Countries with the Highest Smoking Rates (2025 Ranked)

Tobacco smoking kills approximately 8 million people per year — making it the world's leading cause of preventable death, more lethal annually than HIV/AIDS, malaria, and tuberculosis combined. The WHO estimates 1.3 billion people currently use tobacco products; roughly 80% of them live in low- and middle-income countries, where the tobacco industry has aggressively redirected its commercial ambitions as wealthy-country markets shrink. The geography of the global smoking epidemic is shifting south and east — not because the science changed, but because the regulatory environment did.

Where this data comes from

The smoking rate statistics and country rankings in this article come from the WHO Global Tobacco Surveillance System (GTSS), reported in the World Health Organization Global Tobacco Report 2023. The GTSS compiles data from national health surveys, household interviews, and Demographic and Health Surveys (DHS) administered by governments and WHO-supported programmes. Data reflects 2022–2023 estimates for most countries, with some countries using 2021 baseline data projected forward using trend analysis. The GTSS covers 187 countries and is the most internationally standardised smoking prevalence dataset available. All figures measure current adult smoking prevalence (any tobacco use, not just cigarettes) among adults aged 15 and older.

Methodology: how smoking rates are measured

Comparing smoking rates across countries requires understanding what is and is not captured by the standard metrics.

The standard measure: The WHO Global Tobacco Surveillance System (GTSS) reports current adult smoking prevalence — the percentage of adults aged 15 and older who currently smoke any tobacco product, including cigarettes, bidis, kreteks, pipes, and waterpipes. Data comes from national health surveys conducted by governments, WHO-supported surveys, and household interview programmes.

Survey frequency and freshness: Not all countries survey at the same frequency. Some high-income countries survey annually; some low-income countries have used the same baseline figure for years. The "2022" data in many WHO tables is, in some cases, a 2018 survey projected forward using trend modelling. Figures should be read as best available estimates, not precise current measurements.

Product coverage matters: A country with high water-pipe (shisha) use but low cigarette use will have dramatically different rates depending on whether the survey includes waterpipes. In several Middle Eastern countries, cigarette rates are moderate but overall tobacco use (including hookah) is significantly higher.

Gender disaggregation is essential: Global aggregate rates obscure enormous gender disparities. In Indonesia, the aggregate adult rate is 39.9%, but male rate is 73% and female rate is 4.5%. A single headline figure conceals two entirely different social phenomena.

Source: WHO Global Tobacco Report 2023, World Health Organization, Geneva. WHO Global Tobacco Surveillance System (GTSS).

Countries with the highest smoking rates

(% of adults who currently smoke any tobacco product, WHO 2022 estimates)

Rank	Country	Total adult rate	Male rate	Female rate
1	Nauru	52.1%	59.3%	44.7%
2	Myanmar	44.1%	68.5%	21.5%
3	Kiribati	44.0%	55.7%	33.9%
4	Tuvalu	43.0%	52.0%	35.0%
5	Indonesia	39.9%	73.0%	4.5%
6	Timor-Leste	38.9%	71.5%	6.2%
7	Jordan	37.5%	60.8%	14.0%
8	Serbia	38.0%	43.4%	33.0%
9	Armenia	36.8%	59.6%	16.1%
10	China	26.6%	50.5%	2.1%
15	Russia	30.3%	43.0%	19.8%
20	Germany	31.7%	35.0%	28.5%
25	Greece	37.0%	42.8%	31.8%
30	France	25.4%	28.9%	22.3%
40	United States	12.5%	14.1%	11.0%
50	United Kingdom	13.3%	14.4%	12.3%
60	Australia	11.0%	12.3%	9.7%
70	Sweden	6.3%	7.0%	5.6%
80	Brazil	12.1%	15.2%	9.4%
90	India	10.5%	19.0%	1.9%

Why these countries lead in smoking rates

The world's highest smoking rates cluster in three distinct geographies. Pacific Island nations (Nauru 52%, Kiribati 44%, Tuvalu 43%) have extremely high rates driven by tobacco colonialism — historical introduction of a foreign product with no prior cultural norms, now embedded in social rituals with minimal regulatory capacity. Southeast Asian countries (Indonesia 39.9%, Myanmar 44.1%) have high rates driven by the tobacco industry's deliberate marketing to growing economies with weak FCTC enforcement and employment dependencies. Russia and Eastern European countries (Russia 30%, Serbia 38%) have high rates rooted in Soviet-era smoking norms, ongoing industry influence, and social transition stress. Notably, wealthy countries with strong regulatory frameworks show declining rates: Australia reduced from 23% (2001) to 11% (2022); the UK from 28% to 13% over a similar period. This pattern demonstrates smoking rates are responsive to policy — taxation, advertising bans, plain packaging, and cessation support all work. The countries with the highest rates are those with weak regulatory capacity, strong industry influence, or both.

Historical context: how tobacco conquered the world

The global tobacco epidemic is not a natural occurrence — it is the result of deliberate commercial strategy over more than a century.

The industrialisation of cigarettes (1880s): Before James Bonsack's cigarette-rolling machine (1880), cigarettes were hand-rolled and expensive. The machine dropped production costs by 97% and enabled the mass market. James Buchanan Duke used it to build the American Tobacco Company, pioneering modern advertising techniques to create demand for a product most people had never previously used.

The doctors-smoke era (1930s–1950s): By the 1930s, tobacco companies were running advertisements featuring physicians — "More doctors smoke Camels than any other cigarette" was a widely run campaign by R.J. Reynolds. Medical endorsements manufactured credibility for a product whose link to lung cancer was already being established in epidemiological research.

The 1964 Surgeon General's Report: The US Surgeon General Luther Terry released the first official US government report linking smoking to lung cancer in January 1964. It acknowledged approximately 7,000 scientific studies. The report triggered the first wave of regulatory action in high-income countries — advertising restrictions, health warning labels, eventual indoor smoking bans.

The industry's strategic pivot (1990s–2000s): As high-income country markets declined under regulation and cultural change, major tobacco companies acquired local brands, lobbied against regulation, and redirected marketing toward Southeast Asia, Sub-Saharan Africa, and the Middle East. Internal industry documents (released through litigation) showed explicit strategies to target young people and women in markets with weaker regulatory environments.

The Framework Convention on Tobacco Control (FCTC, 2003): The first global public health treaty, the WHO FCTC established an international framework for tobacco control requiring signatory countries to ban tobacco advertising, establish smoke-free public places, require graphic health warnings, restrict tobacco sales to minors, and increase tobacco taxes. As of 2023, 182 countries are parties — but implementation and enforcement vary enormously. Indonesia notably has not ratified the FCTC.

Source: WHO Framework Convention on Tobacco Control, who.int/fctc; US Department of Health, Education, and Welfare, Smoking and Health: Report of the Advisory Committee to the Surgeon General (1964).

Why Pacific island nations lead the global smoking rate

Nauru, Kiribati, and Tuvalu — the world's top three smoking rate nations — are tiny Pacific island states with populations of under 120,000 combined. Their extreme rates reflect specific historical and social dynamics that differ fundamentally from the large-nation tobacco story.

Tobacco colonialism: Pacific island populations had no historical exposure to tobacco before European contact. Tobacco was introduced by traders, missionaries, and colonial administrators in the 18th and 19th centuries — presented as a gift, traded for labour, embedded in social exchange rituals before any health consequences were understood.

The social embedding problem: In small, tight-knit island communities, smoking became embedded in social rituals — offering cigarettes as hospitality, sharing cigarettes in communal settings, smoking as a marker of adulthood and social belonging. These norms are far more difficult to dislodge through individual health messaging than in anonymous urban environments.

Regulatory capacity: Micro-states with populations of 10,000–100,000 have very limited regulatory infrastructure. Health ministries are small; enforcement resources are minimal; tobacco companies that face aggressive regulation in wealthy markets can operate in Pacific countries with comparatively little resistance.

Non-communicable disease crisis: The Pacific's tobacco epidemic intersects with a broader NCD (non-communicable disease) crisis — high rates of obesity, diabetes, and cardiovascular disease compound the tobacco burden. Pacific island nations have some of the world's highest NCD mortality rates relative to population.

Source: Pacific Community (SPC) Pacific Non-Communicable Disease Data portal; WHO Western Pacific Region Tobacco Report.

Indonesia: the cigarette republic in depth

Indonesia's tobacco situation is one of the most studied in global public health precisely because it combines extraordinary prevalence with structural political impediments to change.

Kretek cigarettes — a national product: Indonesia's distinctive contribution to global tobacco is the kretek — a clove-infused cigarette that delivers nicotine alongside eugenol from the cloves, which provides a mild local anaesthetic sensation in the throat, making smoking feel smoother. Kretek accounts for over 90% of Indonesian cigarette consumption and is marketed — accurately — as Indonesian cultural heritage. The largest kretek companies, including Djarum and Gudang Garam, are among Indonesia's most powerful corporations with deep political connections.

Industry employment as political shield: Indonesia's tobacco supply chain employs approximately 6 million workers in farming, processing, and distribution. This employment base creates a political constituency that any government proposing significant tobacco control must confront. When Indonesia's parliament has considered FCTC ratification, the industry mobilises these workers — and their regional representatives — as opposition.

Youth targeting and initiation age: Indonesia's tobacco industry markets heavily to young people — sponsoring music events, football sponsorships, and digital campaigns designed to reach adolescents. The average age of smoking initiation in Indonesia is approximately 12–13 years. Indonesia's 2018 National Basic Health Survey found that among 10–18 year-olds, 9.1% smoked — a figure that has risen from previous surveys.

The female taboo: Indonesian women smoke at only 4.5% — one of the world's lowest female rates. This is not a health outcome; it reflects cultural stigma where female smoking is considered shameful and incompatible with femininity and maternal roles. The same social norms that produce near-universal male smoking consider female smoking a moral transgression. Public health researchers track female rates carefully: if the stigma erodes (as it has historically in Western countries), female rates could rise sharply.

Source: Indonesian Ministry of Health, National Basic Health Survey (Riskesdas) 2018; Campaign for Tobacco-Free Kids, "Indonesia" country profile.

China: 300 million smokers and the state monopoly paradox

China's 300 million smokers represent roughly one-third of the world's total smoking population — a number large enough to distort global statistics regardless of what happens in every other country.

The China National Tobacco Corporation conflict: The world's largest tobacco company is a Chinese state monopoly. CNTC produces and sells approximately 40% of the world's cigarettes. The Chinese government simultaneously runs anti-smoking campaigns and derives approximately 10% of central government tax revenue from tobacco. This fundamental conflict of interest — the health ministry fighting a product the finance ministry depends on — has constrained Chinese tobacco policy for decades.

Cigarettes as social currency: In China, cigarette gifting is embedded in social and professional relationships. Offering cigarettes is an act of hospitality and respect; sharing cigarettes at a meeting or meal signals friendship. Refusing to smoke or offer cigarettes can cause social offence in contexts where hierarchy and face are paramount. This cultural embedding makes behavioural change campaigns far less effective than in societies where smoking has been de-normalised.

Smoke-free space enforcement: China has formal smoke-free laws for certain indoor public spaces, but enforcement is inconsistent and restaurant, bar, and workplace compliance is low in many cities. Beijing and Shanghai have implemented stronger local policies with more active enforcement; smoking in offices and restaurants remains common in smaller cities.

The male-female divergence: Chinese women smoke at 2.1% — among the world's lowest. The female rate in China is driven almost entirely by cultural stigma similar to Indonesia's. Chinese public health researchers note that as social norms around gender become more liberal, female smoking could follow the trajectory of 20th-century Western countries, where female rates rose sharply once the social taboo weakened.

Youth trends as leading indicator: Younger Chinese men (18–30) are smoking less than previous generations — a genuinely encouraging trend. Awareness of health risks, urbanisation, rising incomes that shift status signalling from cigarettes to other goods, and growing social acceptability of not smoking in cities are all contributing. Whether this youth trend translates to population-level declines depends on whether it is offset by rural areas.

Source: China National Health Commission; Yang, G. et al. (2015). "Smoking in China: Findings of the 2010 Global Adult Tobacco Survey." New England Journal of Medicine, 372(25).

Where smoking is declining fastest: the policy toolkit

The most successful tobacco reduction efforts share a consistent set of interventions, proven across multiple national contexts.

Australia — the plain packaging laboratory: Australia became the first country to mandate standardised packaging in December 2012. All cigarettes must be sold in identical dark olive-green packs with large graphic health warnings covering 75% of the front and 90% of the back, with no brand imagery, colours, or logos beyond the brand name in a standardised font. Smoking rates fell from 23% (2001) to 11% (2022). The tobacco industry challenged the law at the World Trade Organisation and the High Court — and lost both times. Australia also implements annual tobacco excise increases tied to average wages, pushing cigarette prices to approximately AUD $40 per pack — among the world's highest.

United Kingdom — the comprehensive regulatory model: The UK's approach layered interventions over two decades: tobacco advertising ban (2003), public place smoking ban (2007), tobacco display ban at point of sale (2012), plain packaging (2017). The smoking rate fell from 28% (2000) to approximately 13% (2023). The NHS funds stop-smoking services and regulates e-cigarettes as cessation tools — a distinctive approach. Prime Minister Rishi Sunak proposed in 2023 to create a "smoke-free generation" barring anyone born after 2009 from ever purchasing tobacco — legislation that passed the House of Commons.

Sweden — the snus substitution model: Sweden has the world's lowest smoking rate among medium-to-large countries at 6.3%, achieved through a specific pathway: Swedish snus (a moist oral tobacco product placed under the lip) is far more popular than cigarettes in Sweden and is widely used as a smoking alternative. While snus is not risk-free — it carries links to oral cancer and cardiovascular risk — it is substantially less harmful than combustible cigarettes. Sweden's experience is cited in debates over tobacco harm reduction: allowing less-harmful substitutes can reduce combustible tobacco mortality even without eliminating nicotine use.

New Zealand — the generational ban experiment: In 2022, New Zealand passed legislation creating a "smoke-free generation" policy prohibiting the sale of tobacco to anyone born after January 1, 2009, intended to create a cohort that would never legally purchase cigarettes. The law also planned to reduce the number of tobacco retailers from approximately 8,000 to 600. The incoming National-led coalition government reversed the policy in 2023 on civil liberties grounds and to generate tobacco tax revenue — a cautionary tale about the political durability of aggressive tobacco policy.

Source: Australian Institute of Health and Welfare, Tobacco Smoking: Australian Institute of Health and Welfare, 2023; UK Office for National Statistics, Adult Smoking Habits in the UK, 2023; WHO MPOWER Report 2023.

Tobacco's economic burden: the cost-benefit reality

Q: What is the economic cost of tobacco globally? A: The WHO estimates the global economic cost of tobacco — combining healthcare expenditures and lost productivity — at approximately $1.4 trillion per year, equivalent to roughly 1.8% of global GDP. This exceeds the tobacco industry's total global revenue of approximately $900 billion annually, meaning tobacco is a net economic negative for the world even before accounting for individual suffering. Low-income countries bear a disproportionate share of healthcare costs while capturing a smaller share of revenue.

Q: Are e-cigarettes safer than combustible cigarettes? A: E-cigarettes (vapes) deliver nicotine through aerosol without combustion, eliminating most of the harmful byproducts of burning tobacco — tar, carbon monoxide, and most carcinogenic particles. Public Health England's 2015 estimate that vaping is "approximately 95% less harmful than smoking" has been widely cited, though it has also been contested. The long-term health effects of vaping are still under active research; major respiratory and cardiovascular concerns have emerged, particularly for products not regulated for quality. The current scientific consensus among tobacco researchers is that switching from cigarettes to regulated e-cigarettes substantially reduces health risk for existing smokers — while initiating non-smokers, particularly adolescents, on nicotine addiction is a separate and genuine harm.

Q: Why do tobacco companies target low-income countries? A: As high-income country smoking rates decline under regulation, taxes, and cultural change, tobacco companies have systematically redirected commercial focus to countries with weaker regulatory environments. Sub-Saharan Africa, Southeast Asia, and the Middle East have seen tobacco marketing intensify as companies seek replacement growth. This strategy — documented in internal industry documents released through US litigation — includes targeting women and young people in markets where female and youth smoking remains low but social norms are shifting. The FCTC was designed partly to limit this regulatory arbitrage.

Q: Does tobacco tax work? A: Tobacco taxation is among the most evidence-based public health interventions available. WHO evidence indicates that a 10% price increase in tobacco reduces consumption by approximately 4% in high-income countries and 5% in low-income countries. Young people and lower-income smokers are most price-sensitive — which means high taxes both reduce smoking and shift its social distribution. The challenge is political: tobacco taxes are visible, affect consumers directly, and generate organised opposition from the industry and, in some contexts, from smokers who perceive them as regressive. Countries that have maintained consistent tax escalation (Australia, Norway, UK) have seen the strongest consumption declines.

Q: What is the health impact of second-hand smoke? A: Second-hand smoke (SHS) — the smoke exhaled by smokers and emitted from the burning end of cigarettes — contains over 70 known carcinogens. The WHO estimates second-hand smoke kills approximately 1.3 million people per year who have never themselves smoked. Children exposed to second-hand smoke have higher rates of sudden infant death syndrome (SIDS), respiratory infections, and asthma. Public place smoking bans were justified primarily on the grounds of protecting non-smokers from this involuntary exposure.

Q: What tobacco product is the most harmful? A: Combustible tobacco — products where tobacco is burned and the smoke inhaled — is the most harmful form. Cigarettes, bidis (hand-rolled cigarettes common in South Asia), kreteks, and pipes all involve combustion and deliver the full range of harmful byproducts. Smokeless tobacco (snus, chewing tobacco, snuff) is associated with oral cancers and cardiovascular risk but is substantially less harmful than combustible products. Waterpipes (hookah/shisha), despite a perception of being harmless, deliver similar levels of carcinogens as cigarettes in a single session — the water filtration does not remove most toxins.

Source: WHO, Global Tobacco Report 2023; US CDC, Health Effects of Secondhand Smoke; IARC Monographs on the Carcinogenicity of Tobacco Products.

What the trends mean

The global pattern is a tale of two trajectories. In wealthy, well-governed countries with strong public health infrastructure, smoking rates are falling consistently — driven by taxation, plain packaging, advertising bans, and shifting social norms where smoking is increasingly seen as neither glamorous nor normal. The UK, Australia, Sweden, and the United States have cut their rates by half or more in the past three decades.

In low- and middle-income countries, the trajectory is flatter or still rising in some cases. The tobacco industry's investment in markets like Indonesia, the Philippines, and Sub-Saharan Africa reflects a long-term commercial calculation: build addiction among young populations before regulation arrives. The FCTC provides the policy framework; the challenge is political will and enforcement capacity.

The human cost of the current distribution is not abstract. Of the 8 million tobacco deaths per year, over 80% occur in low- and middle-income countries. The citizens of Nauru, Myanmar, and Indonesia — who smoke at rates that would have been recognised as public health crises in 1960s America — are experiencing what wealthy nations took three decades and trillions in healthcare costs to begin to reverse. For the individual-level picture of how cancer risk can be reduced, see what the science says about cancer prevention.

Source: WHO Global Tobacco Report 2023; Institute for Health Metrics and Evaluation (IHME), Global Burden of Disease 2019.

The takeaway

Tobacco kills more people annually than any other preventable single cause — 8 million deaths, 80% in low-and-middle-income countries, each one documented in global epidemiology and each one preventable with known interventions. The tools that work are not secret: tobacco taxes, advertising bans, plain packaging, public place restrictions, and smoking cessation support have cut rates dramatically wherever implemented consistently. The reason smoking persists at 52% in Nauru, 73% among Indonesian men, and 300 million Chinese is not ignorance of the science. It is the interaction of cultural embedding, industry political power, weak regulatory capacity, and government revenue dependence — forces that public health evidence, by itself, cannot overcome. The gap between knowing what works and deploying it at scale is where the 8 million annual deaths live.

---

Read next:

• Countries with the Highest Obesity Rates
• Countries with the Best Healthcare Systems
• Countries with the Highest Suicide Rates
• Countries with the Most Alcohol Consumption
• Countries with the Longest Life Expectancy