According to data released earlier this year, tobacco is responsible for slightly less than one in four deaths in the United States. In some countries, it is even more — in Turkey, nearly 40% of deaths among males are related to tobacco. Cigarette smoking, despite strong evidence of its harmful effects, continues to be a serious problem worldwide. Tobacco use is linked to a large number of diseases and is the single most preventable cause of death in the world, according to the World Health Organization.

Read: The 10 Countries Where People Smoke Most

In some countries, people rarely smoke at all. In others, tobacco use is widespread. The number of cigarettes smoked per capita each year in China, the largest by population, is 1,711. In the third largest nation by population, the United States, the figure is 1,028. The number of cigarettes smoked per capita each year in India, the second most populated nation in the world, is only 96. The three nations represent a vast range of tobacco use without a simple explanation.

The reason why people smoke is too complex to have a single answer, but a review of smoking habits by country offers some powerful clues about why some use while others do not. Based on data compiled jointly by the American Cancer Society and the World Lung Foundation in its annual Tobacco Atlas report, 24/7 Wall St. identified the 10 countries with the highest smoking rates.

A look at the history of the tobacco industry in the U.S. illustrates many of the factors that affect smoking. For decades, cigarette companies were among the largest advertisers in print, on radio and on television. In 1964 that began to change, when the government issued the results of “Smoking and Health: Report of the Advisory Committee to the Surgeon General.” Among its most important findings was the direct link between tobacco use and cancer. A ban on cigarette TV and radio advertising soon followed.

A series of marketing restrictions and public relations disasters only made things worse for the American tobacco industry. In 1998, following successful actions brought by 46 state attorneys general, tobacco companies were forced to accept a settlement of $246 billion to be paid over 25 years.

It became clear to the public that tobacco companies had known about the health hazards for decades and had concealed the information to protect profits. As a result, billions spent and made on cigarette advertising was essentially wiped out by a wave of mistrust directed against the industry and its products.

Similar efforts in China are only in their early stages, and government action has gone largely unenforced. According to the Council on Foreign Relations, the severity and breadth of the tobacco problem have failed to prompt a strong response from the government. According to its findings, “none of the Politburo Standing Committee members (all of them nonsmokers) have made any public statements against tobacco production and consumption.”

The effects of limited tobacco regulation are also seen in the smoking rates of Eastern European countries. In an interview with 24/7 Wall St., Tobacco Atlas lead author Michael Eriksen explained, “As a rule, Eastern European countries have been weak on tobacco control programs, particularly low excise taxes, to a large extent due to the undue influence of the tobacco industry on Eastern European governments.”

As might be expected, prices relative to income in each of the 10 countries with the highest rates — six of which are in Eastern Europe — are among the lowest in the world. In Russia, one of the countries with the highest rates of smoking, the cost of cigarettes relative to per capita income is lower than all but four large countries. “Because prices are low,” Eriksen said, cigarettes are affordable, and “smoking becomes a ‘cheap pleasure’ for residents of these countries.”

Despite the availability of inexpensive cigarettes, poverty still appears to keep smoking rates low in some regions. In many poor African nations, rates of tobacco use are the lowest in the world. Limited government resources would suggest these rates are not the result of government controls.

In fact, it is more likely that the reason is limited corporate profits. Large tobacco companies may consider potential sales constrained by the poor and widely distributed populations of Africa. However, the potential size of the continent’s markets means it may become attractive to companies that have begun to reach product saturation elsewhere.

According to Eriksen, while cigarette use in Africa is among the lowest in the world, public health organizations are concerned that tobacco companies will increase cigarette demand. “Africa has the potential of being the only place in the world to prevent the occurrence of the tobacco epidemic, that has elsewhere lasted a century and caused millions of deaths,” said Eriksen.

A review of smoking across the world suggests that the U.S. story reflects a number of common issues, though at very different stages. The large global tobacco companies understand that marketing is critical to getting people to smoke. So is pricing. Government taxes and profit-hungry manufacturers can increase prices high enough to discourage the use of tobacco. The government can play an additional critical role of a health watchdog. In the United States, this began in earnest five decades ago.

To determine the countries that smoked the most, 24/7 Wall St. reviewed data from The Tobacco Atlas, a joint study between the American Cancer Society and the World Lung Foundation. We then analyzed data for all available nations with a population of more than 5 million, in order to study the countries with the largest numbers of smokers. The percentage of smoking among men, women and total adults in each nation are from 2010 or reflect the most-recently available data for that country. Because no combined normalized rate was available for these groups, we used actual data instead of normalized figures. For smoking rates among children aged 13 to 15, data reflects 2011 or the most-recently available year. Information on deaths attributed to tobacco was provided by The Tobacco Atlas for 2004, while information on tobacco production and the number of cigarettes smoked per capita is from 2009. Pricing information is from 2011, and reflects the cost of a 20 cigarette pack of Marlboro cigarettes, or their equivalent.

These are the 10 countries where people smoke the most.

10. Slovakia
> Pct. adults that smoke: 30.5%
> Pct. men that smoke: 40.8% (32nd highest)
> Pct. women that smoke: 23.0% (15th highest)
> Per capita cigarette consumption: 1,403 cigarettes (23rd highest)
> Cigarette prices per pack: $3.66 (30th highest)

Slovakia is one of several Eastern European countries with high smoking rates among adults. In general, Slovakian men smoke at a much higher rate than Slovakian women, with a sizable 18 percentage points difference. But the gap is far narrower among the younger age group. About 26.5% of boys between ages 13 and 15 smoke cigarettes, while 23.4% of girls the same age smoke. Men are also far more likely to die due to tobacco use — 26% of male deaths in 2004 were linked to tobacco use, the ninth highest rate in the world. Meanwhile, only 6% of female deaths in 2004 were attributed to tobacco, ranked a much lower 37th of all measured countries.

9. Turkey
> Pct. adults that smoke: 31.2%
> Pct. men that smoke: 47.9% (16th highest)
> Pct. women that smoke: 15.2% (31st highest)
> Per capita cigarette consumption: 1,399 cigarettes (24th highest)
> Cigarette prices per pack: $4.38 (22nd highest)

In 2004, 38% of all male deaths in Turkey were attributed to tobacco use, the highest rate in the world. Even those who do not smoke are frequently exposed, including children. More than 89% of children aged 13 to 15 are exposed to secondhand smoke at home, the third highest rate in the world. Aside from being one of the world’s leading tobacco consumers, Turkey is also one of its leading producers. In 2009, the country harvested nearly 140,000 hectares and produced 85,000 metric tons of tobacco, both among the world’s largest amounts.

Also Read: Ten Nations that Control The World’s Gold

8.  Romania
> Pct. adults that smoke: 32.4%
> Pct. men that smoke: 40.3% (34th highest)
> Pct. women that smoke: 25.1% (11th highest)
> Per capita cigarette consumption: 1,404 cigarettes (22nd highest)
> Cigarette prices per pack: $3.79 (29th highest)

Just under a third of adults in Romania — yet another Eastern European nation — smoke cigarettes. This includes 40.3% of men and 25.1% of women. The country is extremely lax when it comes to smoking in the home. An estimated 90.2% of children aged 13 to 15 are exposed to secondhand smoke in the home — the highest rate in the world. Tobacco excise taxes account for more than 60% of the total cost of cigarettes in the country. Many Romanians opt to avoid this fee by purchasing their packs illegally. More than a quarter of cigarettes purchased in Romania are sold through illicit trade.

7. Czech Republic
> Pct. adults that smoke: 36.3%
> Pct. men that smoke:42.5% (tied for 28th highest)
> Pct. women that smoke: 30.1% (5th highest)
> Per capita cigarette consumption: 2,125 cigarettes (7th highest)
> Cigarette prices per pack: $4.33 (23rd highest)

The Czech Republic is one of just seven nations where citizens annually consume more than 2,000 cigarettes. Although the country’s men are significantly more likely to smoke than its women, the percentage of female smokers was still the fifth highest among all countries in the study. Czech girls are also more likely to begin smoking at an early age with 32.7% of girls aged 13 to 15 smoking, versus 29.8% of boys that age who do. Regardless, cigarette use for both boys and girls that age is among the highest in the world. In 2001, smoking in the Czech Republic was briefly a subject of significant controversy. That year, tobacco giant Philip Morris International Inc. (NYSE: PM) approved a study that suggested the country’s finances benefited from smokers’ premature deaths, although it later apologized.

6. Hungary
> Pct. adults that smoke: 36.5%
> Pct. men that smoke:  42.5% (tied-28th highest)
> Pct. women that smoke: 31.3% (4th highest)
> Per capita cigarette consumption: 1,518 cigarettes (18th highest)
> Cigarette prices per pack: $3.56 (32nd highest)

Hungarian men, just as is the case in most countries, smoke at higher rates than Hungarian women. Yet, the country’s female smoking rates are higher than the smoking rates of men in many other countries. More than 31% of women smoke tobacco, the fourth highest rate of any country. Meanwhile, the 42.5% of men who smoke is ranked just 28th. Death from cigarette use is also high with 30% of male deaths and 18% of female deaths in 2004 were attributed to tobacco use. Both of those figures rank fifth highest of all countries measured. Hungary’s parliament passed a law in Sept. 2012 that establishes a state monopoly for tobacco products. The bill would limit the number of retailers that can sell tobacco.

5. Bulgaria
> Pct. adults that smoke: 38.8%
> Pct. men that smoke: 50.3% (10th highest)
> Pct. women that smoke: 28.2% (6th highest)
> Per capita cigarette consumption: 2,822 cigarettes (2nd highest)
> Cigarette prices per pack: $3.29 (34th highest)

Bulgaria is one of just 11 countries in which at least half of the adult male population smokes. It is also one of 11 countries in which more than one-quarter of the adult female population smokes, while 31.6% of girls between the ages of 13 and 15 smoke — the fourth highest rate in the world. Bulgaria’s citizens are not only among the most likely to smoke, but also tend to smoke heavily. The nation consumes the second most cigarettes per capita in the world, at 2,822 per year. On June 1, a national ban on smoking inside enclosed public spaces such as restaurants and bars went into effect — although it has been heavily protested by the country’s hospitality industry.

4. Russian Federation
> Pct. adults that smoke: 39.1%
> Pct. men that smoke: 60.2% (3rd highest)
> Pct. women that smoke: 21.7% (20th highest)
> Per capita cigarette consumption: 2,786 cigarettes (4th highest)
> Cigarette prices per pack: $1.74 (34th lowest)

Russia is one of just three countries where more than 60% of all men smoke cigarettes. Meanwhile, fewer than 22% of women in the country smoke cigarettes. That gap is evident in death rates. In 2004, 28% of male deaths were due to tobacco use, the sixth highest rate in the world. Meanwhile, only 4% of female deaths in 2004 were attributed to tobacco use, the 35th lowest of all countries. The country produces more than 400 billion cigarettes a year, more than any country except for China. As a result, cigarette prices relative to income were the fifth lowest in the world as of 2010. Prime Minister Dmitri Medvedev recently called for a cigarette advertising ban, higher sales taxes and a public smoking ban by 2015.

Also Read: The Nine U.S. Cities Selling the Most to China

3. Chile
> Pct. adults that smoke: 40.6%
> Pct. men that smoke: 44.2% (25th highest)
> Pct. women that smoke: 37.1% (3rd highest)
> Per capita cigarette consumption: 860 cigarettes (40th highest)
> Cigarette prices per pack: $3.80 (28th highest)

Chile has the third-highest proportion of adults who smoke for countries of 5 million people or more, but only the 25th highest proportion of men who smoke. More than 37% of women smoke, which is more than all but two large countries. The smoking problem in Chile is not contained to just adults. Nearly 40% of girls aged 13 to 15 smoke cigarettes, the highest rate of any large country. The cost of a pack of cigarettes in Chile is estimated at $3.80, more than $2.50 less than the cost of a pack in the United States, but still higher than most large countries. The Chilean Senate is slated to vote on a bill that would outlaw tobacco use in restaurants and bars.

2. Papua New Guinea
> Pct. adults that smoke: 44.0%
> Pct. men that smoke: 60.3% (2nd highest)
> Pct. women that smoke: 27.0% (7th highest)
> Per capita cigarette consumption: 670 cigarettes (51st highest)
> Cigarette prices per pack: $4.86 (20th highest)

The 60.3% of men who smoke cigarettes in Papua New Guinea is more than any other country except for Syria. These smokers start early as more than 52% of boys between the ages of 13 and 15 use cigarettes, the highest percentage in the world. Meanwhile, just under 36% of girls aged 13 to 15 smoke cigarettes, the second highest percentage of all countries and significantly higher than the 27% of all women who smoke. In late 2011, the Papua New Guinea government introduced a public smoking ban and a prohibition on manufacturers making tobacco packets of five cigarettes, which experts argue targets teenagers and lower-income individuals.

1. Austria
> Pct. adults that smoke: 47.0%
> Pct. men that smoke: 48.0% (15th highest)
> Pct. women that smoke: 47.0% (the highest)
> Per capita cigarette consumption: 1,650 cigarettes (15th highest)
> Cigarette prices per pack: $6.20 (14th highest)

A whopping 47% of women in Austria smoke cigarettes, the highest rate of all countries by eight percentage points and just one percentage point lower than the male smokers rate. A smoking ban has been implemented gradually and haphazardly in the past several years. After a voluntary smoking ban implemented in 2008 failed, the country enacted a law in 2009 to require establishments larger than 80 square meters to provide nonsmoking sections. They had to comply by July 2010, but more than a few business owners have gotten around the rules. For instance, some pubs and restaurants have become licensed “tobacconists,” who are exempt from the smoking bans.

Douglas A. McIntyre, Michael B. Sauter, Alexander E. M. Hess and Samuel Weigley

Also Read: The Most Educated Countries in the World

Thank you for reading! Have some feedback for us?
Contact the 24/7 Wall St. editorial team.