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An estimated 49 percent of men and 11 percent of women in low- and middle-income nations use tobacco, according to the largest international study on tobacco use ever conducted.

Women are starting to smoke at an earlier age than in the past, CNN reports. The study, which looked at tobacco use in 14 countries, “demonstrates an urgent need for policy change in low- and middle-income countries,” said lead researcher Gary Giovino of the University of Buffalo.

Tobacco use was highest in Russia, according to the study, published in The Lancet. In that country, 60 percent of men and 22 percent of women used tobacco between 2008 and 2010, compared with 53 percent of men and 2 percent of women in China, and 50 percent of men and 11 percent of women in Ukraine.

Last year the World Health Organization (WHO) estimated that tobacco would kill nearly 6 million people in 2011, including 600,000 nonsmokers. According to the WHO, governments are not doing enough to help people quit smoking or to protect nonsmokers from secondhand smoke. The WHO’s estimates show that tobacco could kill 8 million people a year by 2030,

According to Edouard Tursan D’Espaignet of WHO’s tobacco control program, marketing is the main reason smoking is increasing in low- and middle-income countries. “In many countries, particularly eastern Europe and China, the market is probably saturated” among men, he said. “We can see the tobacco industry is targeting young people, and they’re targeting women.” He added that tobacco companies are making inroads in new markets, such as Africa.

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