The global tobacco epidemic is predicted to kill 10 million people annually over the next 20 to 30 years, with the vast majority of these deaths occurring in developing countries (Maziak, Ward, Soweid, and Eissenberg, 2004). More than one billion men, women, and youths in the world use tobacco products, which equates to about 35 percent of men in developed countries and about 50 percent of men in developing countries (World Health Organization, 2005). Amongst women, 22% in developed countries and 9% in developing countries use tobacco products, and these rates are on the rise (Haglund, 2004). Tobacco use is the second major cause of death in the world - and those deaths are preventable. “It is currently responsible for the death of one in ten adults' worldwide” (WHO, 2006). Tobacco use also causes major economic burdens due to related treatment costs and the lack of productivity in life. In addition, second-hand smoke is responsible for serious health conditions in non-smoking populations, including low birth weight and asthma.

Tobacco smoke contains many harmful chemicals, among them irritants and systemic toxicants, mutagens, and reproductive and developmental toxicants (National Cancer Institute, 2006). More than fifty compounds in tobacco smoke are known carcinogens. Smoking cigarettes and using other forms of tobacco have been proven to increase risks for heart disease, emphysema, and multiple cancers, including those of the lungs, mouth, and lips. Smoking during pregnancy can also increase the risk of miscarriage, ectopic pregnancy, premature birth, and birth defects. In children, second-hand smoke can cause Sudden Infant Death Syndrome, asthma induction and exacerbation, bronchitis, pneumonia, middle ear infection, chronic respiratory symptoms, and low birth weight.

Tobacco use is of particular concern in the Middle East. For example, Jordan's tobacco epidemic is particularly alarming. Although only 8% of Jordanian women currently smoke tobacco products, more than half (51%) of Jordanian men smoke these products (WHO, Country Profile). Men smoke approximately twenty-three cigarettes per day, compared with twelve per day among women. Very few people had received counseling from a healthcare provider about the harm of smoking. Another serious indicator of this behavioral risk factor's severity is the rate of smoking (about 20%) among school children between 13-15 years of age (Hijazi, 2005). One-quarter of all men in this age category smoke; 15% of their female counterparts smoke.

The Global Youth Tobacco Survey found that 34.3% of Jordanian youths had tried smoking and that 26.1% had smoked their first cigarette before they were 10 years old (Warren et al., 2000). This shows that one's initiation is occurring at an early age and that the exposure time is far longer. Therefore, an increase in the prevalence and severity of chronic disease is expected. Moreover, one-third of students aged 13-15 usually smoke at home and the majority (67.9%) of them can buy cigarettes in a store even though they are under age (Warren, et. al, 2000). Already cardiovascular diseases, including ischemic heart disease, and cancers are among the top causes of DALY's (disability adjusted life years) lost in Jordan. This number is projected to increase (Belbeisi, et al., 2006).

This epidemic is equally alarming in neighboring countries. For example, the rate of smoking in Egypt among adult men is 43.6% and 4.8% among adult women; the mean starting age is fifteen years (WHO, Country Profile). In Lebanon, 52.6% of the adult population smokes, 35% of whom are believed to be women; in Morocco, 30% of men and 10% of women smoke; and in Iran, 24.8% of men and 4.7% of women smoke. Although the prevalence of female smokers has traditionally been low due to the Eastern Mediterranean region's cultural and social values, this difference is slowly disappearing as women's use of tobacco continues to increase.

*References included in report