Public opinion of cigarette smoking in Cambodia has undergone profound shifts over the past century, morphing from a symbol of social status to a major public health issue. 

Each era, from pre-Khmer Rouge society to the present day, tells a story of changing customs, societal perceptions and government intervention, painting a vivid picture of how smoking habits have transformed alongside the Kingdom itself.

In Sihanouk’s 1960s Cambodia, smoking was not merely a habit but a marker of social standing and respectability. 

Cigarettes were often exchanged during business meetings, social gatherings, weddings and funerals, as a symbol of trust and goodwill. 

Different brands reflected different statuses, with imported brands demonstrating affluence and dignity. 

“This practice entrenched smoking as a customary way to foster relationships and pay respect to others, embedding it deeply within social etiquette,” explained a statement from the Documentation Center of Cambodia (DC-Cam).

Smoking as currency, escape under the Khmer Rouge

The rise of the Khmer Rouge in 1975 marked a dark chapter for Cambodia, and the role of cigarettes underwent a significant shift.

The regime’s economy replaced traditional banknotes with items like rice and gold, making the black market a staple for citizens. 

“Tobacco emerged as a valuable commodity, with 200 grammes exchangeable for five cans of rice. This highlighted the prevalence of smoking among both cadres and civilians,” according to (DC-Cam).

The Khmer Rouge did not discourage smoking; instead, they distributed cigarettes to women and children, framing it as a tool to boost productivity and symbolising equality.

“Smoking during the Khmer Rouge era helped ward off mosquitoes at night, served as currency for food exchanges and also allowed smokers more unscheduled breaks from work,” noted DC-Cam.

Kim Vannara, a survivor of the era, recalls that smoking gave workers a rare reprieve and the chance to justify taking breaks: although he acknowledged that this ultimately led to a long-term addiction for many, including himself.

“I began smoking during the Khmer Rouge regime since smokers could take breaks at any time. I ended up becoming addicted, and could not stop until 2015,” he shared.

Smoking also became a way to combat hunger, fatigue and isolation, during this bleak period of Cambodian history.

In a meeting with workers in Kampong Chhnang province in 2023, then-Prime Minister Hun Sen – once well-known for his love of tobacco – recalled his personal smoking history, which began during the Khmer Rouge war. 

“If it weren’t for the war, I wouldn’t have known smoking. Initially, it was just to chase away mosquitoes, but over time, it became enjoyable, and eventually, I couldn’t think without a cigarette. Holding a cigarette in one hand and a pen in the other made me write faster and better than using a typewriter or computer,” he told the crowd.

Post-Khmer Rouge: Persisting customs, growing concerns

Following the fall of the Khmer Rouge, smoking traditions lingered in Cambodian society. Cigarettes continued to be symbols of hospitality, particularly at weddings, where brides often lit cigarettes for their grooms as a gesture of respect. 

While some still value this gesture, younger Cambodians increasingly view it as outdated, reflecting a societal shift in smoking’s cultural relevance. 

“In the old days, giving a cigarette was a symbol of mutual respect between husband and wife. Today, it’s no longer seen that way,” explained one social media user.

Senate president Hun Sen’s personal struggle with smoking illustrates this era’s complex relationship with cigarettes. 

It took him 16 years and six attempts before he successfully quit, but later – as prime minister – he enacted the “Sub-Decree on Measures to Ban Smoking or Fumigation of Tobacco Products in the Workplace or Public Places” in 2016. 

The sub-decree restricts tobacco use in public spaces and imposes fines of 20,000 to 50,000 riel ($5 to $12.50) for violations.

The consequences of Cambodia’s deep-rooted smoking culture have been brought into sharp focus in more recent years. 

A DC-Cam health forum revealed that smoking-related health issues such as high blood pressure, cardiovascular disease and cataracts are prominent among survivors of the Khmer Rouge regime.

In 2023, tobacco use has become one of Cambodia’s major public health challenges, causing over 16,000 deaths annually. Supplied

Modern awareness brings new public health threats 

In 2023, the International Union Against Tuberculosis and Lung Disease (The Union) reported that tobacco use has become one of Cambodia’s major public health challenges, and is responsible for more than 16,000 deaths each year.

The economic impact is equally severe, with the WHO estimating the annual cost to the Kingdom in healthcare and lost productivity through smoking at over $227 million.

The National Adults Tobacco Survey (NATS) 2021 showed a 21.4% decrease in cigarette smoking among men between 2014 and 2021, with similar reductions among women. 

However, exposure to tobacco smoke remains prevalent, particularly in public transportation, where rates have increased from 33.6% in 2014 to 62.03% in 2021.

Minister of Health Chheang Ra highlighted the government’s commitment to non-communicable disease (NCD) prevention in a 2024 address marking World No Tobacco Day. 

“Tobacco products are a significant risk factor for non-communicable diseases such as cancer, cardiovascular diseases and lung disease. They claim an estimated 8 million lives each year worldwide, while also imposing economic, environmental and social costs,” he explained.

He also warned that the tobacco industry has developed new products such as e-cigarettes, heated tobacco products (HTPs) and shisha. These alternatives to traditional cigarettes are available in various forms and over 15,000 flavours, often to attract young people or even children.

As public awareness grows, traditional customs involving cigarettes are increasingly viewed through a critical lens. 

Cambodian weddings, once known for offering cigarettes to guests as a token of respect, have seen a shift. 

Many families in urban areas now offer alternatives like sweets or small gifts, aligning with contemporary values of health consciousness.

Rural areas, however, still maintain some of these customs, where cigarettes, along with betel leaves, hold ceremonial significance in worship and offerings to spiritual guardians.

Health minister Chheang Ra has called for stricter regulation of tobacco products, especially e-cigarettes and heated tobacco products (vapes), which target youth through both their flavours and marketing campaigns. Post Staff

As more quit, new products present new challenges

Government efforts are certainly believed to have contributed to reducing smoking rates. The health ministry’s smoking cessation services, available at health centres nationwide, encourage tobacco users to quit. 

Local authorities, including village chiefs, also work to guide smokers towards these services.

The NATS data reflects changing attitudes, with 95% of Cambodians supporting higher cigarette taxes and nearly 96% advocating for price increases on tobacco products. 

These changes signify a national shift towards reducing the prevalence of smoking and protecting public health, a notable departure from earlier generations.

Despite this progress, the influence of modern products like e-cigarettes (vapes) and flavoured tobacco remains a pressing concern. 

Many young Cambodians are drawn to these products, believing them to be safer alternatives. 

Ra called for closer inspection and regulation of all tobacco products, particularly new forms like vapes, which target youth through appealing flavours and social media advertising.

“First, we must prevent the advertisement and promotion of all tobacco and e-cigarette products. Second, smoking bans in public spaces must be enforced. Third, we need to restrict the sale, distribution and use of e-cigarettes,” he explained.

“I call on young people not to try tobacco products or e-cigarettes in any form,” he appealed.