The smoke that lingers: Kenya’s battle with tobacco addiction
while the mind of an addict fundamentally works like that of a normal person, it is complicated by the presence of an addiction driven by the need to feel a “high” or a sense of satisfaction.
What you need to know:
- 2.3 million Kenyans aged between 15 and 65 use tobacco products, according to the National Authority for the Campaign Against Alcohol and Drug Abuse.
- Between 2012 and 2021, 60,228 deaths were attributed to tobacco-related diseases.
Sarah* was just 20 years old and full of youthful energy when she took her first puff of a cigarette at a friend’s birthday party. The initial harsh cough quickly faded, replaced by a deceptive sense of calm. What began as “just one” soon spiralled into a daily, then multiple-times-a-day ritual. For two years, cigarettes became her constant companion, their smoke filling her lungs and causing a persistent, nagging cough.
Martin Tum, probation officer, Siaya County. He is a former drug and substance abuser.
Early mornings became a struggle, marked by a tightening in her chest and a dull ache in her stomach. Food, once a source of enjoyment, now often led to discomfort. She dismissed it as stress, but worried the cigarettes had affected her gut. Her once-clear skin became pale, and her breath carried the tell-tale scent of stale smoke no matter how many mints she chewed.
When the vape craze hit, promising a “healthier” alternative, Sarah was eager to switch. Her friends, many of whom had also been cigarette smokers, eagerly embraced the sleek, colourful devices.
“The attraction came from the fruity flavours, the absence of the harsh smoke and lingering smell. I traded my pack of cigarettes for a vape pen, which became an extension of my hand for another year. I’d often carry it in my handbag,” she says.
Cough lessened
Initially, she felt a slight improvement: the cough lessened, and the bad breath was gone. But the stomach discomfort persisted, even intensified at times, accompanied by new symptoms like bloating and irregular bowel movements.
The nicotine cravings were more intense. “The immediate hit from the vape kept me constantly tethered to the device. I’d sleep with the vape under my pillow, often reaching for it in the middle of the night,” she recalls.
Later, she developed stomach cramps that left her doubled over in pain, coupled with shortness of breath.
“I visited a doctor who told me that I was showing early signs of Irritable Bowel Syndrome, a condition that affects the digestive system. My lungs, according to the doctors, showed signs of irritation. I realised that if I continued, it was going to get worse, and I was terrified of death,” she recalls.
Prof Jeremiah Chakaya, the Technical Director and Chief Executive Officer of the Respiratory Society of Kenya, explains that while the mind of an addict fundamentally works like that of a normal person, it is complicated by the presence of an addiction driven by the need to feel a “high” or a sense of satisfaction. An addict’s brain needs a constant, specific concentration of the addictive substance, and if the concentration drops, the individual experiences discomfort.
“If today you needed two cigarettes to feel satisfied, tomorrow you need three to be able to get to the same level of highness for whatever you’re addicted to. That’s why when we get hooked into things, we want them all the time,” Prof Chakaya says.
“For tobacco smoking, it’s the nicotine that people are addicted to. And they control the amount of nicotine in their brain by smoking. It is called puff-by-puff fingertip control. So you control the level of nicotine by how frequently you smoke and also how deeply you inhale the smoke from the tobacco.”
He explains that the main problem with tobacco addiction is that it has multiple and severe health consequences that affect the entire body, “from the brain to the toes.”
“It’s been associated with all sorts of problems from increased risk of infectious disease, for example, tuberculosis, increased risk of diabetes, increased risk of hypertension, increased risk of strokes and increased risk of cancers,” he says.
“The health consequences of smoking are bad, and young people need to know this because we start these habits in our early years of life. It’s miserable having a tobacco-related disease. I am a chest doctor. A tobacco-related lung disease is painful. It doesn’t kill you quickly, it kills you slowly. You go through three to five years before you die of a terrible time.”
Sarah’s doctor suggested nicotine gum to slowly wean herself off. Now, a year and two months later, she hasn’t touched a vape or a cigarette.
“The journey has been hard. The constant battle against cravings still flares up occasionally, especially during stressful times. But my lungs are slowly recovering, and the persistent cough has receded. My gut has also improved. I now experience less bloating and regular digestion,” she says.
“I regret every single puff that led me down a dark path. My body paid the price, especially my stomach and lungs. Now, I’m just grateful for the chance to heal, to give my body the care it deserves after all the abuse.”
For Martin Tum, the journey into addiction began at 14, in primary school. When he joined secondary school, other learners pointed out that he “looked like a smoker.” This comment, rather than deterring him, inadvertently propelled him further.
“I soon discovered a practical, albeit dangerous, benefit: being a smoker offered a shield against the pervasive bullying. By joining the smoking group, which consisted of senior students, I became one of them, gaining a form of protection that solidified my place within the addicted circle,” Tum explains.
What began with cigarettes quickly escalated. He started using marijuana and indulging in alcohol. This expansion of vices severely impacted his academic performance, leading to a suspension from school in Form Three. The shadow of addiction followed him to an Adventist institution in Uganda, delaying his graduation until 2012—12 years after he first enrolled.
Even with his degree, the challenges persisted. His struggles made securing a job difficult. He returned to his father’s farm, dependent on cigarettes, whisky, and traditional brews, consuming up to two packets of cigarettes a day.
His turning point arrived after being enrolled in a rehabilitation institution in 2015. The decisive moment to quit came in April 2020.
“On that day, my wife found and picked me up from a drinking den. At home, I got a moment of clarity and asked my wife to collect all the cigarettes and bottles of whisky left in the house and dump them. I then proceeded to a theology school soon after. It was a miracle that I experienced no withdrawal symptoms,” Tum says.
Since April 2020, he has maintained complete sobriety, remaining both smoke-free and alcohol-free. “I have since mended relationships and rebuilt my life,” he says.
Sarah and Martin are among 2.3 million Kenyans aged between 15 and 65 who use tobacco products, according to the National Authority for the Campaign Against Alcohol and Drug Abuse (Nacada).
A study titled Tobacco smoking-attributable mortality in Kenya, 2012–2021, published in 2024, revealed that between 2012 and 2021, 60,228 deaths were attributed to tobacco-related diseases. The study noted that 16.5 per cent of all deaths among adults aged 35 and older in Kenya were attributable to smoking. The leading causes included respiratory diseases (40.5 per cent), cancers (31.4 per cent), cardiovascular diseases (8.9 per cent), tuberculosis (13 per cent) and diabetes (6.1 per cent).
According to Nacada, counties with the highest number of male cigarette and tobacco products users are Meru (28 per cent), Murang’a (27 per cent), Embu (26 per cent), Tharaka Nithi (26 per cent) and Makueni (25 per cent). Murang’a County has the highest percentage of daily male smokers, while Marsabit and Turkana counties have the highest percentage of female cigarette smokers.
The 2018 Status of Drugs and Substance Use in Kenya report by Nacada showed growing demand for smokeless tobacco use, especially among youth and adolescents. The report shows that 14 out of every 100 secondary and six out of every 100 primary school students have used tobacco at least once in their lifetime. Smokeless tobacco, which contains nicotine, has been blamed for oral, oesophageal, and pancreatic cancers. The report also shows that the youngest people start using tobacco aged between 16 and 20, with the minimum age recorded at six years old.
In response, the government is moving to strengthen regulations. On July 1, 2024, the Tobacco Control (Amendment) Bill, 2024 was formally published for introduction into the Senate. The bill has gone through its initial stages (First and Second Reading) and is currently before the Committee of the Whole House in the Senate, where amendments are expected to be voted upon.
The bill, proposed by nominated Senator Catherine Mumma, seeks to significantly update and strengthen Kenya’s existing Tobacco Control Act (Cap. 245A), primarily to regulate Electronic Nicotine Delivery Systems (ENDS), including electronic cigarettes and nicotine pouches.
The bill’s main objectives are to regulate smoking and the production and sale of tobacco products, ensure the advertising of tobacco products is regulated, ensure their sale to persons under the age of 18 is prohibited and ensure that manufacturing, distribution, import, or sale of these products requires prior authorisation from the Health CS.
The CS may ban any product that does not conform to the Act and must publish a list of all approved and banned products, including the name of the authorised manufacturer or importer. Dealing in unapproved products is an offense liable to a fine not exceeding Sh1 million or imprisonment for up to two years, or both.
The bill proposes that a person shall not manufacture or place on the market for sale, distribution, or use an electronic nicotine delivery system or refill container unless the nicotine-containing liquid is contained in a dedicated refill container not exceeding a volume of 10 milliliters, in a disposable electronic cigarette or in single-use cartridge, and the cartridges or tank do not exceed a volume of two millilitres. The system and refill container must also be child and tamper-proof, protected against breakage and leakage, and have a mechanism that ensures refilling without leakage.
The bill also proposes a prohibition of the production or supply of tobacco products containing additives that suggest a health benefit (such as vitamins), additives associated with energy and vitality (such as caffeine), additives that result in a characterising flavour (such as fruit, menthol) and those that facilitate inhalation or increase toxicity or addictiveness.
The bill prohibits the sale of tobacco products through hawking, from vehicles, or via mobile vending, with those found guilty being liable to be fined Sh50,000 or six months’ imprisonment. It also prohibits online sale or offer for sale of tobacco products, including nicotine pouches, linking this to a fine of Sh500,000 or three years’ imprisonment.
The bill also empowers counties to license tobacco product outlets and set the minimum distance of licensed premises from educational institutions. It prohibits offering or providing free tobacco samples, nicotine pouches, or related components as a promotional strategy, and prohibits manufacturing or selling objects (sweets, toys, cartoon characters) that resemble tobacco products, or tobacco products that imitate such objects, if they appeal to persons under 18.
Ministry of Health officials have in the past raised concerns that “Kenya now faces new challenges with the rapid proliferation of Novel Nicotine and Emerging Tobacco Products such as nicotine pouches, vapes, and electronic cigarettes.”
Public Health PS Mary Muthoni previously noted that the products are “often marketed as less harmful alternatives to traditional cigarettes and target young people with appealing flavours and misleading health claims.”
Following this, the ministry released graphic health warnings, which were gazetted on June 12. From February 2026, packaged tobacco products will have pictorial warnings showing that tobacco use harms an unborn baby, causes lung disease, heart disease, infertility, impotence, and mouth cancer. The pictorials also contain warnings that tobacco use is addictive, can cause gum disease and tooth loss, and can ultimately kill.
“The Ministry of Health is enforcing strict regulations under the Tobacco Control Act to protect Kenyans from the harmful effects of tobacco. As stipulated in Section 21 of the Act, all tobacco product packaging must carry clearly visible health warnings, including graphic images and pictograms. Tobacco companies and distributors are hereby given a maximum of nine months from the date of commencement of the Notice to fully comply,” Health CS Aden Duale said.
“This directive serves as a stark reminder of the grave health risks associated with tobacco use, ranging from cancer to cardiovascular and respiratory diseases. The warnings are meant to educate, deter, and protect, especially youth and vulnerable populations. Failure to comply will attract the full force of the law.”
Ken Marau, the Nacada county coordinator for Siaya and Busia counties, notes that graphic health warnings have been proven to effectively communicate the dangers of tobacco and nicotine use, reduce the appeal of tobacco and nicotine products, and motivate users to quit.
“By making these warnings mandatory, the Health ministry has taken a significant step in reducing the prevalence of tobacco use and its associated health risks. In 2018, IILA carried out a study that found that the graphic health warnings on cigarette packaging were ineffective and did not meet World Health Organisation (WHO) recommendations.
Among the three images assessed, the image portraying mouth cancer had the highest recall among both smokers and non-smokers due to its relatability, while the other two didn’t have any significant communication and recall,” he says.
He adds that the new set of graphic health warnings should address these issues, comply with WHO guidelines, and provide relatable warnings about the dangers of tobacco and nicotine product use to aid in quitting. “The warnings will play a crucial role in educating the public about the severe consequences of tobacco and nicotine use, and they will serve as a constant reminder of the health risks, including lung cancer, heart disease, and respiratory illnesses. Such warnings are particularly effective in reaching individuals who may not have access to other forms of health education.”
Prof Chakaya explains that graphic health warnings are considered an effective component of a total package of interventions designed to prevent smoking uptake and encourage quitting, but should be implemented alongside other measures, such as high taxation to make cigarettes expensive, prohibiting tobacco advertising across all media and restricting sales outlets.
“For a young person, seeing ‘crazy things’ on a cigarette packet, coupled with high prices and anti-smoking messaging, serves as a powerful deterrent,” he says. According to the Kenya Tobacco Industry Interference Index Report 2022, tobacco use remains the topmost preventable cause of death and one of the four behavioural risk factors raising the burden of non-communicable diseases (NCDs) in Kenya.
“More than 50 per cent of the hospital admissions are due to NCDs, and on average 80 per cent of premature deaths are related to the use or exposure to tobacco. Tobacco industry interference has been identified as the largest barrier and greatest threat to the implementation of the WHO Framework Convention for Tobacco Control (FCTC),” the report states.
The index report also shows that the manufacturing hub in Kenya exports to at least 17 other countries in the region, and that Mastermind Tobacco Kenya and the other tobacco manufacturer in Kenya controlled around 16 per cent of the market share in 2019.
A WHO report titled ‘Global Tobacco Epidemic 2025’ warns that action is needed to maintain and accelerate progress in tobacco control as rising industry interference challenges tobacco policies and control efforts.
WHO recommends six tobacco control measures to reduce tobacco use, which claims over seven million lives a year globally. These measures include monitoring tobacco use and prevention policies, protecting people from tobacco smoke with smoke-free air legislation, offering help to quit tobacco use, warning about the dangers of tobacco with pack labels and mass media, enforcing bans on tobacco advertising, promotion, and sponsorship and raising taxes on tobacco.
The report shows that from 2007 to 2025, Kenya has only done well in enforcing bans on tobacco advertising and raising taxes on tobacco, making cigarettes less affordable since 2014. However, Kenya is doing poorly in monitoring tobacco use and prevention policies, protecting people from tobacco smoke with smoke-free air legislation, and conducting anti-tobacco mass media campaigns. The country is moderate in offering help to quit tobacco use and warning about the dangers of tobacco with pack labels and mass media.
“For those who already smoke, a comprehensive package of interventions is available. Individuals who need more support can be referred to specialised smoking cessation centres available across the country. The full intervention package includes counselling, asking people to set a quit date, advising people to keep away from friends who encourage smoking until they have formally quit, and the use of medicines to help people cope with the side effects of nicotine withdrawal,” Prof Chakaya states.
Name* changed to protect identity
