On World No Tobacco Day 2026, Economics for Health joins with our tobacco control community to recognize the progress towards reducing tobacco use over the last several decades. Cigarette consumption, specifically, is on the decline in much of the world due to concerted efforts to deter smokers with both price and non-price measures. At the same time, many other tobacco and nicotine products are trending in the opposite direction, following a targeted push from the industry—especially toward kids—to expand the market using both price and non-price strategies. These include heated tobacco products, e-cigarettes, and nicotine pouches, which are cheaper and less regulated in many countries compared to cigarettes. Such policy gaps threaten public health, in addition to raising health care spending and decreasing tax revenue collection at a time of critical budgetary shortfalls.

Below, we explore findings from our think tank partners related to emerging tobacco and nicotine products in low- and middle-income countries and explore opportunities for a more effective policy approach. 

Eastern Mediterranean

In the Eastern Mediterranean, waterpipe smoking is especially popular and culturally acceptable, making it a key public health concern. In Lebanon in 2024, 39% of survey participants report smoking waterpipe, including 57% of women and 51% of those aged 18 to 25. Nearly three out of four users smoke waterpipe daily, for an average of 10 bowls each week. Other tobacco products like e-cigarettes are increasing in popularity as well, especially among younger demographics with 12-13% prevalence among 26 to 45-year-olds. These products remain relatively affordable, with limited change in consumption even throughout the economic crisis, as tax policy is lagging. 

In Jordan, 11% of tobacco use survey respondents in 2022 smoke waterpipe, either at home or in a café, with forthcoming research suggesting an even higher prevalence. Still, excise taxes on waterpipe remain very low at only 21% of the retail price. Estimates suggest that raising prices by 10% would reduce consumption by between 3% in discount cafes, and 9% in the home. Women are also more responsive to price increases, meaning there is an opportunity to reduce consumption among this part of the population. A substantial increase in excise taxes would align with evidence-based best practices to effectively discourage use.

Europe

Heated tobacco products, or HTPs, and e-cigarettes are growing in popularity across much of Europe. In Montenegro, HTP smoking prevalence increased from 0.2% in 2019 to nearly 4% in 2022. HTP use is especially prevalent among Montenegrin females, younger adults, and those residing in urban areas. Recent data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) further underscore this trend among youth aged 15 to 16, as the use of HTPs surged from 2.5% to 13.12% between 2019 and 2024 (ESPAD, 2024). The industry uses strategic pricing strategies to ensure that HTPs remain competitive. For every 1 euro tax increase, only 0.26 euros are passed onto the consumer, which keeps HTPs affordable and results in substantial revenue losses for the government. In 2023, 5.2 million euros of potential tax revenue were lost, underscoring the need to raise taxes on these products.

Similarly, in Slovakia, between January 2022 and June 2025, sales of HTPs increased by 6% each year, on average. Notably, e-cigarette, e-liquid, and nicotine pouch sales grew much faster, with average yearly increases of 80%, 85%, and 32%, respectively[JD1] , although total sales remain much lower than those of HTPs. While cigarette use tends to be more common among boys, Slovak girls have higher rates of experimentation, uptake, and frequency of use when it comes to e-cigarettes. Notably, Slovak consumers are also more than twice as likely to perceive e-cigarettes, HTPs, and nicotine pouches as attractive, compared to the European Union average. These favorable consumer attitudes, as well as the higher use among girls, serve as a warning for future trends without policy intervention.

 Latin America

In Mexico, nicotine pouches entered the market in 2024, although the legal status of these products remains unclear. According to a nationally representative survey conducted in 2025, the prevalence of nicotine pouch use was 0.1% among individuals aged 12-65, for both females and males. As part of a tobacco products tax reform  approved in 2025, nicotine pouches became subject to a 100% ad valorem excise tax rate in addition to the same specific rate applied per cigarette per each 8mg of nicotine contained in these products. These taxes were associated with price increases exceeding 20% during the first months of 2026. Despite representing progress towards raising the prices of these products, larger tax increases may still be needed to further increase prices and reduce the attractiveness of these emerging products.

With similar and troubling developments in populations worldwide, comprehensive tobacco and nicotine excise tax reform can reduce overall consumption and discourage switching between products. One recent example of success is the US state of Indiana. In July 2025, the state increased its cigarette specific excise tax from $0.995 to $2.995 per pack, doubled its ad valorem e-cigarette excise tax to 30%, and raised excise taxes on other tobacco products. As a result, Indiana saw a significant decline in cigarette and e-cigarette sales and increased tobacco tax revenue by $170.4 million in the second half of 2025. This case study highlights the opportunity for governments worldwide to reap public health and fiscal benefits by simultaneously, and substantially, raising excise taxes on the full array of tobacco and nicotine products. These policies remain the most cost-effective tools for decision makers, including in the fight against emerging products. We hope to see more countries implement such best practices, following the lead of Indiana and other forward-looking jurisdictions.