Dangerous prolonged exposure to
tobacco smoke from products like cigarettes, smokeless tobacco, Hookah and others
is widely prevalent. And, there are about 1.1 billion smokers in the world(1).
Moreover, globally, the exposure to second-hand smoke is 40% of children, 33%
of non-smoker males, and 35% of non-smoker females where children are mostly
affected by second-hand smoke from indoor air pollution that cannot be avoided
by children as being in a smoking environment by parents and relatives.(2)

Smoking is the main cause of
avoidable diseases and leads to five million deaths every year (3),
and if left unchecked, will rise to ten million every year by 2020, seven
million of them are in developing countries (1). Of all deaths that are
attributable to smoking, 80% are in low-income and middle-income countries (4).The
most common smoking-attributable diseases are cardiovascular diseases,
cerebrovascular diseases, tuberculosis, diabetes, lung cancer, and chronic
obstructed pulmonary disease COPD.(1)

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Since the eighties, tobacco
manufacturing declined by 36% in developed countries while it reached more than
double its production in developing countries due to shifting in the tobacco
industry and marketing which lead to increasing the prevalence of smoking in
developing countries and decreasing to some degree in developed countries.(4)


To this effect, countries put
a lot of effort to control and prevent smoking both nationally and
internationally. Among these efforts, one that was initiated by World Health
Organization in 2003-the Framework Convention on Tobacco Control (FCTC)-is worth
mentioning. This convention came into action by 2005 and ratified by 180
countries on 2015.(5, 6) In enforcing this convention
and fasten the implementation of FCTC on country level and to fight against
non-communicable diseases, the MPOWER action measures were introduced in 2007.(7)
In addition to that, the WHO introduced a program of non-communicable diseases
(NCDs) control which is aiming to lower tobacco use by 30% between 2010 and


Though these programs and
interventions are still in place due to the growing tobacco industry and
insufficient political will, 80% of the population are without full coverage of
tobacco control programs. (6)

There is a decline in smoking
prevalence among men, especially in developed countries with proper regulations
while there is slight increase among women in some of these countries
considering smoking as a trend and having the right to smoke as men, with
significant increase in both sexes in developing countries due to the
affordability of cigarettes as a result of insufficient taxing and other
control measures, targeting mostly young age group.(4)

In addition to lung cancer, other
cancers like, pharyngeal, oral cavity, nasal cavity, larynx, stomach, liver, pancreas, urinary bladder, kidney, uterine,
cervix, and also myeloid leukemia are added to the list of diseases
associated with smoking along the previous years.(1)

the nineties, of the yearly diagnosed 1.3 million new lung cancer cases, 50%
were in developing countries with thousands of oral and nasal cavity cancers
(664000).(1) COPD is highly linked to smoking in which 90% of deaths
are attributable to tobacco use. An estimated 2.2 million deaths globally were
due to COPD and expecting to rise in 2020 up to 4.7 million.(1) On the other hand, esophageal cancers are 90% related to
smoking and cardiovascular diseases with cerebrovascular disease, are
considered leading causes of morbidity and mortality globally. In spite of the
fact that it is declining in developed countries slightly but still rising in
developing countries according to global burden of diseases study.(4)


To sum
up, 2.7 billion of the population are still uncovered with intervention
measures. As a consequence, they are susceptible to smoking-related diseases,
disability, and premature deaths in addition to other social, ecological, and
financial factors. Despite the fact that smoking prevalence is lowered in some
parts of the world, the total number of smokers worldwide is not.(6) The disparity in mortality between developed and
developing countries is expected to increase furthermore in the future.(9). Although progress has been made with tobacco control
measures worldwide, much more efforts are yet needed to achieve the targeted
Sustainable Development Goals (SDGs 2030) 
that are set in 2015 as a comprehensive and broader continuation of the
previous programs (8).

there is no conducive policy environment, real political will with
continuous commitment (6) and a strengthened health
care system that effectively responds to major problems with accelerated
programs and attainable timely goals, smoking will remain a major public
health issue and millions of people will suffer or/and die from avoidable
smoking-associated diseases where ten billions of dollars would be lost
annually to preventable health-care costs and productivity losses (8). 

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