Tobacco Risk Awareness Stagnates Despite Global Efforts

Key Summary

• • A global analysis of more than 240,000 adults who smoke across 46 countries found little improvement in tobacco risk awareness over the past two decades.
  • While over 90% recognized that smoking causes lung cancer, awareness of cardiovascular disease, heart attack, stroke, and secondhand smoke (SHS) risks remained substantially lower.
  • Knowledge levels varied across countries, with several reporting declining awareness despite ongoing tobacco control efforts.
  • Researchers recommend stronger health warnings, public education campaigns, and smoke-free policies to improve awareness of cardiovascular risks associated with tobacco use.

• For more updates in Cardiovascular Risk or Stroke Care, register for the ISCC2026

Tobacco Risk Awareness Shows Minimal Improvement Over 20 Years

Although tobacco control initiatives have expanded worldwide, tobacco risk awareness among adults who smoke has changed very little over the past two decades, according to a new study published in BMJ Open. The findings, based on data from more than 243,000 adults participating in the International Tobacco Control (ITC) Project and the Global Adult Tobacco Survey (GATS), suggest that many smokers continue to underestimate the cardiovascular consequences of tobacco use and secondhand smoke exposure.

Researchers analyzed survey responses collected between 2002 and 2022 from 46 countries. While awareness that smoking causes lung cancer remained consistently high, knowledge about its association with heart disease, heart attack, stroke, and secondhand smoke-related cardiovascular disease lagged significantly behind.

The findings are particularly important for healthcare professionals because cardiovascular disease remains one of the leading causes of preventable deaths linked to tobacco use worldwide.

What Did the Global Tobacco Surveys Find?

More than 92% of smokers recognized that tobacco smoking causes lung cancer. However, awareness declined when participants were asked about cardiovascular outcomes.

Approximately 85% of respondents in ITC countries and 80% in GATS countries knew smoking could cause heart disease or a heart attack. Stroke knowledge was even lower, with only 75% of ITC participants and 66% of GATS participants identifying smoking as a risk factor.

Awareness of secondhand smoke risks was also inconsistent. Around 77–82% understood that secondhand smoke can cause lung cancer in nonsmokers, while only 62–73% recognized its connection with heart disease or heart attack.

Percentage of adults who smoke who know or believe that smoking causes lung cancer in 25 International Tobacco Control (ITC) Project countries, 2002–2022. 

Researchers also observed considerable variation between countries. Nations including China, Bangladesh, India, and the Netherlands demonstrated improved awareness in selected areas, whereas Germany, France, Japan, New Zealand, Russia, Romania, and Turkey experienced declines for certain tobacco-related health risks.

Overall, average knowledge increased by only 0.14 percentage points annually, indicating virtually no global progress despite years of tobacco prevention campaigns.

Why Cardiovascular Risk Education Needs Greater Attention

The study highlights a persistent knowledge gap surrounding the cardiovascular effects of smoking, even though cardiovascular disease accounts for millions of preventable deaths globally.

Researchers emphasize that comprehensive tobacco control measures, including graphic health warnings, sustained public education campaigns, stronger smoke-free policies, and evidence-based communication strategies, remain essential to improve understanding of both active smoking and secondhand smoke hazards.

The authors also note that awareness alone may not lead to smoking cessation. Effective tobacco control should combine education with supportive environments, cessation resources, and policies that reduce tobacco exposure.

For more updates in Cardiovascular Risk or Stroke Care, register for the ISCC2026

For clinicians, nurses, public health professionals, and policymakers, these findings reinforce the need to consistently discuss cardiovascular risks during tobacco cessation counseling, rather than focusing solely on lung cancer.

Source:

BMJ