{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:08:27Z","timestamp":1790885307669,"version":"4.1.0"},"reference-count":79,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T00:00:00Z","timestamp":1701993600000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,8,20]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Tobacco use begins at an early age and typically leads to a long-term addiction. The age of initiation for tobacco use is not well studied in South Asia, where 22% of tobacco smokers and 81% of smokeless tobacco (SLT) users reside.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from the nationally representative Global Adult Tobacco Surveys in India, Bangladesh and Pakistan were analysed to examine patterns of initiation among smokers and smokeless tobacco users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data on 94\u2009651 individuals were analysed, of which 13\u2009396 reported were ever daily smokers and 17\u2009684 were ever SLT users. The proportion of individuals initiating tobacco use before the age of 15 years has increased over time. The rates of SLT initiation among those aged 15\u201324 years increased markedly in Bangladesh (by 7.8%) and Pakistan (by 37.7%) between 1983 and 1999\u20132000. Among males, the increase in SLT initiation was higher in individuals aged below 15 years compared with other age groups in India and Bangladesh. Smoking initiation among females aged below 15 years has also significantly increased in India over time. Compared with the initiation of tobacco smoking before the age of 15 years, a greater increase in the proportion of SLT users was observed in urban areas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings indicate that the proportion of youth initiating tobacco (both smoking and smokeless) before the age of 15 years has increased over time in all three countries. Moreover, variations in age at initiation for different types of tobacco products across countries, and by rurality, were noticeable. Younger youths (aged up to 15 years) should therefore be a priority population for tobacco control interventions. Strategies such as raising the legal age of tobacco sale and use to 21 years, and, other measures under WHO Framework Convention on Tobacco Control (FCTC), may prevent underage use and avert lifelong addiction to tobacco products.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-067875","type":"journal-article","created":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T13:21:32Z","timestamp":1702128092000},"page":"e067875","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Trends in age of tobacco use initiation over time in Bangladesh, India and Pakistan: analysis of cross-sectional nationally representative surveys"],"prefix":"10.1136","volume":"13","author":[{"given":"Lucky","family":"Singh","sequence":"first","affiliation":[{"name":"ICMR-National Institute of Medical Statistics, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankhuri","family":"Jain","sequence":"additional","affiliation":[{"name":"Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2351-2442","authenticated-orcid":false,"given":"Chandan","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Policy & Management Studies, TERI School of Advanced Studies, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1336-6493","authenticated-orcid":false,"given":"Ankur","family":"Singh","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranay","family":"Lal","sequence":"additional","affiliation":[{"name":"Independent Public Health Researcher, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0638-2105","authenticated-orcid":false,"given":"Amit","family":"Yadav","sequence":"additional","affiliation":[{"name":"International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-5534","authenticated-orcid":false,"given":"Prashant Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India"},{"name":"WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8271-1062","authenticated-orcid":false,"given":"Shalini","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India"},{"name":"WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,9]]},"reference":[{"key":"2025121601461242000_13.12.e067875.1","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2018-054593"},{"key":"2025121601461242000_13.12.e067875.2","doi-asserted-by":"crossref","first-page":"e472","DOI":"10.1016\/S2468-2667(21)00102-X","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and initiation among young people in 204 countries and territories, 1990\u20132019","volume":"6","author":"Reitsma","year":"2021","journal-title":"Lancet Public Health"},{"key":"2025121601461242000_13.12.e067875.3","unstructured":"US Department of Health and Human Services (HHS) . 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