
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From page 260... ...
260 GROWING UP GLOBAL APPENDIX TABLE 4-1 Continued Ever Smoked Currently Smoke Cigarettes Cigarettes Region and Country Male Female Male Female Latvia 2002 86.6 72.7 38.2 29.7 Montenegro 2003 34.8 26.5 3.7 3.4 Republika Srpska 2003 49.6 45.2 14.0 12.2 Serbia 2003 54.4 55.2 15.5 16.8 Slovakia 2002 69.9 58.0 25.5 22.5 Slovenia 2003 66.5 65.7 25.4 29.9 Poland: Rural 1999 68.2 49.8 21.7 11.6 Poland: Urban 1999 71.8 67.0 30.0 27.3 United States 2000 50.5 48.6 17.8 17.7 NOTE: n.a. = not available.
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From page 261... ...
HEALTH 261 Currently Use Any Tobacco Products Never Smokers Smokers Smokers Who Likely to Initiate Wanting to Have Tried Male Female Smoking Next Year Stop to Stop 41.4 33.0 n.a.
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