The tobacco epidemic is one of the greatest public health threats the world has ever faced, killing more than 8 million people each year. More than 7 million of these deaths are caused by direct tobacco use, while about 1.2 million are non-smokers that are exposed to second-hand smoke.
All forms of tobacco are harmful, and there is no safe level of exposure to tobacco. Cigarette smoking is the most common form of tobacco use worldwide. Other tobacco products include waterpipe tobacco, various smokeless tobacco products, cigars, cigarillos, roll-your-own tobacco, pipe tobacco, bidis and kreteks.
Over 80% of the 1.3 billion tobacco users worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco.
The economic costs of tobacco use are substantial and include significant health care costs for treating the diseases caused by tobacco use as well as the lost human capital that results from tobacco-attributable morbidity and mortality.
In 2020, 22.3% of the world’s population, 36.7% of all men and 7.8% of all women used tobacco.
Current smoker: includes daily smokers and non-daily smokers (also known as occasional smokers). Determined from the response to the question “At the present time do you smoke cigarettes every day, occasionally, or not at all?”
Daily smoker: refers to those who respond “every day” to the question “At the present time do you smoke cigarettes every day, occasionally or not at all?”
Non-daily smoker: often referred to as “occasional” smoker, refers to those who respond “Occasionally” to the question “At the present time do you smoke cigarettes every day, occasionally or not at all?”
Former smoker: was not smoking at the time of the interview, however, answered “YES” to the question “Have you smoked at least 100 cigarettes in your life?”
Ex-smoking’ refers to someone who has smoked more than 100 cigarettes in their lifetime but has not smoked in the last 28 days. The international convention is to treat someone as an ex-smoker once they have been smokefree for one month (at least 28 days). (Statistically, the risk of relapse reduces dramatically after 12 month)
Short term quitter: former smoker who quit smoking less than one year prior to the survey. Determined by the response to the question “When did you stop smoking? Was it less than 1 year ago, 1 to 2 years ago, 3 to 5 years ago, or more than 5 years ago?”
Long term quitter: former smoker who quit smoking a year or more ago and has not resumed smoking during that time frame. Determined by the response to the question “When did you stop smoking? Was it less than 1 year ago, 1 to 2 years ago, 3 to 5 years ago, or more than 5 years ago?”
Ever-smokers: current and former smokers combined.
Never-smoker: was not smoking at the time of the interview and answered “NO” to the question “Have you smoked at least 100 cigarettes in your life?”
Non-smokers: former smokers and never-smokers combined.
Light smoker: a smoker who reports consuming between 1-10 cigarettes per day.
Moderate smoker: a smoker who reports consuming between 11-19 cigarettes per day.
Heavy smoker: a smoker who reports consuming 20 cigarettes or more per day.
People who smoke may respond in all kind of ways when asked if they smoke. Occasional smoking might mean once a week, in which case they would be defined as current smokers (assuming they have smoked more than 100 cigarettes in their lifetime).
People who define themselves as social smokers often only smoke when they are out socialising, but they may do this at least once a week
Scenarios to define smokers
| Scenario | Defined as |
| 50-year-old, currently smoking 10 cigs per day, recently cut down from 20 | Currently smoking |
| 30-year-old ‘social smoker’ – smoking at most on 4 days per month, up to 5 cigarettes on each occasion. Has been smoking like this for 10 years. | Currently smoking |
| 17-year-old, tried smoking 2 cigarettes | Never smoked |
| 25-year-old, smoked occasionally at university, but never more than 100 cigarettes | Never smoked |
| 40-year-old, used to smoke 20 cigs per day, gave up 5 years ago | Ex-smoking for more than 1 year |
| 30-year-old, smoked socially at university (more than 100 cigarettes), but has not smoked for the last 6 years | Ex-smoking for more than 1 year |
| 36-year-old who admits to smoking a cigar ‘every now and then’ (less than once a year) and has never smoked cigarettes. | Never smoked |
| 60-year-old, smokes the ‘occasional cigar’ (2–3 times per month), gave up smoking cigarettes daily 3 years ago. | Currently smoking |
| 32-year-old, ‘occasional smoker’ (smokes 1–2 times per year, last cigarette 6 months ago). Has not smoked more than 20 packets in lifetime. | Ex-smoking for less than 1 year |
Types of Cigarettes
- Bidi: Small, thin, hand-rolled cigarettes imported to the United States primarily from India and other Southeast Asian countries. Bidis contain tobacco and can be flavored. When smoked, bidis have higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States.
- Cigarette: A thin cylinder of ground or shredded tobacco that is wrapped in paper, lit, and smoked.
Other Tobacco Products that are Smoked
- Cigar: A tube of tobacco that is thicker than a cigarette, wrapped in tobacco leaf, lit, and smoked. Cigars include regular cigars, cigarillos, and little filtered cigars.
- Hookah: Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon. Also called water pipes.
- Pipe: A tube with a small bowl at one end that is filled with tobacco, lit, and smoked.
Smokeless Tobacco Products
- Chewing tobacco: A type of shredded or twisted smokeless tobacco that the user keeps in his or her mouth, between the cheek and gum.
- Dip: Dipping tobacco (so called because users dip their fingers into the package to pinch a portion to insert into the mouth) is moist ground tobacco placed between the lower lip or cheek and the gums; it is not used nasally.
- Dissolvables: Dissolvables are finely ground tobacco pressed into shapes such as tablets, orbs, sticks, or strips and slowly dissolve in the mouth.
- Snuff: Finely ground smokeless tobacco usually sold in round cans. Can be placed between the check and gum or may be sniffed.
- Snus: Moist snuff packaged in ready-to-use pouches that resemble small tea bags Pouch is placed between cheek or teeth and gums; does not require spitting
Heated tobacco products (HTPs)
HTPs are, like all other tobacco products, inherently toxic and contain carcinogens. They should be treated like any other tobacco product when it comes to setting policies. HTPs produce aerosols containing nicotine and toxic chemicals upon heating of the tobacco, or activation of a device containing the tobacco. The aerosols are inhaled by users during a process of sucking or smoking involving a device. They contain the highly addictive substance nicotine, non-tobacco additives and are often flavoured.
In recent years, HTPs have been promoted as reduced harm products or products that can help people quit conventional tobacco smoking. HTPs expose users to toxic emissions, many of which cause cancer and currently there is not enough evidence to suggest that they are less harmful than conventional cigarettes. There is also insufficient evidence at present on the effects of second-hand emissions produced by HTPs, though the emissions from these products contain harmful and potentially harmful chemicals
E-cigarettes
Electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS), commonly referred to as e-cigarettes, are devices which heat a liquid to create an aerosol which is then inhaled by the user. These may or may not contain nicotine. The main constituents of the solution by volume are propylene glycol, with or without glycerol, and flavouring agents. E-cigarettes do not contain tobacco but are harmful to health and are not safe. However, it is too early to provide a clear answer on the long-term impacts of using them or being exposed to them.
E-cigarettes are particularly risky when used by children and adolescents. Nicotine is highly addictive and young people’s brains develop up to their mid-twenties.
ENDS use increases the risk of heart disease and lung disorders. They also pose significant risks to pregnant women who use them, as they can damage the growing fetus.
Quitting tobacco
When tobacco users become aware of the dangers of tobacco, most want to quit. However, nicotine contained on tobacco products is highly addictive and without cessation support only 4% of users who attempt to quit tobacco use will succeed. Professional support and proven cessation medications can more than double a tobacco user’s chance of successful quitting.