Smoking prevalence remains high worldwide

Despite a steep drop in the number of smokers in the United States over the last three decades, researchers say that cigarettes remain a growth industry for the rest of the world because of expanding population.

In a package of studies published online Tuesday in the Journal of the American Medical Assn., researchers found that the total number of world smokers with a pack-a-day habit had "increased significantly."

Even though the global smoking rate has declined since 1980 by about 25% for men and 42% for women, the total number of smokers has grown from 721 million to 967 million. The total number of cigarettes consumed annually has risen from 4.96 trillion to 6.25 trillion.

"The number of smokers has increased steadily worldwide, and there are preliminary indications that global prevalence among men increased in recent years," wrote lead study author Marie Ng, a world health statistician at the University of Washington, and her colleagues.

The studies in JAMA were published to mark the 50th anniversary of the U.S. surgeon general's first report on smoking, a landmark document that first laid out the health dangers of the habit.

The studies are a reminder that not everyone understands the health risks of tobacco, experts said. While recent studies suggest that annual tobacco-related deaths are close to half a million in the U.S., that figure is more than 5 million worldwide.

"Smoking is still a big deal," said Dr. Hal Strelnick, a professor of family and social medicine at Albert Einstein College of Medicine in New York who was not involved in the study. "Smoking is the No. 1 cause of preventable death in the U.S., and it's going to become that worldwide."

Study authors noted that global smoking rates began falling rapidly in 1996. In 2006, the rate continued to fall but not nearly as fast. "This deceleration in the global trend was in part due to increases in the number of smokers since 2006 in several large countries including Bangladesh, China, Indonesia and Russia," the authors wrote.


Currently, the global smoking rate is 31% for men and 6% for women. Study authors found no discernible changes in the global average number of cigarettes smoked per day, which remained about 18, just a couple of cigarettes shy of a typical full pack.

In the United States, the smoking rate among adults is now 18%. In 1964, the year Surgeon General Luther Terry released the report on smoking, the adult smoking rate was 43% — the nation's highest rate ever recorded.

Dr. Steve Schroeder, who directs the Smoking Cessation Leadership Center at UC San Francisco, noted that the U.S. had not seen a similar increase in cigarette sales over the decades and remained among the world's leaders in smoking reduction efforts.

At the same time, however, it is also one of the world's top tobacco exporting nations.

Schroeder, who wrote an editorial accompanying the studies, said there was an immense "tug of war" that would play out over the coming years between health advocates and tobacco companies.

"The smoking rates among Asian women are really low — 1%, 2%, 3%. In Muslim countries, smoking rates among women are really, really low," Schroeder said.

"As these nations become Westernized and as they look toward Western glamour, these are potential markets. In Africa, smoking rates for both men and women are really low, so the industry is targeting those too," he said.