By Dr Aung Tun
1.Introduction
Every year on 31 May, the world observes World No Tobacco Day (WNTD), a global campaign led by the World Health Organization (WHO) to raise awareness of the devastating health consequences of tobacco use and to advocate for effective policies to reduce tobacco consumption.
The theme for WNTD 2026 is “Unmasking the Appeal — Countering Nicotine and Tobacco Addiction” — a powerful call to expose the evolving strategies of the tobacco and nicotine industry and to advance policies that protect young people and communities from addiction.
The 2026 campaign focuses on three core objectives: exposing the tobacco and nicotine industry’s strategies — including the use of synthetic nicotine, nicotine salts, and analogues designed to enhance addiction potential while being marketed as innovative or less harmful; promoting stronger policy action through bans on flavours, advertising and promotion (including digital and social media), and stricter regulation of packaging and product design that increase youth appeal; and empowering youth and the public by providing knowledge and tools to recognize and resist industry influence, while ensuring access to evidence-based cessation support.
Tobacco use remains the world’s single largest preventable cause of death, killing more than eight million people every year. With the global tobacco and nicotine industry aggressively targeting youth through e-cigarettes, flavoured nicotine products, and social media campaigns, countering addiction at its source has never been more urgent.
2. What Is Tobacco?
Tobacco is a plant-based product that contains nicotine, a highly addictive substance. When tobacco leaves are burned, smoked, chewed, or heated, they release a toxic mixture of more than 7,000 chemicals, at least 250 of which are known to be harmful and more than 70 of which can cause cancer. Tobacco is consumed in many forms — cigarettes, cigars, bidis, pipes, smokeless tobacco (such as chewing tobacco and snuff), heated tobacco products (HTPs), and electronic cigarettes (e-cigarettes or ENDS).
Nicotine, the primary addictive chemical in tobacco, activates the brain’s reward system by stimulating the release of dopamine, creating a cycle of dependence. Once addicted, users find it extremely difficult to quit, even when confronted with severe health consequences.
This addiction potential is precisely why the tobacco industry has long targeted young people – early initiation leads to lifelong dependency and profit. Electronic cigarettes – battery-powered devices that heat a liquid to produce an aerosol – are the tobacco industry’s newest vehicle for recruiting young users. Marketed as ‘safer’ or as smoking cessation tools, e-cigarettes deliver nicotine along with a cocktail of toxic chemicals, including formaldehyde, acrolein, and glycerin decomposition products, many of which are classified as known or probable carcinogens by the International Agency for Research on Cancer (IARC).
3.The Global Burden of Tobacco
Tobacco use is one of the world’s greatest public health challenges. According to the WHO Global Tobacco Epidemic Report 2023, tobacco kills more than 8 million people each year, accounting for nearly one-sixth of all global deaths.
More than 80 per cent of the world’s 1.3 billion tobacco users live in low- and middle-income countries, where the burden of tobacco-related disease and economic loss falls most heavily on the poorest and most vulnerable populations. The health consequences of tobacco use are devastating and wide-ranging. Tobacco causes lung cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease, stroke, and numerous other cancers affecting the mouth, throat, oesophagus, stomach, kidney, cervix, and bladder.
According to the Myanmar STEPS Survey 2024, 23.3 per cent of adults currently smoke tobacco, with male prevalence (40.9 per cent) far exceeding female prevalence (2.9 per cent). According to the WHO Global Tobacco Survey (GYTS) 2016 report, among youths, 30 per cent of boys and 8.5 per cent of girls smoked cigarettes. The global rise of e-cigarette use represents a new and alarming dimension of the tobacco epidemic. The estimated global e-cigarette market attracted 82 million users by 2021, up from 68 million in 2020 — a 20.6 per cent increase in a single year.
Market analysts project the global ENDS industry to reach US$55 billion in annual revenue by 2030, driven by aggressive expansion into developing markets across Asia, Africa, and Latin America. Children are being deliberately recruited as the next generation of nicotine-dependent consumers.
4. Myanmar’s Tobacco Situation
The most current and comprehensive picture of tobacco use in Myanmar comes from the Myanmar STEPS Survey 2024 — a population-based survey of NCD risk factors conducted from 10 November to 12 December among 8,252 adults aged 18-69 years (response rate 97.9 per cent), carried out by the Ministry of Health, Myanmar.
The survey provides updated national estimates across tobacco use, alcohol consumption, diet, physical activity, and key biometric indicators.
Key tobacco findings from the Myanmar STEPS Survey 2024 include:
• Current tobacco smoking prevalence: 23.3 per cent of adults aged 18-69 years currently smoke tobacco (males 40.9 per cent; females 2.9 per cent), representing a notable reduction from the 2014 STEPS Survey figure of 26 per cent.
• Daily smoking prevalence: 18.1 per cent of adults smoke tobacco daily (males 31.8 per cent; females 2.2 per cent), with 55.4 per cent of daily smokers using manufactured cigarettes.
• Mean cigarettes per day: Among daily smokers, the mean number of manufactured cigarettes smoked per day is 2.7 overall (males 2.8; females 1.1) — with urban daily smokers consuming more (3.5 sticks/ day) than rural smokers (2.2 sticks/day).
• Gender disparity: Tobacco smoking remains overwhelmingly male-dominated. Male prevalence (40.9 per cent) is approximately 14 times higher than female prevalence (2.9 per cent), reflecting deeply entrenched social norms around tobacco use.
• Tobacco types among male daily smokers: Manufactured cigarettes are the most common (mean 2.8/day), followed by hand-rolled cigarettes (mean 0.9/ day), cigars/cheroots/ cigarillos (mean 2.8/ day), and pipes (mean 0.1/day). Shisha use is negligible (0.0 sessions/ day).
• Urban vs rural pattern: Urban male daily smokers consume more manufactured cigarettes (mean 3.5/ day) compared to rural counterparts (mean 2.2/ day), suggesting higher product availability and marketing exposure in urban settings.
While the reduction in overall smoking prevalence from 26 per cent (2014) to 23.3 per cent (2024) reflects positive progress, the absolute burden remains high. The persistently large gender gap – with male smoking rates nearly 14 times higher than female rates — highlights the need for targeted cessation interventions for adult males. The continued use of traditional tobacco products such as hand-rolled cigarettes and cheroots, especially in rural areas, underscores the complexity of Myanmar’s tobacco landscape.
E-cigarette use among Myanmar youth, which rose from 6.8 per cent in 2011 to 8.3 per cent in 2016 per the Global Youth Tobacco Survey (GYTS), is likely to have accelerated further given the global proliferation of cheap disposable vapes before Myanmar’s comprehensive ENDS ban in December 2024. The social and economic costs of tobacco-related illness continue to place a heavy strain on Myanmar’s health system.
The STEPS 2024 data provide an essential evidence base for calibrating national tobacco control policies, including the enforcement of the plain packaging mandate and the newly enacted e-cigarette ban, and for directing cessation support where it is most needed.
5. Health Risks of Tobacco and E-Cigarettes
Tobacco causes irreversible harm across nearly every organ system in the body. Key health risks include: • Lung cancer and other respiratory cancers – tobacco smoke contains at least 70 carcinogens and is the leading cause of lung cancer globally.
• Cardiovascular disease — smoking accelerates atherosclerosis, greatly increasing the risk of heart attack and stroke.
• Chronic Obstructive Pulmonary Disease (COPD) — a progressive, incurable lung disease that severely impairs breathing.
• Brain development impairment in adolescents – nicotine harms the developing brain, reducing concentration and learning abilities.
• Second-hand smoke exposure — endangers non-smokers, particularly children and pregnant women, causing respiratory illness, ear infections, and sudden infant death.
• E-cigarette-specific risks — respiratory inflammation (bronchiolitis obliterans/’popcorn lung’), cardiovascular stress, and nicotine addiction leading to regular cigarette use.
E-cigarettes are not a safe alternative to conventional cigarettes. While they may produce fewer combustion-related toxins, they still deliver nicotine and numerous harmful chemicals. The WHO and most major health organizations do not recommend e-cigarettes as smoking cessation tools. The flavouring chemicals in e-cigarettes, such as diacetyl, used in buttery flavours, are linked to severe, irreversible obstructive lung disease.
6. Previous and Recent Developments in Myanmar’s Tobacco Control
6.1 Legislative Foundation Myanmar’s tobacco control journey is built on a strong legislative foundation. The Control of Smoking and Consumption of Tobacco Products Law was enacted in May 2006 and subsequently revised in October 2021, introducing comprehensive restrictions on tobacco advertising, promotion, sponsorship, and sale.
The law prohibits the sale of tobacco products to persons under the age of 18 and mandates prominent pictorial health warnings (PHWs) on tobacco packaging. 6.2 From Warnings to Plain Packs: A Landmark Journey Myanmar has made substantial progress in pictorial health warning (PHW) implementation. Following the adoption of the WHO Framework Convention on Tobacco Control (FCTC) in 2004, Myanmar progressively expanded PHW requirements.
By 2016, PHWs were mandated to cover 75 per cent of the front and back of tobacco packaging. By September 2025, Myanmar had become the second country in the Asian region to introduce standardized plain packaging, after Australia (2012), Singapore (2019), and Thailand (2019). Plain packaging removes all branding, logos, and attractive design elements from tobacco packaging, replacing them with a standardized drab brown pack featuring large graphic PHWs covering 75 per cent or more of the surface. Evidence from multiple countries shows that plain packaging is highly effective in reducing the appeal of tobacco products, making health warnings more salient, and discouraging youth from smoking initiation. In Thailand and Singapore, plain packaging combined with large PHWs increased the proportion of smokers reporting they wanted to quit by nearly 80 per cent. Myanmar’s adoption of plain packaging in 2025 represents a landmark achievement that positions the country as a regional leader in tobacco control.
TO BE CONTINUED
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