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Smoking estimates from around the world: data from the first 17 participating countries in the World Mental Health Survey Consortium
  1. Carla L Storr1,2,
  2. Hui Cheng3,
  3. Jordi Alonso4,
  4. Matthias Angermeyer5,
  5. Ronny Bruffaerts6,
  6. Giovanni de Girolamo7,
  7. Ron de Graaf8,
  8. Oye Gureje9,
  9. Elie G Karam10,11,
  10. Stanislav Kostyuchenko12,
  11. Sing Lee13,
  12. Jean-Pierre Lepine14,
  13. Maria Elena Medina Mora15,
  14. Landon Myer16,
  15. Yehuda Neumark17,
  16. Jose Posada-Villa18,
  17. Makoto Watanabe19,
  18. J Elisabeth Wells20,
  19. Ronald C Kessler21,
  20. James C Anthony3
  1. 1Department of Family and Community Health, University of Maryland, Baltimore, School of Nursing, Baltimore, Maryland, USA
  2. 2Department of Mental Health, Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Department of Epidemiology, Michigan State University, College of Human Medicine, East Lansing, Michigan, USA
  4. 4Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar), CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
  5. 5Center for Public Mental Health, Gösing am Wagram, Austria
  6. 6Department of Neurosciences and Psychiatry, University Hospitals Gasthuisberg, Leuven, Belgium
  7. 7IRCCS Fatebenefratelli, Brescia, Italy
  8. 8Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
  9. 9Department of Psychiatry, University College Hospital, Ibadan, Nigeria
  10. 10Department of Psychiatry and Clinical Psychology, Balamand University School of Medicine, St George University Medical Center, Lebanon
  11. 11Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
  12. 12Ukrainian Psychiatric Association, Kiev, Ukraine
  13. 13Department of Psychiatry, The Chinese University of Hong Kong, HKSAR
  14. 14Hospital Ferdinand Widal, Paris, France
  15. 15Department of Epidemiology, National Institute of Psychiatry, Mexico City, Mexico
  16. 16School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  17. 17Legacy Heritage International MPH Program, Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
  18. 18Ministry of Social Protection, Colegio Mayor de Cundinamarca University, Bogota, Colombia
  19. 19Department of Preventive Cardiology, National Cardiovascular Center, Japan
  20. 20Christchurch School of Medicine and Health Science, Christchurch, New Zealand
  21. 21Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Carla Storr, 655 W Lombard Street, Suite 655A, Baltimore, MD 21201, USA; cstor002{at}


Objective To contribute new multinational findings on basic descriptive features of smoking and cessation, based upon standardised community surveys of adults residing in seven low-income and middle-income countries and 10 higher-income countries from all regions of the world.

Methods Data were collected using standardised interviews and community probability sample survey methods conducted as part of the WHO World Mental Health Surveys Initiative. Demographic and socioeconomic correlates of smoking are studied using cross-tabulation and logistic regression approaches. Within-country sample weights were applied with variance estimation appropriate for complex sample survey designs.

Results Estimated prevalence of smoking experience (history of ever smoking) and current smoking varied across the countries under study. In all but four countries, one out of every four adults currently smoked. In higher-income countries, estimated proportions of former smokers (those who had quit) were roughly double the corresponding estimates for most low-income and middle-income countries. Characteristics of smokers varied within individual countries, and in relation to the World Bank's low-medium-high gradient of economic development. In stark contrast to a sturdy male-female difference in the uptake of smoking seen in each country, there is no consistent sex-associated pattern in the odds of remaining a smoker (versus quitting).

Conclusion The World Mental Health Surveys estimates complement existing global tobacco monitoring efforts. The observed global diversity of associations with smoking and smoking cessation underscore reasons for implementation of the Framework Convention on Tobacco Control provisions and prompt local adaptation of prevention and control interventions.

  • International
  • epidemiology
  • smoking prevalence
  • cessation
  • prevalence
  • surveillance and monitoring
  • tobacco products

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  • Funding The preparation of this manuscript was funded by the US National Institute on Drug Abuse (R01DA016558 and K05DA015799).The surveys discussed in this article was carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the WMH staff for assistance with instrumentation, fieldwork, and data analysis. These activities were supported by the United States National Institute of Mental Health (R01MH070884), the John D and Catherine T MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R01-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc, GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Lebanese National Mental Health Survey (LEBANON) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from Janssen Cilag, Eli Lilly, GlaxoSmithKline, Roche, and Novartis. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the PanAmerican Health Organization (PAHO). Te Rau Hinengaro:The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575) and National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W Alden Trust. Other funders:NIH.

  • Conflict of interests None.

  • Ethics approval The institutional review board of the organisation coordinating the survey in each country approved and monitored the compliance of human subject protection and obtaining informed consent. Data analysis activities were approved by the Johns Hopkins Bloomberg School of Public Health and Michigan State University institutional review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.