Introduction:
The tobacco epidemic is one of the world's most serious public health issues, and all forms of tobacco are dangerous to health. Moreover, cigarette smoking which is the most common form of tobacco use reported to be the second cause of death worldwide. In Saudi Arabia (SA), one of the primary public health concerns is tobacco use and the harm it causes to both users and second-hand smokers. The number of cigarette smokers has fluctuated during the last decade. Several prior studies in SA reported tobacco usage status; however, they were inconsistent in showing the timeline despite aggressive national initiatives in controlling tobacco use before, during, and after (peri) implementations of the FCTC MPOWER. Therefore, this study was designed to conduct a comprehensive review of tobacco control legal activities and the prevalence of cigarette use in the nation.

Material and Methods:
We searched through all tobacco-related literature and included every study that estimated current prevalence of cigarette use between 1980 and 2020 in SA. Additionally, two online data sources were used to extract legal documents of tobacco control policy: 1) Regional Office for the Eastern Mediterranean (EMRO) at WHO and 2) Tobacco Control Laws (TCL). EMOR has tobacco control legislation from 21 Eastern Mediterranean countries while the TCL provides tobacco control documents retrieved from 193 countries.

Results:
The current prevalence of cigarette use was measured among different categories which were community settings, college students, and school students. With respect to community settings, the prevalence of cigarette in 2016 was the greatest (≈50%); however, the highest prevalence was recorded for males (≈45%) in 1999 and 1987 in reference to females (≈15%). Additionally, cigarette use were predominant in 1986 among male university students (≈50%), and among female university students in 2015 (≈ 30%). The research studies for the prevalence among school students were limited to males only until 2005 when females were included. With respect to tobacco control policies, SA issued its first tobacco control law in 1983 and ratified FCTC in 2004; however, full implementation of MPOWER was in 2018 after the royal decree of anti-smoking law in 2015.

Conclusions:
In SA, the studies were inconsistent and conducted in different geographical locations, hence the results on cigarette smoking were fluctuating. Therefore, a continuous national surveillance system is required to examine the timeline of tobacco use and establish a trend of use that reflects the state’s actions of tobacco control policies implemented in the nation. In addition, an impact assessment of FCTC MPOWER implementations is highly needed to evaluate its enforcement and effectiveness in the nation.