essay against tobacco

Persuasive Essay Guide

Persuasive Essay About Smoking

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

What You Need To Know About Persuasive Essay

A persuasive essay is a type of writing that aims to convince its readers to take a certain stance or action. It often uses logical arguments and evidence to back up its argument in order to persuade readers.

It also utilizes rhetorical techniques such as ethos, pathos, and logos to make the argument more convincing. In other words, persuasive essays use facts and evidence as well as emotion to make their points.

A persuasive essay about smoking would use these techniques to convince its readers about any point about smoking. Check out an example below:

Simple persuasive essay about smoking

Tough Essay Due? Hire Tough Writers!

Persuasive Essay Examples About Smoking

Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally.

A lot has been written on topics related to the effects of smoking. Reading essays about it can help you get an idea of what makes a good persuasive essay.

Here are some sample persuasive essays about smoking that you can use as inspiration for your own writing:

Persuasive speech on smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

Persuasive Essay About Smoking Introduction

Persuasive Essay About Stop Smoking

Short Persuasive Essay About Smoking

Stop Smoking Persuasive Speech

Check out some more persuasive essay examples on various other topics.

Argumentative Essay About Smoking Examples

An argumentative essay is a type of essay that uses facts and logical arguments to back up a point. It is similar to a persuasive essay but differs in that it utilizes more evidence than emotion.

If you’re looking to write an argumentative essay about smoking, here are some examples to get you started on the arguments of why you should not smoke.

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

Argumentative essay about smoking introduction

Check out the video below to find useful arguments against smoking:

Tips for Writing a Persuasive Essay About Smoking

You have read some examples of persuasive and argumentative essays about smoking. Now here are some tips that will help you craft a powerful essay on this topic.

Choose a Specific Angle

Select a particular perspective on the issue that you can use to form your argument. When talking about smoking, you can focus on any aspect such as the health risks, economic costs, or environmental impact.

Think about how you want to approach the topic. For instance, you could write about why smoking should be banned.

Check out the list of persuasive essay topics to help you while you are thinking of an angle to choose!

Research the Facts

Before writing your essay, make sure to research the facts about smoking. This will give you reliable information to use in your arguments and evidence for why people should avoid smoking.

You can find and use credible data and information from reputable sources such as government websites, health organizations, and scientific studies.

For instance, you should gather facts about health issues and negative effects of tobacco if arguing against smoking. Moreover, you should use and cite sources carefully.

Paper Due? Why Suffer? That's our Job!

Make an Outline

The next step is to create an outline for your essay. This will help you organize your thoughts and make sure that all the points in your essay flow together logically.

Your outline should include the introduction, body paragraphs, and conclusion. This will help ensure that your essay has a clear structure and argument.

Use Persuasive Language

When writing your essay, make sure to use persuasive language such as “it is necessary” or “people must be aware”. This will help you convey your message more effectively and emphasize the importance of your point.

Also, don’t forget to use rhetorical devices such as ethos, pathos, and logos to make your arguments more convincing. That is, you should incorporate emotion, personal experience, and logic into your arguments.

Introduce Opposing Arguments

Another important tip when writing a persuasive essay on smoking is to introduce opposing arguments. It will show that you are aware of the counterarguments and can provide evidence to refute them. This will help you strengthen your argument.

By doing this, your essay will come off as more balanced and objective, making it more convincing.

Finish Strong

Finally, make sure to finish your essay with a powerful conclusion. This will help you leave a lasting impression on your readers and reinforce the main points of your argument. You can end by summarizing the key points or giving some advice to the reader.

A powerful conclusion could either include food for thought or a call to action. So be sure to use persuasive language and make your conclusion strong.

To conclude,

By following these tips, you can write an effective and persuasive essay on smoking. Remember to research the facts, make an outline, and use persuasive language.

However, don't stress if you need expert help to write your essay! Our professional essay writing service is here for you!

Our persuasive essay writing service is fast, affordable, and trustworthy.

Try it out today!

Write Essay Within 60 Seconds!

Caleb S. has been providing writing services for over five years and has a Masters degree from Oxford University. He is an expert in his craft and takes great pride in helping students achieve their academic goals. Caleb is a dedicated professional who always puts his clients first.

Paper Due? Why Suffer? That’s our Job!

Keep reading

Essay on Smoking

500 words essay on smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

Customize your course in 30 seconds

Which class are you in.

Travelling Essay
Picnic Essay
Our Country Essay
My Parents Essay
Essay on Favourite Personality
Essay on Memorable Day of My Life
Essay on Knowledge is Power
Essay on Gurpurab
Essay on My Favourite Season
Essay on Types of Sports

Download the App

Persuasive Essay Writing

Persuasive Essay About Smoking

Craft an Engaging Persuasive Essay About Smoking: Examples & Tips

Published on: Jan 25, 2023

Last updated on: Jan 29, 2024

Persuasive Essay-Defined

A persuasive essay is a form of academic writing that presents an argument in favor of a particular position, opinion, or viewpoint.

It is usually written to convince the audience to take a certain action or adopt a specific viewpoint.

The primary purpose of this type of essay is to provide evidence and arguments that support the writer's opinion.

In persuasive writing, the writer will often use facts, logic, and emotion to convince the reader that their stance is correct.

The writer can persuade the reader to consider or agree with their point of view by presenting a well-researched and logically structured argument.

The goal of a persuasive essay is not to sway the reader's opinion. It is to rather inform and educate them on a particular topic or issue.

Check this free downloadable example of a persuasive essay about smoking!

Simple Persuasive essay about smoking

Read our extensive guide on persuasive essays to learn more about crafting a masterpiece every time.

Persuasive Essay Examples About Smoking

Are you a student looking for some useful tips to write an effective persuasive essay about the dangers of smoking?

Look no further! Here are several great examples of persuasive essays that masterfully tackle the subject and persuade readers creatively.

Persuasive speech on the smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

For more examples about persuasive essays, check out our blog on persuasive essay examples .

Paper Due? Why Suffer? That's our Job!

Argumentative Essay About Smoking Examples

Our examples can help you find the points that work best for your style and argument.

Argumentative essay about smoking introduction

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

10 Tips for Writing a Persuasive Essay About Smoking

Here are a few tips and tricks to make your persuasive essay about smoking stand out:

1. Do Your Research

Before you start writing, make sure to do thorough research on the topic of smoking and its effects.

Look for primary and secondary sources that provide valuable information about the issue.

2. Create an Outline

An outline is essential when organizing your thoughts and ideas into a cohesive structure. This can help you organize your arguments and counterarguments.

Read our blog about creating a persuasive essay outline to master your next essay.

Check out this amazing video here!

3. Clearly Define the Issue

Make sure your writing identifies the problem of smoking and why it should be stopped.

4. Highlight Consequences

Show readers the possible negative impacts of smoking, like cancer, respiratory issues, and addiction.

5. Identity Solutions

Provide viable solutions to the problem, such as cessation programs, cigarette alternatives, and lifestyle changes.

6. Be Research-Oriented

Research facts about smoking and provide sources for those facts that can be used to support your argument.

7. Aim For the Emotions

Use powerful language and vivid imagery to draw readers in and make them feel like you do about smoking.

8. Use Personal Stories

Share personal stories or anecdotes of people who have successfully quit smoking and those negatively impacted by it.

9. Include an Action Plan

Offer step-by-step instructions on how to quit smoking, and provide resources for assistance effectively.

10. Reference Experts

Incorporate quotes and opinions from medical professionals, researchers, or other experts in the field.

These tips can help you write an effective persuasive essay about smoking and its negative effects on the body, mind, and society.

When your next writing assignment has you feeling stuck, don't forget that essay examples about smoking are always available to break through writer's block.

And if you need help getting started, our expert essay writer at CollegeEssay.org is more than happy to assist.

Just give us your details, and our persuasive essay writer will start working on crafting a masterpiece.

We provide top-notch essay writing service online to help you get the grades you deserve and boost your career.

Try our AI writing tool today to save time and effort!

Frequently Asked Questions

What would be a good thesis statement for smoking.

A good thesis statement for smoking could be: "Smoking has serious health risks that outweigh any perceived benefits, and its use should be strongly discouraged."

What are good topics for persuasive essays?

Good topics for persuasive essays include the effects of smoking on health, the dangers of second-hand smoke, the economic implications of tobacco taxes, and ways to reduce teenage smoking.

These topics can be explored differently to provide a unique and engaging argument.

Cathy A. (Marketing, Literature)

For more than five years now, Cathy has been one of our most hardworking authors on the platform. With a Masters degree in mass communication, she knows the ins and outs of professional writing. Clients often leave her glowing reviews for being an amazing writer who takes her work very seriously.

Paper Due? Why Suffer? That’s our Job!

Keep reading

Legal & Policies

Privacy Policy
Cookies Policy
Terms of Use
Refunds & Cancellations
Our Writers
Success Stories
Our Guarantees
Affiliate Program
Referral Program
AI Essay Writer

Disclaimer: All client orders are completed by our team of highly qualified human writers. The essays and papers provided by us are not to be used for submission but rather as learning models only.

Home — Essay Samples — Nursing & Health — Smoking — Effect of Tobacco: Why Cigarette Smoking Should Be Banned

Effect of Tobacco: Why Cigarette Smoking Should Be Banned

Categories: Smoking Smoking Ban Tobacco

About this sample

Words: 1585 |

Published: Dec 3, 2020

Words: 1585 | Pages: 3 | 8 min read

Works Cited

Rezaei, S., Akbari, M. E., Hajizadeh, M., & Heydari, G. (2015). The financial burden imposed on healthcare system due to smoking-attributable diseases: A report from Iran. Global Journal of Health Science, 7(2), 1-9. https://doi.org/10.5539/gjhs.v7n2p1
World Health Organization. (2017). Tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco
Centers for Disease Control and Prevention. (2022). Smoking & tobacco use: Health effects. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm
Tobacco in Australia. (2021). Tobacco use in Australia. https://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-2-prevalence-of-smoking-adults
American Cancer Society. (2022). Lung cancer risk factors. https://www.cancer.org/cancer/lung-cancer/prevention-and-early-detection/risk-factors.html
National Institute on Drug Abuse. (2019). DrugFacts: Cigarettes and other tobacco products. https://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products
National Cancer Institute. (2022). Harms of smoking and health benefits of quitting. https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet
U.S. Department of Health and Human Services. (2014). The health consequences of smoking—50 years of progress: A report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
Gao, B., Chapman, S., & Sun, S. (2019). The tipping point for tobacco control: Time to prohibit the sale of tobacco products?. Tobacco Control, 28(3), 349-353. https://doi.org/10.1136/tobaccocontrol-2017-054108
National Academies of Sciences, Engineering, and Medicine. (2018). Public health consequences of e-cigarettes. National Academies Press. https://doi.org/10.17226/24952

Cite this Essay

Let us write you an essay from scratch

450+ experts on 30 subjects ready to help
Custom essay delivered in as few as 3 hours

Get high-quality help

Prof. Kifaru

Verified writer

Expert in: Nursing & Health Law, Crime & Punishment

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

3 pages / 1160 words

4 pages / 2003 words

2 pages / 1162 words

3 pages / 1586 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Effect of Tobacco: Why Cigarette Smoking Should Be Banned Essay

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Smoking

Vape has become one of the most popular means of smoking nowadays. People find that vaping is better than smoking cigarettes. Vape has many characteristics those attract people to take it instead of cigarettes. As people are [...]

Good afternoon, ladies and gentlemen. Today, I would like to talk to you about the dangers of smoking and the impact it has on individuals and society as a whole. Smoking is a prevalent habit that has been around for centuries, [...]

Smoking is a pervasive and harmful habit that affects millions of people worldwide. Despite the widely known health risks associated with smoking, many individuals continue to engage in this detrimental behavior. Anti-smoking [...]

In the "should smoking be illegal argumentative" debate, one of the primary concerns is the well-known harmful effects of cigarettes on the human body. Many people are aware that smoking cigarettes is detrimental. Cigarettes [...]

Stop smoking it can cost you your life! What is smoking? How can something small cause so much harm to the world? Smoking is an addictive drug that can cause death or cancer it has caused, More than 10 times as many U.S. [...]

Vaping is not a traditional smoking. Many of us don’t even consider it as a substitute of smoking. That’s why a large chunk of non-smokers get attracted towards vaping because it’s harmless, flavored, aromatic and obviously [...]

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

Instructions Followed To The Letter
Deadlines Met At Every Stage
Unique And Plagiarism Free

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

View all journals
My Account Login
Explore content
About the journal
Publish with us
Sign up for alerts
Open access
Published: 21 January 2021

The effects of tobacco control policies on global smoking prevalence

Luisa S. Flor ORCID: orcid.org/0000-0002-6888-512X 1 ,
Marissa B. Reitsma 1 ,
Vinay Gupta 1 ,
Marie Ng ORCID: orcid.org/0000-0001-8243-4096 2 &
Emmanuela Gakidou ORCID: orcid.org/0000-0002-8992-591X 1

Nature Medicine volume 27 , pages 239–243 ( 2021 ) Cite this article

32k Accesses

108 Citations

365 Altmetric

Metrics details

Risk factors

Substantial global effort has been devoted to curtailing the tobacco epidemic over the past two decades, especially after the adoption of the Framework Convention on Tobacco Control 1 by the World Health Organization in 2003. In 2015, in recognition of the burden resulting from tobacco use, strengthened tobacco control was included as a global development target in the 2030 Agenda for Sustainable Development 2 . Here we show that comprehensive tobacco control policies—including smoking bans, health warnings, advertising bans and tobacco taxes—are effective in reducing smoking prevalence; amplified positive effects are seen when these policies are implemented simultaneously within a given country. We find that if all 155 countries included in our counterfactual analysis had adopted smoking bans, health warnings and advertising bans at the strictest level and raised cigarette prices to at least 7.73 international dollars in 2009, there would have been about 100 million fewer smokers in the world in 2017. These findings highlight the urgent need for countries to move toward an accelerated implementation of a set of strong tobacco control practices, thus curbing the burden of smoking-attributable diseases and deaths.

Reductions in smoking due to ratification of the Framework Convention for Tobacco Control in 171 countries

Accelerating tobacco control at the national level with the Smoke-free Generation movement in the Netherlands

A dynamic modelling analysis of the impact of tobacco control programs on population-level nicotine dependence

Decades after its ill effects on human health were first documented, tobacco smoking remains one of the major global drivers of premature death and disability. In 2017, smoking was responsible for 7.1 (95% uncertainty interval (UI), 6.8–7.4) million deaths worldwide and 7.3% (95% UI, 6.8%–7.8%) of total disability-adjusted life years 3 . In addition to the health impacts, economic harms resulting from lost productivity and increased healthcare expenditures are also well-documented negative effects of tobacco use 4 , 5 . These consequences highlight the importance of strengthening tobacco control, a critical and timely step as countries work toward the 2030 Sustainable Development Goals 2 .

In 2003, the World Health Organization (WHO) led the development of the Framework Convention on Tobacco Control (FCTC), the first global health treaty intended to bolster tobacco use curtailment efforts among signatory member states 1 . Later, in 2008, to assist the implementation of tobacco control policies by countries, the WHO introduced the MPOWER package, an acronym representing six evidence-based control measures (Table 1 ) (ref. 6 ). While accelerated adoption of some of these demand reduction policies was observed among FCTC parties in the past decade 7 , many challenges remain to further decrease population-level tobacco use. Given the differing stages of the tobacco epidemic and tobacco control across countries, consolidating the evidence base on the effectiveness of policies in reducing smoking is necessary as countries plan on how to do better. In this study, we evaluated the association between varying levels of tobacco control measures and age- and sex-specific smoking prevalence using data from 175 countries and highlighted missed opportunities to decrease smoking rates by predicting the global smoking prevalence under alternative unrealized policy scenarios.

Despite the enhanced global commitment to control tobacco use, the pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, sex and age 8 ; in 2017, there were still 1.1 billion smokers across the 195 countries and territories assessed by the Global Burden of Diseases, Injuries, and Risk Factors Study. Global smoking prevalence in 2017 among men and women aged 15 and older, 15–29 years, 30–49 years and 50 years and older are shown in Extended Data Figs. 1 , 2 , 3 and 4 , respectively. We found that, between 2009 and 2017, current smoking prevalence declined by 7.7% for men (36.3% (95% UI, 35.9–36.6%) to 33.5% (95% UI, 32.9–34.1%)) and by 15.2% for women globally (7.9% (95% UI, 7.8–8.1%) to 6.7% (95% UI, 6.5–6.9%)). The highest relative decreases were observed among men and women aged 15–29 years, at 10% and 20%, respectively. Conversely, prevalence decreased less intensively for those aged over 50, at 2% for men and 9.5% for women. While some countries have shown an important reduction in smoking prevalence between 2009 and 2017, such as Brazil, suggesting sustained progress in tobacco control, a handful of countries and territories have shown considerable increases in smoking rates among men (for example, Albania) and women (for example, Portugal) over this time period.

In an effort to counteract the harmful lifelong consequences of smoking, countries have, overall, implemented stronger demand reduction measures after the FCTC ratification. To assess national-level legislation quality, the WHO attributes a score to each of the MPOWER measures that ranges from 1 to 4 for the monitoring component (M) and 1–5 for the other components. A score of 1 represents no known data, while scores 2–5 characterize the overall strength of each measure, from the lowest level of achievement (weakest policy) to the highest level of achievement (strongest policy) 6 . Between 2008 and 2016, although very little progress was made in treatment provision (O) 7 , 9 , the share of the total population covered by best practice (score = 5) P, W and E measures increased (Fig. 1 ). Notably, however, a massive portion of the global population is still not covered by comprehensive laws. As an example, less than 15% of the global population is protected by strongly regulated tobacco advertising (E) and the number of people (2.1 billion) living in countries where none or very limited smoke-free policies (P) are in place (score = 2) is still nearly twice as high as the population (1.1 billion) living in locations with national bans on smoking in all public places (score = 5).

To assess national-level legislation quality, the WHO attributes a score to each MPOWER component that ranges from 1 to 5 for smoke-free (P), health warning (W) and advertising (E) policies. A score of 1 represents no known data or no recent data, while scores 2–5 characterize the overall strength of each policy, from 2 representing the lowest level of achievement (weakest policy), to 5 representing the highest level of achievement (strongest policy).

Source data

In terms of fiscal policies (R), the population-weighted average price, adjusted for inflation, of a pack of cigarettes across 175 countries with available data increased from I$3.10 (where I$ represents international dollars) in 2008 to I$5.38 in 2016. However, from an economic perspective, for prices to affect purchasing decisions, they need to be evaluated relative to income. The relative income price (RIP) of cigarettes is a measure of affordability that reflects, in this study, what proportion of the country-specific per capita gross domestic product (GDP) is needed to purchase half a pack of cigarettes a day for a year. Over time, cigarettes have become less affordable (RIP 2016 > RIP 2008) in about 75% of the analyzed countries, with relatively more affordable cigarettes concentrated across high-income countries.

Our adjusted analysis indicates that greater levels of achievement on key measures across the P, W and E policy categories and higher RIP values were significantly associated with reduced smoking prevalence from 2009 to 2017 (Table 2 ). Among men aged 15 and older, each 1-unit increment in achievement scores for smoking bans (P) was independently associated with a 1.1% (95% UI, −1.7 to −0.5, P < 0.0001) decrease in smoking prevalence. Similarly, an increase of 1 point in W and E scores was associated with a decrease in prevalence of 2.1% (95% UI, −2.7 to −1.6, P < 0.0001) and 1.9% (95% UI, −2.6 to −1.1, P < 0.0001), respectively. Furthermore, a 10 percentage point increase in RIP was associated with a 9% (95% UI, −12.6 to −5.0, P < 0.0001) decrease in overall smoking prevalence. Results were similar for men from other age ranges.

Among women, the magnitude of effect of different policy indicators varied across age groups. For those aged over 15, each 1-point increment in W and E scores was independently associated with an average reduction in prevalence of 3.6% (95% UI, −4.5 to −2.9, P < 0.0001) and 1.9% (95% UI, −2.9 to −1.8, P = 0.002), respectively, and these findings were similar across age groups. Smoking ban (P) scores were not associated with reduced prevalence among women aged 15–29 years or over 50 years. However, a 1-unit increase in P scores was associated with a 1.3% (95% UI, −2.3 to −0.2, P = 0.016) decline in prevalence among women aged 30–49 years. Lastly, while a 10 percentage point increase in RIP lowered women smoking prevalence by 6% overall (95% UI, −10.0 to −2.0, P = 0.014), this finding was not statistically significant when examining reductions in prevalence among those aged 50 and older (Table 2 ).

If tobacco control had remained at the level it was in 2008 for all 155 countries (with non-missing policy indicators for both 2008 and 2016; Methods ) included in the counterfactual analysis, we estimate that smoking prevalence would have been even higher than the observed 2017 rates, with 23 million more male smokers and 8 million more female smokers (age ≥ 15) worldwide (Table 3 ). Out of the counterfactual scenarios explored, the greatest progress in reducing smoking prevalence would have been observed if a combination of higher prices—resulting in reduced affordability levels—and strictest P, W and E laws had been implemented by all countries, leading to lower smoking rates among men and women from all age groups and approximately 100 million fewer smokers across all countries (Table 3 ). Under this policy scenario, the greatest relative decrease in prevalence would have been seen among those aged 15–29 for both sexes, resulting in 26.6 and 6.5 million fewer young male and female smokers worldwide in 2017, respectively.

Our findings reaffirm that a wide spectrum of tobacco demand reduction policies has been effective in reducing smoking prevalence globally; however, it also indicates that even though much progress has been achieved, there is considerable room for improvement and efforts need to be strengthened and accelerated to achieve additional gains in global health. A growing body of research points to the effectiveness of tobacco control measures 10 , 11 , 12 ; however, this study covers the largest number of countries and years so far and reveals that the observed impact has varied by type of control policy and across sexes and age groups. In high-income countries, stronger tobacco control efforts are also associated with higher cessation ratios (that is, the ratio of former smokers divided by the number of ever-smokers (current and former smokers)) and decreases in cigarette consumption 13 , 14 .

Specifically, our results suggest that men are, in general, more responsive to tobacco control interventions compared to women. Notably, with prevalence rates for women being considerably low in many locations, variations over time are more difficult to detect; thus, attributing causes to changes in outcome can be challenging. Yet, there is already evidence that certain elements of tobacco control policies that play a role in reducing overall smoking can have limited impact among girls and women, particularly those of low socioeconomic status 15 . Possible explanations include the different value judgments attached to smoking among women with respect to maintaining social relationships, improving body image and hastening weight control 16 .

Tax and price increases are recognized as the most impactful tobacco control policy among the suite of options under the MPOWER framework 10 , 14 , 17 , particularly among adolescents and young adults 18 . Previous work has also demonstrated that women are less sensitive than men to cigarette tax increases in the USA 19 . Irrespective of these demographic differences, effective tax policy is underutilized and only six countries—Argentina, Chile, Cuba, Egypt, Palau and San Marino—had adopted cigarette taxes that corresponded to the WHO-prescribed level of 70% of the price of a full pack by 2017 (ref. 20 ). Cigarettes also remain highly affordable in many countries, particularly among high-income nations, an indication that affordability-based prescriptions to countries, instead of isolated taxes and prices reforms, are possibly more useful as a tobacco control target. In addition, banning sales of single cigarettes, restricting legal cross-border shopping and fighting illicit trade are required so that countries can fully experience the positive effect of strengthened fiscal policies.

Smoke-free policies, which restrict the opportunities to smoke and decrease the social acceptability of smoking 17 , also affect population groups differently. In general, women are less likely to smoke in public places, whereas men might be more frequently influenced by smoking bans in bars, restaurants, clubs and workplaces across the globe due to higher workforce participation rates 16 . In addition to leading to reduced overall smoking rates, as indicated in this study, implementing complete smoking bans (that is, all public places completely smoke-free) at a faster pace can also play an important role in minimizing the burden of smoking-attributable diseases and deaths among nonsmokers. In 2017 alone, 2.18% (95% UI, 1.8–2.7%) of all deaths were attributable to secondhand smoke globally, with the majority of the burden concentrated among women and children 21 .

Warning individuals about the harms of tobacco use increases knowledge about the health risks of smoking and promotes changes in smoking-related behaviors, while full advertising and promotion bans—implemented by less than 20% of countries in 2017 (ref. 20 )—are associated with decreased tobacco consumption and smoking initiation rates, particularly among youth 17 , 22 , 23 . Large and rotating pictorial graphic warnings are the most effective in attracting smokers’ attention but are lacking in countries with high numbers of smokers, such as China and the USA 20 . Adding best practice health warnings to unbranded packages seems to be an effective way of informing about the negative effects of smoking while also eliminating the tobacco industry’s marketing efforts of using cigarette packages to make these products more appealing, especially for women and young people who are now the prime targets of tobacco companies 24 , 25 .

While it is clear that strong implementation and enforcement are crucial to accelerating progress in reducing smoking and its burden globally, our heterogeneous results by type of policy and demographics highlight the challenges of a one-size-fits-all approach in terms of tobacco control. The differences identified illustrate the need to consider the stages 26 of the smoking epidemics among men and women and the state of tobacco control in each country to identify the most pressing needs and evaluate the way ahead. Smoking patterns are also influenced by economic, cultural and political determinants; thus, future efforts in assessing the effectiveness of tobacco control policies under these different circumstances are of value. As tobacco control measures have been more widely implemented, tobacco industry forces have expanded and threaten to delay or reverse global progress 27 . Therefore, closing loopholes through accelerated universal adoption of the comprehensive set of interventions included in MPOWER, guaranteeing that no one is left unprotected, is an urgent requirement as efforts toward achieving the Sustainable Development Goals by 2030 are intensified.

This was an ecological time series analysis that aimed to estimate the effect of four key demand reduction measures on smoking rates across 175 countries. Country-year-specific achievement scores for P, W and E measures and an affordability metric measured by RIP—to capture the impact of fiscal policy (R)—were included as predictors in the model. Although the WHO also calls for monitoring (M) and tobacco cessation (O) interventions, these were not evaluated. Monitoring tobacco use is not considered a demand reduction measure, while very little progress has been made in treatment provision over the last decade 7 , 9 . Further information on research design is available in the Life Sciences Reporting Summary linked to this paper.

Smoking outcome data

The dependent variable is represented by country-specific, age-standardized estimates of current tobacco smoking prevalence, defined as individuals who currently use any smoked tobacco product on a daily or occasional basis. Complete time series estimates of smoking prevalence from 2009 to 2017 for men and women aged 15–29, 30–49, 50 years and older and 15 years and older, were taken from the Global Burden of Disease (GBD) 2017 study.

The GBD is a scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries and risk factors by age, sex and geography for specific points in time. While full details on the estimation process for smoking prevalence have been published elsewhere, we briefly describe the main analytical steps in this article 3 . First, 2,870 nationally representative surveys meeting the inclusion criteria were systematically identified and extracted. Since case definitions vary between surveys, for example, some surveys only ask about daily smoking as opposed to current smoking that includes both daily and occasional smokers, the extracted data were adjusted to the reference case definition using a linear regression fit on surveys reporting multiple case definitions. Next, for surveys with only tabulated data available, nonstandard age groups and data reported as both sexes combined were split using observed age and sex patterns. These preprocessing steps ensured that all data used in the modeling were comparable. Finally, spatiotemporal Gaussian process regression, a three-step modeling process used extensively in the GBD to estimate risk factor exposure, was used to estimate a complete time series for every country, age and sex. In the first step, estimates of tobacco consumption from supply-side data are incorporated to guide general levels and trends in prevalence estimates. In the second step, patterns observed in locations, age groups and years with smoking prevalence data are synthesized to improve the first-step estimates. This step is particularly important for countries and time periods with limited or no available prevalence data. The third step incorporates and quantifies uncertainty from sampling error, non-sampling error and the preprocessing data adjustments. For this analysis, the final age-specific estimates were age-standardized using the standard population based on GBD population estimates. Age standardization, while less important for the narrower age groups, ensured that the estimated effects of policies were not due to differences in population structure, either within or between countries.

Using GBD-modeled data is a strength of the study since nearly 3,000 surveys inform estimates and countries are not required to have complete survey coverage between 2009 and 2017 to be included in the analysis. Yet, it is important to note that these estimates have limitations. For example, in countries where a prevalence survey was not conducted after the enactment of a policy, modeled estimates may not reflect changes in prevalence resulting from that policy. Nonetheless, the prevalence estimates from the GBD used in this study are similar to those presented in the latest WHO report 28 , indicating the validity and consistency of said estimates.

MPOWER data

Summary indicators of country-specific achievements for each MPOWER measure are released by the WHO every two years and date back to 2007. Data from different iterations of the WHO Report on the Global Tobacco Epidemic (2008 6 , 2009 29 , 2011 30 , 2013 31 , 2015 32 and 2017 20 ) were downloaded from the WHO Tobacco Free Initiative website ( https://www.who.int/tobacco/about/en/ ). To assess the quality of national-level legislation, the WHO attributes a score to each MPOWER component that ranges from 1 to 4 for the monitoring (M) dimension and 1–5 for the other dimensions. A score of 1 represents no known data or no recent data, while scores 2–5 characterize the overall strength of each policy, from the lowest level of achievement (weakest policy) to the highest (strongest policy).

Specifically, smoke-free legislation (P) is assessed to determine whether smoke-free laws provide for a complete indoor smoke-free environment at all times in each of the respective places: healthcare facilities; educational facilities other than universities; universities; government facilities; indoor offices and workplaces not considered in any other category; restaurants or facilities that serve mostly food; cafes, pubs and bars or facilities that serve mostly beverages; and public transport. Achievement scores are then based on the number of places where indoor smoking is completely prohibited. Regarding health warning policies (W), the size of the warnings on both the front and back of the cigarette pack are averaged to calculate the percentage of the total pack surface area covered by the warning. This information is combined with seven best practice warning characteristics to construct policy scores for the W dimension. Finally, countries achievements in banning tobacco advertising, promotion and sponsorship (E) are assessed based on whether bans cover the following types of direct and indirect advertising: (1) direct: national television and radio; local magazines and newspapers; billboards and outdoor advertising; and point of sale (indoors); (2) indirect: free distribution of tobacco products in the mail or through other means; promotional discounts; nontobacco products identified with tobacco brand names; brand names of nontobacco products used or tobacco products; appearance of tobacco brands or products in television and/or films; and sponsorship.

P, W and E achievement scores, ranging from 2 to 5, were included as predictors into the model. The goal was to not only capture the effect of adopting policies at its highest levels but also assess the reduction in prevalence that could be achieved if countries moved into the expected direction in terms of implementing stronger measures over time. Additionally, having P, W and E scores separately, and not combined into a composite score, enabled us to capture the independent effect of different types of policies.

Although compliance is a critical factor in understanding policy effectiveness, the achievement scores incorporated in our main analysis reflect the adoption of legislation rather than degree of enforcement, representing a limitation of these indicators.

Prices in I$ for a 20-cigarette pack of the most sold brand in each of the 175 countries were also sourced from the WHO Tobacco Free Initiative website for all available years (2008, 2010, 2012, 2014 and 2016). I$ standardize prices across countries and also adjust for inflation across time. This information was used to construct an affordability metric that captures the impact of cigarette prices on smoking prevalence, considering the income level of each country.

More specifically, the RIP, calculated as the percentage of per capita GDP required to purchase one half pack of cigarettes a day over the course of a year, was computed for each available country and year. Per capita GDP estimates were drawn from the Institute for Health Metrics and Evaluation; the estimation process is detailed elsewhere 33 .

Given that the price data used in the analysis refer to the most sold brand of cigarettes only, it does not reflect the full range of prices of different types of tobacco products available in each location. This might particularly affect our power in detecting a strong effect in countries where other forms of tobacco are more popular.

Statistical analysis

Sex- and age-specific logit-transformed prevalence estimates from 2009 to 2017 were matched to one-year lagged achievement scores and RIP values using country and year identifiers 34 . The final sample consisted of 175 countries and was constrained to locations and years with non-missing indicators. A multiple linear mixed effects model fitted by restricted maximum likelihood was used to assess the independent effect of P, W and E scores and RIP values on the rates of current smoking. Specifically, a country random intercept and a country random slope on RIP were included to account for geographical heterogeneity and within-country correlation. The regression model takes the following general form:

where y c,t is the prevalence of current smoking in each country ( c ) and year ( t ), β 0 is the intercept for the model and β p , β w , β e and β r are the fixed effects for each of the policy predictors. $\mathrm{P}_{c,\,t - 1},\,\mathrm{W}_{c,\,t - 1},\,\mathrm{E}_{c,\,t - 1}$ are the P, W and E scores and R c , t −1 is the RIP value for country c in year t − 1. Finally, α c is the random intercept for country ( c ), while δ c represent the random slope for the country ( c ) to which the RIP value (R t − 1 ) belongs. Variance inflation factor values were calculated for all the predictor parameters to check for multicollinearity; the values found were low (<2) 35 . Bivariate models were also run and are shown in Extended Data Fig. 5 . The one-year lag introduced into the model may have led to an underestimation of effect sizes, particularly as many MPOWER policies require a greater period of time to be implemented effectively. However, due to the limited time range of our data (spanning eight years in total), introducing a longer lag period would have resulted in the loss of additional data points, thus further limiting our statistical power in detecting relevant associations between policies and smoking prevalence.

In addition to a joint model for smokers from both sexes, separate regressions were fitted for men and women and the four age groups (15–29, 30–49, ≥50 and ≥15 years old). To assess the validity of the mixed effects analyses, likelihood ratio tests comparing the models with random effects to the null models with only fixed effects were performed. Linear mixed models were fitted by maximum likelihood and t -tests used Satterthwaite approximations to degrees of freedom. P values were considered statistically significant if <0.05. All analyses were executed with RStudio v.1.1.383 using the lmer function in the R package lme4 v.1.1-21 (ref. 36 ).

A series of additional models to examine the impact of tobacco control policies were developed as part of this study. In each model, cigarette affordability (RIP) and a different set of policy metrics was used to capture the implementation, quality and compliance of tobacco control legislation. In models 1 and 2, we replaced the achievements scores by the proportion of P, W and E measures adopted by each country out of all possible measures reported by the WHO. In model 3, we used P and E (direct and indirect measures separately) compliance scores provided by the WHO to represent actual legislation implementation. Finally, an interaction term for compliance and achievement to capture the combined effect of legislation quality and performance was added to model 4. Results for men and women by age group for each of the additional models are presented in the Supplemental Information (Supplementary Tables 1–4 ).

The main model described in this study was chosen because it includes a larger number of country-year observations ( n = 823) when compared to models including compliance scores and because it is more directly interpretable.

Counterfactual analysis

To further explore and quantify the impact of tobacco control policies on current smoking prevalence, we simulated what smoking prevalence across all countries would have been achieved in 2017 under 4 alternative policy scenarios: (1) if achievement scores and RIP remained at the level they were at in 2008; (2) if all countries had implemented each of P, W and E component at the highest level (score = 5); (3) if the price of a cigarette pack was I$7.73 or higher, a price that represents the 90th percentile of observed prices across all countries and years; and (4) if countries had implemented the P, W and E components at the highest level and higher cigarette prices. To keep our results consistent across scenarios, we restricted our analysis to 155 countries with non-missing policy-related indicators for both 2008 and 2016.

Random effects were used in model fitting but not in this prediction. Simulated prevalence rates were calculated by multiplying the estimated marginal effect of each policy by the alternative values proposed in each of the counterfactual scenarios for each country-year. The global population-weighted average was computed for status quo and counterfactual scenarios using population data sourced from the Institute for Health Metrics and Evaluation. Using the predicted prevalence rates and population data, the additional reduction in the number of current smokers in 2017 was also computed. Since models were ran using age-standardized prevalence, the number of smokers was proportionally redistributed across age groups using the sex-specific numbers from the age group 15 and older as an envelope.

The UIs for predicted estimates were based on a computation of the results of each of the 1,000 draws (unbiased random samples) taken from the uncertainty distribution of each of the estimated coefficients; the lower bound of the 95% UI for the final quantity of interest is the 2.5 percentile of the distribution and the upper bound is the 97.5 percentile of the distribution.

Reporting Summary

Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

The dataset generated and analyzed during the current study is publicly available at http://ghdx.healthdata.org/record/ihme-data/global-tobacco-control-and-smoking-prevalence-scenarios-2017 ( https://doi.org/10.6069/QAZ7-6505 ). The dataset contains all data necessary to interpret, replicate and build on the methods or findings reported in the article. Tobacco control policy data that support the findings of this study are released every two years as part of the WHO’s Global Report on Tobacco Control; these data are also directly accessible at https://www.who.int/tobacco/global_report/en/ . Source data are provided with this paper.

Code availability

All code used for these analyses is available at http://ghdx.healthdata.org/record/ihme-data/global-tobacco-control-and-smoking-prevalence-scenarios-2017 and https://github.com/ihmeuw/team/tree/effects_tobacco_policies .

World Health Organization. WHO Framework Convention on Tobacco Control https://www.who.int/fctc/text_download/en/ (2003).

United Nations. Transforming Our World: the 2030 Agenda for Sustainable Development https://sustainabledevelopment.un.org/post2015/transformingourworld/publication (2015).

Stanaway, J. D. et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392 , 1923–1994 (2018).

Article Google Scholar

Jha, P. & Peto, R. Global effects of smoking, of quitting, and of taxing tobacco. N. Engl. J. Med. 370 , 60–68 (2014).

Article CAS Google Scholar

Ekpu, V. U. & Brown, A. K. The economic impact of smoking and of reducing smoking prevalence: review of evidence. Tob. Use Insights 8 , 1–35 (2015).

World Health Organization. WHO Report on the Global Tobacco Epidemic, 2008: the MPOWER Package https://www.who.int/tobacco/mpower/2008/en/ (2008).

Chung-Hall, J., Craig, L., Gravely, S., Sansone, N. & Fong, G. T. Impact of the WHO FCTC over the first decade: a global evidence review prepared for the Impact Assessment Expert Group. Tob. Control 28 , s119–s128 (2019).

Reitsma, M. B. et al. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 389 , 1885–1906 (2017).

Nilan, K., Raw, M., McKeever, T. M., Murray, R. L. & McNeill, A. Progress in implementation of WHO FCTC Article 14 and its guidelines: a survey of tobacco dependence treatment provision in 142 countries. Addiction 112 , 2023–2031 (2017).

Dubray, J., Schwartz, R., Chaiton, M., O’Connor, S. & Cohen, J. E. The effect of MPOWER on smoking prevalence. Tob. Control 24 , 540–542 (2015).

Anderson, C. L., Becher, H. & Winkler, V. Tobacco control progress in low and middle income countries in comparison to high income countries. Int. J. Environ. Res. Public Health 13 , 1039 (2016).

Gravely, S. et al. Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study. Lancet Public Health 2 , e166–e174 (2017).

Ngo, A., Cheng, K.-W., Chaloupka, F. J. & Shang, C. The effect of MPOWER scores on cigarette smoking prevalence and consumption. Prev. Med. 105S , S10–S14 (2017).

Feliu, A. et al. Impact of tobacco control policies on smoking prevalence and quit ratios in 27 European Union countries from 2006 to 2014. Tob. Control 28 , 101–109 (2019).

Google Scholar

Greaves, L. Gender, equity and tobacco control. Health Sociol. Rev. 16 , 115–129 (2007).

Amos, A., Greaves, L., Nichter, M. & Bloch, M. Women and tobacco: a call for including gender in tobacco control research, policy and practice. Tob. Control 21 , 236–243 (2012).

Hoffman, S. J. & Tan, C. Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health 15 , 744 (2015).

Chaloupka, F. J., Straif, K. & Leon, M. E. Effectiveness of tax and price policies in tobacco control. Tob. Control 20 , 235–238 (2011).

Rice, N., Godfrey, C., Slack, R., Sowden, A. & Worthy, G. A Systematic Review of the Effects of Price on the Smoking Behaviour of Young People (Centre for Reviews and Dissemination, 2009); https://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12013060057&LinkFrom=OAI&ID=12013060057

World Health Organizaion. WHO Report on the Global Tobacco Epidemic 2017: Monitoring Tobacco Use and Prevention Policies https://www.who.int/tobacco/global_report/2017/en/ (2017).

Institute for Health Metrics and Evaluation. GBD Compare https://vizhub.healthdata.org/gbd-compare/ (2017).

Saffer, H. & Chaloupka, F. The effect of tobacco advertising bans on tobacco consumption. J. Health Econ. 19 , 1117–1137 (2000).

Noar, S. M. et al. The impact of strengthening cigarette pack warnings: systematic review of longitudinal observational studies. Soc. Sci. Med. 164 , 118–129 (2016).

Moodie, C., Brose, L. S., Lee, H. S., Power, E. & Bauld, L. How did smokers respond to standardised cigarette packaging with new, larger health warnings in the United Kingdom during the transition period? A cross-sectional online survey. Addict. Res. Theory 28 , 53–61 (2020).

Wakefield, M. et al. Australian adult smokers’ responses to plain packaging with larger graphic health warnings 1 year after implementation: results from a national cross-sectional tracking survey. Tob. Control 24 , ii17–ii25 (2015).

Thun, M., Peto, R., Boreham, J. & Lopez, A. D. Stages of the cigarette epidemic on entering its second century. Tob. Control 21 , 96–101 (2012).

Bialous, S. A. Impact of implementation of the WHO FCTC on the tobacco industry’s behaviour. Tob. Control 28 , s94–s96 (2019).

World Health Organization. Global Report on Trends in Prevalence of Tobacco Smoking 2000–2025 http://www.who.int/tobacco/publications/surveillance/trends-tobacco-smoking-second-edition/en/ (2018).

World Health Organization. WHO Report on the Global Tobacco Epidemic 2009: Implementing Smoke-Free Environments https://www.who.int/tobacco/mpower/2009/en/ (2009).

World Health Organization. WHO Report on the Global Tobacco Epidemic 2011: Warning About the Dangers of Tobacco https://www.who.int/tobacco/global_report/2011/en/ (2011).

World Health Organization. WHO Report on the Global Tobacco Epidemic 2013: Enforcing Bans on Tobacco Advertising, Promotion and Sponsorship https://www.who.int/tobacco/global_report/2013/en/ (2013).

World Health Organization. WHO Report on the Global Tobacco Epidemic 2015: Raising Taxes on Tobacco https://www.who.int/tobacco/global_report/2015/en/ (2015).

James, S. L., Gubbins, P., Murray, C. J. & Gakidou, E. Developing a comprehensive time series of GDP per capita for 210 countries from 1950 to 2015. Popul. Health Metr. 10 , 12 (2012).

Institute for Health Metrics and Evaluation. Global Tobacco Control and Smoking Prevalence Scenarios 2017 (dataset) (Global Health Data Exchange, 2020).

Zuur, A. F., Ieno, E. N. & Elphick, C. S. A protocol for data exploration to avoid common statistical problems. Methods Ecol. Evol. 1 , 3–14 (2010).

Bates, D., Mächler, M., Bolker, B. & Walker, S. Fitting linear mixed-effects models using lme4. J. Stat. Softw. https://doi.org/10.18637/jss.v067.i01 (2015).

Download references

Acknowledgements

The study was funded by Bloomberg Philanthropies (grant 47386, Initiative to Reduce Tobacco Use). We thank the support of the Tobacco Metrics Team Advisory Group, which provided valuable comments and suggestions over several iterations of this manuscript. We also thank the Tobacco Free Initiative team at the WHO and the Campaign for Tobacco-Free Kids for making the tobacco control legislation data available and providing clarifications when necessary. We thank A. Tapp, E. Mullany and J. Whisnant for assisting in the management and execution of this study. We thank the team who worked in a previous iteration of this project, especially A. Reynolds, C. Margono, E. Dansereau, K. Bolt, M. Subart and X. Dai. Lastly, we thank all GBD 2017 Tobacco collaborators for their valuable work in providing feedback to our smoking prevalence estimates throughout the GBD 2017 cycle.

Author information

Authors and affiliations.

Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA

Luisa S. Flor, Marissa B. Reitsma, Vinay Gupta & Emmanuela Gakidou

IBM Watson Health, San Jose, CA, USA

You can also search for this author in PubMed Google Scholar

Contributions

L.S.F., M.N. and E.G. conceptualized the study and designed the analytical framework. M.B.R. and V.G. provided input on data, results and interpretation. L.S.F. and E.G. wrote the first draft of the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Emmanuela Gakidou .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Additional information

Peer review information Jennifer Sargent was the primary editor on this article and managed its editorial process and peer review in collaboration with the rest of the editorial team.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Extended data

Extended data fig. 1 prevalence of current smoking for men (a) and women (b) aged 15 years and older (age-standardized) in 2017..

Age-standardized smoking prevalence (%) estimates from the 2017 Global Burden of Disease Study for men (a) and women (b) aged 15 years and older for 195 countries. Smoking is defined as current use of any type of smoked tobacco product. Details on the estimation process can be found in the Methods section and elsewhere 3 .

Extended Data Fig. 2 Prevalence of current smoking for men (a) and women (b) aged 15 to 29 years old (age-standardized) in 2017.

Age-standardized smoking prevalence (%) estimates from the 2017 Global Burden of Disease Study for men (a) and women (b) aged 15–29 years old for 195 countries. Smoking is defined as current use of any type of smoked tobacco product. Details on the estimation process can be found in the Methods section and elsewhere 3 .

Extended Data Fig. 3 Prevalence of current smoking for men (a) and women (b) aged 30 to 49 years old (age-standardized) in 2017.

Age-standardized smoking prevalence (%) estimates from the 2017 Global Burden of Disease Study for men (a) and women (b) aged 30–49 years old for 195 countries. Smoking is defined as current use of any type of smoked tobacco product. Details on the estimation process can be found in the Methods section and elsewhere 3 .

Extended Data Fig. 4 Prevalence of current smoking for men (a) and women (b) aged 50 years and older (age-standardized) in 2017.

Age-standardized smoking prevalence (%) estimates from the 2017 Global Burden of Disease Study for men (a) and women (b) aged 50 years and older for 195 countries. Smoking is defined as current use of any type of smoked tobacco product. Details on the estimation process can be found in the Methods section and elsewhere 3 .

Extended Data Fig. 5 Percentage changes in current smoking prevalence based on fixed effect coefficients from bivariate mixed effect linear regression models, by policy component, sex and age group.

Bivariate models examined the unadjusted association between smoke-free (P), health warnings (W), and advertising (E) achievement scores, and cigarette’s affordability (RIP) and current smoking prevalence, from 2009 to 2017, across 175 countries (n = 823 country-years). Linear mixed models were fit by maximum likelihood and t-tests used Satterthwaite approximations to degrees of freedom. P values were considered statistically significant if lower than 0.05.

Supplementary information

Supplementary information.

Supplementary Tables 1–4: additional models results.

Source Data Fig. 1

Input data for Fig. 1 replication.

Source Data Extended Data Fig. 1

Input data for Extended Data 1 replication.

Source Data Extended Data Fig. 2

Input data for Extended Data 2 replication.

Source Data Extended Data Fig. 3

Input data for Extended Data 3 replication.

Source Data Extended Data Fig. 4

Input data for Extended Data 4 replication.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Flor, L.S., Reitsma, M.B., Gupta, V. et al. The effects of tobacco control policies on global smoking prevalence. Nat Med 27 , 239–243 (2021). https://doi.org/10.1038/s41591-020-01210-8

Download citation

Received : 28 May 2020

Accepted : 10 December 2020

Published : 21 January 2021

Issue Date : February 2021

DOI : https://doi.org/10.1038/s41591-020-01210-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

This article is cited by

Marketing claims, promotional strategies, and product information on malaysian e-cigarette retailer websites-a content analysis.

Sameeha Misriya Shroff
Chandrashekhar T Sreeramareddy

Substance Abuse Treatment, Prevention, and Policy (2024)

Challenges in legitimizing further measures against smoking in jurisdictions with robust infrastructure for tobacco control: how far can the authorities allow themselves to go?

Karl Erik Lund
Gunnar Saebo

Harm Reduction Journal (2024)

Health effects associated with exposure to secondhand smoke: a Burden of Proof study

Luisa S. Flor
Jason A. Anderson
Emmanuela Gakidou

Nature Medicine (2024)

Predictors of quitting smoking behavior: evidence from Pakistan

Assad Ullah Khan
Sareer Ahmad

Environmental Science and Pollution Research (2024)

Impacts of heavy smoking on non-coding RNA expression for patients with esophageal carcinoma

Jianming Wang

BMC Medical Genomics (2023)

Quick links

Explore articles by subject
Guide to authors
Editorial policies

Tobacco, Nicotine, and E-Cigarettes Research Report How can we prevent tobacco use?

Photo of a cigarette that has been put out

The medical consequences of tobacco use—including secondhand exposure—make tobacco control and smoking prevention crucial parts of any public health strategy. Since the first Surgeon General’s Report on Smoking and Health in 1964, states and communities have made efforts to reduce initiation of smoking, decrease exposure to smoke, and increase cessation. Researchers estimate that these tobacco control efforts are associated with averting an estimated 8 million premature deaths and extending the average life expectancy of men by 2.3 years and of women by 1.6 years. 18 But there is a long way yet to go: roughly 5.6 million adolescents under age 18 are expected to die prematurely as a result of an illness related to smoking. 13

Prevention can take the form of policy-level measures, such as increased taxation of tobacco products; stricter laws (and enforcement of laws) regulating who can purchase tobacco products; how and where they can be purchased; where and when they can be used (i.e., smoke-free policies in restaurants, bars, and other public places); and restrictions on advertising and mandatory health warnings on packages. Over 100 studies have shown that higher taxes on cigarettes, for example, produce significant reductions in smoking, especially among youth and lower-income individuals. 217 Smoke-free workplace laws and restrictions on advertising have also shown benefits. 218

Prevention can also take place at the school or community level. Merely educating potential smokers about the health risks has not proven effective. 218 Successful evidence-based interventions aim to reduce or delay initiation of smoking, alcohol use, and illicit drug use, and otherwise improve outcomes for children and teens by reducing or mitigating modifiable risk factors and bolstering protective factors. Risk factors for smoking include having family members or peers who smoke, being in a lower socioeconomic status, living in a neighborhood with high density of tobacco outlets, not participating in team sports, being exposed to smoking in movies, and being sensation-seeking. 219 Although older teens are more likely to smoke than younger teens, the earlier a person starts smoking or using any addictive substance, the more likely they are to develop an addiction. Males are also more likely to take up smoking in adolescence than females.

Some evidence-based interventions show lasting effects on reducing smoking initiation. For instance, communities utilizing the intervention-delivery system, Communities that Care (CTC) for students aged 10 to14 show sustained reduction in male cigarette initiation up to 9 years after the end of the intervention. 220

Our top issues

In our fight to end smoking, vaping and nicotine addiction, we focus on the issues that matter most. We constantly monitor the latest topics and trends in tobacco and substance use.

Youth vaping, smoking & nicotine use
Menthol & flavored tobacco products
Harm reduction
Tobacco & social justice
Tobacco-free communities & campuses
Tobacco industry interference
Tobacco in pop culture
Quitting smoking & vaping
Opioids crisis

Truth Initiative is America's largest nonprofit public health organization committed to making tobacco use and nicotine addiction a thing of the past.

Our mission
Our history
Annual reports

Research & resources

Get the latest facts and analyses on the most important issues related to smoking, vaping, nicotine and substance use.

Search by keywords

Emerging tobacco products
Traditional tobacco products
Targeted communities
Smoking by region
Quitting smoking / vaping

We give young people the facts about smoking, vaping, nicotine and the tobacco industry, engage individuals and groups to make change in their communities, innovate ways to end nicotine addiction and join forces with collaborators committed to a future where tobacco and nicotine addiction are a thing of the past.

Truth Initiative Schroeder Institute®

truth® campaign

Community & youth engagement
Quit smoking & vaping tools
Corporate tobacco cessation programs
Truth Initiative Impact Series

Partnerships

Get involved.

Enlist in our movement, explore youth activism programs, share quitting resources and learn about more ways you can get involved.

Take action
Partner with us
Request a training
Participate in our research
Apply for grants or scholarships

Join our newsletter

Search our site.

Sign up for our newsletter

Quitting Tobacco: Facts and Stats

Most smokers – nearly 70% – say they want to quit, and many make quit attempts each year. In 2020, slightly more than half of current smokers (56%) made a quit attempt in the past year.

White House Delay in Issuing Final Menthol and Flavored Cigar Rules Represents Huge Loss for Public Health, Social Justice

Lack of action squanders the ability to save lives, protect youth and stand up for social justice by reducing health disparities.

Girl on the couch watching shows on a tablet

Lights, Camera, Tobacco?

How rising smoking and vaping imagery in top entertainment influences e-cigarette use and fuels nicotine addiction among young audiences.

2023 Monitoring the Future Survey Shows Encouraging Declines in Youth E-Cigarette Use and Increased Risk Perception Among High Schoolers

The findings shared in the 2023 Monitoring the Future Survey (MTF) are encouraging, highlighting notable decreases in e-cigarette use among high school students.

Truth Initiative and EVERFI Collaborate to Launch Updated Prescription Drug Safety Curriculum for Middle and High School Students Amid Growing Youth Overdose Crisis

We are Truth Initiative

Inspiring lives free from smoking, vaping and nicotine

We seek, speak and spread the truth about smoking , vaping , and nicotine

Truth Initiative Schroeder Institute ® Research & Evaluation

We do rigorous, science-backed research then share what we find.

Community & youth engagement

We inspire and train future leaders to counter tobacco's influence

Youth vaping & smoking prevention & education

We deliver the facts so young people can make informed decisions.

Quit smoking tools

We help people quit through scalable, cost-efficient interventions.

We work with corporations, organizations and individuals who share our commitment.

Our latest research and resources

Screenshots of discreet shipping vapes on TikTok

We need your help to achieve a culture where all young people reject smoking, vaping and nicotine

The latest news from Truth Initiative

White house decision not to issue final menthol rule represents huge loss for public health, social justice, truth initiative partners with pennsylvania’s office of attorney general to provide prescription drug safety course, powered by everfi from blackbaud, hear it first.

The pros and cons of a total smoking ban

Plans to phase out the sale of tobacco completely have won cross-party support

Newsletter sign up Newsletter

Pro: saving lives

Con: black markets, pro: avoiding poverty, con: risk to civil liberties, pro: environmental protection, con: losing tax revenue.

Rishi Sunak's plans to phase out the sale of cigarettes appears to have gained cross-party backing, making a total smoking ban in the UK a real possibility.

The prime minister used his Conservative Party conference speech to announce plans to raise the age at which people can buy tobacco in England year by year until it applies to the whole population. This would mean a 14-year-old today will never legally be able to buy a cigarette, putting England on a par with the likes of New Zealand, which introduced a similar law last year, in having "some of the strictest smoking laws in the world", Sky News reported.

While an outright ban – even one introduced over several decades – may prove controversial, its chances of coming into law have received a boost after it won support from Labour, as well as Welsh and Scottish governments, where laws on smoking are devolved.

Subscribe to The Week

Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.

https://cdn.mos.cms.futurecdn.net/flexiimages/jacafc5zvs1692883516.jpg

Sign up for The Week's Free Newsletters

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

"Political instincts on this issue are coalescing around a similar position," said BBC political editor Chris Mason, meaning the plan could be both "profound and long-lasting".

Almost six million people in England smoke, and tobacco remains the single biggest cause of preventable illness and death. Tobacco smoke can cause cancer, stroke and heart disease, with smoking-related illnesses costing the NHS £17 billion a year, according to campaign group Action on Smoking and Health (ASH).

An independent government-commissioned review , which last year recommended proposals similar to those announced by Sunak, argued that tackling tobacco use and supporting smokers to quit would help prevent 15 types of cancer – including lung cancer, throat cancer and acute myeloid leukaemia. Recent data showed that one in four deaths from all cancers were estimated to be from smoking.

Speaking on BBC Radio 4 's "Today" programme, the prime minister said his proposals represented the "biggest public health intervention in a generation", a claim backed up by England's chief medical officer, Sir Chris Whitty, who stressed how beneficial the health improvements would be.

Simon Clark, of smokers' lobby group Forest, told the BBC that "creeping prohibition won't stop young adults smoking" but it will "simply drive the sale of tobacco underground and consumers will buy cigarettes on the black market where no-one pays tax and products are completely unregulated".

The illicit trade in tobacco products "poses major health, economic and security concerns around the world", according to the World Health Organization , which estimates 1 in every 10 cigarettes and tobacco products consumed globally is illicit.

Writing for The Conversation , Dr Brendan Gogarty, of the University of Tasmania, argued that "laws that rely on prohibition to reduce the prevalence and harm from drugs generally fail to achieve their aims".

Smoking causes a disproportionate burden on the most disadvantaged families and communities, last year's independent review found. The average smoker in the North East of England spends over 10% of their income on tobacco, compared to just over 6% in the South East.

This mirrors research from 2015 conducted by University of Nottingham, which found parents who smoke were "plunging nearly half a million children into poverty", The Independent reported.

As smokers quit, said Sudyumna Dahal for The Conversation , household budgets "become easier, facilitating what a study in the British Medical Journal describes as an income transfer from male smokers to females and other family members".

Therefore, argue anti-smoking campaigners, banning smoking would bring greater benefits to the less well-off.

Smokers and the groups who advocate on their behalf argue that their habit is a civil right, even if it kills the smoker. In a report published in 2019, the smokers’ group Forest argued that "smokers are the canaries for civil liberties".

It added that the call for a ban "directly violates the harm principle that assumes a person has autonomy over their own life and body as long as they do not hurt other people".

As The Spectator editor Fraser Nelson pointed out on Twitter , plans to phase out the sale of cigarettes could lead to the absurd situation where pensioners will have to produce ID to prove which side of the ever-moving line of legality they are on.

"I'd love to live in a smoke-free world," wrote Rachael Bletchly in the Daily Mirror . "I wish people would stop wrecking their health with cigarettes. But I don't think it's the job of politicians to police other grown-ups' filthy habits. And I fear that Rishi Sunak's new smoking ban is just well-meaning, populist puff."

Cigarette smoking has several negative environmental impacts and banning smoking would bring these to an end. Smokers release pollution into the atmosphere, cigarette butts litter the environment, and the toxic chemicals in the residues cause soil and water pollution.

Tobacco is commonly planted in rainforest areas and has contributed to major deforestation, said Conserve Energy Future .

A 2013 report in the journal Tobacco Control found that cigarette manufacturing “consumes scarce resources in growing, curing, rolling, flavouring, packaging, transport, advertising and legal defence” and “also causes harms from massive pesticide use”.

Taxation on smoking raises more than £8.8 billion per year for the Treasury, noted Politics.co.uk . The TaxPayers’ Alliance rejected the argument that smokers also cost the taxman more due to their health burden, arguing that smokers who suffer major health problems are more likely to die prematurely, reducing expenditure on state pensions and other age-related benefits.

Sign up for Today's Best Articles in your inbox

A free daily email with the biggest news stories of the day – and the best features from TheWeek.com

2020 presidential debate between Donald Trump and Joe Biden seen on the screen of a smartphone

Instant Opinion Opinion, comment and editorials of the day

By Harold Maass, The Week US Published 29 April 24

Speed Read The Tesla CEO won China's approval to introduce Full Self-Driving (FSD) cars

By Peter Weber, The Week US Published 29 April 24

Cartoons Monday's cartoons - Tik Tok tactic, Cricket sounds, and more

By The Week US Published 29 April 24

White House Advisor Stephen Miller watched President Donald Trump

In Depth The former president is planning to fundamentally flip America's civil rights protections if he wins a second term in office

By Rafi Schwartz, The Week US Published 9 April 24

Illustration of Donald Trump, submarines and a map of Australia

Today's Big Question US, UK and Australia seek to expand 'game-changer' defence partnership ahead of Republican's possible return to White House

By Sorcha Bradley, The Week UK Published 22 March 24

By Harold Maass, The Week US Published 21 March 24

Today's Big Question PM's pledge to deliver economic growth is 'in tatters' as stagnation and falling living standards threaten Tory election wipeout

By Harriet Marsden, The Week UK Published 16 February 24

Tesla CEO Elon Musk speaks during the unveiling of the Tesla Model Y

By Harold Maass, The Week US Published 1 February 24

The Explainer Across England, local councils are suffering from grave financial problems

By The Week UK Published 28 January 24

Talking Point The Telegraph launches 'assault' on PM just as many Tory MPs are contemplating losing their seats

By Keumars Afifi-Sabet, The Week UK Published 26 January 24

Former U.S. President Donald Trump prepares to speak at the Conservative Political Action Conference

Today's Big Question Re-election of Republican frontrunner could threaten UK security, warns former head of secret service

By Harriet Marsden, The Week UK Published 17 January 24

Contact Future's experts
Terms and Conditions
Privacy Policy
Cookie Policy
Advertise With Us

The Week is part of Future plc, an international media group and leading digital publisher. Visit our corporate site . © Future US, Inc. Full 7th Floor, 130 West 42nd Street, New York, NY 10036.

Log in using your username and password

Search More Search for this keyword Advanced search
Latest content
Current issue
JME Commentaries
BMJ Journals More You are viewing from: Google Indexer

Kalle Grill 1 ,
Kristin Voigt 2 , 3
1 Department of Historical, Philosophical and Religious Studies , University of Umeå , Umea , Sweden
2 Ethox Centre, Nuffield Department of Population Health, University of Oxford, UK
3 Institute for Health and Social Policy & Department of Philosophy, McGill University, Canada
Correspondence to Dr Kristin Voigt, Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF; kristin.voigt{at}ethox.ox.ac.uk

Lifelong smokers lose on average a decade of life vis-à-vis non-smokers. Globally, tobacco causes about 5–6 million deaths annually. One billion tobacco-related deaths are predicted for the 21st century, with about half occurring before the age of 70. In this paper, we consider a complete ban on the sale of cigarettes and find that such a ban, if effective, would be justified. As with many policy decisions, the argument for such a ban requires a weighing of the pros and cons and how they impact on different individuals, both current and future. The weightiest factor supporting a ban, we argue, is the often substantial well-being losses many individuals suffer because of smoking. These harms, moreover, disproportionally affect the disadvantaged. The potential gains in well-being and equality, we argue, outweigh the limits a ban places on individuals’ freedom, its failure to respect some individuals’ autonomous choice and the likelihood that it may, in individual cases, reduce well-being.

Population Policy
Public Health Ethics
Public Policy

https://doi.org/10.1136/medethics-2015-102682

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Introduction

Lifelong smokers lose on average a decade of life vis-à-vis non-smokers. Globally, tobacco causes about 5–6 million deaths annually. 1 This number is expected to grow: a total of one billion deaths are predicted during the 21st century, with about half occurring before the age of 70. 1 , 2 It is against this background that we will argue for a complete ban on the sale of cigarettes. While our argument focuses on tobacco cigarettes, which in many countries are by far the most popular tobacco product and in the aggregate the most harmful, we think it could be extended to include other forms of combustible tobacco as well.

As with many policy decisions, the argument for a ban requires a weighing of its pros and cons, including its impact on different individuals, both current and future. The weightiest factor supporting a ban, we argue, is the often substantial well-being losses many individuals suffer as a result of smoking. These harms, moreover, disproportionately affect the disadvantaged. The potential gains in well-being and equality, we argue, outweigh the limits a ban places on individuals’ freedom, its failure to respect some individuals’ autonomous choice and the likelihood that it may, in individual cases, reduce well-being.

The idea of a complete ban on the sale of cigarettes is not new. Bans were in place in 15 US states from 1890 to 1927, and Bhutan has had a ban since 2004. 3 Bans on the sale of (at least some) tobacco products have also been endorsed by members of the international tobacco control community. 3–6

In order to bring into focus the fundamental normative issues surrounding a ban on sales, we will simplify our discussion in two ways. First, we assume that a ban would be effective. In the real world, of course, any all-things-considered judgement must be informed by an assessment of a ban's likely effectiveness in different contexts, with due consideration of problems such as smuggled cigarettes and black markets. Second, we focus on a complete ban on sales, comparing this only to the status quo and not to the full range of policy alternatives. i We believe that the necessary debate about different policy instruments in various contexts will be greatly facilitated by consideration of the principled argument for a perfectly effective ban, which is what our paper seeks to provide.

We discuss smoking as a global problem, although most real bans would likely be implemented domestically and our argument might have to be adapted to reflect the situation of individual countries or regions. In rich countries, factors such as the greater availability of cessation resources and information about the risks of smoking make a ban less warranted than in countries where much of the population may be unaware of the risks associated with smoking. We therefore focus our discussion on rich countries in order to tackle the most challenging case for our position. This should not detract from the fact that the majority of death and disease a global ban would prevent will occur in low-income and middle-income countries.

We begin by considering the impact of smoking on health and well-being (section ‘Health and well-being’) and the egalitarian effects of a ban (section ‘Equality’), both of which will be central to our argument. We then discuss how individual freedom and autonomy are affected by a ban in the section ‘Freedom and autonomy’. The sections ‘Voluntariness’, ‘Irrationality’ and ‘Preferences and endorsement’ consider three putative aspects of smoking choices that have been emphasised in the literature: non-voluntariness, irrationality and inconsistency with smokers’ endorsed preferences. These aspects do strengthen the argument for a ban, but their role is different from what is often proposed. In ‘Banning cigarettes: pros and cons’, we bring together these various considerations and explain why overall they speak in favour of a ban. The final section concludes by briefly commenting on how e-cigarettes could help address some of the problems and opposition facing a ban on conventional cigarettes.

Health and well-being

The health risk of smoking naturally varies with the extent of tobacco use. Long-time smokers face significantly increased health risks, including higher risks of lung and other cancers, cardiovascular disease and chronic obstructive pulmonary disease. Significant differences in mortality rates between smokers and never-smokers become apparent from middle age onwards. 8 Studies suggest a 10-year to 11-year difference between the lifespans of long-term and never-smokers. 8 , 9 In addition, smoking is implicated in causing many non-fatal conditions that can substantially lower individuals’ quality of life, ranging from asthma, tuberculosis, digestive problems and gum disease to vision problems, reduced fertility as well as impotence. 10

While heavy tobacco use is of course more harmful than light use, even light use, when long term, yields substantial health risks, in some respects approximating those of long-term heavy use. For example, ischaemic heart disease risk is similar in light, intermittent and heavy smokers. 11 With respect to lung cancer, for men smoking 1–4 cigarettes per day, the risk is three times that of never-smokers; for women, it is five times as high. 12

Conversely, cessation—which an effective ban would ensure—is associated with substantial health benefits. While for those who quit before their 30s excess mortality is reduced almost to the level of never-smokers, even those who quit at the ages of 40, 50 and 60 gain about 9, 6 and 3 years of life expectancy, respectively. 8 , 9

We believe that a comprehensive argument for a ban should look beyond health to overall well-being: improving health outcomes would not be worthwhile if this left people worse off overall. Many health risks are quite reasonably considered worth taking by the individuals concerned because of the benefits they bring in other, non-health areas of their lives.

While there may be disagreement in specific instances, on most accounts of well-being both the premature mortality and various diseases associated with smoking will reduce lifetime well-being. On hedonist views, the pain and frustration associated with non-fatal diseases typically decrease well-being with no countervailing benefit. Regarding mortality, life is, with some tragic exceptions, on balance a positive experience, and so more life is better. On preferentist or desire-based views, more of a person's most important preferences will typically be satisfied, and fewer frustrated, if she lives longer and has better health. A longer and healthier life also advances typical objective list entries such as developing and sustaining human relationships, and various moral and rational pursuits. Even if one refrains from specifying the nature of well-being, in line with liberal neutrality, long life and good health are all-purpose means that contribute to the pursuit of almost any life plan.

Importantly, we do not deny that smoking can also promote well-being in certain respects; in fact, we will emphasise below that it can do so and consider the possibility that there may be individuals for whom smoking leads to an overall gain in well-being. However, in the aggregate, the negative well-being effects of smoking are likely much larger than its positive effects.

Smoking also contributes to inequality. Most obviously, smokers are, to varying degrees, worse off than non-smokers because of the health risks and the monetary costs associated with smoking. Less obviously, because of the denormalisation of smoking, smokers are increasingly stigmatised and discriminated against. 13 , 14

What makes smoking particularly problematic from the point of view of equality is that it disproportionately harms people who are disadvantaged in other regards. In many rich countries, smoking rates are significantly higher among low-income groups. In the UK, for example, smoking prevalence in routine or manual occupations is 30% while in managerial and professional occupations it is 16%. 15 Among the most deprived groups, smoking rates reach >70%; among homeless people sleeping rough, 90% are smokers. 16

Of course, not all disadvantaged people smoke, and not all smokers are disadvantaged, socio-economically or otherwise. In the aggregate, however, a ban could help reduce inequalities in health outcomes. Studies suggest that, in Europe, smoking could be the largest single contributor to socio-economic inequalities in health, particularly among men. 17 In the UK, tobacco is considered the cause of about half of the socioeconomic status difference in death rates. 18

Many factors may contribute to unequal smoking rates. Smoking norms vary substantially across different groups. 19 In deprived communities, smoking often plays an important social role. 20 Support with cessation, including nicotine replacement therapy (NRT), counselling and medical advice, may also be more accessible for those from better-off groups. Further, the tobacco industry has specifically targeted disadvantaged populations, for example by placing its advertising disproportionately in low-income and ethnic minority neighbourhoods 21 , 22 and devising marketing strategies with particular appeal to the homeless and those with mental health problems. 23 These factors may help explain differences in cessation rates: studies suggest that across social groups smokers make similar numbers of cessation attempts but those in better-off groups are more likely to succeed. 24 It is an ongoing concern that many tobacco control strategies have greater effects on cessation rates among better-off groups vis-à-vis disadvantaged groups; 25 ii an effective ban would enforce cessation equally across social groups, avoiding these inegalitarian effects.

The idea that a ban would enhance equality in health outcomes assumes that those who quit as a result of a ban will substitute smoking with something less harmful to their health. The fact that, as we noted above, cessation is associated with such substantially improved health outcomes suggests that those who quit do so in ways that are overall beneficial for their health. It is not implausible that many of those who would quit as a result of a ban (many of whom, as we note below, are very motivated to quit) would see similarly improved health prospect. However, much will depend on how exactly a ban is phased in and the extent to which it is accompanied by measures to help smokers quit.

Our assessment of a ban should be based on its likely effects not only on health inequalities but on inequalities more broadly conceived. One important concern is that, while unequal smoking rates across different socio-economic groups mean that the health loss averted by a ban should be much greater among disadvantaged groups, a ban could also impose additional burdens on these smokers. As Gostin emphasises, a complete ban would leave many highly addicted smokers in withdrawal and distress, 26 many of them from vulnerable populations, including the poor, prisoners and the homeless, as well as those with mental health problems, for whom the immediate effects of quitting might be more complicated and/or more difficult to deal with. 27

More generally, being disadvantaged—be it socio-economically or in other ways—may also affect people's ability to respond or adapt to a ban. Different ways of ‘phasing in’ a ban might help address these concerns, as could the availability of suitable substitutes, such as e-cigarettes. For example, a ban could be accompanied by free NRT for those on low incomes, prison populations or those in mental health institutions.

For some smokers, the burdens imposed by a ban may be so significant that they will not be compensated for by the benefits cessation would bring; smokers in their 80s or 90s might be a case in point. Limited licensing schemes might be a suitable strategy for this group. Importantly, as we explain in more detail below, these concerns arise in relation to the current generation of smokers and will have much less significance with respect to future generations, who—because of the ban—would not become smokers in the first place. We return to this issue in the section ‘Banning cigarettes: pros and cons’.

Freedom and autonomy

An important concern about our proposal is that a ban would pose an undue restriction on individual freedom and autonomy. Regarding freedom, we accept that any restriction of the available opportunities reduces freedom of choice. iii However, more freedom is not always better, nor is it always preferred. The disvalue of a particular restriction on freedom depends both on the interest people have in using the opportunity that is being removed, and on the interest people have in having or keeping the opportunity as an opportunity , whether or not they use it. Even non-smokers may have an interest in having the opportunity to smoke: this might be quite a specific interest (eg, in resisting temptation) or a more general interest in having a wide range of options.

Autonomy we understand here as self-direction, involving both an internal and an external aspect. Internal autonomy is the absence of internal obstacles to self-rule, such as ignorance, poor self-confidence or sense of self-worth, incoherent desires or preferences, and various psychological conditions such as clinical depression and obsessive-compulsive disorder. External autonomy is the absence of external obstacles to self-rule, most obviously various malign influences from others to manipulate one's deliberations and so undermine one's independence. iv So understood, a ban will not necessarily reduce autonomy. Quite to the contrary, to the extent that a ban frees many smokers of a debilitating addiction, it strengthens their internal autonomy.

A ban may fail to respect individual autonomy. Respecting autonomy, we propose, requires abstaining from frustrating the choices of relatively autonomous people. We accept that there are strong reasons to respect autonomy in this sense. While significant shortfalls from full autonomy reduce our reasons to respect choices, they do not fully eliminate such reasons; interference still requires some justification. v Indeed, since people are typically quite prone to make choices that are far from fully autonomous, we think that almost any choice should warrant some respect. Note that one may choose something even if one does not find the freedom to do so important, or indeed even if one would prefer not to have this freedom. Such choices indicate some sort of inner conflict, but it may still be disrespectful of others to interfere with them.

Freedom and respect for autonomy, as we have described them, can pull in different directions when it comes to evaluating a ban on cigarettes. An autonomous smoker may choose to restrict her own freedom to smoke. For example, she may engage her partner in keeping their shared home free of cigarettes. If someone prevents her from making this arrangement, this protects her freedom to smoke but fails to respect her autonomy. Similarly, smokers may try to engage their government in keeping their society free of cigarettes (in fact, many smokers would welcome a ban imposed by the government; we return to this issue in the section ‘Preferences and endorsement’); for these smokers, a ban, by restricting their freedom, will respect their autonomy.

Respect for autonomy can also part ways with well-being considerations. A person may autonomously choose to smoke because she does not care about her future well-being or because she falsely believes that a shorter and less healthy life will not decrease her well-being (eg, because she believes, at 21, that she will never want to live past the age of 40 anyway). We have reason both to respect this choice and to protect this person's lifetime well-being.

The next three sections address three related considerations that have been taken to strengthen the case for a ban: the degree to which smoking choices are less than fully voluntary, the limited rationality of these choices and the fact that many smokers do not endorse their smoking choices. Sometimes, these factors are explicitly invoked in relation to freedom or autonomy, sometimes they are invoked as arguments in their own right. As will become apparent, we believe that these considerations can indeed play an important role in the argument for a ban; however, their role has been overstated in the literature and must be qualified in various respects.

Voluntariness

The most comprehensive philosophical argument for strict regulation of smoking (though not explicitly a complete ban on cigarettes) has arguably been put forth by Robert Goodin, especially in his 1989 book, No Smoking: The Ethical Issues . One of Goodin's central arguments for tobacco regulation starts from the idea that because smokers typically have not fully appreciated the risks of smoking, and because smoking is addictive, the associated risks are not voluntarily assumed. This, in Goodin's argument, makes interference with smoking choices much less problematic than interference with other kinds of choices.

Goodin proposes that people are often not sufficiently informed about the consequences of smoking. Being sufficiently informed, on his account, requires not only being able to state the relevant probabilities about risks but also to ‘appreciate them in an emotionally genuine manner’ (ref. 33 , p. 24, citing Gerald Dworkin 34 ). Goodin does not seem to believe that being uninformed completely removes any reasons against regulation, but rather that the less informed a choice is, the less reason we have to abstain from frustrating it (ref. 33 , p. 21).

We share Goodin's concern that smokers must know the risks associated with smoking if we are to fully respect their choice to smoke. Knowledge of the risks of smoking is now well spread in developed countries, but much less so in many developing countries, 35 making the concern about involuntarily incurred risk highly relevant in these countries. This is important not least because 82% of the world's smokers currently live in low-income and middle-income countries. 36

However, Goodin's claim that in order to be sufficiently informed we must also have an emotionally genuine appreciation of these risks amounts to a very strong requirement. It may be very difficult for a 20-year-old to appreciate, ‘in an emotionally genuine manner’, the suffering she might endure as a victim of emphysema 40 years later, especially if she lacks experience of major illness in herself or those close to her. Such a demanding requirement may be more reasonable for choices with immediate effects, but one of the problems with smoking is precisely that people typically start young and suffer the consequences much later. Goodin's criterion of what counts as informed choice may turn out to be too high a bar to clear for most of the choices people make, including our most important choices, such as whether and with whom to have children. On Goodin’s account, we have strong reasons to interfere with such choices if we believe them to be unwise. It is beyond the scope of this article to fully engage with Goodin's arguments on its own terms. However, we believe that the best argument for a tobacco ban does not depend on such a controversial interpretation of informed choice. We think that the argument for a ban can succeed even if we accept that we have strong reasons to respect the choices smokers make, even if they do not fully appreciate the risks of smoking.

The second factor Goodin emphasises is the addictiveness of smoking. He argues that while it is not impossible to overcome addictions, what matters normatively is whether the addictiveness makes it ‘unreasonably costly’ (ref. 33 , p. 25) to do so: if the addiction is so strong “that even someone with ‘normal and reasonable self-control’ would succumb to it, we have little compunction in saying that the addict's free will was sufficiently impaired that his apparent consent counts for naught” (ref. 33 , pp. 25–6, citing Gary Watson 37 ). This condition, Goodin argues, is met in the case of smoking. Thus, a smoker's continuing to smoke cannot be taken as consent to the risks involved. Further, many smokers become addicted below the age of consent and so, Goodin argues, they cannot be taken to have consented to the risk of becoming addicted to nicotine.

While we share some of Goodin's concerns about the implications of addiction, the heterogeneity of smokers means that his argument applies to fewer smokers than Goodin suggests. Consider first the matter of age. It is often claimed that the quota of smokers who become addicted below the age of 21 is extremely high; Goodin puts this number at 95%. However, these numbers are typically based on studies that ask respondents at what age they first started smoking. This question may lead them to focus on their first ever cigarette, which need not indicate the beginning of addiction. Studies that instead ask respondents when they started smoking regularly indicate that the number of smokers who took up smoking as minors is substantially smaller. Surveys of UK smokers indicate that 55–66% start before the age of 18 (ref. 38 , p. 42, ref. 39 , p. 11).

Even regular smoking, however, is not necessarily a good indicator of addiction. Some adolescents may be able to maintain intermittent smoking without developing dependence. 40 Among adults, too, not all smokers become dependent. One study finds that almost 40% of daily smokers fail to meet the criteria of nicotine dependence (though they may exhibit individual symptoms of addiction, such as difficulties abstaining from cigarettes). 41 While there is disagreement about how to define addiction and what proportion of smokers meet the required criteria, there may be a significant proportion of smokers to whom this part of Goodin's argument does not apply.

Furthermore, it is not clear that addiction fully undermines the voluntariness of smoking in all regards. Even if addiction makes it ‘unreasonably costly’ to abstain from one's next cigarette, there may still be scope for devising a longer-term cessation strategy. This kind of long-term planning is arguably less susceptible to the forces of addiction. The addictiveness of tobacco may of course still thwart any cessation attempts smokers do make (we return to this below); but Goodin's argument, by not addressing this issue, proceeds too quickly.

Finally, irrespective of the degree to which addictiveness undermines the voluntariness of smoking, we are more concerned than Goodin that we have some reason to abstain from frustrating even those choices that are substantially non-voluntary. As John Christman notes, “I might know that a person is to some degree under the sway of external pressures that are severely limiting her ability to govern her life and make independent choices. But as long as she has not lost the basic ability to reflectively consider her options and make choices, if I intervene against her will (for her own good), I show less respect for her as a person than if I allow her to make her own mistakes”. 42

Our scepticism about Goodin’s argument should not be taken to imply that we think addictiveness is irrelevant. It is certainly true that many smokers are addicted and have become addicted in their youth; we agree that we have less reason to respect these smokers’ choice to smoke. Moreover, the addictiveness of smoking is often an intermediary cause in people becoming long-term smokers and thus facing substantial health risks. However, the lack of consent argument may apply to a smaller proportion of smokers than Goodin suggests.

More generally, we think that the broader concern here—whether or not smokers voluntarily accept the risks of smoking—should play a somewhat different role in the argument. On the one hand, as we have said, the degree of voluntariness affects the degree to which the choices involved are autonomous and so to what degree we have reason to respect them. At the same time, though, even if risks were accepted in a fully voluntary manner, this does not mean that the resulting harm is not undesirable or that we should not seek to prevent it.

Harms can be undesirable even if they result from risks that are voluntarily assumed. If, for example, I risk my health by donating a kidney to a relative, this does not detract from the undesirability of any ensuing harms. There may be an exception for harms that are actively sought out: a person may want to die, or want to amputate an arm, where this is not merely instrumental to some aim that can be reached in less harmful ways. However, when a person simply accepts a risk of what is for her an undesirable outcome, this is clearly not by itself a reason to disregard the risk or outcome.

Jason Hanna makes a persuasive argument against tying the justifiability of paternalism to voluntarily assumed risks. 43 Hanna gives the example of a reckless hiker who voluntarily abstains from gathering information on which bridges in the area are dangerous. Later on, the hiker unknowingly starts to cross a dangerous bridge, not because he wants to court danger but simply to finish his hike. If respect for autonomy precludes from moral consideration voluntarily assumed risks, then a bystander has no reason to intervene, which seems an unacceptable conclusion (ref. 43 , pp. 424–5). Similarly, we cannot conclude that we should abstain from intervening with smoking simply because smokers have voluntarily assumed the health risks.

Irrationality

A further concern in the normative debate about smoking and about how governments ought to respond to it is that smoking choices are in some sense irrational. This is the argument Sarah Conly pursues in her recent book, Against Autonomy: Justifying Coercive Paternalism , where she argues that we should often disregard, at least to some extent, smokers’ apparent preference for smoking. Goodin takes similar considerations to bolster his argument from lack of consent. The argument from irrationality can start from either impairments in the decision-making of smokers (in particular, cognitive biases) or, relatedly, from a discrepancy between smokers’ own goals and their choices.

Invoking impairment, Goodin argues that intervention into the choice to smoke is especially warranted if smokers’ false beliefs are caused by cognitive biases. Goodin points to evidence that smokers are subject to three biases, which are now most often called optimistic bias (‘wishful thinking’), the availability heuristic (‘anchoring’) and hyperbolic or temporal discounting (‘time discounting’). 33 As is more thoroughly researched and more widely appreciated now than when Goodin wrote his book, these biases are quite general, and not particular to smokers. 44 Therefore, either of two conclusions are possible: either the charge that smoking choices in particular are impaired loses its force or the charge is expanded to very many decisions we make. The latter option is the one pursued by Conly.

Conly cites a wide range of research in behavioural psychology and concludes: “We generally suffer from many flaws in instrumental reasoning that interfere with our ability to make effective and efficient choices” (ref. 45 , p. 23). The same conclusion has motivated Richard Thaler and Cass Sunstein to promote what they call libertarian paternalism—benevolent structuring of choice situations that does not significantly affect the outcomes of the various options in the choice set. 46 , 47 Conly argues that libertarian paternalist measures are insufficient to ensure that people's choices promote their well-being and that we have no good reason to abstain from coercive measures. Her argument, however, is thoroughly consequentialist and does not give a role to respect for autonomy as we understand it. Instead, she assumes that we have reason to respect autonomy only if this is an effective means of promoting some other goal: “the basic premise of liberalism […] is that we are basically rational, prudent creatures who may thus, and should thus, direct themselves autonomously” (ref. 45 , p. 30). Conly rejects this premise and draws the conclusion that “when it comes to respect for autonomy, we can see that our belief that autonomous actions should not be interfered with was based on a mistake” (ref. 45 , p. 192).

Since we believe that there is reason to respect an agent's choices, even when these choices do not promote the agent's well-being, we find the argument from irrationality unpersuasive. Behavioural research may have proven that poor instrumental rationality is a general aspect of human decision-making. This, however, does not necessarily undermine our reasons to respect choices that are about as autonomous as choices typically are. What would be more relevant is if smokers in particular were prone to irrationality. There is some evidence that addiction causes behaviour that may be deemed irrational, though this is disputed. vi

We now turn from the proposal that poor instrumental rationality is an impairment to the more consequentialist observation that poor instrumental rationality, impaired or not, is prone to create a discrepancy between goals and actions. It is clear that people make choices that do not further their own well-being. What has been open to interpretation and debate is whether this means that people fail to effectively promote their goals or whether, instead, they might have goals other than furthering their own well-being. The extensive study of cognitive biases has given us some reason to favour the first interpretation: if people are under the constant influence of cognitive bias, we can expect that they will not effectively further their own goals. Therefore, the fact that they do not promote their own well-being need not indicate that this is not their goal.

Conly argues that “[w]hat we need to do is to help one another avoid mistakes so that we may all end up where we want to be ” (ref. 45 , p. 2, emphasis added). Where we want to be, Conly assumes, there are no cigarettes. She describes smoking as a “bad course[] of action” (ref. 45 , p. 8) and an instance of people “choos[ing] poorly” (ref. 45 , p. 9). Smokers, she says, “spend a disproportionate amount of their income on a habit that will probably leave them in worse health and possibly shorten their life without bestowing compensating benefits ” (ref. 45 , p. 33, emphasis added). Goodin similarly argues that “what is involved here is a weak form of paternalism, working within the individual's own theory of the good and merely imposing upon him better means of achieving his own ends ” (ref. 50 , p. 23, emphasis added).

While we agree that we should be concerned about a possible discrepancy between smokers’ goals and their choices, Conly's argument does not give sufficient weight to the fact that many people find smoking pleasurable and enjoy the taste or the buzz and relaxing effects that come from nicotine. As summarised in a recent study, “nicotine induces pleasure and reduces stress and anxiety. Smokers use it to modulate levels of arousal and to control mood. Smoking improves concentration, reaction time, and performance of certain tasks” (ref. 51 , p. 2298). The behavioural components of smoking may also be experienced as relaxing. 52 It is certainly not obvious that the net effect of smoking on well-being is necessarily negative. While Conly briefly discusses pleasure in the context of tobacco and acknowledges the pleasure addicted smokers experience from cigarettes (mainly the pleasure of alleviating withdrawal symptoms) (ref. 45 , pp. 170–1), she dismisses too quickly the possibility that those who smoke but are not addicted can derive substantial pleasure from cigarettes. vii This is particularly important because, as we noted above, a significant portion of smokers may not in fact be addicted.

Could these pleasures indeed outweigh the risks and so make smoking consistent with the goal of furthering one's own well-being? This, we think, can vary, depending primarily on an individual's level of tobacco consumption. Consider lung cancer, which is one of the most severe conditions associated with smoking (though, of course, not the only one; lung cancer causes less than half of the excess mortality among smokers). 8 For heavy, life-long smokers, studies estimate the risk of developing lung cancer over the course of one's life to be up to 25% compared with 0.2–1% for never-smokers. 54 For these smokers, it seems plausible to claim that the benefits could not possibly outweigh the risks. However, this is much less clear at lower levels of consumption. Though smoking 1–4 cigarettes a day, as noted above, increases the risk of lung cancer by 3–5 times, 12 this must be seen in relation to the very low risk for never-smokers. Further, while the literature emphasises that there is no ‘safe’ or ‘risk-free’ level of tobacco consumption, those who quit before age 30 appear to avoid almost all of the excess mortality risk associated with continued smoking. 8 , 9 , 55 Given that smoking can further such goals as pleasure, manifesting a romantic nonchalance and social belonging, these risks seem potentially quite acceptable. viii Moreover, given that the cost of cessation is typically higher than the cost of not starting, it may be more rational to keep smoking than to start.

Further, even when the harms of long-time smoking and the limited benefits it brings combine to make smoking apparently irrational for the typical smoker, it does not follow that we should completely disregard these choices. Some limited irrationality is common and should not automatically undermine respect for individuals’ choices. At the same time, outright irrationality, caused by smoking-specific cognitive failures or simply inferred from severe lack of goal orientation, may remove or significantly weaken our reasons to respect choice. To the extent that smokers display such irrationality, this strengthens the case for a ban. However, the degree to which this concern applies to individual smokers will vary and we should be cautious in giving it too much weight in our argument.

While the irrationality of smoking has played an important role in arguments for tight tobacco control, we have emphasised two broad concerns in this section: first, smoking choices may be more rational than is often assumed and, second, even irrational choices warrant more respect than is typically allowed in the literature on smoking. Our argument for a ban on cigarettes focuses instead on the well-being losses it would avert; that people may be irrational and not secure these benefits for themselves in the absence of a ban is an additional consideration in its favour but should play a much smaller role in the argument than it does for Goodin and Conly.

Preferences and endorsement

A further factor supporting the case for a ban is that smokers often do not endorse their preference for smoking: They have a preference to smoke but also a preference about that preference : they would prefer not to have it. In a 1991 article, Goodin argues that public policy “can hardly be said to be paternalistic in any morally offensive respect [if] the preferences which it overrides are ones which people themselves wish they did not have” (ref. 56 , p. 48). For Goodin, the fact that smokers typically go through many failed cessation attempts shows that their preference for smoking is often not endorsed. The preference for quitting, on the other hand, typically has second-order endorsement (ref. 56 , pp. 47–48).

Studies indeed suggest that the majority of smokers want to quit. US data puts this proportion at 70%, 57 UK data at 64% of smokers. 39 Further, in a study with participants from Canada, the USA, the UK and Australia, about 90% of smokers agreed with the statement, “If you had to do it over again, you would not have started smoking”. 58 This indicates that many smokers themselves do not find smoking consistent with their goals, lending support both to concerns about irrationality and non-voluntariness, which we discussed above. It also indicates, more directly, that many smokers are unhappy with their smoking.

However, if (endorsed) preferences are to guide policy decisions, then a policy designed to prevent smokers from smoking may also need to be evaluated based on smokers’ preferences about that policy : it is quite possible that I would prefer not to prefer to smoke, but that I also prefer that the government not prevent my smoking. In fact, Goodin seems to assume that smokers will themselves be opposed to regulation (ref. 56 , p. 42). It is not clear why, on his account, such preferences about policy would not tell against a ban.

Looking at preferences about a ban, a somewhat different picture emerges. Many smokers would welcome a ban, though not a majority. Studies from the USA, England, Hong Kong, New Zealand and the Australian state of Victoria suggest that among current smokers about 25–38% would support the introduction of a ban over the next 10 years or so. 59–63

Where does this leave the argument for a ban? Though Goodin’s treatment is not sufficiently sensitive to vast individual variations, the high degree to which smokers want and try to quit certainly weakens those reasons against a ban that are based on respect for autonomy and the value of freedom: it is arguably more important to respect choices that are endorsed by the chooser, and people generally have a greater interest in preserving options that they would like to make use of. We must also consider smokers’ preferences about the ban. As noted, studies from several countries indicate that about a third of them support such a proposal; for these smokers, respect for autonomy actually tells in favour of a ban.

Importantly, people will not have equal ‘stakes’ in this decision. On the one hand, those supporting the ban may be heavy smokers who find themselves unable to quit, seeking to free themselves of a substantial burden on their health, well-being and finances. On the other hand, those who are not addicted and enjoy the occasional cigarette may find that a ban removes a source of pleasure for them. Non-smokers, too, may value the opportunity to smoke; as we noted above, people can value opportunities even if they have no intention of making use of them. However, if—as seems likely—very few non-smokers actually have any intention of using this option, their interest in keeping it open should weigh much less heavily in decisions about tobacco control. Simply ‘adding up’ these different preferences may, therefore, not be an appropriate way to give them the respect they are due. ix

Banning cigarettes: pros and cons

It is time to bring together the various strands of our argument and consider how they inform the desirability or otherwise of a ban on the sale of cigarettes. Much of the literature on strict tobacco regulation focuses on various ways in which smoking choices are significantly less than fully autonomous—involuntariness, irrationality and lack of endorsement of smoking choices are the most prominent considerations in the literature, as we discussed in the preceding sections. We agree that these factors are crucial; however, contrary to how they are viewed by other proponents of strict tobacco regulation (such as Conly and Goodin), these factors do not by themselves establish that a cigarette ban is justified, for two reasons: first, many smokers and/or smoking choices do not in fact meet the identified criterion: a significant proportion of smokers may not be addicted, not all smoking choices reflect an irrational assessment of benefits and risks, and so on. Second, when smoking choices do fall short of requirements of autonomy in these ways, interference with these choices becomes more acceptable but it does not become wholly unproblematic. As we discussed above, the primary concern for us is the well-being loss that is associated with cigarettes. We accept that a ban would interfere with some (reasonably) autonomous choices as well as restrict individual freedom, but these negative implications are far outweighed by the well-being gains a ban would imply for both current and future generations.

What speaks against a ban is, first, its negative effects on freedom, in terms of the loss of a valued opportunity to smoke and, second, its failure to respect the autonomy of the many smokers who apparently choose to smoke. With respect to the first concern, we noted that non-smokers have an interest in keeping the option of smoking open and a cigarette ban will involve a restriction of their freedom, even if they have no intention of consuming cigarettes. While it is important to acknowledge this point, we must also emphasise that this is a fairly minimal cost, especially relative to what is at stake for smokers.

The degree to which smokers value the freedom to smoke is likely to vary. Indeed, about a third would favour a ban, which indicates that they do not value the opportunity to smoke very highly, or at least that this value is outweighed by other considerations. Furthermore, it seems that the majority of smokers plan to quit and wish they had never started. Therefore, the freedom to smoke may be unimportant for many—possibly the majority of—smokers.

Regarding autonomy, we noted that by removing a source of addiction a ban would contribute to many current smokers’ internal autonomy. This is, of course, a strong reason in favour of a ban. At the same time, a ban fails to respect the choices of the many people who currently smoke, especially those who wish to continue. We have discussed how lack of voluntariness, irrationality and lack of endorsement may mean that many smoking choices warrant less respect than choices typically warrant. Of these facts, lack of voluntariness due to early smoking initiation and due to addiction, lack of second-order endorsement of the preference to smoke and a positive preference for a ban strike us as the most significant. However, many choices to smoke are not burdened by any of these factors, and even when they are, they warrant some respect.

These concerns with freedom and autonomy must be weighed against what we considered the two main considerations supporting a ban: first, the well-being gained by averting substantial health losses that many individuals would otherwise face. This includes averting the expected increase from the current 5–6 million annual premature deaths from tobacco, many of which occur in middle age, and eventually reducing this number to zero, as well as avoiding many non-fatal but severe health conditions. Second, the positive effects on equality achieved by removing a source of poor health that disproportionately affects those who are already disadvantaged.

We recognised that some smokers’ well-being might be negatively affected by a ban. This is most likely for two kinds of smokers. First, those who enjoy smoking and only smoke occasionally and thus face much smaller health risks that are outweighed by the pleasures they gain—think, for example, of people who like to smoke a cigar a few times a year. Second, those who, despite substantial cigarette use, will not see substantial benefits from cessation, for example, because they are very old or fatally ill. Cessation support and limited licensing schemes may help this latter group but do not necessarily address this concern fully. While these burdens should not be downplayed, it must be noted that a ban would lower well-being for only a small minority of people and only for the current generation.

The group that stands to gain the most from a ban, on the other hand, are lifelong heavy smokers for whom the pleasures of smoking are not worth the risks and who, because of tobacco's addictive properties, find it extremely difficult or even impossible to effectively act on their preference not to smoke. These smokers are often among the most disadvantaged in society in other regards. Significant well-being gains can also be expected for those who smoke less, and even much less—as we noted above, even low levels of tobacco consumption can be associated with significant health risks.

As far as the current generation is concerned, then, four factors speak in favour of a ban: first, very large benefits in aggregate well-being. Second, reduced inequality in well-being because the benefits accrue largely to the disadvantaged. Third, improvements in internal autonomy for those who would prefer not to smoke. Fourth, respect for the autonomy of that proportion of the smoking population who want a ban (the evidence we cited suggests that this is about a third). These considerations stand against three opposing considerations: first, diminished well-being for those smokers whose well-being is improved by smoking (which we consider to be a small number of smokers). Second, a reduction in freedom that, as we argued, should be given less weight where non-smokers are concerned, and which is unimportant to many smokers (at least to those who want a ban and perhaps also to many who do not but who do not want to smoke). Third, a ban will fail to respect the autonomy of current smokers—though some of our reasons for such respect are weakened by lack of voluntariness, irrationality and lack of endorsement. This failure of respect is arguably greatest with regard to that proportion of smokers who do not favour a ban (about two-thirds). To us, despite the weighty considerations opposing a ban, the balance is very much in its favour.

Consider now all those potential future people who have not yet faced the choice of whether or not to smoke. With an effective ban, these people will not be tempted by the presence of cigarettes. They will not encounter social settings where smoking is advantageous. They may simply regard smoking a historical curiosity. While their freedom is restricted by a ban, it seems likely that the lost option will be quite insignificant to most of them. Some future people might have improved their well-being by smoking, some will surely oppose the ban and some will think they would have liked to smoke. For some of them, the choice to smoke may have been rational and/or endorsed. We expect, however, that this group will form a small minority and a significantly smaller section of the population than is the subsection of the present population who smoke and oppose a ban. For future people, therefore, the arguments against a ban are much weaker than for current people. The arguments for a ban, on the other hand, are just as strong: well-being and equality will be promoted by preventing the harms of smoking, for future people as for current people. With respect to future generations, therefore, the case for a ban seems even more clear-cut than for the current generation.

Some of these future people, it should be noted, are already alive, in the form of children who are too young to have faced the choice of whether or not to smoke. Especially in poor countries, this group is not as large as one would like since children encounter smoking very early. Still, >600 million people are below the age of five. x This group will supply many of the 10 million annually who are expected to face premature death from smoking from 2050 and on. For them, as well as for future people, the case for a ban seems overwhelming.

For those who consider freedom and/or respect for autonomy more important than we do, or promotion of autonomy and/or well-being and/or equality less important, taking a more long-term perspective is likely to shift the balance of reasons to favour a ban. Indeed, it seems to us merely a matter of how long a perspective one takes. If we consider all the people who will be born in this present century, it is hard to see how prevention of the more than one billion expected premature deaths and the substantial individual suffering that comes with it could be outweighed by respect for the choice of some present (and some future would-be) smokers and concern for the restrictions on freedom involved.

One concern we might have about making the case for a cigarette ban is that of a ‘slippery slope’: once we acknowledge the possibility that cigarettes should be banned, what would stop us from banning, say, certain types of food, alcohol or risky sports? In response, it is crucial to emphasise that arguments about banning or legalising any particular substances or activities need to be made on their own terms and focus on the characteristics of the activity or substance in question. Much of the argument we present here relies on a combination of features that is specific to cigarettes and could not be easily extended to other substances—such as the high risks for long-term users and the high level of addictiveness. At the same time, we think that the broad strategy we pursued here—going beyond questions about individual freedom to consider the well-being impact of smoking on different individuals—could be helpful in discussing the status of other substances and activities.

Philosophical arguments for bans typically focus on particular features of smoking choices—that they are irrational, non-voluntary and/or unendorsed—that are taken to make it (fairly) unproblematic for policymakers to interfere. However, these arguments are too quick in two respects: first, many smoking choices do not, in fact, share the identified characteristic. Second, while irrationality, non-voluntariness and lack of endorsement may weaken our reasons for protecting choices, they certainly do not remove them entirely. Much of the opposition to bans rests precisely on the understanding that we have reason to respect people's choices, even when these choices are problematic in various respects. Our argument has sought to stake out a more nuanced position, which acknowledges and gives substantial weight to the potential of a ban to disrespect individual autonomy and restrict freedom but emphasises the well-being losses such a ban could avert.

Of course, the argument for a ban faces not only philosophical but also political opposition. However, the idea is slowly gaining traction in the tobacco control community and various ways of phasing in such a ban are being explored. What is more, electronic cigarettes and the debate surrounding them could provide a helpful entry point towards a serious discussion about a ban on conventional cigarettes. E-cigarettes deliver nicotine to users in a way that is much more similar to conventional cigarettes than other currently available nicotine delivery systems. While the jury is still out on the harmfulness of e-cigarettes to users and bystanders, 65 there is a decent chance that these devices will turn out to be much less harmful than conventional cigarettes. Appropriate regulation could help ensure that these harms remain below acceptable levels. To the extent that e-cigarettes can provide a substitute for conventional cigarettes, many of the costs associated with a ban—in terms of limiting freedom and forcing current smokers to quit—would be alleviated. At the same time, many of the concerns about e-cigarettes—for example, that they would act as a ‘gateway’ to conventional cigarettes 66 and that they would ‘renormalise’ smoking 67 —would fall away if conventional cigarettes are effectively banned.

Some readers may not agree with the weighing we have given to the different pros and cons of banning cigarettes. For these readers, a more cautious conclusion is that it is important to recognise the variety of considerations at stake, as well as the fact that the costs of a ban would diminish with respect to future generations as these would grow up without cigarettes. Our conclusion, however, is that in light of the substantial death and disease it could avert, the case for a complete and effective ban on the sale of cigarettes is very strong.

Acknowledgments

The authors would like to thank Adina Preda for helpful comments on an earlier draft. KG's work is supported by the Swedish Research Council for Health, Working Life and Welfare (grant no. 2009-2189). KV's work is supported by the Fonds de recherche du Québec – Société et culture (grant no. 172569).

McDaniel P ,
Walters EH ,
Boreham J , et al
Reeves GK , et al
↵ ASH . Smoking statistics: illness and death. ash.org.uk. http://ash.org.uk/files/documents/ASH_107.pdf (accessed 14 May 2015 ).
Schane RE ,
Bjartveit K ,
Richardson K ,
Mackenbach J
Hiscock R ,
Amos A , et al
MacAskill S ,
MacKintosh A , et al
Barbeau EM ,
Naumova E , et al
Yerger VB ,
Przewoznik J ,
Apollonio DE ,
Clifford D , et al
Schroeder SA ,
Dworkin G ,
Abdullah A ,
Chaloupka F ,
Corrao M , et al
Fernander A ,
Rayens MK ,
Zhang M , et al
↵ USDHHS . Preventing tobacco use among youth and young adults: a report of the surgeon general . Atlanta, GA : US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion , 2012 .
Christman J
Sunstein CR ,
Benowitz NL
Fagerström K
Brennan P ,
Zaridze D , et al
Ramasundarahettige C ,
Landsman V , et al
Hammond D ,
Laux FL , et al
Connolly GN ,
Healton CG , et al
Lam TH , et al
Edwards R ,
Peace J , et al
Wakefield MA ,
Benowitz NL ,

Competing interests None declared.

Provenance and peer review Commissioned; externally peer reviewed.

↵ i Note that many proposals are not alternatives to a ban but rather strategies for its implementation. This includes gradual phase-out schemes, such as the Tobacco Free Generation legislation currently under consideration by Tasmania’s government. 7

↵ ii A possible exception to this appears to be increased taxation. However, taxation comes with a set of egalitarian concerns of its own; see Voigt 19 for further discussion.

↵ iii This is in accordance with the mainstream liberal tradition whose proponents include Isaiah Berlin, 28 Joel Feinberg 29 and Ian Carter. 30 This is, we believe, a quite intuitive way to think about freedom.

↵ iv By defining autonomy negatively, we hope to remain somewhat neutral between various more substantial accounts. Sometimes, external autonomy is taken to require freedom (ref. 31 , p. 204). Since we consider freedom separately, we will leave this possibility to the side here.

↵ v For an extensive treatment of respect for less than fully autonomous choice, see Grill. 32

↵ vi For a range of perspectives, see Elster and Skog; 48 for a convincing case that addicts do display some particular irrationality, see Rachlin. 49

↵ vii The idea that smoking might be pleasurable typically receives little attention in the literature. For an interesting discussion of how the relationship between harm and pleasure is viewed in public health discourses about smoking, particularly in the context of e-cigarettes, see Bell and Keane. 53

↵ viii This should not detract from the concern that unfair inequalities can affect the costs and benefits associated with smoking and thereby the extent to which the risks of smoking become acceptable. For example, as we mentioned in the section ‘Equality’, social norms around smoking vary across social groups, with smoking often playing an important social role in disadvantaged communities but much less so in affluent ones; this means that not smoking can come with a cost for those in disadvantaged communities that does not exist for those in wealthier ones. That this can make the risks of smoking more acceptable in some social groups than others should be viewed as an unfair disadvantage. 19

↵ ix On respect for divergent preferences in groups, cf. discussion on group consent by Grill. 64

↵ x CIA World Factbook, https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html

Linked Articles

Mini-Symposium: Regulating smoking Ethics of tobacco harm reduction from a liberal perspective Yvette van der Eijk Journal of Medical Ethics 2015; 42 273-277 Published Online First: 26 Nov 2015. doi: 10.1136/medethics-2015-102974
The concise argument Paternalism on Mars Dominic Wilkinson Journal of Medical Ethics 2016; 42 271-272 Published Online First: 25 Apr 2016. doi: 10.1136/medethics-2016-103598

Read the full text or download the PDF:

Banning the use of Tobacco Essay

Introduction, why the use of tobacco should be banned, works cited.

Tobacco is a product of a species of plant that has nicotine content. Harvested as leaves of that particular plant, tobacco can be used to control pests or even as medicine.

It is however widely used as a drug through smoking, snuffing, chewing among others. This paper seeks to support the banning of the use of tobacco. The paper will give reasons in support of the opinion.

Tobacco and cardiovascular diseases

Tobacco like many other drugs has varied side effects that call for the control of its use. These negative impacts are manifested in individuals and ends up costing lives in the long run. One of the reasons why tobacco should be banned is its danger in relation to cardiovascular diseases.

Cardiovascular diseases are complications that are associated with the heart and blood vessels in the body such as arteries which carry blood to body parts. Once a cardiovascular disease is induced in a person, it manifests in different ways causing threats to a person’s health and thus life.

A significant percentage of heart complications related deaths have, for example, been associated with tobacco smoking with reports ranging this value at about thirty percent. One of the contents of tobacco, carbon monoxide, has for example been identified to have an impact on the oxygen carrying capacity of blood.

Consequently, a person who is under the influence of tobacco will suffer from insufficient supply of oxygen to vital body parts that include the “heart, lungs, brain and other vital body organs” (Wvdhhr 1).

The nicotine content of tobacco also induces increased “heart beat rate and blood pressure” (Wvdhhr 1) as a result, the blood circulatory system is over worked and exposed to risks of being damaged.

This in the long run results in cases such as “heart attacks, high blood pressure, blood clots, strokes, hemorrhages” (Wvdhhr 1) among other disorders. A person who smokes is thus endangered by a number of complications that will negatively hinder the person’s operations and subsequently his or her life due to malfunctioning body parts.

These effects can be easily transferred to aspects such as economic instability of the tobacco victim and immediate family members if the victim was the sole bread winner and is put down by such cardiovascular complications.

A government’s responsibility over the welfare of its citizens therefore calls for a step to control such cardiovascular complications and subsequent impacts and one of the primary ways to do this is by banning the consumption of tobacco.

Tobacco and cancers

Another reason why tobacco should be banned is because of its effect in causing a number of cancers in the body. Cancer is characterized by an induced growth of malignant cells in a person’s body.

These cancerous growths also have an effect of malfunctioning of specified body organs despite the level of pain that might be associated with it. Tobacco smoking has been identified to; for example, cause about “ninety percent of laryngeal cancer and lung cancer and a significant percentage of oral, esophageal and stomach cancers” (Tobacco 1).

Once the cancerous cells start to grow in the body parts, they impair the parts and might even spread causing wounds in the body with subsequent dangers such as death. Lung cancer will, for example, be characterized with growth of foreign cells in the lungs and a corresponding damage of the normal cells.

As a result, the normal functionality of the lungs such as the absorption of oxygen into the body and the elimination of carbon dioxide from the body will be impaired. Respiratory processes that require oxygen and are necessary for cellular activities of the body will therefore be compromised.

Stomach cancer may also impair digestive processes and subsequent poor supply of nutrients to the body. The other cancers such as oral or esophageal may also be associated with a level of pain that can even discourage an individual from eating.

As a result, there will be poor nutritional habit in a victim of these cancers due to insufficient supply of nutrients to the body cells and subsequent insufficient energy generated by the body.

Tobacco therefore with respect to its induced cancers affects the functionality of body organs and the overall health of an individual. These complications have been associated with significant percentage of premature deaths among tobacco users (Tobacco 1).

Tobacco and Addiction

Another reason for alarm over the use of tobacco is the threat of addiction that it poses to its users. Like in cases of other drugs, and induced by its nicotine content, tobacco compels its users into addiction which makes them to even overlook the side effects that the drug has in their lives.

Following the addiction, individual addicts together with help that they receive from social society is not sufficient to help them out of the drug. The only viable control is thus an authoritative step to ban the drug (Dugdale 1).

The use of tobacco is identifiably unhealthy following its risks to the user’s health that is then spread to other members of the society through social and economic costs. Since the drug is addictive, individual users can not easily and willingly stop the consumption the drug. The significant control measure therefore lies in banning usage of the drug.

Dugdale, David. Drug dependence . NCBI, 20101. Web.

Tobacco. Dangers of tobacco . Tobacco Facts, n.d. Web. < http://www.tobacco-facts.info/dangers_of_tobacco.htm >

Wvdhhr. Tobacco and CVD . WVDHHR, n.d. Web. < http://www.wvdhhr.org/bph/cvd/page1.htm >

Chicago (A-D)
Chicago (N-B)

IvyPanda. (2023, December 5). Banning the use of Tobacco. https://ivypanda.com/essays/banning-the-use-of-tobacco/

"Banning the use of Tobacco." IvyPanda , 5 Dec. 2023, ivypanda.com/essays/banning-the-use-of-tobacco/.

IvyPanda . (2023) 'Banning the use of Tobacco'. 5 December.

IvyPanda . 2023. "Banning the use of Tobacco." December 5, 2023. https://ivypanda.com/essays/banning-the-use-of-tobacco/.

1. IvyPanda . "Banning the use of Tobacco." December 5, 2023. https://ivypanda.com/essays/banning-the-use-of-tobacco/.

Bibliography

IvyPanda . "Banning the use of Tobacco." December 5, 2023. https://ivypanda.com/essays/banning-the-use-of-tobacco/.

Should Cigarettes Be Banned? Essay
Pharmacology of Nicotine: Absorption and Distribution
Bisphenol-A Should be Banned
Nicotine Addiction Research and Assessment
Nicotine: E-Cigarettes and Tobacco Use
Banning Violent Video Games Argumentative Essay
Arguments for and Against Banning All Forms of Child Labour
Tobacco and COVID-19 Relations
Banning Gender Affirming Care: Denying Transgenders Access to Healthcare
Banning Texting while Driving Saves Lives
Impact of Culture on Communication in a Health Setting
Workplace Stress Problem
Health Outcome of Tobacco Use: Lung Cancer
The Different Lifestyle Issues that Affect People’s Health
The Influence on Health of Economic Inequality

Skip to main content
Skip to FDA Search
Skip to in this section menu
Skip to footer links

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

U.S. Food and Drug Administration

Search
Menu
Tobacco Products
CTP Newsroom

FDA Seeks Approximately $20,000 Each from 22 Retailers Selling Elf Bar and Other Unauthorized E-Cigarettes

Agency Seeking Civil Money Penalties After Retailers Were Previously Warned and Failed to Take Corrective Action

April 23, 2024

On Apr. 23, FDA announced the issuance of complaints for civil money penalties (CMPs) against 20 brick and mortar retailers and two online retailers for the sale of unauthorized e-cigarettes, including Elf Bar, a popular youth-appealing brand. FDA previously issued warning letters to these retailers for their sale of unauthorized tobacco products, however, follow-up inspections revealed that the retailers had failed to correct the violations. Accordingly, the agency is now seeking a CMP of approximately $20,000 from each retailer.

According to the 2023 National Youth Tobacco Survey , Elf Bar was the most commonly used brand among middle and high school students who reported using e-cigarettes in the past 30 days, with 56.7% of youth e-cigarette users reporting current use of Elf Bar and about one-third (31.1%) reporting it was their “usual” brand.

The approximately $20,000 CMP sought from each retailer is consistent with similar CMPs sought against retailers for the sale of unauthorized Elf Bar products over the last few months, including in Sept. , Nov. , Dec. and Feb. The retailers can pay the penalty, enter into a settlement agreement, request an extension to respond, or request a hearing. Retailers that do not take action within 30 days after receiving a complaint risk a default order imposing the full penalty amount.

Today’s CMP actions continue the comprehensive effort by FDA to take action across the supply chain to remove unauthorized e-cigarettes, particularly those that are popular among youth, from the marketplace. As of April 2024, FDA has issued more than 550 warning letters and 108 CMPs to retailers, including brick and mortar and online retailers, for selling unauthorized tobacco products. In addition to actions involving retailers, FDA has issued more than  670 warning letters   to manufacturers, importers, and distributors for illegally selling and/or distributing unauthorized new tobacco products, including e-cigarettes. The agency has also filed  civil money penalty complaints  against 55 e-cigarette firms for manufacturing unauthorized products and sought  injunctions  in coordination with the U.S. Department of Justice against seven manufacturers of unauthorized e-cigarette products.

To date, the FDA has authorized 23 tobacco-flavored e-cigarette products and devices . These are the only e-cigarette products that currently may be lawfully marketed and sold in the U.S; further information on tobacco products that may be legally marketed in the United States is available in FDA’s new Searchable Tobacco Products Database .

Judge temporarily halts Ohio law to keep Columbus, other cities from regulating tobacco

Judge says state law looks unconstitutional in that it targets cities, not people.

A Franklin County judge issued a temporary restraining order late Friday afternoon, stopping a state law from taking effect next week that would prevent Columbus, several Franklin County suburbs, Cincinnati and other Ohio cities from regulating tobacco products.

The ruling means the local cities' bans on the sale of flavored tobacco products will remain in effect for now but indicates that Franklin County Common Pleas Judge Mark Serrott believes the cities' case is likely to succeed.

Serrott scheduled a preliminary injunction hearing in the case for May 17.

Columbus, Cincinnati and several other Ohio cities filed a lawsuit Tuesday challenging the law created by the Republican-controlled Ohio General Assembly, arguing the legislature violated an Ohio constitutional amendment giving cities "home rule" to set their own laws for the good of their residents on certain matters, including on issues of public safety. The cities argue the new Ohio law allowing flavored tobacco sales negatively affects the health of Ohioans, particularly of teens increasingly turning to vaping.

After a 50-minute hearing Friday in downtown Columbus, Serrott left the courtroom for about half an hour before returning with a decision. He explained that the state law effectively pre-empting municipalities from regulating tobacco locally appeared to be missing key elements, such as a comprehensive state regulation scheme, which appears to infringe on cities' rights under the Ohio Constitution.

"Basically all (the state law) does is say 'We are pre-empting the municipalities' ability to regulate," Serrott said, adding that the Ohio Supreme Court has ruled that for "general laws" to be valid, they are supposed to "prescribe conduct by citizens," not by cities, which are granted special regulatory rights under the state constitution.

Serrott also noted that while one state law prohibits municipalities from regulating tobacco, another one requires a plan a to reduce tobacco use by Ohioans. That code emphasizes reducing the use of tobacco by "youth, minority and regional populations, pregnant women, medicaid recipients, and others who may be disproportionately affected by the use of tobacco."

In granting the restraining order, Serrott concluded the cities' challenge to the constitutionality of the state law is likely to ultimately succeed — although he also acknowledged his final ruling will likely be appealed.

Serrott found not granting the restraining order would cause harm because of future health consequences to juveniles targeted by tobacco distributors.

"It's fortunate that he sided with us temporarily," said Columbus City Attorney Zach Klein, while leaving the courtroom. "And really this is a win for kids, which is the whole focus of this. How can we get … flavored tobacco products and vaping... How can we get that out of the hands of children?"

Klein said the state had really "overstepped their bounds" in trying to keep local governments from protecting kids.

"The intent was just to get the cities out of the business, not for the state to step in and do something different. And that cuts right at the heart of what home rule is," Klein said, adding the state law also kept Columbus Public Health from checking whether stores would illegally sell tobacco to minors.

Jonathan Secrest, an attorney with the Dickinson Wright law firm in Columbus who is representing the state, said the state law will go into effect everywhere in Ohio next week except the municipalities that are parties to the case.

Besides Columbus, Cincinnati and Cleveland, that includes the suburban Franklin County cities of Bexley, Dublin, Gahanna, Grandview Heights, Hilliard, Reynoldsburg, Upper Arlington, Whitehall and Worthington, The Dispatch previously reported .

Gov. Mike DeWine twice vetoed the state legislature's efforts to prohibit cities from enacting bans on flavored tobacco products, saying at one point: “When a local community wants to make the decision to ban these flavors to protect their children, we should applaud those decisions."

But lawmakers voted to override his veto , restoring the law. State lawmakers have argued that they, not local governments, should have broad controls to keep the law uniform statewide, such as penalizing merchants selling tobacco products to those under 21, and that the ban also hurts small businesses that rely on such sales.

Klein, DeWine and other proponents of the city bans have argued that flavored tobacco and e-cigarettes, or vapes, have led to a sharp rise in nicotine use among teens — wiping out decades of efforts to put anti-smoking laws into place — and that those products have historically targeted minorities and low-income people.

Central Ohio mayors blasted state lawmakers earlier this year when they finally achieved passing the law over DeWine's veto.

"The statehouse arbitrarily decided that, for the first time in Ohio history, local communities shouldn't have the ability to decide what's best for the health of our communities," said Bexley Mayor Ben Kessler in a written statement to The Dispatch in January. "Local laws around nicotine regulation are not new, and until now local authority has never been questioned in this arena."

Kessler charged that lawmakers were siding with tobacco companies planning "to lure our teenagers and children into addiction."

Dispatch reporter Shahid Meighan contributed to this report .

[email protected]

@ReporterBush

Share full article

Supported by

Guest Essay

Liz Cheney: The Supreme Court Should Rule Swiftly on Trump’s Immunity Claim

A black-and-white photo of the U.S. Supreme Court building, with trees in the foreground.

By Liz Cheney

Ms. Cheney, a Republican, is a former U.S. representative from Wyoming and was vice chairwoman of the Jan. 6 select committee in the House of Representatives.

On Thursday, the U.S. Supreme Court will hear Donald Trump’s arguments that he is immune from prosecution for his efforts to steal the 2020 presidential election. It is likely that all — or nearly all — of the justices will agree that a former president who attempted to seize power and remain in office illegally can be prosecuted. I suspect that some justices may also wish to clarify whether doctrines of presidential immunity might apply in other contexts — for example, to a president’s actions as commander in chief during a time of war. But the justices should also recognize the profoundly negative impact they may have if the court does not resolve these issues quickly and decisively.

If delay prevents this Trump case from being tried this year, the public may never hear critical and historic evidence developed before the grand jury, and our system may never hold the man most responsible for Jan. 6 to account.

The Jan. 6 House select committee’s hearings and final report in 2022 relied on testimony given by dozens of Republicans — including many who worked closely with Mr. Trump in the White House, in his Justice Department and on his 2020 presidential campaign. The special counsel Jack Smith’s election-related indictment of Mr. Trump relies on many of the same firsthand witnesses. Although the special counsel reached a number of the same conclusions as the select committee, the indictment is predicated on a separate and independent investigation. Evidence was developed and presented to a grand jury sitting in Washington, D.C.

The indictment and public reporting suggest that the special counsel was able to obtain key evidence our committee did not have. For example, it appears that the grand jury received evidence from witnesses such as Mark Meadows, a former Trump chief of staff, and Dan Scavino, a former Trump aide, both of whom refused to testify in our investigation. Public reporting also suggests that members of Mr. Trump’s Office of White House Counsel and other White House aides testified in full, without any limitations based on executive privilege, as did Vice President Mike Pence and his counsel.

The special counsel’s indictment lays out Mr. Trump’s detailed plan to overturn the 2020 election, including the corrupt use of fraudulent slates of electors in several states. According to the indictment, senior advisers in the White House, Justice Department and elsewhere repeatedly warned that Mr. Trump’s claims of election fraud were false and that his plans for Jan. 6 were illegal. Mr. Trump chose to ignore those warnings. (Remember what the White House lawyer Eric Herschmann told Mr. Trump’s alleged co-conspirator John Eastman on Jan. 7, 2021: “Get a great f’ing criminal defense lawyer. You’re gonna need it.”) There is little doubt that Mr. Trump’s closest advisers also gave the federal grand jury minute-to-minute accounts of his malicious conduct on Jan. 6, describing how they repeatedly begged the president to instruct the violent rioters to leave our Capitol and how Mr. Trump refused for several hours to do so as he watched the attack on television. This historic testimony about a former president’s conduct is likely to remain secret until the special counsel presents his case at trial.

As a criminal defendant, Mr. Trump has long had access to federal grand jury material relating to his Jan. 6 indictment and to all the testimony obtained by our select committee. He knows what all these witnesses have said under oath and understands the risks he faces at trial. That’s why he is doing everything possible to try to delay his Jan. 6 federal criminal trial until after the November election. If the trial is delayed past this fall and Mr. Trump wins re-election, he will surely fire the special counsel, order his Justice Department to drop all Jan. 6 cases and try to prevent key grand jury testimony from ever seeing the light of day.

I know how Mr. Trump’s delay tactics work. Our committee had to spend months litigating his privilege claims (in Trump v. Thompson) before we could gain access to White House records. Court records and public reporting suggest that the special counsel also invested considerable time defeating Mr. Trump’s claims of executive privilege, which were aimed at preventing key evidence from reaching the grand jury. All of this evidence should be presented in open court, so that the public can fully assess what Mr. Trump did on Jan. 6 and what a man capable of that type of depravity could do if again handed the awesome power of the presidency.

Early this year, a federal appeals court took less than a month after oral argument to issue its lengthy opinion on immunity. History shows that the Supreme Court can act just as quickly , when necessary. And the court should fashion its decision in a way that does not lead to further time-consuming appeals on presidential immunity. It cannot be that a president of the United States can attempt to steal an election and seize power but our justice system is incapable of bringing him to trial before the next election four years later.

Mr. Trump believes he can threaten and intimidate judges and their families , assert baseless legal defenses and thereby avoid accountability altogether. Through this conduct, he seeks to break our institutions. If Mr. Trump’s tactics prevent his Jan. 6 trial from proceeding in the ordinary course, he will also have succeeded in concealing critical evidence from the American people — evidence demonstrating his disregard for the rule of law, his cruelty on Jan. 6 and the deep flaws in character that make him unfit to serve as president. The Supreme Court should understand this reality and conclude without delay that no immunity applies here.

Liz Cheney, a Republican, is a former U.S. representative from Wyoming and was vice chairwoman of the Jan. 6 select committee in the House of Representatives.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .

Skip to main content
Keyboard shortcuts for audio player

Protests against the war in Gaza intensify at Columbia and other universities

Adrian Florido

Authorities are being called to disperse pro-Palestinian demonstrations on college and university campuses across the U.S. — leading to mass arrests.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Trump says it’s up to states whether to punish, monitor women for abortions

Former president Donald Trump said in an interview published Tuesday that he would not intervene in state decisions on abortion policy, including in situations where states seek to monitor women’s pregnancies and prosecute those who violate abortion bans.

Trump also declined during the interview with Time magazine to commit to veto any additional federal restrictions if they were to come to his desk upon a possible return to the White House.

Asked by Time if he would be comfortable with states prosecuting women for having abortions outside limited periods permitted by state laws, Trump suggested the federal government should have no role.

“It’s irrelevant whether I’m comfortable or not,” Trump said. “It’s totally irrelevant, because the states are going to make those decisions.”

Trump’s comments highlight the fraught politics of the stance on abortion that he outlined earlier this month.

Trump announced on social media that policy should be left to the states, after months of mixed signals about his position. Trump has consistently taken credit for overturning Roe v. Wade — three of the justices who ruled on the case were appointed by him — yet has distanced himself from the political repercussions of the decision.

Shortly after Trump articulated his states-rights stance this month, Arizona’s Supreme Court revived an 1864 law passed before it was granted statehood that forbids abortions except to save a mother’s life and punishes providers with prison time. In that case, Trump said the state had gone too far.

During the Time interview, however, Trump repeatedly emphasized his support for state autonomy, at least in concept.

When asked, for instance, about the federal Republican-sponsored Life at Conception Act, which would grant “full legal rights to embryos,” Trump said: “I’m leaving everything up to the states.”

He declined to say whether he would veto such a bill, suggesting he wouldn’t be presented with that decision.

“I don’t have to do anything about vetoes,” Trump said, “because we now have it back in the states.”

Asked by Time if states should monitor women’s pregnancies to detect whether they get abortions after a ban takes effect, Trump said: “I think they might do that.”

“Again, you’ll have to speak to the individual states,” he said. “Look, Roe v. Wade was all about bringing it back to the states.”

Democrats have sought to make abortion the dominant issue in the 2024 elections, highlighting Trump’s role in appointing the three conservative Supreme Court justices who helped overturn a constitutional right to abortion in 2022, and legislation pushed by Republican lawmakers to ban or severely restrict access to the procedure.

President Biden’s campaign seized on the Time interview after it was published Tuesday.

Biden campaign manager Julie Chavez Rodriguez said Trump’s latest remarks are proof that reproductive health care is at stake in the election.

“Donald Trump’s latest comments leave little doubt: if elected he’ll sign a national abortion ban, allow women who have an abortion to be prosecuted and punished, allow the government to invade women’s privacy to monitor their pregnancies, and put IVF and contraception in jeopardy nationwide,” Rodriguez said in a statement. “Simply put: November’s election will determine whether women in the United States have reproductive freedom, or whether Trump’s new government will continue its assault to control women’s health care decisions.”

Trump declined to answer directly when asked by Time if he thinks women should be able to obtain the abortion pill mifepristone .

“Well, I have an opinion on that, but I’m not going to explain. I’m not gonna say it yet.” He said he would announce his position “probably over the next week.” When pressed for an answer, Trump sought more time. “I will be making a statement on that over the next 14 days.”

Trump spoke with writer Eric Cortellessa at his home in Florida on April 12 and had a follow-up phone interview April 27, the magazine reported. On Tuesday it published a story about the interview along with a transcript .

The interview comes as Republicans brace for fallout from their newly pushed restrictions.

Florida’s ban on abortion after six weeks of pregnancy takes effect this week, one of the strictest in the nation.

The Republican-led Arizona Senate is expected to vote on a repeal of the state’s near total abortion ban after the state Supreme Court ruled a Civil War-era bill can take effect following the overturning of Roe v. Wade . Arizona’s House last week voted to repeal the law, after prominent antiabortion Republicans such as Senate candidate Kari Lake reversed course on the issue .

Trump, who once described himself as “very pro-choice,” said in 2000 that he would “indeed support a ban.” As a candidate, Trump struggled to adopt a position to fully satisfy leading members of the antiabortion movement while shielding himself and Republicans from blowback at the ballot box.

During the GOP nominating contests, Trump declined to take a firm stance on federal legislation and criticized Florida’s six-week abortion ban as a “terrible mistake.” In a CNN town hall last year, Trump would not say whether he would sign a federal abortion ban. Instead he said the antiabortion movement was in a “very good negotiating position” after the Supreme Court overturned Roe.

As president, Trump backed a 20-week abortion ban that did not have the votes to pass Congress and at the time conflicted with Roe, which gave Americans nationwide a right to abortion until a fetus was viable outside the womb, often pegged at roughly 24 weeks of pregnancy.

After publication of the Time interview Tuesday, Trump celebrated the piece while speaking to reporters outside the courtroom in New York, where he is on trial.

“I want to thank the Time magazine,” he said. “They did a cover story, which is very nice.”

“It’s at least 60 percent correct, which is all I could ask for,” Trump said, without identifying anything that he might say were inaccuracies. Trump walked away and ignored questions shouted by reporters.

Isaac Arnsdorf contributed to this report.

U.S. abortion access, reproductive rights

Tracking abortion access in the United States: Since the Supreme Court struck down Roe v. Wade , the legality of abortion has been left to individual states. The Washington Post is tracking states where abortion is legal, banned or under threat.

Abortion and the election: Voters in about a dozen states could decide the fate of abortion rights with constitutional amendments on the ballot in a pivotal election year. Biden supports legal access to abortion , and he has encouraged Congress to pass a law that would codify abortion rights nationwide. After months of mixed signals about his position, Trump said the issue should be left to states . Here’s how Biden and Trump’s abortion stances have shifted over the years.

New study: The number of women using abortion pills to end their pregnancies on their own without the direct involvement of a U.S.-based medical provider rose sharply in the months after the Supreme Court eliminated a constitutional right to abortion , according to new research.

Abortion pills: The Supreme Court seemed unlikely to limit access to the abortion pill mifepristone . Here’s what’s at stake in the case and some key moments from oral arguments . For now, full access to mifepristone will remain in place . Here’s how mifepristone is used and where you can legally access the abortion pill .

States where abortion is on the ballot in the 2024 election April 15, 2024 States where abortion is on the ballot in the 2024 election April 15, 2024
States where abortion is legal, banned or under threat April 9, 2024 States where abortion is legal, banned or under threat April 9, 2024
Trump says it’s up to states whether to punish, monitor women for abortions April 30, 2024 Trump says it’s up to states whether to punish, monitor women for abortions April 30, 2024

IMAGES

Essay Writing Competition on World No Tobacco Day, 2021 by MoHFW
Pin on essay
World No Tobacco Day: Meet The Winners of Our Essay Competition
Write a short essay on World No Tobacco Day
Protection of future generation from harmful effects of tobacco Essay
Customize 21+ World No Tobacco Day Posters Templates Online

VIDEO

How Big Tobacco Intentionally Made Snacks Addictive
Антилирика или борьба с наркоманией в Ингушетии
Essay on smoking in public places should be banned || Essay writing in English|| essay writing

COMMENTS

Examples & Tips for Writing a Persuasive Essay About Smoking
Persuasive Essay Examples About Smoking. Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally. A lot has been written on topics related ...
Essay on Smoking in English for Students
500 Words Essay On Smoking. One of the most common problems we are facing in today's world which is killing people is smoking. A lot of people pick up this habit because of stress, personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them.
Argumentative Essay on Smoking Cigarettes
The dangers of smoking cigarettes have been well-documented, yet millions of people continue to engage in this harmful habit. The debate over the impact of smoking on public health is ongoing, with some arguing for stricter regulations and others advocating for personal freedom. In this essay, we will explore the various arguments surrounding smoking cigarettes and ultimately make the case for ...
Tobacco Smoking and Its Dangers
Introduction. Tobacco use, including smoking, has become a universally recognized issue that endangers the health of the population of our entire planet through both active and second-hand smoking. Pro-tobacco arguments are next to non-existent, while its harm is well-documented and proven through past and contemporary studies (Jha et al., 2013).
Introduction, Summary, and Conclusions
Tobacco use is a global epidemic among young people. As with adults, it poses a serious health threat to youth and young adults in the United States and has significant implications for this nation's public and economic health in the future (Perry et al. 1994; Kessler 1995). The impact of cigarette smoking and other tobacco use on chronic disease, which accounts for 75% of American spending ...
Should Cigarettes Be Banned? Essay
The essay will evaluate arguments for and against cigarettes in particular. Many people smoke them to lighten up and enhance their concentration at places of work. Meanwhile, some claim that this relaxation method is too harmful to enjoy. ... Tobacco related infertility in women and impotence in men would be no more. Risks of miscarriage ...
235 Smoking Essay Topics & Titles for Smoking Essay + Examples
In your essay about smoking, you might want to focus on its causes and effects or discuss why smoking is a dangerous habit. Other options are to talk about smoking prevention or to concentrate on the reasons why it is so difficult to stop smoking. Here we've gathered a range of catchy titles for research papers about smoking together with ...
10+ Top Persuasive essay about smoking examples
Aim For the Emotions. Use powerful language and vivid imagery to draw readers in and make them feel like you do about smoking. 8. Use Personal Stories. Share personal stories or anecdotes of people who have successfully quit smoking and those negatively impacted by it. 9. Include an Action Plan.
Essays About Smoking
1 page / 576 words. Smoking is a prevalent practice in many societies, with approximately 1 billion people engaging in this habit. The act of smoking involves burning substances, such as tobacco or cannabis, and inhaling the resulting smoke into the lungs. This combustion process releases active substances, including nicotine,...
Effect of Tobacco: Why Cigarette Smoking Should Be Banned
Left to 'idle' between puffs, a dropped, forgotten or discarded cigarette can start a fire. According to (WHO, 2017), smoking causes an estimated 20% of Australia and 10% of global fire death burdens. This shows that global and Australian economy are greatly affected due to consequences of tobacco smoking.
The effects of tobacco control policies on global smoking ...
Decades after its ill effects on human health were first documented, tobacco smoking remains one of the major global drivers of premature death and disability. In 2017, smoking was responsible for ...
How can we prevent tobacco use?
Prevention can also take place at the school or community level. Merely educating potential smokers about the health risks has not proven effective. 218 Successful evidence-based interventions aim to reduce or delay initiation of smoking, alcohol use, and illicit drug use, and otherwise improve outcomes for children and teens by reducing or ...
Truth Initiative: inspiring lives free from smoking, vaping, and nicotine
Truth Initiative is America's largest nonprofit public health organization dedicated to a future where tobacco and nicotine addiction are things of the past. Our mission is clear: achieve a culture where young people reject smoking, vaping, and nicotine.
Persuasive Essay On Tobacco
Persuasive Essay On Tobacco Sales ... Litigation against tobacco companies has successfully reduced tobacco use in the U.S. by placing restrictions on marketing methods, an increase in product prices, and mak¬ing tobacco industry documents available for scientific analy¬sis and strategic awareness. Tobacco product regulation has the potential ...
IELTS Essay: Cigarettes
Use complex grammar to help you development. Conclude the paragraph. 1. However, tobacco is an almost entirely harmful product in its effects. 2. In contrast to other narcotics, such as caffeine, alcohol, and cannabis, there is no discernible sensation produced by smoking cigarettes or chewing tobacco. 3.
Essay on Arguments For and Against a Smoking Ban
Tobacco is one of the most widely-used recreational drugs in the world; mainly in the form of cigarettes, but also in cigars and pipes, and in combination with cannabis and marijuana in 'joints'. ... In the developed world, public opinion has shifted against smoking. By the 1990s, the sheer weight of evidence had forced ... This essay will ...
Anti-smoking essay, 1st place winner
Nov 20, 2012 Updated Nov 21, 2012. 1st place winner High School essay contest: Blake Ballard, 16yrs old, 10th grade from Doniphan-Trumbull. About 23 percent of all adults are smokers. This fact ...
The pros and cons of a total smoking ban
Tobacco smoke can cause cancer, stroke and heart disease, with smoking-related illnesses costing the NHS £17 billion a year, according to campaign group Action on Smoking and Health (ASH).
The case for banning cigarettes
Introduction. Lifelong smokers lose on average a decade of life vis-à-vis non-smokers. Globally, tobacco causes about 5-6 million deaths annually.1 This number is expected to grow: a total of one billion deaths are predicted during the 21st century, with about half occurring before the age of 70.1, 2 It is against this background that we will argue for a complete ban on the sale of cigarettes.
Banning the use of Tobacco
Introduction. Tobacco is a product of a species of plant that has nicotine content. Harvested as leaves of that particular plant, tobacco can be used to control pests or even as medicine. It is however widely used as a drug through smoking, snuffing, chewing among others. This paper seeks to support the banning of the use of tobacco.
Scientific Evidence for the Addictiveness of Tobacco and Smoking
A litigation claim for damages by smoking brought by the Korea National Health Insurance Service against 3 tobacco companies, including KT&G, British American Tobacco Korea, and Philip Morris Korea (Seoul Central District Court 2014 Ga Hap 525 054 case) in April 2014 is ongoing. There have been arguments regarding various issues, and the focus ...
King James I, His Counterblast to Tobacco, 1604
Up for Debate: Discuss government regulation of tobacco. Argue for or against legalizing other drugs since tobacco and alcohol are both legal. Assign sides and hold a debate. Analyze: Compare and contrast King James I's Counterblast to a modern-day Surgeon General's warning on tobacco and smoking. Today the emphasis is on the damage the drug ...
Banning Smoking Essay
Banning Tobacco Essay Smoking Should Be Banned Essay Banning The Issue Of Banning Cigarettes Argumentative Essay: Should Tobacco Be Banned? Ohio Banning Smoking ... Essays On World War 1; Essay Against Euthanasia; Process Paper Essay; Fin360 class notes chapter 1 & 2; 2020-organic chemistry lab2(chem225)-lab three;
FDA Seeks Approximately $20,000 Each from 22 Retailers Selling Elf Bar
FDA issued complaints for civil money penalties against 20 brick and mortar retailers and two online retailers for the sale of unauthorized e-cigarettes, including Elf Bar, a popular youth ...
I'm a Young Conservative, and I Want My Party to Lead the Fight Against
Mr. Backer is the founder and executive chairman of the American Conservation Coalition. Conservatives were once America's environmental champions. Not that long ago, Republican presidents were ...
Ohio state law regulating flavored tobacco put on hold in some cities
A Franklin County judge issued a temporary restraining order against a state law that would halt flavored tobacco bans in Columbus and other cities. News Sports Entertainment Business Opinion ...
Opinion
Mr. Shugerman is a law professor at Boston University. About a year ago, when Alvin Bragg, the Manhattan district attorney, indicted former President Donald Trump, I was critical of the case and ...
Opinion
Ms. Cheney, a Republican, is a former U.S. representative from Wyoming and was vice chairwoman of the Jan. 6 select committee in the House of Representatives. On Thursday, the U.S. Supreme Court ...
Protests against the war in Gaza intensify at Columbia and other
Authorities are being called to disperse pro-Palestinian demonstrations on college and university campuses across the U.S. — leading to mass arrests.
Trump says it's up to states whether to punish, monitor women for
Former president Donald Trump said in an interview published Tuesday that he would not intervene in state decisions on abortion policy, including in situations where states seek to monitor women ...

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

What You Need To Know About Persuasive Essay

Persuasive Essay Examples About Smoking

Argumentative Essay About Smoking Examples

Tips for Writing a Persuasive Essay About Smoking

Choose a Specific Angle

Research the Facts

Make an Outline

Use Persuasive Language

Introduce Opposing Arguments

Finish Strong

Keep reading

Essay on Smoking

Ill-Effects of Smoking

How to Quit Smoking?

Conclusion of the Essay on Smoking

FAQ of Essay on Smoking

Customize your course in 30 seconds

Leave a Reply Cancel reply

Download the App

Craft an Engaging Persuasive Essay About Smoking: Examples & Tips

Persuasive Essay-Defined

Persuasive Essay Examples About Smoking

Argumentative Essay About Smoking Examples

10 Tips for Writing a Persuasive Essay About Smoking

Frequently Asked Questions

What are good topics for persuasive essays?

Keep reading

Effect of Tobacco: Why Cigarette Smoking Should Be Banned

Works Cited

Cite this Essay

Related Essays

Still can’t find what you need?

Related Essays on Smoking

Related Topics

Get Your Personalized Essay in 3 Hours or Less!

The effects of tobacco control policies on global smoking prevalence

Similar content being viewed by others

Reductions in smoking due to ratification of the Framework Convention for Tobacco Control in 171 countries

Accelerating tobacco control at the national level with the Smoke-free Generation movement in the Netherlands

A dynamic modelling analysis of the impact of tobacco control programs on population-level nicotine dependence

Source data

Smoking outcome data

MPOWER data

Statistical analysis

Counterfactual analysis

Reporting Summary

Data availability

Code availability

Acknowledgements

Author information

Contributions

Corresponding author

Ethics declarations

Additional information

Extended data

Extended Data Fig. 2 Prevalence of current smoking for men (a) and women (b) aged 15 to 29 years old (age-standardized) in 2017.

Extended Data Fig. 3 Prevalence of current smoking for men (a) and women (b) aged 30 to 49 years old (age-standardized) in 2017.

Extended Data Fig. 4 Prevalence of current smoking for men (a) and women (b) aged 50 years and older (age-standardized) in 2017.

Extended Data Fig. 5 Percentage changes in current smoking prevalence based on fixed effect coefficients from bivariate mixed effect linear regression models, by policy component, sex and age group.

Supplementary information

Source Data Fig. 1

Source Data Extended Data Fig. 1

Source Data Extended Data Fig. 2

Source Data Extended Data Fig. 3

Source Data Extended Data Fig. 4

Rights and permissions

About this article

Share this article

This article is cited by

Challenges in legitimizing further measures against smoking in jurisdictions with robust infrastructure for tobacco control: how far can the authorities allow themselves to go?

Health effects associated with exposure to secondhand smoke: a Burden of Proof study

Predictors of quitting smoking behavior: evidence from Pakistan

Impacts of heavy smoking on non-coding RNA expression for patients with esophageal carcinoma

Quick links

Tobacco, Nicotine, and E-Cigarettes Research Report How can we prevent tobacco use?

Our top issues

Research & resources

Search by keywords

Partnerships

The latest news from Truth Initiative