The impact of tobacco and alcohol use on NCD prevalence: a review 

01 Sep 2021
Xinqi Yuan

The impact of tobacco and alcohol use on NCD prevalence: a review 

The purpose of this article is to articulate the impact of high-risk behaviours including smoking and alcohol use on the prevalence of non-communicable diseases (NCDs) by conducting a rapid review. The studies included are searched from several databases such as PubMed, MEDLINE as well as the WHO website. Only literature published after 2015 was used.  


The impact of tobacco use on NCD prevalence 

Non-communicable diseases (NCDs) tend to be of long duration, and are the result of a combination of genetic, physiological, environmental and behavioural factors. The main types of NCDs include cardiovascular diseases, chronic respiratory diseases and diabetes. According to the WHO in 2021, NCDs account for 71% of mortality worldwide, causing 41 million deaths each year.

One of the chief risk factors of NCDs is tobacco use, which accounts for over 8.7 million deaths every year, while over 1.2 million deaths are the result of non-smokers being exposed to second-hand smoke (Ritchie and Roser, 2021). In 2017, one fifth of the population of China, Denmark, Netherlands, Greece, Bosnia and Greenland died from smoking.

There are 1.3 billion tobacco users worldwide in 2021, and 80% of those are from low- and middle-income countries (LMICs). In recent years, the tobacco industry has increasingly turned its focus toward emerging market in LMICs, as LMICs do not have such strict policies against tobacco use and their demographics are different, with larger proportional youth populations (Delobelle, 2019). From 1990 to 2017, the death rates from smoking have declined in most of developed countries from 146 per 100,000 people to 90 per 100,000 people. Meanwhile, deaths caused by tobacco use have been increasing in the LMICs.  


What makes smoking so dangerous?

Cigarette smoking is highly addictive and harmful to our health because tobacco contains many cancer-causing toxins such as nicotine, tar and carbon monoxide (Cancer Research UK, 2021). Nicotine is a stimulant drug that speeds up the messages travelling between the brain and body. A long–term use of nicotine may eventually cause diseases including stroke, coronary heart disease, pneumonia, respiratory disease, diabetes, etc. Tar is a sticky-brown substance that collects in lungs when the smoker breathes in cigarette smoke, and it can largely increase the risk of lung cancer and other lung diseases such as emphysema and chronic obstructive pulmonary disease (COPD). Carbon monoxide is a poisonous gas that stops the blood from carrying as much oxygen, which means the heart need to work harder to provide more oxygen, leading to potential risk of heart disease and stroke. 


What about vaping?

According to the WHO (2021), all forms of tobacco use are harmful, including cigarette smoking, waterpipe tobacco, cigars, and electronic cigarettes. Having first entered the market in 2007, e-cigarettes have evolved and become more popular than ever, especially among teenagers due in part to the various flavours available. From 2019 to 2020, the usage of e-cigarettes among high school students increased from 2.4% to 26.55%, and 10.9 million US adults reported using e-cigarettes in 2019 (Truth initiative, 2021). However, e-cigarettes contain nicotine and other toxic substances, and exposure to nicotine can have long-lasting, damaging effects on the brain development of children and adolescents (WHO, 2020). Moreover, a number of teenagers have reported signs of severe dependence, such as inability to concentrate in class, using an e-cigarette upon waking, and using e-cigarettes at night after waking with a craving. Up to Jan 21, 2020, the Centers for Disease Control and Prevention (CDC) has confirmed 60 deaths in patients with e-cigarettes using. 



Cancer Research UK. (2021) What’s in a cigarette? Available at: [Accessed 6 August 2021] 

Delobelle, P. (2019) Big tobacco, alcohol, and food and NCDs in LMICs: An Inconvenient Truth and Call to Action. International Journal of Health Policy and Management. 8(12), pp.729-731. 

Truth Initiative. (2021) E-cigarattes: Facts, stats and regulations. Available at: [Accessed 20 August 2021] 

WHO. (2021) Noncommunicable disease. Available at: [Accessed 6 August 2021] 

WHO. (2020) Tobacco: E-cigarettes. Available at: [Accessed 20 August 2021] 

Ritchie, H and Roser, M. (2021) Smoking. Available at: [Accessed 6 August 2021]