# **1. INTRODUCTION**

The male smoking rate in Papua New Guinea is ranked the 5th highest in the world (Ng et al. 2014). However, little is known about the determinants of tobacco consumption and smoking behaviors in Papua New Guinea. This paper is the first to study tobacco consumption in Papua New Guinea using the 2009-2010 Papua New Guinea Household Income and Expenditure Survey (2009-2010 PNG HIES). The main objective of the paper is to understand the prevalence and direct financial burden of tobacco use among Papua New Guinea households, and the factors that are correlated with tobacco use and choices. The information and evidence provided in the paper will help in the design of effective policies to control tobacco usage and better understand some of the challenges of tobacco control in Papua New Guinea and more broadly in the Pacific region.

Tobacco use is the leading global cause of preventable death. The World Health Organization states that “the tobacco epidemic is one of the biggest public health threats the world has ever faced, killing nearly six million people a year”(World Health Organization 2014). There is no safe level of tobacco use. Tobacco use is the only risk factor common to all four of the main noncommunicable diseases (NCDs) – cancer, cardiovascular disease, diabetes and respiratory disease. While tobacco use accounts for an estimated one in six of all NCD deaths (Beaglehole et al. 2011; Boutayeb and Boutayeb 2005), it is also the single greatest preventable cause of NCDs.

Tobacco use raises direct costs for individuals and governments. Individuals who smoke will, on average, have higher health costs than non-smokers. Women subject to second hand smoke are likely to have babies with a lower birth weight and higher medical costs (Bonu et al. 2005; Been et al. 2014). Tobacco use makes treating existing diseases like diabetes more complex and more expensive. It also raises the costs to the government health system (Yang et al. 2011). The money that individuals spend on tobacco could be spent on beneficial products and services, such as improved housing and education rather than this always potentially harmful product (World Health Organization 2004a; Rokx et al. 2009). Smokers impose costs on industry through absenteeism. The extra money that governments spend to treat tobacco-related diseases could instead be spent on rural roads, electricity generation, or education. Last, tobacco use increases social and financial inequity by disproportionately harming the poor (Townsend 1987). The poor tend to have a worse health status to begin with; have fewer financial resources to spend on tobacco; and are less able to access health care if tobacco-related diseases occur.

There are a handful of studies on smoking prevalence in Papua New Guinea. Using national data from Papua New Guinea, Vallance et al. (1987) showed a three-fold increase in the consumption of commercial tobacco from 1960 to 1979. Among smokers, the proportion using commercial tobacco increased substantially, from 28% to 93% from 1960 to 1979. Chapman and Richardson (1990) showed the elasticity of demand for non-cigarette tobacco and cigarettes were -0.50 and - 0.71 in Papua New Guinea from 1973-86. In a survey study of young people conducted during the 1996/1997 school break in National Capital District and Manus, Hiawaler (2002) showed that 12% of males and 8% of females smoked cigarettes. The study also showed that 13% of males and 10% of females smoked marijuana. Those who smoked marijuana also smoked cigarettes and mutrus. Despite a higher rate of male smokers, there is a significantly high rate of female smokers in National Capital District. The World Health Organization (WHO) Global Tobacco Epidemic 2