Despite worldwide declines in smoking rates, the overall number of smokers has increased due to extreme population growth among countries notorious for heavy smoking, a new study finds.

Published as part of JAMA’s commemorative Jan. 8 issue, which pays homage to the 50th anniversary of the surgeon general’s first report on the dangers of smoking, the study illuminates a vexing problem for public health advocates, namely, that legality isn’t the prime concern for reducing smoking rates. Drugs of any kind are consumed generally according to a population’s level of awareness into the drug’s effects. While many a warning label has gone unnoticed by smokers, researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington argue awareness for smoking cessation remains their number one concern.

“Despite the tremendous progress made on tobacco control, much more remains to be done,” IHME Director Dr. Christopher Murray said in a statement. “We have the legal means to support tobacco control, and where we see progress being made we need to look for ways to accelerate that progress. Where we see stagnation, we need to find out what’s going wrong.”

To conduct their research, the team took data from 187 countries between 1980 and 2012, looking specifically at the trend of smoking rates and total population figures from surveys, government statistics, and World Health Organization data. While age-standardized smoking rates fell by 42 percent among women and 25 percent among men, the total numbers increased among both genders. In the 33-year period, 41 percent more men and seven percent more women had started smoking. In several countries, in fact, over 50 percent of men smoke every day, including those in Russia, Indonesia, Armenia, and Timor Leste — where 61.1 percent of men smoke daily.

Women, too, partook in the habit frequently, as Greece sported the highest rate of female smokers, at 34.7 percent. Bulgaria and Kiribati rounded out the top three, at just over 31 percent each. Meanwhile, among the countries with the lowest rates, male smokers still had a rate five times higher than the 10th lowest female rate (five percent in Antigua and Barbuda vs. Sudan and Ethiopia at one percent). Eritrea and Cameroon tied for the lowest rates of female smoking, with only 0.6 percent prevalence.

These growing numbers don’t exist in a vaccum; they have actual — indeed, fatal — implications. According to the most recent figures from the Global Burden of Disease (GBD) study, coordinated by IHME, tobacco led to 5.7 million deaths, 6.9 percent of life years lost, and 5.5 percent of total health loss around the world. (These estimates do not take secondhand smoke into account.)

“Tobacco control is particularly urgent in countries where the number of smokers is increasing,” noted Alan Lopez, laureate professor at the University of Melbourne. “Since we know that half of all smokers will eventually be killed by tobacco, greater numbers of smokers will mean a massive increase in premature deaths in our lifetime.”

Not all news was bad news, however. In several countries — Canada, Mexico, Iceland, Norway, and the United States, refreshingly — smoking rates and total numbers have both dropped significantly. Researchers collected data on the countries whose national smoking rates exceeded 20 percent in 1980, then tracked how those countries fared in the years following. Iceland, Mexico, and Canada have all dropped an average of three percent each year, while the U.S. holds steady at 2.1 percent per year. Meanwhile, an unsettling trend has emerged in Austria, Bulgaria, and Greece, where not only the total number of smokers has risen, but the rates have ascended too. These increases likely reflect the deeply held social and cultural aspects of smoking, which can often trump health-related concerns in other arenas, such as diet and exercise.

“Change in tobacco prevalence typically has been slow, underscoring what a hard habit it is to break,” Emmanuela Gakidou, professor of global health and director of education and training at IHME, said in the news release. “But we know from these global trends that rapid progress is possible. If more countries were able to repeat the success we have seen in Norway, Mexico, and the United States, we would see much less health loss from smoking.”

 

Source: Ng M, Freeman M, Fleming T. Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012. JAMA. 2014.