This week the WHO has launched its fourth report on Tobacco Usage. Trend data on tobacco use is now available from 165 countries. Data on E-cigarettes and other inhaled products has not been measured for long enough to be able to determine long-term trends.
The global tobacco usage rates (15 years of age and over) have declined from 50% of the population in 1950 to an estimated 34% in 2025. For women the numbers are down from 16% to 6%. The downward trend has occurred in all regions of the world. In Table One we have extracted data from the report for APACPH member countries. The data in Table One were all collected before the COVID pandemic and as of now it is not known what has happened to smoking rates. It is possible that smoking rates will have declined as family income has decreased. It is also possible that it may have increased due to boredom. What we do know is that Smoking exacerbates the effects of COVID illness.
The good news is that smoking is in decline.
The bad news is that the prevalence of smoking remains high enough to make it the most important cause of preventable mortality in our region1.
The country with the highest rate of smoking in the world is Indonesia where the rate for males remains above 70%. This is a real public health emergency and the costs to the health system and the country of Indonesia are extremely high.
The global tobacco industry does not want to forgo its profits and is shifting its promotion to other inhaled products: electronic nicotine devices (ENDS) including e-cigarettes. Important components of any School of Public Health are Environmental and Occupational Health. Researchers in these fields have long sought to document the harm caused by inhaling pollutants. The global tobacco companies are continuing to develop and market these products to maintain profits. The Asia Pacific Journal of Public Health has continued to publish papers highlighting the dangers of these products2,3. In the future WHO will collect data on their use. As with most pollutants it may be some years before the extent of damage to health becomes evident.
Smoking, E-cigs and Breastfeeding
Breastfeeding is very important in infants and for lifelong health. We have previously reported on the association between smoking tobacco and shortened breastfeeding duration4,5. Coinciding with the WHO report a new major study has been released from the USA showing that ENDS also shortens breastfeeding duration6.
ENDS is the abbreviation now in common use. Does it have a hidden meaning? Perhaps it means that any way you get tobacco into your lungs will END your life sooner than for non-users.
WHO global report on trends in the prevalence of tobacco use 2000-2025, fourth edition. Geneva: World Health Organization; 2021.
Table: WHO Smoking Data 2020 for the Asia Pacific Region
Population smoking rates 15 years and over (Age standardised prevalence)
| Country | Population | Male | Female |
|---|---|---|---|
| Australia | 13.6 | 15.6 | 11.5 |
| Cambodia | 21.1 | 36.1 | 6.0 |
| China | 25.6 | 49.4 | 1.7 |
| Japan | 20.1 | 30.1 | 10.0 |
| Lao People’sDemocraticRepublic | 31.8 | 53.3 | 10.3 |
| Malaysia | 22.5 | 43.8 | 1.1 |
| Mongolia | 29.4 | 51.7 | 7.1 |
| New Zealand | 13.7 | 15.0 | 12.3 |
| Papua New Guinea | 39.3 | 53.5 | 25.1 |
| Philippines | 22.9 | 39.3 | 6.5 |
| Republic of Korea | 20.8 | 35.7 | 5.9 |
| Singapore | 16.5 | 28.0 | 5.0 |
| Solomon Islands | 36.5 | 53.8 | 19.2 |
| Vanuatu | 17.8 | 33.0 | 2.6 |
| Viet Nam | 24.8 | 47.4 | 2.2 |
| Bangladesh | 34.7 | 52.2 | 17.1 |
| Democratic People’s Republic of Korea | 17.4 | 34.8 | 0.0 |
| India | 27.2 | 41.3 | 13.0 |
| Indonesia | 37.6 | 71.4 | 3.7 |
| Maldives | 25.2 | 44.4 | 6.0 |
| Myanmar | 44.1 | 68.5 | 19.7 |
| Nepal | 30.4 | 47.9 | 12.8 |
| Sri Lanka | 22.0 | 41.4 | 2.6 |
| Thailand | 22.1 | 41.3 | 2.9 |
| Timor-Leste | 39.2 | 67.6 | 10.8 |
| USA | 23.0 | 28.4 | 17.3 |
- G. B. D. Viewpoint Collaborators. Five insights from the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1135-1159.
- Binns C, Lee MK, Low WY. Children and E-Cigarettes: A New Threat to Health. Asia Pac J Public Health. 2018;30(4):315-320.
- Jancey J, Maycock B, McCausland K, Howat P. E-Cigarettes: Implications for Health Promotion in the Asian Pacific Region. Asia Pac J Public Health. 2018;30(4):321-327.
- Giglia R, Binns CW, Alfonso H. Maternal cigarette smoking and breastfeeding duration. Acta paediatrica. 2006;95(11):1370-1374.
- Xu F, Binns C, Zhang H, Yang G, Zhao Y. Paternal smoking and breastfeeding in Xinjiang, PR China. Journal of human lactation : official journal of International Lactation Consultant Association. 2010;26(3):242-247.
- McBride M, Haile ZT. Association Between Electronic Nicotine Delivery Systems Use and Breastfeeding Duration. Breastfeed Med. 2021;16(11):886-893.
Colin Binns, MBBS, PhD
Editor-in-Chief, Asia-Pacific Journal of Public Health
School of Public Health, Curtin University, Perth, Australia
Wah Yun Low, PhD
Managing Editor, Asia-Pacific Journal of Public Health
President, Asia-Pacific Academic Consortium for Public Health
Deputy Executive Director, Asia Europe Institute
University of Malaya, Kuala Lumpur, Malaysia
Victor Hoe Chee Wai, MBBS, PhD
Webmaster, Asia-Pacific Academic Consortium for Public Health
Department of Social and Preventive Medicine, Faculty of Medicine
University of Malaya, Kuala Lumpur, Malaysia
