CHCHAPTER 2
Nicotine and Tobacco Addiction
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Chapter List

1
Profiting from Deadly Products
2
Nicotine and Tobacco Addiction
3
Basic Needs Sacrificed
4
Burden of Death, Disease and Disability
5
Human and Financial Resources for Tobacco Control
6
Insulating Public Health Policies from Industry Interference
7
Reducing Tobacco Affordability and Consumption
8
Clearing the Air for a Healthier Environment
9
A Picture is Worth a Thousand Words
10
Pulling the Plug on Tobacco Marketing and Tobacco Philanthropy
11
Protecting Future Generations from Nicotine Addiction
12
Alternative Livelihood for Tobacco Growers
Chapter 2

Nicotine and Tobacco Addiction

This highly additive product is commonly used by different segments of the population including vulnerable groups such as women, youth, and children. About 6.5 trillion cigarettes are sold each year, estimated 18 billion cigarettes are smoked every day worldwide (1.457 billion sticks in ASEAN). In 2020, an estimated 505 billion cigarettes were sold in ASEAN countries with 92% primarily consumed in Indonesia, Philippines, Thailand, and Vietnam.

Due to the expansion of the world's population and dynamic economic growth, the number of smokers is expected to reach at least 2 billion people by 2030. Among ASEAN countries, adult male smoking prevalence is highest in Indonesia (62.9%) and lowest in Singapore (18.4%). Adult female smoking rates are particularly high (ranging between 4.4% and 7.1%) in Indonesia, Lao PDR, Myanmar and Philippines.

Youth smokers are estimated to be around 24 million worldwide. Of these, the South East Asian (6.4 million or 27%) and Western Pacific (4.7 million or 19.9%) regions have the largest number of youth cigarette smokers. In ASEAN, youth smoking prevalence is high (ranging between 11.3% and 19.2%) particularly in Indonesia, Malaysia, Philippines and Thailand. In addition to smoking, an increasing exposure and prevalence of electronic nicotine delivery systems (ENDS, also known as e-cigarettes) and and heated tobacco products (HTPs) use among youths in ASEAN further contribute to nicotine addiction. The prevalence of ENDS among youth is high (ranging between 9.8% and 13.3%) particularly in Brunei, Indonesia, Malaysia and Philippines.

Adult Smoking Prevalence in ASEAN

Adult Smoking Prevalence in ASEAN Click to enlarge

Reducing the prevalence of tobacco use (smoked and smokeless tobacco)

*A 30% relative reduction in prevalence of current tobacco use in persons aged 15+years by 2025 (2020 baseline).
Country National target (%) *Global target (%)
Brunei 13.93% (30% relative reduction in prevalence of current tobacco use (19.9%) in adults by 2023, set in 2019) 12.88% (30% relative reduction from 18.4% in 2011)
Cambodia No target available 13.65% (30% relative reduction from 19.5% in 2011)
Indonesia 10 - 18 years old: 8.7% in 2024 (no target for adults) 24.01% (30% relative reduction from 34.3% in 2010)
Lao PDR 17.85% (30% relative reduction in adult smoking prevalence in 2012 (25.5%) by 2025, set in 2015) Same as national target
Malaysia 19.63% (15% relative reduction in adult smoking prevalence (23.1%) by 2025 set in 2015) 17.22% (30% relative reduction from 24.6% in 2011)
Myanmar 24.8% and 23.5% (5% and 10% relative reduction in prevalence of current tobacco use (26.1%) in persons aged 15+ years by 2021 and 2025 respectively, set in 2017) 15.4% (30% relative reduction from 22% in 2009)
Philippines 15% - 18% adult smoking prevalence by 2022 20.8% (30% relative reduction from 29.7% in 2009)
Singapore < 10% adult smoking prevalence by 2020 10% (30% relative reduction from 14.3% in 2010)
Thailand 17.59% (15% relative reduction in prevalence of current tobacco use (20.7%) in persons aged 15+ years by 2025, set in 2010) 14.49% (30% relative reduction from 20.7% in 2009)
Vietnam 28.54% (37% relative reduction in prevalence of adult male smokers (45.3%) 16.66% (30% relative reduction from 23.8% in 2010)

Global estimate of smokers* by WHO region in 2020

Global estimate of smokers* by WHO region in 2020
Global estimate of smokers* by WHO region in 2020
by gender

About 1.3 billion tobacco users aged 15 years and above worldwide - 1.07 billion smokers and 367 million smokeless tobacco users.

About 80% of the world's smokers live in low- and middle-income countries and 226 millions of them are living in poverty.

ASEAN has 10% of world's smokers

22.5% of adults in ASEAN smoke.

ASEAN has 124.3 million adult smokers, half of whom live in Indonesia.

Total ASEAN population: 667,304,000 (2020).

quick fact box

About 1.3 billion tobacco users aged 15 years and above worldwide - 1.07 billion smokers and 367 million smokeless tobacco users.

About 80% of the world's smokers live in low- and middle-income countries and 226 millions of them are living in poverty.

quick fact box

Adult smoking and ENDS use

Numbers don't lie: Numbers don't lie: Percentage of adult male and female smokers and ENDS users

Adult smoking and ENDS use
Adult smoking and ENDS use
quick fact box

Smoking is associated with an increased risk of suffering from a wider range of COVID-19 symptoms and smokers are more likely to visit hospital than non-smokers.

Numbers don't lie: Percentage of adult male and female smokers and ENDS users

Percentage of adult male and female smokers and ENDS users
Percentage of adult male and female smokers and ENDS users

Regular smokers and ENDS users by gender (Global)

Regular smokers and ENDS users by gender (Global)
Regular smokers and ENDS users by gender (Global)

Prevalence of current dual users of ENDS and cigarettes

Prevalence of current dual users of ENDS and cigarettes
Prevalence of current dual users of ENDS and cigarettes

Regular smokers and ENDS users by generations (Global)

Regular smokers and ENDS users by generations (Global)
Regular smokers and ENDS users by generations (Global)
quick fact box

The World Health Organization (WHO) has warned that all forms of tobacco, including heated tobacco products (HTPs), are harmful. The Conference of Parties to the WHO FCTC recommends that HTPs be regulated as tobacco products. (then move this to a page about smoking)

Prevalence and number of ever-tried adult ENDS users in ASEAN*

Prevalence and number of ever-tried adult ENDS users in ASEAN*
Prevalence and number of ever-tried adult ENDS users in ASEAN*

Cigarette per capita annual consumption in ASEAN (2015 - 2020)

Cigarette per capita annual consumption in ASEAN (2015 - 2020)
Cigarette per capita annual consumption in ASEAN (2015 - 2020)

Number of cigarettes smoked daily by adults in ASEAN

Number of cigarettes smoked daily by adults in ASEAN
Number of cigarettes smoked daily by adults in ASEAN
quick fact box

Smoking causes thousands of DNA mutations, such that every 15 cigarettes smoked causes a genetic mutation leading to the development of lung cancer.

Most common source of the last purchase of manufactured cigarettes in ASEAN

Most common source of the last purchase of manufactured cigarettes in ASEAN
Most common source of the last purchase of manufactured cigarettes in ASEAN

Cigarette sales volumes in ASEAN region (2015 - 2023)

Cigarette sales volumes in ASEAN region (2015 - 2023)
Cigarette sales volumes in ASEAN region (2015 - 2023)
quick fact box

In ASEAN, an estimated 505.65 billion cancer sticks were sold in 2020.

Over six trillion cancer sticks with highly addictive nicotine are produced annually worldwide.

Cigarette sales volumes in Cambodia, Lao PDR, Malaysia, Myanmar and Singapore

Cigarette sales volumes in Cambodia, Lao PDR, Malaysia, Myanmar and Singapore
Cigarette sales volumes in Cambodia, Lao PDR, Malaysia, Myanmar and Singapore

Number and percentage of adults who use smokeless tobacco in ASEAN

Number and percentage of adults who use smokeless tobacco in ASEAN
Number and percentage of adults who use smokeless tobacco in ASEAN
quick fact box

About 303 million people globally (from 133 countries), aged 15 years and older, currently use smokeless tobacco. Of these, 248 million smokeless tobacco users live in the WHO South-East Asia region, primarily in India.

More than 85% of the smokeless tobacco-related burden was in South and Southeast Asia and the risk estimates for cancers were highest in this region. In 2017, at least 2.5 million DALYs and 90,791 lives were lost across the globe due to oral, pharyngeal and oesophageal cancers that can be attributed to smokeless tobacco.

Quitting Tobacco Use

Percentage of current smokers (aged>15 years old) who intend to quit within next 12 months*

Percentage of current smokers (aged>15 years old) who intend to quit within next 12 months*
Percentage of current smokers (aged>15 years old) who intend to quit within next 12 months*

Percentage of current smokers who attempted to quit in the past 12 months

Percentage of current smokers who attempted to quit in the past 12 months
Percentage of current smokers who attempted to quit in the past 12 months

Health benefits in quitting for all tobacco users

Health benefits in quitting for all tobacco users
Health benefits in quitting for all tobacco users
quick fact box

Smoking cessation is beneficial at any age. It improves health status and enhances quality of life as well as reduces the risk of premature death and many adverse health effects, including reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease (COPD), and cancer.

Years gained by quitting smoking by age

Years gained by quitting smoking by age
Years gained by quitting smoking by age

Cessation support (national toll-free tobacco quitline service) in selected ASEAN countries

Cessation support (national toll-free tobacco quitline service) in selected ASEAN countries
Country National toll-free tobacco quitline service
Indonesia Layanan Berhenti Merokok (0800-177-6565)
Malaysia Infoline: 03-8883 4400
Philippines Quit Smoking: Call DOH Quitline 1558 (formerly 165-364)
Singapore QUITLINE 1800 438 2000
Thailand Quitline 1600
healthy family

Youth*smoking prevalence in ASEAN

Youth*smoking prevalence in ASEAN
Youth*smoking prevalence in ASEAN

Youth Smoking

Numbers don't lie: Percentage of smoking among boys and girls (13 - 15 years)* in ASEAN

Percentage of smoking among boys and girls (13 - 15 years)* in ASEAN
Percentage of smoking among boys and girls (13 - 15 years)* in ASEAN

The highest average rate (10.5%) for boy's cigarette smoking is in the Western Pacific among the WHO regions.

Around 24 million youth aged 13-15 (17 million boys and 7 million girls) globally report current smoking of cigarettes.

quick fact box

The South East Asian (6.4 million or 27%) and Western Pacific (4.7 million or 19.9%) regions have the largest number of youth cigarette smokers of the global total (23.6 million) respectively.

“They represent tomorrow's cigarette business.. As this 14-24 age group matures, they will account for a key share of the total cigarette volume -- for at least the next 25 years.”

1974 R.J. Reynolds Tobacco Co. marketing plan presented to the company's board of directors. Bates No. 501421310-1335
girl smoking in room

Youth smoking initiation

Youth smoking initiation
Youth smoking initiation
Youth*smoking prevalence in ASEAN

Globally, 25 million youth aged 13-15 smoke, and 13 million use smokeless tobacco.

Average age of adults smoking initiation (daily smokers) in ASEAN

Average age of adults smoking initiation (daily smokers) in ASEAN
Average age of adults smoking initiation (daily smokers) in ASEAN

Intentions of non-smoking youths to start smoking in the next year

Intentions of non-smoking youths to start smoking in the next year
Intentions of non-smoking youths to start smoking in the next year

Numbers don't lie: Percentage of youth smokers* and ENDS users in ASEAN

Percentage of youth smokers* and ENDS users in ASEAN
Percentage of youth smokers* and ENDS users in ASEAN
quick fact box

Globally, the number of youths aged 13 - 15 years, who smoke, is estimated to be around 24 million, and 13 million use smokeless tobacco products.

Prevalence of ever tried and initiation age using ENDS in ASEAN*

Prevalence of ever tried and initiation age using ENDS in ASEAN*
Prevalence of ever tried and initiation age using ENDS in ASEAN*

Prevalence of current youth dual users of ENDS and cigarettes in ASEAN*

Prevalence of current youth dual users of ENDS and cigarettes in ASEAN*
Prevalence of current youth dual users of ENDS and cigarettes in ASEAN*
quick fact box

Electronic nicotine delivery systems (ENDS) use is associated with a higher risk of cigarette smoking among adolescents who had no prior intention of taking up conventional smoking. They are more than four times more likely to start smoking cigarettes one year later compared to those who did not use ENDS.

Electronic nicotine delivery systems (ENDS) are associated with adolescents starting to smoke tobacco cigarettes; adolescents who use ENDS are three to five times more likely to start smoking tobacco cigarettes compared to those who never used ENDS.

Smoking initiation trend among Indonesian between 1995 and 2018

Smoking initiation trend among Indonesian between 1995 and 2018
Smoking initiation trend among Indonesian between 1995 and 2018

Deaths from tobacco

290,444

Indonesians / year

795.7

Indonesians / day

Recruit New Smokers

16.8 million

new Indonesian smokers (10-19 years old) / year

46,027

youth smokers (below 19 years) / day
quick fact box

Indonesia has one of the highest smoking rates in the world where 63% of adult males and 38.3% of youths (aged between 10 and 18) smoke.

Youth susceptibility to tobacco advertising and promotion in ASEAN

Youth susceptibility to tobacco advertising and promotion in ASEAN
Youth susceptibility to tobacco advertising and promotion in ASEAN

Percentage of youths offered free cigarettes by a tobacco company representative in ASEAN

Percentage of youths offered free cigarettes by a tobacco company representative in ASEAN
Percentage of youths offered free cigarettes by a tobacco company representative in ASEAN

CHAP 1

Nicotine and Tobacco Addiction
CHAP 3

Basic Needs Sacrificed