Tobacco use is the leading global cause of preventable deaths and kills more than 8 million people each year, of whom more than 7 million are from direct tobacco use and around 1.3 million are non-smokers exposed to second-hand smoke (WHO, 2023[1]). It is estimated that there were almost 1.25 billion current tobacco users aged 15 years and above in 2022, 1 billion of which were men. Amongst adolescents aged between 13 and 15, around 37 million (25 million boys and 12 million girls) are current tobacco users and an estimated 19 million (13 million boys and 6 million girls) are current cigarette smokers (WHO, 2024[2]). Although global tobacco use has fallen in all income groups of countries over the past two decades, the progress is still off track for achieving the WHO’s target of cutting tobacco use by 30% between 2010 and 2025 as part of the global efforts to reduce mortality from the four main non-communicable diseases (cardiovascular diseases, cancer, chronic lung diseases and diabetes) (WHO, 2021[3]). Over this period, the relative reduction of global average tobacco use prevalence would account for 25% (21% reduction among males and 40% reduction among females) (WHO, 2023[1]). Among Asia Pacific countries, Australia, Cambodia, India, Japan, Korea, New Zealand, Nepal and Pakistan would be on track to achieve a 30% relative reduction by 2025. The UN SDGs call for strengthening the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries and territories, as appropriate.
Tobacco use is a major risk factor for six of the eight leading causes of premature mortality – ischemic heart disease, cerebrovascular disease, lower respiratory infections, chronic obstructive pulmonary disease, tuberculosis and cancer of the trachea, bronchus, and lung. Moreover, smoking in pregnancy can lead to low birthweight and illness amongst infants (NCD Alliance, 2010[4]). Children who establish smoking habits in early adolescence also increase their risk of cardiovascular diseases, respiratory illnesses, and cancer, and they are more likely to experiment with alcohol and other drugs (CDC, 2021[5]). Smoking is also a risk factor for dementia. Studies have shown that 14% of Alzheimer’s cases worldwide may be attributed to smoking (WHO, 2014[6]; Livingston et al., 2017[7]). Tobacco smoking is also found to be associated with higher risks of developing severe symptoms and mortality amongst COVID‑19 patients (WHO, 2020[8]; Vardavas and Nikitara, 2020[9]). Smoking is harmful not only for smokers but also surrounding people such as families, colleagues, and bystanders. Protecting people from second-hand smoke, has become a public health priority and globally the number of countries with smoke‑free laws has increased largely over the past years (WHO, 2023[1]).
In 2008, only 5% of the world’s population was covered by comprehensive smoke‑free laws, but today over one‑quarter of the world’s population is covered. In Asia-Pacific, Australia, Brunei Darussalam, Cambodia, Hong Kong (China), Lao PDR, Nepal, New Zealand, Pakistan, Papua New Guinea and Thailand have complete smoke‑free policies. Evidence shows that countries and territories with smoke‑free policies have decreased the number of smokers and reduced mortality from smoking-related illnesses (WHO, 2021[3]).
The economic and social costs of tobacco use are also high, with families deprived of breadwinners, large public health costs for treatment of tobacco-related diseases, and lower workforce productivity (WHO, 2019[10]). Smoking rates in low-income countries are about half the rate in high-income countries (WHO, 2024[2])
Almost one in two men aged 15 and above in middle- and low-income Asia-Pacific countries and territories reported using tobacco currently in 2022, as compared to one in four in high-income countries and territories (Figure 4.15, left panel). The proportion of current tobacco users varied greatly across countries and territories. This proportion amongst men was highest in Indonesia and Myanmar at more than 70%, while the Solomon Islands, Papua New Guinea, Mongolia and Bangladesh, had over half of the adult males using tobacco currently. New Zealand and Australia, however, reported the lowest prevalence, with around 15% of adult males using tobacco currently. India has reduced smoking rates recently partly through an innovative smoking cessation programme developed in 2015 that sends personalised encouraging text messages to quit smoking to registered smokers’ cell phones (WHO, 2019[10]). However, India has a high prevalence of daily smokeless tobacco use amongst adults at 18.2% in 2018, and one in four adult men use smokeless tobacco daily.
There are large male‑female disparities and 7%, 4% and 10% of women aged 15 and above report using tobacco currently in high, upper-middle, and lower-middle- and low-income Asia-Pacific countries and territories respectively (Figure 4.15, right panel). The rates were highest amongst female tobacco users in Papua New Guinea (25%), Myanmar (19%) and the Solomon Islands (19%).
Although regular smoking in adolescence has both immediate and long-term health consequences, amongst youth aged 13 to 15 years, two in five males used tobacco in Papua New Guinea, and around one in four females used tobacco in Papua New Guinea and Solomon Islands (Figure 4.16, left panel). Moreover, Electronic nicotine delivery systems (ENDS) are targeted specifically at children and young adults and marketed in thousands of flavours and the use of ENDS has increased over the past years among the young generation. Findings show that non-smoking young people who use ENDS are more likely to become cigarette smokers, exposing them to the harmful effects of smoking, including addiction to tobacco (WHO, 2023[1]).
Increasing tobacco prices through higher taxes is an effective intervention to reduce tobacco use, by discouraging youth from beginning tobacco use and encouraging tobacco users to reduce their consumption or quit (WHO, 2019[10]). Higher taxes also assist in generating additional government revenue. However, only Australia, New Zealand, and Thailand have total taxes that account for over 75% of the tobacco retail price in 2022 (WHO, 2024[11]). In Thailand, increased tax revenue has been used to support smoking cessation programmes (WHO, 2019[10]). As a measure of affordability of cigarettes, in Nepal, around one fifth of the GDP per capita is required to purchase 2000 cigarettes of the most sold brand, while this figure is of less than 2% of the GDP per capita in China, Mongolia, Japan, Korea and Singapore.
In Asia-Pacific, health warnings against tobacco use, including labels on tobacco product packaging and anti-tobacco mass media campaigns to build public awareness, could be used more to reduce tobacco use. Australia, Pakistan, Singapore and Thailand report that graphic pictorial warning labels have effectively impacted smoking-related behaviour. To increase the effectiveness of health warnings, Australia, Lao PDR, Myanmar, New Zealand, Singapore and Thailand have also mandated plain packaging of tobacco products. One area of innovation is the application of health warnings on individual cigarettes as in Canada (WHO, 2023[1]).
