A Bahrain farmer sits smoking a water pipe during a break as he works in his farm in the village of Bori, south of Manama, on December 25, 2013. AFP Image Credit: AFP

Dubai: Globally, smoking prevalence — the percentage of the population that smokes — has decreased, but the number of daily cigarette smokers in the Middle East and other parts of the world has increased due to population growth, according to new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Saudi Arabia, Yemen, and Oman were among the 10 countries with a population over 1 million that had the highest average daily cigarette consumption in 2012.

Kuwait was among the countries — including China and Russia — with the combination of high smoking prevalence and cigarette consumption.

Lebanon was one of the few countries globally where smoking rates for women were higher than 20 per cent.

Smokers in Kuwait consumed an average of 22 cigarettes daily in 2012. Average daily cigarette consumption was even higher in Saudi Arabia, Yemen, and Oman. Saudi Arabia ranked sixth globally at 35 cigarettes, Oman was seventh at 33, and Yemen was tenth at 30.

Globally, the number of cigarettes smoked has grown to more than 6 trillion. In 75 countries, smokers consumed an average of more than 20 cigarettes per day in 2012.

The study, “Smoking prevalence and cigarette consumption in 187 countries, 1980-2012,” was published on January 8 in the Journal of the American Medical Association in a special issue devoted to tobacco.

Speaking to Gulf News, Ali Mokdad, professor of Global Health at IHME and director of Middle Eastern Initiatives, said there are almost 100 million smokers in the world today, while there was 721 million in 1980.

“Effective tobacco control policies are one reason that smoking rates have dropped in certain countries,” he said. “Cigarette consumption is as important to monitor as smoking prevalence,” said Alan Lopez, laureate professor at the University of Melbourne. “In some regions, the number of cigarettes smoked daily is comparatively low but smoking rates remain high. Tobacco control is particularly important in countries where the number of smokers is increasing.”

Overall, age-standardised smoking prevalence decreased by 42 per cent for women and 25 per cent for men between 1980 and 2012. Despite decreases in prevalence, substantial population growth between 1980 and 2012 contributed to a 41 per cent increase in the number of male daily smokers and a 7 per cent increase for females.

Lebanon is the only Middle Eastern country where smoking prevalence for women was above 20 per cent. At 21.2 per cent, the smoking rate for women in Lebanon is higher than in all but approximately two dozen countries in the world.

Other forms of smoking, such as shisha, are also seen in the Middle East. These differences persist despite decades of strong tobacco control measures globally.

Fifty years ago, the first US Surgeon General’s report on the health impact of smoking led to groundbreaking research on tobacco and investments by governments and nonprofit agencies to reduce tobacco prevalence and cigarette consumption.

In 2003, the Framework Convention on Tobacco Control (FCTC) was adopted by the World Health Assembly and has since been ratified by 177 countries.

“Despite the tremendous progress made on tobacco control, much more remains to be done,” said IHME Director Dr Christopher Murray. “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.”

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 per cent of years of life lost, and 5.5 per cent of total health loss around the world.

These estimates exclude the health effects from second-hand smoke. IHME arrived at its estimates based on a wide range of data sources, including in-country surveys, government statistics, and World Health Organization data.

Previous estimates typically have been focused on fewer data sources. The greatest health risks for both men and women are likely to occur in countries where smoking is pervasive and where smokers consume a large quantity of cigarettes.

These countries include Kuwait, China, Italy, and several countries in Eastern Europe. The current study does not examine shisha trends, but previous research by IHME has shown an increase in shisha smoking in the region.

“Any form of smoking is harmful, and tobacco control should target all forms of smoking,” said Mokdad. There have been three phases of global progress in reducing the age-standardised prevalence of smokers; modest progress from 1980 to 1996, followed by a decade of more rapid global progress, then a slowdown in reductions from 2006 to 2012.

This was in part due to increases in the number of smokers since 2006 in several large countries, including Bangladesh, China, Indonesia, and Russia. “Change in tobacco prevalence typically has been slow, underscoring what a hard habit it is to break,” said Emmanuela Gakidou, professor of Global Health and Director of Education and Training at IHME.

“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.”