Many countries have made significant progress in implementing effective tobacco control policies. Despite the availability of clinical treatment guidelines for smoking cessation, their integration into routine healthcare systems is less well-known. In Finland, recommendations addressing the infrastructure of tobacco and nicotine cessation, aimed at healthcare service providers, were published in 2024. This study aims to provide a baseline assessment for their evaluation. This cross-sectional study collected data in autumn 2024 from twenty-one wellbeing service counties (88%) using an online survey directed at professionals working in healthcare services involved in tobacco and nicotine-related care, including smoking cessation counseling, early identification, and brief interventions. Data were analyzed using descriptive statistics. HHS Framework to Support and Accelerate Smoking Cessation 2024 was utilized to provide a conceptual framework for interpreting the findings. Established structures for cessation services were limited; only 29% (6/21) of counties had appointed a dedicated entity, and 33% (7/21) provided annual training for healthcare professionals in tobacco cessation. Documentation of tobacco and nicotine use in medical records was the most successfully implemented component, reported by 81% (17/21) of counties, followed by the provision of digital services, 71% (15/21). The system includes features for structural documentation, with 62% (13/21) of counties recording early identification and brief interventions in medical records. Cessation services were communicated through multiple channels, including websites, social media, and healthcare centers. There is a significant variation in the structure and organization of tobacco and nicotine cessation services across wellbeing service counties, with many still in the early stages of development. While documentation of tobacco and nicotine use among patients has been increasingly adopted, the implementation of key components such as early identification, brief interventions, and cessation support remains underemphasized. Strengthening institutional support, organizational structures, professional training, communication, and information flow are associated with more effective implementation.
Tobacco use remains a global public health challenge, leading to over 8 million annual deaths and significant economic burden. Effective tobacco control and cessation interventions are essential to mitigate these impacts. Using data from the Global Adult Tobacco Surveys (between 2011 and 2021) and WHO reports from 29 countries, this study analysed determinants of quitting behaviour among n=51 196 individuals. Random Forest classification models were employed to identify key predictors for two outcomes: quit attempts and successful cessation. The model incorporated individual characteristics and all MPOWER policies, addressing gaps in the existing literature. Permutation variable importance was used to investigate the predictive power of the features. The Random Forest misclassification rates were 6% and 21%, indicating predictive reliability. Country-level factors, tobacco control legislation and WHO region significantly influence quit attempts. Individual-level factors, specifically smoking habits and smoking-permissive home environments-more strongly predicted successful cessation. Results highlight the importance of comprehensive tobacco control policies in promoting cessation. To improve cessation rates and reduce the global burden of tobacco-related diseases, public health initiatives must enhance the enforcement and reach of tobacco control measures, provide targeted support for people who smoke heavily and people in smoking-permissive environments and integrate a broader range of population-specific influences. Further research is necessary to understand the impact of actual policy enforcement and the cultural dynamics affecting tobacco use and cessation. These findings are crucial for guiding public health policies and interventions aimed at achieving better tobacco cessation outcomes globally.
 Mild cognitive decline and a faster reduction of entorhinal cortex volume are found to be more prevalent in individuals with a history of smoking, as shown in longitudinal and neuroimaging-based studies. Early screening of high-risk demographics may reduce cognitive decline progression.  Objective: The objective of this study is to understand the association between tobacco cessation and cognitive decline in the United States of America when adjusted for age, race, sex, education, and income, based on population-level survey data.  Methods: The data for this study were derived from the 2023 Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey that collects self-reported health information from non-institutionalized adults aged 18 years or older. Participants under 45 years old were excluded, as they were not administered questions from the BRFSS Cognitive Decline (CD) Module. Individuals from Florida, Maine, Rhode Island, Utah, Vermont, Wisconsin, Nevada, and Indiana participated in the CD module. Frequencies and percentages were computed for categorical demographic variables and the category of time since the individual stopped smoking. Bivariate analysis was used to determine whether the category of time since tobacco cessation and the demographic characteristics were independently associated with cognitive decline. Variables independently associated with CD (p≤0.10) were entered into a multivariable binary logistic model to determine the risk of CD for length of time category since smoking cessation when adjusted for age, race, sex, income, and education.  Results: This study identified a significant association between smoking cessation duration and cognitive decline (CD). Individuals who quit smoking 10 or more years prior had 3.648 times higher odds (95% CI 3.495, 3.807) of reporting CD compared to those who had never smoked regularly. Moreover, a general trend was observed, indicating greater CD with shorter durations since smoking cessation. The highest odds were observed among individuals who quit smoking between 1 month and less than 3 months prior, with an odds ratio of 5.466 (95% CI 5.197, 5.748) relative to the reference group. All analyses were adjusted for age, race, sex, income, and education.  Conclusion: This study concludes that individuals who have never smoked or quit at least 10 years ago are less likely to experience cognitive decline. A limitation is that the data is self-reported, which may introduce bias. The literature suggests smoking cessation is not linked to episodic memory loss, while smoking is associated with memory impairment. The effects of tobacco use on cognitive functioning may be reversed or halted with smoking cessation. Early intervention, including cognitive testing and smoking cessation counseling, may help reduce cognitive decline in smokers.
In 2019, Massachusetts enacted the nation's first comprehensive statewide restriction on flavored tobacco sales and expanded tobacco cessation coverage. This study assessed the policy's sustained effectiveness by examining trends and factors associated with tobacco use during the maintenance phase of the policy. We conducted monthly cross-sectional surveys (April 2021 to July 2022) to assess trends of past 30-day use of cigarettes, e-cigarettes, and other tobacco products of youth (ages 13-17, N=1,858) and adults (ages 18+, past 30-day tobacco use, N=1,548), including quit attempts among adults. We compared trends in Massachusetts to four neighboring states that did not have similar statewide restrictions using generalized linear models, modeling each outcome as a function of time (one-month increments), state (Massachusetts vs. four neighboring states), and an interaction between month and state, and adjusted for demographic covariates. Analyses identified no significant differences in tobacco use trends between residents of Massachusetts and comparison states. While Massachusetts youth showed stable cigarette use and slower increases in e-cigarette use compared to steeper rises in neighboring states, these differences were not statistically significant. Among adults who currently use tobacco, monthly trends of their tobacco use and past-year quit attempts were also comparable across states. Findings highlight the need for comprehensive approaches combining sales restrictions with enhanced cessation support and prevention programs to achieve sustained effects on reducing population tobacco use. We found no unintended increase in trends of cigarette use among youth or adults in response to the Massachusetts flavor restrictions versus comparison states. This study aimed to compare trends in tobacco use for youth and adults, and quit attempts for adults in Massachusetts with those in neighboring states over a 16-month period in the maintenance period of implementation (in 2021 and 2022) of the statewide Massachusetts flavored tobacco sales restriction. We found no unintended increase in trends of cigarette use among youth or adults, and findings highlight the need for comprehensive approaches to achieve sustained effects on reducing population tobacco use. Given the focused New England population of this study, additional evaluation of the sustained impact of flavored tobacco sales restrictions is needed.
Tobacco use remains a leading preventable cause of morbidity and mortality globally. The state of Jharkhand faces challenges because multiple forms of tobacco are in widespread use and limited resources are available for tobacco control. There is paucity of information related to the effectiveness of community-based tobacco cessation intervention and oral cancer screening program in Jharkhand therefore there is need for the present study. This quasi-experimental study in Ranchi district, Jharkhand, evaluated the effectiveness of an integrated, population-based tobacco cessation intervention implemented in Ayushman Aarogya Mandirs. The intervention comprised pharmacotherapy, behavioural counselling, and capacity building of community health workers. After one year, 657 of 4429 participants achieved cessation, representing a quit rate of 15.03% indicating the effectiveness of involving community health workers at grass root level. Findings demonstrate that combination therapy is more effective than behaviour counselling alone. Thus, we show the value of integrated cessation strategies in public health interventions, particularly in settings with a high burden of tobacco use.
High prevalence of smoking tobacco among people with tuberculosis (TB) contribute towards poor outcomes in low- and middle-income countries. A mobile phone-based intervention for smoking cessation among this population (mTB-Tobacco) was evaluated for its cost-effectiveness alongside a cluster randomised controlled trial in Pakistan and Bangladesh. A two-arm superiority cluster randomised controlled trial with 6 months follow up was conducted between September 2023 and January 2025 in Dhaka, Bangladesh and Punjab, Pakistan. The trial compared the mTB-Tobacco intervention with usual care as control. Participants included those older than or equal to 15 years of age, diagnosed with drug-sensitive pulmonary TB in the past 4 weeks, smoked tobacco daily but willing to quit, and had access to mobile phones. Eighteen TB health facilities (cluster) were randomised to mTB-Tobacco group (n = 720 participants) and nine to usual care (n = 360 participants). The primary analysis was an incremental cost-utility analysis from a public/voluntary sector perspective and primary outcome measure was Quality-Adjusted Life Years (QALYs). Total costs included the costs of TB treatment, costs of intervention or control, and costs of doctor visit and hospital stay. Secondary and sensitivity analyses were also conducted. Total costs were INT$ (international dollars) 36.17 (95% CI 3.65-65.81) higher and QALYs were 0.017 (95% CI 0.003-0.030) higher in mTB-Tobacco group than usual care group. Incremental cost-effectiveness ratio was calculated at INT$2127.64 per QALY gained. Estimates by country suggested mTB-Tobacco being unlikely cost-effective in Bangladesh (ICER = INT$4261.11 per QALY gained) but likely cost-effective in Pakistan (ICER = INT$1024.29 per QALY gained). If decision makers in the public/voluntary sector are willing to pay over INT$2100 for one additional QALY gained, mTB-Tobacco intervention could likely be cost-effective. The UK NIHR Global Health Research Unit on Respiratory Health (RESPIRE) (NIHR132826).
Introduction Tobacco use significantly contributes to the occurrence of morbidity and mortality. Therefore, preventing tobacco use is very important to reduce these health risks. Groups that have jobs (such as bus drivers) have increased susceptibility to tobacco use based on extended work hours, workplace-related stress, sedentary job activities, and social peer pressure, all of which can increase the likelihood of tobacco use. Tobacco education programs that are located at the workplace provide a good opportunity for educating workers about smoking cessation and increasing their knowledge, motivation, and readiness to stop using tobacco. Aim This study aims to determine whether cognitive behavioral therapy (CBT)-based tobacco education programs or basic health education (BHE) tobacco education programs are effective for increasing quit readiness among bus drivers. Methods A randomized comparative pilot trial compared CBT and BHE interventions on quit readiness among 40 active male smoker bus drivers. Participants were randomized into a CBT-based tobacco awareness program (n = 20) or a BHE-based program (n = 20). The transtheoretical model (TTM) stages of change were assessed at baseline, four weeks, and six months using the validated stages of change questionnaire. Results Baseline stage distributions were comparable (p = 0.751). At four weeks, the CBT group showed significantly greater progression toward the preparation and action stages (p = 0.033). At six months, the CBT group demonstrated substantially greater advancement toward the action and maintenance stages (p = 0.001). Conclusion Workplace-based tobacco awareness programs incorporating CBT were more effective than BHE in enhancing quit readiness, as measured by TTM stage progression, among bus drivers. These findings should be interpreted with caution, given the pilot design, reliance on self-reported outcomes, and the absence of biochemical verification of cessation. Larger, multicenter trials with longer follow-up and objective cessation measures are needed to confirm these results.
Tobacco use remains a major global public health issue that results in more than 8 million deaths annually, with over 80% occurring in low- and middle-income countries (LMICs). South Asian countries bear an unevenly increased burden of tobacco-related cancers and other diseases. Beyond its health effects, tobacco deepens poverty, widens social inequalities, and burdens national economies. Although the World Health Organization (WHO) provides effective frameworks, progress in LMICs remains limited due to weak enforcement, industrial lobbying, and poor implementation. In the absence of well-resourced healthcare systems, community-based approaches have emerged as a sustainable and resource-efficient strategy for tobacco control. These initiatives empower trusted local figures to integrate cessation messages into schools, maternal health visits, and community gatherings. Empowering communities as co-designers of cessation programs is essential to achieving the WHO Framework Convention on Tobacco Control goals and Sustainable Development Goal 3.
Smoking cessation outcomes vary widely across individuals, yet clinic-based services often rely on uniform intervention strategies. Understanding heterogeneity in smoking behaviors, co-occurring health behaviors, and cessation-related psychological profiles may help refine community-based cessation services. This study aimed to identify distinct subgroups of smokers enrolled in public health center-based smoking cessation clinics and to examine differences in cessation outcomes and related characteristics across subgroups. Data from 21,105 newly enrolled adults attending 16 public health center-based smoking cessation clinics in C Province were drawn from the Smoking Cessation Service Integrated Information System of the National Tobacco Control Center. Latent class analysis was conducted using five indicators: time to first cigarette, cigarettes per day, prior quit attempts, alcohol use, and physical activity. Associations between latent class membership, covariates, and distal outcomes were examined using a three-step approach. Four distinct latent classes were identified: Sedentary heavy smokers (46.8%), Active social heavy smokers (34.6%), Inactive-nicotine addictive-light smokers (13.6%), and Active lifestyle light smokers (5.0%). The latent classes showed different socioeconomic, smoking-related, and cessation-related confidence. Six-month cessation successes differed across classes, with higher abstinence among light-smoking classes and among Sedentary Heavy Smokers relative to Active Social Heavy Smokers. These findings highlight the value of person-centered profiling for informing more precise, context-sensitive cessation strategies and support the integration of behavioral and environmental considerations into community-based tobacco control programs.
Tobacco use remains the leading cause of preventable morbidity and mortality in Lao People's Democratic Republic (Lao PDR). Despite the prevalence of cigarette smoking in Lao PDR (51% in men and 7% in women), no national tobacco treatment programs are available. Therefore, the development and evaluation of sustainable tobacco cessation interventions suitable for widespread adoption in Lao PDR are pressing public health needs. This project aims to adapt our theoretically and empirically based mobile health (mHealth) technology to help people quit smoking cigarettes in Lao PDR. Our mHealth approach includes a fully automated, interactive, personalized, smartphone-delivered intervention for behavioral treatment. This project includes 2 main phases. In the first phase, we use formative research methods to adapt our intervention content to the sociocultural context, language, and communication styles of Laotians. In the second phase, we conduct a randomized controlled trial to evaluate the efficacy of our mHealth intervention. In the trial, adult smokers are recruited through 2 national hospitals: Setthathirath Hospital in Vientiane and Champasak Hospital in Champasak Province. Participants (n=500) are randomized to either the standard care (SC; n=250) or automated treatment (AT; n=250) group. SC consists of brief advice to quit smoking delivered by research staff, self-help written materials, and a 2-week supply of nicotine replacement therapy (transdermal patches). AT consists of all SC components plus a fully automated smartphone-based treatment program that involves interactive and personalized proactive messages, images, or videos. The primary health outcome of the trial is biochemically confirmed self-reported 7-day point prevalence abstinence 12 months post study enrollment. Secondary outcomes include abstinence at 3 and 6 months post enrollment. This study was approved by the ethical review boards of the respective domestic and international institutions. Data collection for the formative phase occurred from January 2022 to May 2023, and data analyses are ongoing. Data collection for the trial phase is ongoing and is expected to be completed by the end of 2026. If the proposed project is successful, it has the potential to transform health care services for tobacco treatment throughout Lao PDR and, ultimately, to significantly reduce tobacco-induced morbidity and mortality in the country. The AT's potential for widespread adoption and sustainability is enhanced by the direct involvement of Lao governmental stakeholders at multiple national institutes. Furthermore, the US-Lao collaborative work and capacity-building activities in this project will contribute to creating a knowledge base for mHealth research applications and advancing mHealth research capacity in Lao PDR.
Tobacco use remains a leading cause of preventable death in the United States, and smoking is disproportionately concentrated among individuals who have experienced trauma. Trauma-informed care offers a framework for addressing tobacco use in this population, yet few training programs provide guidance on integrating trauma-informed principles into cessation treatment. To address this, our team added a tobacco treatment module to the Trauma, Addictions, Mental Health, and Recovery (TAMAR) training for behavioral health providers in two California counties. We conducted semi-structured qualitative interviews with seven community-based providers who completed the training and analyzed them using inductive thematic analysis. Participants described the module as relevant and actionable. Participants reported changes in practice after the training, including adding tobacco questions to intake workflows, incorporating mindfulness strategies to help clients manage cravings, and integrating cessation goals into treatment planning. Participants viewed trauma-informed cessation care as requiring empathy, cultural humility, nonjudgment, and an understanding of the role of trauma in tobacco use. Barriers included limited time, staffing constraints, insufficient cessation training, rigid workflows, and a lack of physical space to deliver the training. Facilitators included organizational support, leadership buy-in, and access to professional development in providing cessation care. Participants emphasized that one-time trainings are insufficient to sustain trauma-informed tobacco treatment. Effective implementation requires organizational infrastructure, repeated reinforcement of skills, and materials that support real-time application. Findings highlight the need to align trauma-informed cessation curricula with the realities of diverse community settings and to expand training opportunities for professionals serving populations experiencing trauma.
Tobacco use is a major global cause of oral cancer. Chronic exposure of the oral mucosa to its toxins induces oxidative stress, cellular damage, and carcinogenesis. Jazan region of Saudi Arabia reports a high prevalence of both tobacco use and oral malignancies. This study aimed to evaluate the cytological effects of tobacco on oral epithelial cells and assess the utility of exfoliative cytology for early detection. The study included 100 voluntary participants from Jazan region, which were categorized into three groups: non-tobacco users (n = 10), active tobacco smokers (n = 81), and smokeless tobacco users (n = 9). Buccal epithelial cells were collected via sterile spatulas, fixed in 95% ethanol, and stained using the Papanicolaou technique. The micronucleus-to-nucleus (M/N) and nucleus-to-cytoplasm (N/C) ratios were analyzed microscopically. Smokers exhibited a significant increase in both M/N and N/C ratios compared to non-tobacco users, indicating pronounced genotoxic and cytotoxic effects. Smokeless tobacco users also showed cellular abnormalities, though these were less marked than in smokers. A positive correlation was observed between the duration of tobacco use and the extent of cellular damage. Both smoking and smokeless tobacco cause significant cytological alterations in oral epithelial cells. Regular cytological screening, combined with effective tobacco cessation programs, is essential to prevent precancerous lesions and reduce the oral cancer burden in high-risk populations like Jazan. In addition, the findings of the current study confirm the utility of exfoliative cytology as a reliable, non-invasive screening method.
Tobacco cessation services delivered via quitlines increase the likelihood of smoking cessation. Integrated media communication campaigns are a critical channel for promoting quitlines. This study used real-world data to explore the effect of various tobacco control advertising campaign strategies on generating quitline self-referrals, including among high prevalence communities. Monthly counts of self-referrals to the Victorian quitline were examined during periods of Quit Victoria advertising campaign activity and inactivity between January 2018 and December 2023. Campaigns varied by spend, pairing of motivational plus capacity-building messages or not, and extent of repeated airings over the previous 6 years. Negative binomial regression models examined associations between different advertising campaign strategies and self-referrals, adjusted for periods surrounding tobacco tax increases, and time. Self-referral rates accelerated as funding increased. These accelerating effects were particularly evident among high prevalence groups. Greater increases were observed when messages with different behavioural goals (eg, motivational and capacity-building) were delivered together, as well as during advertising campaign periods with messages that had aired at least once before in the previous 6 years. Findings reinforce the importance of well-funded advertising campaigns, especially for high prevalence groups. Effects of previously delivered campaign messages can build with repeated use and so can be effectively re-used over an extended period. Pairing creative concepts with distinct behaviour change objectives may also drive a greater number of self-referrals to quitlines.
To quantify risk reduction in oral precancer and cancer with time since cessation of betel quid chewing, smoking, and alcohol drinking. We conducted a multicenter case-control study in Taiwan of patients with invasive oral cancer (n = 768), visual/clinical oral precancer (n = 1,998), and hospital-based controls (n = 717, recalibrated/reweighted to represent the Taiwan general population). Weighted logistic regression was used to evaluate associations of duration, intensity, and time since cessation of betel quid chewing without tobacco, smoking, and alcohol drinking (modeled using splines and categorically) with oral precancer and cancer risk versus controls. Risk of oral precancer increased with increased duration and intensity of chewing and smoking, and increased intensity of alcohol drinking. Risk of oral cancer increased with increased duration and intensity of chewing, increased duration of smoking, and increased intensity of alcohol drinking. For oral precancer, when compared with current users (defined as current users and individuals who quit for ≤2 years before study recruitment), odds ratios (ORs) for 10-year cessation of behaviors were as follows: chewing = 0.63 (bootstrap 95% CI, 0.43 to 0.83); smoking = 0.30 (95% CI, 0.18 to 0.41); and alcohol = 0.60 (95% CI, 0.34 to 0.86). Likewise, risk of oral cancer decreased with increasing time since cessation; ORs for 10-year cessation were as follows: chewing = 0.74 (95% CI, 0.44 to 1.05); smoking = 0.45 (95% CI, 0.22 to 0.67); and alcohol drinking = 0.55 (95% CI, 0.20 to 0.90). Adjusted population-attributable fractions show that cessation of chewing for ≥10 years would prevent an estimated 23.2% of oral precancers and 24.2% of oral cancers; cessation of smoking for ≥10 years would prevent 51.5% of oral precancers and 44.6% of cancers in Taiwan. Our findings support the potential for primary prevention of oral precancer and cancer through cessation of betel quid chewing (without tobacco), smoking, and alcohol drinking among current users.
The purpose of this study was to characterize smoking cessation at pregnancy and postpartum return to use as a function of pre-pregnancy menthol vs. non-menthol cigarette use. Data were drawn from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study, using three longitudinal time-points indicating pre-pregnancy, pregnancy, and postpartum in 179 participants who reported exclusive cigarette smoking at pre-pregnancy and were currently pregnant during the middle interval. Outcomes included (1) quit attempts and successful quitting within 12 months of pregnancy change in past 30-day smoking frequency at pregnancy, and postpartum return to use. Generalized estimating equations were conducted adjusting for sociodemographic and smoking characteristics. Approximately 47% of pregnant persons who smoked reported use of menthol cigarettes at pre-pregnancy, almost 80% attempted to quit/cut down during pregnancy, and 43.6% successfully quit. Approximately 56% of those who reported being quit at pregnancy returned to use in postpartum. Menthol use was associated with smoking on 1.13 fewer days among those who continued to smoke at pregnancy. Although pre-pregnancy menthol cigarette use was associated with greater nicotine dependence (fewer minutes to first cigarette; p < .05), menthol cigarette use was not significantly associated with quit attempts, successful cessation or changes in smoking frequency at pregnancy, or postpartum return to use (ps > .05). Our study did not find an impact of pre-pregnancy menthol cigarette use on quit attempts, cessation, or postpartum return to use. Findings suggest cessation efforts should focus on behavioral and contextual factors beyond cigarette mentholation alone.
Smoking continues to be a leading cause of preventable morbidity and mortality, and more than 480,000 Americans die annually due to smoking-related illness attributable to smoking and secondhand smoke. More advanced, responsive, and tailored digital interventions using machine learning and artificial intelligence may be a valuable tool for successful smoking cessation referrals. This study used the dynamic systems development method to incorporate patient and consumer sources of conversational data to develop a technology-assisted motivational interviewing (TAMI) chatbot, a digital agent using machine learning models to deliver motivational interviewing (MI) for tobacco cessation. During the functional model iteration phase, user-centered design interviews with smokers (n=3) informed the creation of TAMI. The design and build phase involved the use of existing datasets to guide the incorporation of MI-consistent utterances, language recognition, and topic classification to guide a discussion about smoking, and providing a tailored quit plan if indicated. During the implementation phase, user experience interviews with randomly selected participants (n=9) in a pilot trial discussed their experiences with TAMI. User-centered design interviews indicated a desire for a chatbot that was engaging and adaptable to personal interests in quitting smoking. Inductive analysis of user experience interviews revealed that anonymity, regular reminders, and a humanized experience facilitated engagement with TAMI, but technical glitches, chatbot misunderstandings, and issues with rapport were barriers to engagement. Informed by user input and patient and consumer datasets, TAMI can use MI skills to elicit change talk and/or accurately evaluate readiness for tobacco cessation. Further development will enhance TAMI's ability to seamlessly engage with users when discussing behavior change and assist underserved populations achieve improvements in a variety of health behavior goals.
Flavored tobacco products engage neural reward and sensory integration pathways, increasing appeal and dependence, particularly among youth people. Although tobacco control policies such as taxation and adoption of smoke-free laws have reduced overall tobacco use, their benefits are unevenly distributed across socioeconomic and racial/ethnic groups. This study, by reviewing evidence from neuroscience, epidemiology, and public policy, aims to examine how flavored tobacco and major tobacco control strategies differentially affect population. We focus on tobacco taxation, smoke-free laws, and complementary policies, with attention to policy reach, enforcement, and structural inequities. Neuroscientific findings showed that flavor additives enhance reward and mask aversive properties of tobacco, amplifying vulnerability among targeted populations. While taxes and smoke-free laws reduce tobacco use at the population level, disadvantaged minority groups often experience weaker benefits due to uneven policy adoption, limited enforcement, targeted industry marketing, and reduced access to cessation resources. The Minorities' Diminished Returns framework helps explain why similar policy exposure yields smaller health gains in marginalized populations. Tobacco control policies are effective but not inherently equitable. Reducing tobacco-related inequalities requires integrating flavor restrictions with uniformly applied taxation, comprehensive smoke-free protections, strong enforcement, and accessible cessation support.
New and innovative measures are needed to combat tobacco industry marketing strategies and reduce the harm caused by tobacco products. This rapid review aimed to identify and synthesize global evidence relating to dissuasive tobacco product measures, defined as unappealing colours and/or messages directly applied to individual tobacco products to discourage uptake and motivate cessation. Scopus, PubMed, Ovid, and Google were systematically searched from January 2000 to September 2024 to capture all published evidence relating to dissuasive measures, regardless of study design and tobacco product investigated. 'Forward' and 'backward' citation searching was also conducted. Studies were assessed for quality using JBI critical appraisal tools. Forty-seven eligible publications from 6011 titles/abstracts were included, all relating to conventional cigarettes: 37 peer-reviewed journal articles, including 2 reviews, 29 empirical studies (19 quantitative, 9 qualitative, 1 mixed-methods) and 6 commentaries, 8 government publications, 1 market research report and 1 doctoral thesis. Evidence largely related to perceptions of dissuasive products and their likely impacts. No empirical evidence regarding the relation of dissuasive measures to tobacco control outcomes was located. When compared with standard cigarettes, darker coloured cigarettes-often brown and green-were perceived to be less appealing, whilst cigarettes with messages related to the impact of smoking on finances, others, mortality, and life expectancy were viewed as novel and effective, and capable of inciting behavioural change. The available evidence is generally supportive of dissuasive cigarettes as a tobacco control measure, although a lack of empirical evidence on tobacco control outcomes limits the findings.
Tobacco use remains the leading preventable cause of death worldwide, while the rise of electronic nicotine products has sparked a new wave of initiation. The urgent need for scalable, multilevel tobacco-control interventions converges with the rapid advances in artificial intelligence (AI). This article reviews the most recent literature on integrating machine- and human expertise to enhance tobacco-cessation strategies within a multilevel framework. Recent advances in predictive analytics, large-language models (LLM), AI chatbots, and related tools create a framework to strengthen tobacco prevention. Predictive analytics merge electronic health records, behavioral surveys, genetics, and real-time sensor data to model the complex multilevel factors that influence quitting. LLMs instantly uncover informative features, revealing novel predictors that shape targeted interventions. AI-driven conversational agents deliver stage-specific counseling and medication guidance, with preliminary trials showing improved engagement and quit rates. Reinforcement learning personalizes messaging, rewards, and medication schedules to optimize outcomes, while natural-language processing of social media provides fine-grained sentiment data to assess policy impact. Realizing AI's potential to reduce tobacco's public-health burden requires interdisciplinary collaboration, equity-oriented design, external validation, and strong governance. These safeguards can enable scalable, adaptable, and culturally relevant smoking-cessation interventions and facilitate timely, effective tobacco-control policies.
Smoking cessation has been a public health focus for many years due to the impact of tobacco-use on the health system, society and wider economy. Evidence based information on supporting patients with smoking cessation is already available to dental teams but there appears to be limited information on the effects of tobacco on oral health for smoking cessation teams. Smoking affects the mouth, including increasing the risk of oral cancer, with prevention and early detection of oral diseases, a key priority in supporting health. There are opportunities for smoking cessation advisers to pass on oral health messages to their clients to help them maintain a good level of oral hygiene and encourage them to visit the dentist for regular checks. We developed and delivered a training session for smoking cessation advisors in a Southeast local authority. The session presented the effects of tobacco-use on the mouth, oral health promotion messaging for teams to incorporate into their sessions with clients, the importance of oral hygiene and available resources for soft tissue self-checks. The role of the dental team in oral health care was described and the importance of regular dental visits highlighted. This paper reflects the development, delivery and learning from this training initiative, particularly around future opportunities and challenges. Public Health Competencies being illustrated: oral health promotion, strategic leadership and collaborative working for health and oral health improvement.