The Global Adult Tobacco Survey

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In countries like the United Kingdom and the United States, smoking is now accepted as a definite health hazard. Research has indicated clear links between smoking and a wide range of potentially lethal illnesses. Whereas at one time almost everyone smoked, this is no longer the case and in many people's eyes smoking is now regarded as an anti-social activity.

This is not the case in the developing world. The largest survey to date on international tobacco use has revealed that in many developing countries nearly half of all men and one in ten of all women are regular users of tobacco.

The Global Adult Tobacco Survey looked at smoking trends among people aged from 15 years and above in 16 sample countries. 14 of these were low or middle-income countries: Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam, while the United States and the United Kingdom were included as comparisons.

By the use of extensive sampling it was possible to estimate the smoking habits of 3 billion people and this indicated that there are 852 million tobacco users in these countries.

49% of men and 11% of women used tobacco, with cigarette smoking being the most popular; 41% of men and 5% of women. According to the World Health Organisation (WHO), 6 million people die from tobacco-related causes each year, which is surely a good enough reason to quit.

Countries with the highest numbers of quitters, not surprisingly include the UK and the US, but also Brazil and Uruguay. It is significant that tobacco controls are the strongest in these four countries.

Other countries such as China, India, Russia and Egypt have little or no control and in these countries quit rates are the lowest. So-called smokeless tobacco is very popular in some countries. This is generally chewed or taken as snuff. In India and Bangladesh, where smokeless tobacco use is very high, oral cancer rates are among the highest in the world.

Given that China has the world's highest population, it is not surprising that it has the highest number of tobacco users. 53% of men and 2% of women use tobacco, totalling 301 million people. One of the problems in China is the complete lack of regulation. It seems that China National Tobacco, a government-owned company, is the sponsor of dozens of elementary schools, where students are subjected to pro-tobacco propaganda, suggesting in some cases that there is a link between smoking and academic success.

Russian smoking rates are even higher than those in China. 60% of Russian men and 22% of Russian women use tobacco, but it is Indonesia that tops the world where nearly 70% of men over the age of 15 are cigarette smokers.

Indonesia is the world's fifth-largest producer of cigarettes and there is an enormous pro-tobacco lobby. Indonesia is among a small handful of countries that have not signed up to the WHO 2005 tobacco treaty. Cigarettes are very cheap and large hoardings advertising cigarettes and tobacco products are everywhere to be seen. In addition, tobacco companies routinely sponsor sporting events and concerts, a practice that has been banned in most other countries.

With its population of 240 million, 200,000 Indonesians are estimated to die each year from smoking related illnesses. Although laws were passed in 2009 calling for tighter controls, the country's powerful tobacco lobby has effectively blocked all regulation attempts.

The influence of these pro-tobacco forces should not be under-estimated. As tobacco use in the industrial world continues to decline, the tobacco industry is continually seeking new markets. New factories have opened in the developing world and in countries like Indonesia the tobacco industry is a major employer.

Any restriction in smoking and the consequent cut in the number of cigarettes being purchased would cause a shrinking of the market, leading to a reduction in output that could have an extremely damaging effect on the country's economy.

Countries in the developing world are also subjected to fierce marketing strategies and mass media advertising campaigns. Since men have always smoked more than women, women are particularly targeted. The campaigns take pains to make smoking seem glamorous and equate tobacco use with Western themes, such as freedom and gender equality.

What the campaigns obviously fail to point out is that smoking kills up to half of its users. As mentioned above, nearly six million people die each year from the results of smoking and 600,000 of these are non-smokers who have been exposed to second-hand smoke. Tobacco use accounts for one in ten of all deaths with approximately one person dying every six seconds.

If current trends continue, according to WHO, by 2030 the annual death toll will have reached eight million and by the end of the present century smoking will have killed a billion people.

The facts are perfectly clear; what is now needed is the action.

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Fifty years ago nobody in Britain thought twice about lighting up a cigarette in public. Cinemas, theatres, pubs and public transport were all popular locations where people could relax and enjoy a cigarette.

Tobacco came to Britain in the sixteenth century and wealthy men usually smoked it in pipes. Later snuff became very popular along with cigar smoking, but it was not until cigarette-making machines were invented in the late nineteenth century that tobacco smoking hit the mass market in a big way.

The horrors of the Great War led to a great rise in smoking and by 1919 cigarette smoking was by far the most popular form. Initially it was only men who smoked, but by the 1920s it also became acceptable for women to follow suit.

World War II gave cigarette smoking another tremendous boost and by 1945 consumption peaked at 12 manufactured cigarettes a day for every adult male in the country. This soon tailed off to about 10 a day, where it remained for the next 30 years or so.

It was not until after World War II that women began to smoke in large numbers. In 1945 2.4 cigarettes were being smoked each day for every adult female, but while the level of cigarette smoking for men remained constant during the next 30 years, female consumption nearly trebbled to 7 cigarettes a day.

In 1948, when surveys began, 82% of men smoked, and 65% were cigarette smokers, but smoking has never been a majority habit among women and even at its peak fewer than 44% of adult women were smokers.

By the mid 1960s 70% of the UK male population and 43% of women were regular smokers and smoking was regarded more or less as a fact of life. Cinemas, theatres, pubs, restaurants and public transport were all places where one could relax with a cigarette and nobody thought twice about it. Even hospitals and schools were not exempt.

But things were to change. From the early 1950s reports had been appearing about dangers that smoking posed to health, but these were all either ignored or greeted with hostility. Then in March 1962 The Royal College of Physicians published a groundbreaking report Smoking and Health in which they warned the Government about the dangers of smoking-related death and diseases.

This time the warning hit home, the public responded and the Ministry of Health was inundated with anti-smoking ideas.

In 2012 smoking is no longer the norm in Britain, but although numbers of smokers have dramatically decreased, around 10 million British adults still smoke cigarettes, and tobacco consumption continues to be recognised as the UK's single greatest cause of preventable illness and early death.

Latest estimates put the annual number of UK deaths from smoking related diseases at 104,000.

Every year tobacco smoking is estimated to be responsible for approximately one in four cancer deaths; that is around 44,000. 86% of lung cancer deaths in the UK are a result of smoking, but smoking also causes cancers in many other parts of the body. These include cancers of the oral cavity, the nasal cavity, the pharynx, larynx and oesophagus; the pancreas, stomach, liver, bladder, kidney, cervix, bowel and ovary. It can also cause myeloid leukaemia.

Numbers of smokers vary according to age group. In the 1990s the 20 to 34-year-olds made up the largest group, with 48% being regular smokers, but by 2009 this number had fallen to 26%, roughly the same as for the 35-49 age group. It is in the over 60 age group where numbers have fallen most. 34% of this age group were regular smokers in 1974, but by 2009 this number had fallen to 14%.

Numbers of smokers also vary according to socio-economic grouping. In 2009, 29% of adults in what are described as routine and manual households were regular smokers, while for those in managerial and professional households the figure was only 15%.

Geographical region can also influence the numbers of smokers within the UK. In Scotland the figure is 25%, followed by Wales with 23% and England with 21%. There are also more smokers in the North West of England than in the South West.

Smoking prevalence varies widely around the world, where there are currently around 1.3 billion smokers, 80% of whom live in low or middle-income countries. It is estimated that by 2025/2030 around 10 million people will die each year from smoking-related diseases and 70% of these deaths will be in developing countries.

Asia contains a third of the world's population, but has over half of the world's male smokers. Individual levels are fearfully high. 53% of Japanese males are smokers, while the figure for China is 63% and for Vietnam 73%. In China alone, 600,000 people die each year from smoking-related diseases and it is estimated that if current smoking rates continue, one in three of China's young men will die as a result.

In Britain during the last 50 years a rise in awareness of smoking's very real danger to health has helped to bring an encouraging fall in the numbers of regular smokers, but is clear that the problems associated with smoking-related diseases are still very much with us.

Worldwide the surface has hardly been scratched.

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Even if a mother has smoked, stopping smoking when she falls pregnant should mean her baby suffers no ill effects according to a recent report from the University of Southampton.

Professor Nick Macklon, from the Department of Obstetrics and Gynaecology, University of Southampton told the annual conference of the European Society of Human Reproduction and Embryology about the results of his study into more than 50,000 pregnancies.

Risks associated with smoking in pregnancy are low birthweight, premature birth and the risks that are associated with that, including brain damage and cleft lip.

The study looked at seven groups of women - non-smokers, those who had stopped more than a year prior to conceiving, those who had stopped less than a year prior to conceiving, smokers who stopped once the pregnancy was confirmed, and those who continued to smoke up to 10 a day, between 10 and 20 a day, and more than 20 a day.
The results were adjusted for a number of other factors that can affect birth outcomes and found that stopping at the start of pregnancy has beneficial effects.

"Not only was birthweight much better in this group than it was in the groups where the mothers had continued to smoke, but we also found that the babies reached the same gestational age and head circumference as those born to women who had never smoked," said Professor Macklon.

"While a recent study has shown that the rate of pre-term and small-for-gestational-age births can be reduced by stopping smoking before the 15th week of pregnancy, our research goes much further. We can now give couples hard evidence that making the effort to stop smoking in the periconceptional period will be beneficial for their baby."

Professor Macklon warned mothers to be of the dangers of deliberately continuing to smoke to try for a smaller baby and an easier birth.

"It is important that people who believe that a smaller baby means an easier birth take into account the increased risks of complicated deliveries in smokers," said Professor Macklon, "as well as the risk of disease later in life which goes with low birthweight. Smoking during pregnancy is not just bad for the mother and baby, but for the adult it will grow into."

Professor Macklon now intends to examine the impact of smoking on fertility.