Tobacco in Cambodia: One in Five Men Smoke, and the Northeastern Highlands Lead the Way

A study published in Advances in Public Health offers the most detailed portrait yet of tobacco use among Cambodian men, revealing deep geographic and social disparities — and a tight link with alcohol.

A man in Ratanakiri province, northeastern Cambodia — a region where tobacco prevalence exceeds 39%.

Twenty-one percent. That's the share of Cambodian men aged 15 to 49 who currently use tobacco in some form. The figure, drawn from a new analysis of the Cambodia Demographic and Health Survey (CDHS) 2021–2022, was just published by a team of Cambodian and Belgian researchers led by Samnang Um of the National Institute of Public Health in Phnom Penh. Nearly 8,825 men were interviewed as part of this large national survey, one of the most reliable sources on health behavior in Cambodia.

The overall finding is no surprise: tobacco remains a major public health scourge across Southeast Asia. But the details of the study are worth pausing on — they sketch a map of the country where smoking follows almost exactly the lines of poverty, isolation, and limited education.

The Northeast, Epicenter of Smoking

The most striking fact in this study is geographic. While tobacco prevalence falls below 10% in Phnom Penh, it climbs above 40% in Stung Treng province, and past 39% in Mondulkiri and Ratanak Kiri — three mountainous northeastern provinces home to much of the country's indigenous population. Preah Vihear follows closely, with more than a third of men affected.

These same provinces also post the highest rates of chewing or snuff tobacco, a practice otherwise marginal nationwide (under 1% on average). Researchers attribute this to cultural norms specific to indigenous communities, combined with limited access to health information and harsher rural living conditions.

A Profile Emerges

Beyond geography, the study identifies a cluster of factors that statistically raise the risk of tobacco use. Unsurprisingly, age plays a role: the older a man gets, the more likely he is to smoke, with odds nearly quadrupling among 40–49 year-olds compared to 15–18 year-olds.

But education emerges as the most powerful lever. Men with no formal schooling show a smoking rate above 50%, compared to under 2% among those with higher education. Working in agriculture or manual labor nearly doubles the odds of smoking compared to not working, while belonging to the poorest households is associated with markedly higher rates than in the wealthiest ones. In other words, tobacco use in Cambodia isn't just a matter of individual habit — it's a social marker.

One detail stands out: owning a smartphone and using the internet daily appears linked to lower odds of smoking — a signal, the authors note, of how important access to health information is for prevention.

Tobacco and Alcohol, the Same Terrain

One of the study's major contributions is documenting, with hard numbers, what many health professionals already suspected: in Cambodia, tobacco and alcohol move together. The more frequently a man drinks, the higher his risk of smoking — a "dose-response" relationship that holds consistently: the odds of tobacco use nearly quadruple among daily drinkers compared to non-drinkers.

For the researchers, this points to the need for integrated public policy. Cambodia already has a fairly solid legal framework against tobacco — ratification of the WHO Framework Convention in 2005, the 2015 anti-tobacco law, a ban on smoking in tourism establishments — but alcohol regulation remains far less developed. The study suggests the country could draw on its own tobacco-control successes — advertising restrictions, plain packaging, higher taxation — to build an equivalent framework for alcohol.

A Target Still Far Off

Cambodia had set itself the goal, between 2018 and 2027, of reducing tobacco prevalence among adults by 30%. Reading this study, that target still looks distant — particularly in rural and mountainous areas where the most vulnerable populations are concentrated.

The authors call for targeted awareness campaigns in the northeastern provinces and among agricultural and manual workers, for anti-tobacco education to be built into school curricula, and for interventions that address tobacco and alcohol together rather than as separate problems. A reminder that, behind the statistics, this is a battle against social inequality as much as against addiction.

Sources : Um, S., Supheap, L., Chamroen, P., Sieng, C., Heng, S., & Ku, G. M. (2026). Sociodemographic Correlates of Tobacco Use Among Cambodian Men Aged 15–49 Years: Evidence From the Cambodia Demographic and Health Survey 2021–2022. Advances in Public Health, 2026:1205397.