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Two fifths of men in developing countries still smoke or use tobacco, and women are increasingly starting to smoke at younger ages, according to a large international study which found “alarming patterns” of tobacco use.

Despite years of anti-smoking measures across the world, most developing countries have low quit rates, according to the study in The Lancet medical journal on Friday.

There are wide differences in the rates of smoking between genders and nations, as well as major disparities in access to effective anti-smoking treatments.

“Although 1.1 billion people have been covered by the adoption of the most effective tobacco control policies since 2008, 83 percent of the world’s population are not covered by two or more of these policies,” said Gary Giovino of the University at Buffalo School of Public Health and Health Professions in New York, who led the research.

Measures include legislation banning smoking in public places, imposing advertising bans and requiring more graphic health warnings on cigarette packets.

The findings come as the world’s leading tobacco firms, British American Tobacco, Imperial Tobacco, Philip Morris and Japan Tobacco lost a crucial legal appeal in Australia this week against the introduction of plain tobacco packaging.