reduce smoking essay

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.

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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.

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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

Essay on Teenage Smoking

Students are often asked to write an essay on Teenage Smoking in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Teenage Smoking

What is teenage smoking.

Teenage smoking means when young people, usually between 13 and 19 years old, start to smoke cigarettes. It is a big problem because it can harm their health very badly. Smoking can cause diseases like cancer and heart problems.

Why Do Teenagers Start Smoking?

Many teenagers start smoking because they see their friends doing it or they think it makes them look cool. Sometimes, they are under a lot of stress and think smoking will help them relax.

Effects of Smoking on Teenagers

Smoking can make teenagers sick. It can reduce their lung function and make it hard for them to breathe. It also increases the risk of getting sick with diseases like bronchitis and pneumonia.

Stopping Teenage Smoking

To stop teenagers from smoking, adults should talk to them about the dangers of smoking. Schools can also help by teaching students about the risks of smoking and how to say no to cigarettes.

250 Words Essay on Teenage Smoking

One main reason teenagers start smoking is peer pressure. They see their friends doing it and don’t want to feel left out. Some teenagers think smoking makes them look cool or grown-up. Others might start smoking because they are curious or because they see family members smoking.

Smoking is very harmful to anyone’s health, but it is especially bad for teenagers because their bodies are still growing. Smoking can lead to serious health problems like lung cancer, heart disease, and breathing problems. It also affects how they look, causing bad breath, yellow teeth, and a greater risk of getting sick.

Stopping teenage smoking is important. Parents, teachers, and communities can help by teaching teenagers about the dangers of smoking. They can also set a good example by not smoking themselves. Programs that encourage teenagers to stay away from cigarettes and offer support to those who want to quit are also very helpful.

In conclusion, teenage smoking is a problem that affects the health and future of young people. By understanding why teenagers start smoking and the effects it has, we can work together to help stop it.

500 Words Essay on Teenage Smoking

Teenage smoking: a grave threat to young lives.

Smoking among teenagers has become a pressing concern, posing significant risks to their health and overall well-being. It’s crucial to understand the harmful effects of smoking and take proactive measures to prevent and discourage teenagers from engaging in this dangerous habit.

Health Hazards of Teenage Smoking

Negative impact on physical development.

Smoking interferes with the normal growth and development of teenagers. It can stunt their physical growth, delay puberty, and weaken their immune system, making them more susceptible to illnesses. Smoking also affects bone health, increasing the risk of osteoporosis in later life.

Social and Psychological Effects

Teenage smoking has detrimental social and psychological consequences. It can lead to isolation, peer pressure, and impaired social skills. Smokers are more likely to engage in risky behaviors, such as alcohol consumption and drug abuse. Moreover, smoking can negatively impact academic performance, concentration, and memory.

Preventing Teenage Smoking

Teenage smoking is a serious public health issue that demands immediate attention. It’s essential to raise awareness about the harmful effects of smoking and empower teenagers with the knowledge and skills to resist tobacco use. By working together, we can create a smoke-free environment for our youth, ensuring their health and well-being for a brighter future.

That’s it! I hope the essay helped you.

Happy studying!

Smoking: Problems and Solutions Report

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Introduction

Case study: canada.

The tobacco industry is worth billions of dollars in annual profits made from the sale of cigarettes. This industry promotes the smoking of cigarettes by millions of individuals in countries all over the world. While most people enjoy smoking, this habit has many harmful effects that outweigh any perceived merits. Tobacco smoking is the number one cause of preventable deaths in most nations across the globe. The United Press International (2010) reports that, “more than 440,000 U.S. residents die annually from cigarette smoking” (p.1).

Smoking not only affects the smoker but also the people around him who are forced to inhale the polluted air. The CDC (2013) reveals that secondhand smokers incur adverse health conditions and even death because of the exposure. In addition to the negative health consequences associated with tobacco use, smoking leads to loss in productivity by an individual costing the economy billions of dollars annually.

The CDC (2002) further notes that smoking leads to a loss of money for citizens as they use thousands of dollars each year to sustain their habit. Considering the significant negative impact that smoking has on the society, measures should be taken to address the problem. Policies should be implemented to ensure that people are dissuaded from smoking.

If measures are not taken, the deaths and disease burden of smoking-related illness will continue to be prevalent in the society. Even more troubling, more young people will take up this damaging habit. The financial cost of smoking will also continue to be felt by the society.

To solve the problem, I would impose laws that restrict adults from smoking in the presence of children. Specifically, parents would be prevented from smoking at home when their children are present. A report by Wang and Phil (2011) reveals that children who are exposed to secondhand smoke at home are likely to engage in smoking themselves in future. Making smoking in the presence of children illegal would therefore have the desirable effect of preventing most children from taking up smoking in the future.

The community should engage in preventative programs to reduce smoking prevalence. Smoking remains to be a major problem due to the significant percentage of new smokers each year. Such programs would especially be effective to the youth who are thinking of picking up smoking.

Lovato (2012) states that “teenagers are likely to start smoking due to peer influence while at school” (p.363). With effective preventative programs targeted at such groups, the number of new smokers will remain low ensuring that the problem of smoking is mitigated. The National Cancer Institute (2013) suggests that greater investments should be made in efforts to assist individuals to quit smoking. A large percentage of smokers attempt to quit the habit at some point.

Reid et al. (2012) reveal that most of the smokers who are successful in their quitting attempts get some form of assistance from health care providers and community workers. To fund these solutions, the government can increase the taxation on tobacco companies. Such an action will not only provide the necessary finances but also increase the price of cigarettes therefore reducing consumption due to high prices.

One developed nation where the impacts of smoking are felt is Canada. CBPP (2013) reports that in Canada, 16.7% of the population smoke with the daily smokers, who consume an average of 13 cigarette sticks a day, being 13.1%. The highest percentage of smokers were found among the young adults aged between 20 and 24.

The Lung Association (2013) documents that approximately 37,000 Canadians die from smoking related conditions annually making tobacco a major killer in the country. In addition to this, the disease increases the risk for various forms of cancer, leukemia, and coronary problems. The CDC (2002) asserts that smoking “produces substantial health-related economic costs to society” (p.1).

In recognition of the problems that tobacco causes in the country, The Canadian government has taken steps to reduce smoking in the country. Reid et al. (2012) note that the government has engaged in aggressive campaigns to promote awareness of the adverse effects of smoking. CBC News (2010) reveals that the government has “forced cigarette manufacturers to carry picture-based warnings” (p.1).

These efforts have led to a marked decline in revenues for the industry as sales in the country have dropped. In spite of this drop, reports by CBC News (2010) indicate that “nearly one-fifth of Canadians call themselves smokers” (p.1). This indicates that the smoking problem is far from solved in the country. Better solutions will have to be implemented to ensure that the problem of smoking is mitigated and eventually eradicated from the society.

CBC News. (2010). Statistical look at cigarettes and Canadian smokers . Web.

CBPP. (2013). Tobacco Control . Web.

CDC (2002). Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Economic Costs – United States, 1995-1999 . Web.

CDC (2013). Tobacco: Fast Facts . Web.

Lovato, C. (2012). School and Community Predictors of Smoking: A Longitudinal Study of Canadian High Schools. American Journal of Public Health , 103(2), 362-368.

National Cancer Institute (2013). Cigarette Smoking: Health Risks and How to Quit . Web.

Reid J. L., Hammond, D., Burkhalter, R., & Ahmed, R. (2012). Tobacco Use in Canada: Patterns and Trends, 2012 Edition. Web.

The Lung Association. (2013). Smoking and Tobacco: Facts about smoking. Web.

United Press International (2010). CDC: U.S. smoking kills 440,000 a year . Web.

Wang, P., & Phil, M. (2011). Parental Smoking, Exposure to Secondhand Smoke at Home, and Smoking Initiation Among Young Children. Nicotine & Tobacco Research , 13(9), 827–832.

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Quit smoking

Quitting smoking: 10 ways to resist tobacco cravings

Tobacco cravings can wear you down when you're trying to quit. Use these tips to reduce and resist cravings.

For most people who use tobacco, tobacco cravings or smoking urges can be strong. But you can stand up against these cravings.

When you feel an urge to use tobacco, keep in mind that even though the urge may be strong, it will likely pass within 5 to 10 minutes whether or not you smoke a cigarette or take a dip of chewing tobacco. Each time you resist a tobacco craving, you're one step closer to stopping tobacco use for good.

Here are 10 ways to help you resist the urge to smoke or use tobacco when a craving strikes.

1. Try nicotine replacement therapy

Ask your health care provider about nicotine replacement therapy. The options include:

Prescription nicotine in a nasal spray or inhaler
Nicotine patches, gum and lozenges you can buy without a prescription
Prescription non-nicotine stop-smoking drugs such as bupropion (Wellbutrin SR, Wellbutrin XL, others) and varenicline

Short-acting nicotine replacement therapies — such as nicotine gum, lozenges, nasal sprays or inhalers — can help you overcome intense cravings. These short-acting therapies are usually safe to use along with long-acting nicotine patches or one of the non-nicotine stop-smoking drugs.

Electronic cigarettes (e-cigarettes) have had a lot of interest recently as a replacement for smoking traditional cigarettes. But e-cigarettes haven't proved to be safer or more effective than nicotine-replacement medications in helping people stop smoking.

2. Avoid triggers

Tobacco urges are likely to be strongest in the places where you smoked or chewed tobacco most often, such as at parties or bars, or at times when you were feeling stressed or sipping coffee. Find out your triggers and have a plan in place to avoid them or get through them without using tobacco.

Don't set yourself up for a smoking relapse. If you usually smoked while you talked on the phone, for instance, keep a pen and paper nearby to keep busy with doodling rather than smoking.

If you feel like you're going to give in to your tobacco craving, tell yourself that you must first wait 10 more minutes. Then do something to distract yourself during that time. Try going to a public smoke-free zone. These simple tricks may be enough to move you past your tobacco craving.

4. Chew on it

Give your mouth something to do to resist a tobacco craving. Chew on sugarless gum or hard candy. Or munch on raw carrots, nuts or sunflower seeds — something crunchy and tasty.

5. Don't have 'just one'

You might be tempted to have just one cigarette to satisfy a tobacco craving. But don't fool yourself into thinking that you can stop there. More often than not, having just one leads to one more. And you may end up using tobacco again.

6. Get physical

Physical activity can help distract you from tobacco cravings. Even short bursts of activity — such as running up and down the stairs a few times — can make a tobacco craving go away. Get out for a walk or jog.

If you're at home or in the office, try squats, deep knee bends, pushups, running in place, or walking up and down a set of stairs. If you don't like physical activity, try prayer, sewing, woodwork or writing in a journal. Or do chores for distraction, such as cleaning or filing papers.

7. Try relaxation techniques

Smoking may have been your way to deal with stress. Fighting back against a tobacco craving can itself be stressful. Take the edge off stress by trying ways to relax, such as deep breathing, muscle relaxation, yoga, visualization, massage or listening to calming music.

8. Call for reinforcements

Connect with a family member, friend or support group member for help in your effort to resist a tobacco craving. Chat on the phone, go for a walk, share a few laughs, or meet to talk and support each other. Counseling can be helpful too. A free telephone quit line — 800-QUIT-NOW (800-784-8669) — provides support and counseling.

9. Go online for support

Join an online stop-smoking program. Or read a quitter's blog and post encouraging thoughts for someone else who might be dealing with tobacco cravings. Learn from how others have handled their tobacco cravings.

10. Remind yourself of the benefits

Write down or say out loud why you want to stop smoking and resist tobacco cravings. These reasons might include:

Feeling better
Getting healthier
Sparing your loved ones from secondhand smoke
Saving money

Keep in mind that trying something to beat the urge to use tobacco is always better than doing nothing. And each time you resist a tobacco craving, you're one step closer to being tobacco-free.

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Rigotti NA. Overview of smoking cessation management in adults. https://www.uptodate.com/contents/search. Accessed March 23, 2022.
How to manage cravings. Smokefree.gov. https://smokefree.gov/challenges-when-quitting/cravings-triggers/how-manage-cravings. Accessed March 23, 2022.
Know your triggers. Smokefree.gov. https://smokefree.gov/challenges-when-quitting/cravings-triggers/know-your-triggers. Accessed March 23, 2022.
AskMayoExpert. Tobacco use (adult). Mayo Clinic; 2021.
Broaddus, VC. Smoking cessation. In: Murray & Nadel's Textbook of Respiratory Medicine. Elsevier; 2022. https://www.clinicalkey.com. Accessed March 23, 2022.
Rigotti NA. Pharmacotherapy for smoking cessation in adults. https://www.uptodate.com/contents/search. Accessed March 23, 2022.
Park ER. Behavioral approaches to smoking cessation. https://www.uptodate.com/contents/search. Accessed March 23, 2022.
Making your plan to quit and planning your quit day. American Cancer Society. https://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/deciding-to-quit-smoking-and-making-a-plan.html. Accessed March 23, 2022.
US Preventive Services Task Force. Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force Recommendation Statement. JAMA. 2021; doi:10.1001/jama.2020.25019.

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Persuasive Essay Writing

Persuasive Essay About Smoking

Craft an Engaging Persuasive Essay About Smoking: Examples & Tips

Published on: Jan 25, 2023

Last updated on: Jul 23, 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.

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.

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How to reduce smoking among teenagers

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The most important way to stop the pandemic of smoking would be to stop the influx of new smokers i.e. mainly teenagers. When youngsters aged 13–14 yrs try their first cigarette, most of them are not aware of the possible risk they are exposed to. Among young people, the short-term health consequences of smoking include respiratory and nonrespiratory effects, addiction to nicotine, and the associated risk of other drug use. Long-term health consequences of youth smoking is reinforced by the fact that most young people who smoke regularly continue to smoke throughout adulthood 1 .

In this issue of the Journal, Holmen et al. 2 report their findings from a cross-sectional population study in a county in Norway. The study seems to be well designed and conducted with a high participation rate of >90%. In this group of student teenagers physical activity was inversely associated with smoking and a positive correlation was observed between exercise and lung function in never-smokers. This is in accordance with other studies i.e. in US high schools. Students who play at least one sport are 40% less likely to be regular smokers and 50% less likely to be heavy smokers. Regular and heavy smoking decreases substantially with an increase in the number of sports played 3 .

The lower rates of smoking for student athletes may be related to a number of factors: 1) greater self-confidence gained from sports participation; 2) additional counselling from coaching staff about smoking; 3) reduced peer influences about smoking; 4) perceptions about reduced sports performance because of smoking; 5) greater awareness about the health consequences of smoking. Answers, with regards causal relationships, cannot be obtained from cross-sectional studies. Thus, other internal factors might be influential; high participation in sport might be selected by the more healthy subjects with better personal and psychosocial recourses.

Cigarette smokers have a lower level of lung function than those persons who have never smoked. Smoking reduces the rate of lung growth. Smoking hurts young people's physical fitness in terms of both performance and endurance, even among young people trained in competitive running. Teenage smokers suffer from shortness of breath almost three times as often and produce phlegm more than twice as often as teenagers that do not smoke. Teenage smokers are more likely to have seen a doctor or other health professionals for an emotional or psychological complaint. Teenagers who smoke are three times more likely than nonsmokers to use alcohol. Smoking is associated with a host of other “risky” behaviours, such as fighting and engaging in unprotected sex 4 , 5 .

Several other important findings from this Norwegian study 2 should be emphasized. First, smoking is not very common amongst teenagers, 10% of 13–18-yr-olds were daily smokers. There might be a misinterpretation among children of the same age that smoking is very common in their age group. Serious efforts should be made to correct this misinterpretation. This should be communicated out in the schools. Second, children should be informed about the very high addictive power of cigarettes i.e. nicotine. After only a short period of time, such as a few months of daily smoking, addiction to nicotine may occur. Quitting will then be more difficult. Youngsters should also be aware that the tobacco industry has manipulated the cigarettes to make them a better starter product by adding additives.

A recent Cochrane meta-analysis identified eight randomized studies which had exercise included in their smoking cessation 6 . In six trials however, the number of participants were <25 in each arm, making it almost impossible to get any consistent answer in smoking-cessation studies. Thus, larger trials are required to find out if exercise will increase success rate in smoking-cessation programmes.

There are several ways in which exercise may theoretically support a quit attempt: by decreasing withdrawal symptoms, by increasing the overall feeling of well-being and by decreasing the postcessation weight gain. The possible success of exercise programmes will, among others, be dependent on the adherence to the programme. The potential benefits of exercise programmes in smoking cessation, if effective, might be of special interest in low-income countries that cannot afford the use of nicotine-replacement products or bupropion for smoking cessation. Nonpharmacological approaches to smoking cessation may also be more attractive to teenagers.

The tobacco industry has used enormous amounts of money on advertisements for cigarettes. The European Union has recently passed a “law” which from the year 2003, forbids advertisements for tobacco. Several examples of how the tobacco industry targets teenagers are apparent. Recently, inside papers from the tobacco industry have revealed how cigarettes have been manipulated, to become a better starter product, by using additives.

There is some evidence of an effect of mass-media interventions for preventing smoking in youngsters. Six out of 63 studies about mass-media smoking campaigns were randomized and included in a Cochrane analysis. Two of six studies found that mass-media intervention was effective in preventing the uptake of smoking in young people 7 .

Several different approaches have been used in school interventions during the last 40 yrs. In the 1960s, “The Information Deficit Model” was used, based on the rationale that preventing the initiation of smoking in teenagers could be achieved if they received information about the adverse health effects of cigarettes 1 . This did increase knowledge but appeared ineffective in dissuading youngsters from smoking. In the 1970s “The Affective Education Model” was applied i.e. trying to develop stronger intrapersonal resources and general social competence. This was because a complex set of personal factors were related to smoking such as a reduced level of self-esteem and poor attitudes to family, school and community 1 . In the mid 1970s, “The Social Influences Model” 8 focused on a complex set of psychosocial factors associated with smoking initiation (peer smoking, smoking in the immediate environment and other social and psychological factors).

In the 1980s “The Public Health Model” looked at the smoking-habit spread as a social contagion; the goal was to strengthen resistance of nonsmokers against smokers i.e. to teach youngsters skills to resist social pressure to try smoking 9 . Meta-analysis of the entire interventions, discussed earlier, showed small, short term and limited effects 10 .

A much more effective outcome has been observed in multicomponent interventions, combining school and local society interventions. Three multicomponent studies in USA consisting of a strong school programme (15 class sessions over 3–5 yrs in grades 6–9) combined with community and media-based activity reported 31–39% less weekly smoking at end of grades 10–12 11 – 13 . This sort of intervention should have a much higher priority in Europe than is evident today.

The National Guidelines for Tobacco prevention in schools in the USA (Centres for Disease control) could be an example for all European Schools 14 : “Guideline 1: all schools should develop and enforce a school policy on tobacco use. Policies should prohibit tobacco use by all students, and visitors during school-related activity. Guideline 2: all schools should provide tobacco prevention education in kindergarten through 12th grade. The instruction should be especially intensive in middle and junior high school and reinforced in high school. Guideline 3: schools should provide instructions about immediate and long-term consequences of tobacco use and the reasons why adolescents say they smoke, and about social influences that promote tobacco use. Schools should provide behavioural skills for resisting social influences that promote tobacco use. Guideline 4: improve curriculum implementation and overall programme effectiveness.”

These guidelines were only implemented fully in very few schools and in part by two-thirds of the schools in USA 15 . Regarding guideline 1 about smoke-free schools, the Danish parliament has recently passed a law prohibiting smoking for students in elementary school but not in high school. Across Europe smoke-free schools should be a common goal. Educational strategies conducted in conjunction with community and media-based activity can postpone or prevent smoking onset in 20–40% of adolescents.

© ERS Journals Ltd
↵ USDHHS. Preventing Tobacco use among Young People. A Report of the Surgeon General. US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, Georgia, 1994 .
↵ Holmen TL, Barrett-Connor E, Clausen J, Holmen J, Bjermer L. Physical exercise, sports, and lung function in smoking versus nonsmoking adolescents. The Nord-Trøndelag Health Study, Norway, 1995–1997. Eur Respir J 2002 ; 19 : 8 –15. OpenUrl Abstract / FREE Full Text
↵ Escobedo LG, Marcus SE, Holtzman D, Giovino GA. Sports participation, age at smoking initiation, and the risk of smoking among US high school students. JAMA 1993 ; 269 : 1391 –1395. OpenUrl CrossRef PubMed Web of Science
↵ Arday DR, Giovino GA, Schulman J, Nelson DE, Mowery P, Samet JM. Cigarette smoking and self-reported health problems among U.S. high school seniors, 1982–1989. Am J Health Promot 1995 ; 10 : 111 –116. OpenUrl PubMed Web of Science
↵ Lew EA, Garfinkel L. Differences in Mortality and Longevity by Sex, Smoking Habits and Health Status, Society of Actuaries Transactions, 1987 .
↵ Ussher MH, West R, Taylor AH, McEwen A. Exercise interventions for smoking cessation (Cochrane Review). Oxford, Update Software, The Cochrane Library, 2, 2001 .
↵ Sowden AJ, Arblaster L. Mass media intervention for preventing smoking in young people (Cochrane Review). Oxford, Update Software, The Cochrane Library, 2, 2001 .
↵ USDHHS. Strategies to control tobacco use in United States: A blue-print for Public Health Action in the 1990's. Smoking and Tobacco Monograph No.1., US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, Bethesda (MD), 1991 .
↵ USDHHS. Reducing Tobacco Use. A Report of the Surgeon General. US Department of Health and Human Services, Public Health Service,Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, Georgia, 2000 ; pp. 61 ––80.
↵ Ennett ST, Tobler NS, Ringwalt CL, Flewelling RL. How effective is drug abuse resistance education? A meta-analysis of Project DARE outcome evaluations. Am J Publ Health 1994 ; 84 : 1394 –1401. OpenUrl PubMed Web of Science
↵ Flynn BS, Worden LK, Secker-Walker RH, Badger GJ, Geller BM, Costanza MC. Prevention of cigarette smoking through mass media intervention and school programs. Am J Publ Health 1992 ; 82 : 827 –834. OpenUrl CrossRef PubMed Web of Science
Johnson CA, Pentz MA, Weber MD, et al. Relative effectiveness of comprehensive community programming for drug abuse prevention with high-risk and low-risk adolescents. J Consult Clin Psychol 1990 ; 58 : 447 –456. OpenUrl CrossRef PubMed Web of Science
↵ Perry CL, Kelder SH, Murray DM, Klepp KI. Community wide smoking prevention: long-term outcomes of the Minnesota Heart Health program and the Class of 1989 Study. Am J Publ Health 1992 ; 82 : 1210 –1216. OpenUrl PubMed Web of Science
↵ Centers for Disease Control and Prevention. Guidelines for school health programs to prevent tobacco use and addiction. Morbidity and Mortality Weekly Report 1994b; 43(RR-2): pp. 1 ––18.
↵ Crossett LS, Everett SA, Brener ND, Fishman JA, Pechacek TF. Adherence to the CDC Guidelines for School Health Programs to Prevent Tobacco use and Addiction. J Health Education 1999 ; 30 : S4 –S11. OpenUrl
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Best ways to quit smoking: E-cigs, medications, and counseling proven effective in new Cochrane analysis

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Breakthrough Quit-Smoking Methods Unveiled: What Works and What's Missing, According to New Cochrane Reviews.

Study: Effects of interventions to combat tobacco addiction: Cochrane update of 2021 to 2023 reviews. Image Credit: Josep Suria/Shutterstock.com

In a recent study published in the Addiction , a group of researchers summarized Cochrane Tobacco Addiction Group (CTAG) systematic reviews published from 2021 to 2023, highlighting key findings on effective smoking cessation interventions and identifying areas for future research.

Background

Tobacco smoking is a leading cause of preventable death, responsible for over 8 million deaths annually, and a major contributor to health inequalities. Quitting smoking significantly improves health and reduces the risk of disease and death.

Evidence-based support for cessation and prevention is critical for healthcare providers and policymakers. Cochrane, a not-for-profit organization, produces systematic reviews to support informed healthcare decisions.

The CTAG focused on smoking cessation interventions until March 2023. Further research is needed to refine existing interventions, explore emerging therapies, and address gaps in understanding to enhance the effectiveness of tobacco addiction treatment and prevention strategies.

About the study

The present article provides detailed information on abstinence and harms. These comparisons include effect estimates, number of contributing studies, sample size, the certainty of the evidence, and statistical heterogeneity.

The data presented reflect the original published reviews, with certainty of evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, which consider study limitations, imprecision, indirectness, consistency of effect, and publication bias.

Certainty levels range from high, where the true effect is believed to be close to the estimate, to very low, indicating minimal confidence in the estimate.

Due to their inherent heterogeneity, CTAG generally used random-effects models for behavioral interventions, while pharmacotherapies and e-cigarette (EC) interventions were analyzed using fixed-effect models.

Study results

Between 2021 and 2023, the CTAG published five new reviews one overview, and updated eight previous reviews. This included a living systematic review updated three times. Another related review by the Cochrane Public Health Group, which investigated interventions to prevent or cease EC use in young people, found no studies.

CTAG also published protocols for two upcoming reviews, focusing on the impact of ECs on cigarette smoking in young people and interventions for smokeless tobacco cessation, both expected in 2024.

The updated reviews incorporated new evidence, particularly in the area of pharmacotherapies. For instance, the 2023 update on nicotine receptor partial agonists found that varenicline and cytisine were more effective for smoking cessation than placebo, with varenicline showing higher efficacy than bupropion or nicotine replacement therapy (NRT).

Cytisine may have fewer serious AEs (SAEs) compared to varenicline. Similarly, an updated review of antidepressants for smoking cessation reaffirmed that bupropion helps more people quit compared to placebo, although there was some evidence suggesting potential AEs.

CTAG's review of NRT added new studies but did not change its overall conclusions. Combination NRT, particularly fast-acting forms with patches, was more effective than single-form NRT.

Evidence also supported the use of pre-loading NRT before the quit date. There was mixed evidence regarding different doses and forms of NRT, with limited data on safety comparisons.

A new review using component network meta-analysis (cNMA) provided insight into the comparative effectiveness of smoking cessation interventions. Nicotine ECs, varenicline, and cytisine emerged as the most effective treatments.

The review also found moderate evidence suggesting bupropion may slightly increase SAEs. This technique allowed comparisons between treatments that had not been directly studied, offering new insights into intervention effectiveness.

Behavioral interventions were also assessed. An overview of reviews found that behavioral support, such as counseling and financial incentives, improved quit rates.

The economic evaluation suggested all effective behavioral interventions were cost-effective, though no particular method was found to be superior. Lastly, updated reviews on waterpipe cessation, mindfulness, and preventing weight gain post-smoking cessation offered mixed or low-certainty evidence.

Conclusions

To summarize, from 2021 to 2023, Cochrane Tobacco Addiction updated key reviews using newer methods, including component network meta-analyses, a living systematic review, and an overview of reviews.

These approaches provided clear evidence of the effectiveness of smoking cessation interventions, but important gaps remain.

More trials are needed to compare dosages, durations, and combinations of pharmacotherapies, as well as safety data. Behavioral interventions, EC, and heated tobacco products also require further study.

Livingstone-Banks J, Lindson N, Hartmann-Boyce J. (2024) Effects of interventions to combat tobacco addiction: Cochrane update of 2021 to 2023 reviews. Addiction . doi: https://doi.org/10.1111/add.16624 . https://onlinelibrary.wiley.com/doi/10.1111/add.16624

Posted in: Medical Science News | Medical Research News | Medical Condition News

Tags: Abstinence , Addiction , Bupropion , Cigarette , Cytisine , Efficacy , Healthcare , Nicotine , Placebo , Public Health , Receptor , Research , Smoking , Smoking Cessation , Tobacco

Vijay Kumar Malesu

Vijay holds a Ph.D. in Biotechnology and possesses a deep passion for microbiology. His academic journey has allowed him to delve deeper into understanding the intricate world of microorganisms. Through his research and studies, he has gained expertise in various aspects of microbiology, which includes microbial genetics, microbial physiology, and microbial ecology. Vijay has six years of scientific research experience at renowned research institutes such as the Indian Council for Agricultural Research and KIIT University. He has worked on diverse projects in microbiology, biopolymers, and drug delivery. His contributions to these areas have provided him with a comprehensive understanding of the subject matter and the ability to tackle complex research challenges.

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John P Pierce 1 ,
Victoria M White 2 ,
Sherry L Emery 3
1 Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California, USA
2 Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Victoria, Australia
3 Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
Correspondence to Dr John P Pierce, Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California 92093-0901, USA; jppierce{at}ucsd.edu

Smoking initiation is a key behaviour that determines the future health consequences of smoking in a society. There is a marked difference in smoking patterns around the world, driven by initiation rates. While a number of high-income countries have seen smoking prevalence decline markedly from peak, many low-income and middle-income countries appear to still be on an upward trend. Unlike cessation where changes are limited by nicotine dependence, rates of smoking initiation can change rapidly over a short time span. Interventions that can be effective in achieving this include increases in the price of tobacco products, mass media anti-smoking advertising, smoke-free policies, smoking curricula in schools, restrictions on marketing opportunities for the tobacco industry as well as social norms that lead to restrictions on adolescents' ability to purchase cigarettes. Comprehensive tobacco control programmes that aim to denormalise smoking behaviour in the community contain all of these interventions. Rapid reductions in smoking initiation in adolescents have been documented in two case studies of comprehensive tobacco control programmes in California and Australia. Consistent and inescapable messages from multiple sources appear to be key to success. However, the California experience indicates that the rapid decline in adolescent smoking will not continue if tobacco control expenditures and the relative price of cigarettes are reduced. These case studies provide strong additional evidence of the importance of countries implementing the provisions of the Framework Treaty on Tobacco Control.

Smoking initiation
tobacco control programmes
tobacco advertising
smoke-free policies
mass media programmes
school programmes
youth access
harm reduction
taxation and price
advertising and promotion
uptake risk factors
adolescents

https://doi.org/10.1136/tobaccocontrol-2011-050359

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Introduction

During the 20th century, cigarettes became the predominant form of tobacco use across the world and ushered in the global lung cancer epidemic. 1 In Western high-income countries, public health approaches to reduce the health consequences of tobacco use started in the 1960s and have focused primarily on cigarette smoking. 2 Almost 50 years later, it is time to review tobacco control and tobacco industry strategies that are focused on the initiation of cigarette smoking.

Lopez and colleagues 3 described the different patterns of diffusion of cigarette smoking across world cultures, noting the early adoption of Western high-income countries and the slower adoption in many lower-income and middle-income countries. From tables 1 and 2 , three groups of countries are worth noting. Countries in Western Europe, North America and Australasia were early adopters of smoking, and experienced a rapid increase to a high per-capita cigarette consumption in the beginning of the 20th century that peaked in the 1960s. 4 Since the start of tobacco control programmes, these countries have experienced dramatic declines (over 70% in the USA) from that peak consumption. Table 1 shows that in 2006, male smoking prevalence in these countries was generally in the 21% to 30% category, considerably below those with the highest smoking prevalence such as the Russian Federation, Greece and Indonesia. Similarly for women, smoking prevalence in these early adopter countries has declined to the 10% to 20% level ( table 2 ). A second large group of countries (eg, China, Malaysia and Thailand) has a low female smoking prevalence, which is in stark contrast to the male smoking prevalence. Hitchman and Fong 5 have noted that many countries in this group have low levels of female gender empowerment (measured by participation in economics and politics including decision-making roles). The tobacco industry has a history of adeptly linking cigarette smoking to the female empowerment movement that occurred in earlier years in high-income countries. 6 There appears to be a third small group (eg, Ghana, Ethiopia) where cigarette smoking may have never been a common behaviour for either gender.

View inline

Smoking prevalence among men aged ≥15 years of age in 2006, WHO Health Statistics

Smoking prevalence among women aged ≥15 years of age in 2006, WHO Health Statistics

Across high-income and low-income countries, the process of adopting smoking as a socially normative behaviour has typically started among the higher educated groups; in countries where reductions have occurred, this group has also been the first to reduce smoking. 7 8 Indeed, the prevalence of smoking in medical students, compared to the population, can be a reasonable marker of the current strength of tobacco control. 4 9 Recently, Sreeramareddy et al (2010) noted that over 20% of female medical students from Bangladesh, Pakistan, Malaysia and Nepal had experimented with smoking. 10 This is significantly higher than adult female smoking prevalence, and suggests that these countries may need to implement additional effective strategies if they are to avoid the general equilibration of smoking rates across genders that is present in many high-income countries. 11

The process of smoking initiation

It usually takes time for an individual to become a smoker, allowing for several opportunities for tobacco control interventions that can either focus on the prevention of experimentation or progression to higher smoking levels. There are identifiable cognitions (curiosity, weakening of intention not to smoke) that predict future smoking, whether it be first experimentation or progression to a higher level of smoking experience (eg, puffer, experimenter, to occasional and then regular smoker, etc). 12 13 In high-income countries such as the USA, there is good evidence that experimentation generally occurs between the ages of 10–24 years. 14 While some cultures have reported smoking at an earlier age, there is little evidence to suggest an uptake pattern in which never smokers start the initiation process after the age of 24 years. Early experimentation and use is nearly always undertaken in a social context, which emphasises the importance of interventions focused on denormalising smoking. As there is considerable change in friendship groups during adolescence, high-risk cognitions may lead an adolescent to seek out friends who offer the opportunity to smoke. 15 Certainly, in almost all studies, having peers who smoke is a strong predictor of future adult smoking. 16

The role of the tobacco industry in encouraging initiation

Industry documents obtained as part of the legal process have demonstrated that tobacco companies use a business model that is focused on maintaining or increasing new users of their products, even if this means targeting adolescents. This is achieved by marketing products that promote adolescent cognitions that increase the probability of experimentation and continued use. 17 18 Over the past century, cigarettes have become one of the most heavily marketed products around the world. Tobacco companies have created distinct lifestyle images associated with different brands, and their marketing strategies include package design, product placement, advertising, promotional activities and pricing. In 2008, the US National Cancer Institute published a major review of the evidence that concluded that tobacco product marketing is causally associated with tobacco usage, particularly by the young. 19

Marketing 18 and psychology 20 theories both suggest that there is a hierarchy of effects from persuasive communications. Initially, individuals need to be exposed to a communication, and a proportion will attend to the message. Of those who attend to the message, a portion will like it, maybe as much as to indicate that the message is one of their favourites. Some will identify so strongly with the image that they will be prepared to wear it on clothing or use imprinted accessories. 21 Young teens who have a favourite cigarette brand are almost 50% more likely to smoke 6 years later, and those prepared to wear or use a tobacco-branded item were 84% more likely to be adult smokers. 22

Countries have implemented restrictions on tobacco marketing practices; however, in every case, restrictions have been implemented gradually so that a variety of marketing channels still remained open to the tobacco industry. In response, the industry increased its overall expenditure on marketing 23 and companies have been innovative with their marketing strategies. In the USA, after the 1999 restrictions on advertising targeting young people, the tobacco industry shifted their marketing dollars to young adult venues 24 and point-of-sale advertising. 25 There was a marked increase in the quantity of in-store advertising, 26 especially among those stores frequented by adolescents. 27 This shift led to an increase in adolescent recall of in-store advertising; a longitudinal study has found that those who recall in-store exposure were more likely to start smoking. 28

The cigarette packet design is also part of the brand's marketing as it provides key components of the brand image from which all other marketing is built. The pack colours, graphic elements, proportioning, texture, materials and typography promote the brand's image. 29 Tobacco industry documents reveal that a key strategy for promoting initiation is to convince adolescents that the ‘psychological benefits’ that are associated with the brand will help them deal with the emotional challenges of adolescence. 30

Tobacco industry-sponsored ‘prevention’ efforts

Starting in the 1980s, tobacco companies have launched programmes in at least 26 countries ostensibly to prevent smoking initiation among the school-aged population. However, internal documents show that tobacco industry leaders viewed such initiatives as a way to prevent or delay legislation, regulation, or even threatened litigation. 31 In addition, by controlling the prevention intervention, the tobacco industry could ensure that more effective strategies were suppressed. In 1990, Philip Morris was temporarily successful in convincing the California Department of Education to distribute a tobacco industry sponsored ‘anti-smoking’ set of materials to schools. 31

In 1998, Philip Morris USA created its own Department of Youth Smoking Prevention with the stated objective of helping to prevent adolescent smoking. Through 2010, they made payments of over US$55 billion to numerous USA states to disseminate their projects that included the ‘We Card’ programme in retail stores, an online “Raising Kids Who Don't' Smoke” parent resource series and selected ‘anti-smoking’ school curricula. 32 A number of these programmes were evaluated independently; it was concluded that none of the programmes were effective at preventing teen smoking, with some showing evidence that the programmes encouraged smoking. 19 In the late 1990s, an evaluation of illegal underage sales in retail stores in California demonstrated that stores with ‘We Card’ and other tobacco industry signs had considerably higher sales to minors than stores with government signs. 33

Following the 1998 Master Settlement Agreement, Philip Morris and Lorillard launched substantial television advertising campaigns, targeted at youth and adults, with the putative message of preventing youth smoking. In contrast to government sponsored anti-smoking TV adverts, higher youth exposure to these tobacco industry adverts was associated with reduced anti-smoking attitudes and beliefs, and a higher probability of smoking among USA high school youth. 34 In California, advertising messages such as adults lecturing teens were nominated as a favourite anti-smoking advertisement by a number of adults over the age of 55 years. 35 This suggests that this may have been the real target audience with a goal of improving company image in the community as a way to prevent strengthening public support for anti-smoking interventions.

Tobacco control interventions

There is substantial literature on interventions aimed at reducing smoking initiation, mainly from high-income countries. These interventions include school programmes, increasing price through excise tax increases, large graphic warning labels on packages, restricting the tobacco industry's ability to advertise, tobacco control mass media programmes, smoke-free policies and restricting the ability of minors from purchasing tobacco products. It is important to note that the effectiveness of an overall approach is more than the sum of the effectiveness of the independent strategies. In Australia 36–38 and California 2 39 comprehensive community-wide programmes using multiple strategies have documented large declines in smoking initiation. The key goal of such programmes is the denormalisation of tobacco in the entire community. 40 41

School interventions

School programmes are often one of the first approaches mentioned in efforts to denormalise tobacco. Early training might be able to ‘inoculate’ students against influences encouraging them to experiment with smoking, or social skills training/practice could help them resist temptations from peers to smoke. A Cochrane review 42 identified 133 studies of school interventions of which 94 had the most rigorous design (ie, randomised trial). The authors concluded that evidence for the effectiveness of these interventions was mixed with effects being limited to short-term outcomes only. They focused on one ‘high quality’ trial that had a particularly rigorous measurement protocol 43 and noted that the school intervention had no effect. However, this study did not demonstrate a between-group difference as a result of the educational intervention. Without such a difference, it would be impossible for the study design to demonstrate an effect. Others have also reviewed the 30-year history of studies and concluded that adequate evidence exists to recommend ongoing implementation of school-based tobacco prevention interventions. 44 However, confidence of tobacco control advocates in school programmes was shaken when Philip Morris chose to promote the Lifeskills Training Program, a 6th grade intervention programme that had been designated as an effective programme by the Centers for Disease Control and Prevention (CDC). 45

One of the problems with this research is that very few of the interventions are up-to-par with standards necessary for quality comprehensive education. The USA National Health Education Standards 46 require that students: (a) comprehend the health risks, (b) analyse the influences of family, peers, culture and media on usage patterns, (c) develop interpersonal skills to resist temptations and (d) practice goal setting and decision making skills to protect against use. They recommend that this be included in the curriculum of every school year (kindergarten through grade 12). The CDC supports such a curricula approach, but indicates that it is not enough. In addition, schools need to (a) have explicit tobacco control policies, (b) have appropriate teacher training, (c) involve parents and families, (d) support cessation for teachers, staff and students and (e) regularly evaluate performance. The only way schools can reach all of the above goals (especially with limited budgets) is a comprehensive approach in which preventing initiation is a high public priority and significant progress has been made on denormalising tobacco use in the broader community. Supporting this, a recent European study 47 found that disciplining students for a smoking infraction was only associated with lower prevalence when teachers and parents were non-smokers and supportive of the programme.

Warning labels and plain packaging

Warning labels on cigarette packs, which were introduced in the USA in 1966, are often one of the first tobacco control initiatives. 48 Whereas obscure text-only warnings appear to have little impact, recently implemented prominent graphic health warnings on packages have been demonstrated to serve as a key source of health information for smokers and non-smokers, increasing health knowledge and perceptions of risk. 49 Prominent pictorial warning labels have been found to lower smoking intentions among adolescent smokers and non-smokers. 50

Australia is the first country to attempt to counter the tobacco industry's package advertising and require that cigarette packages do not include any tobacco marketing (ie, plain packaging). Formative research on plain packaging among Australian youth found that they would be less likely to purchase the product and more likely to take the health warnings seriously. 51 Should the Australian government successfully defend its new law in 2012, this will result in a major demonstration project that will be carefully followed by the tobacco industry and tobacco control advocates across the world.

Increasing the price of cigarettes to prevent initiation

Price elasticity refers to the relationship between price and demand for a particular consumer product. In the context of adolescent smoking, there is significant literature on the price elasticity of youth demand for cigarettes. Key studies in the early years of USA tobacco control interventions estimated that price elasticity of adolescent demand for cigarettes was −1.44; in other words, for every US$0.10 increase in the price/pack of cigarettes, youth smoking declines by approximately 14%. 52 While the price of cigarettes does not appear to influence whether or not an adolescent experiments with cigarettes, 53 there is strong evidence that price matters once teens progress as far as buying their own cigarettes. 54

However, many USA states dramatically increased state cigarette taxes after 1999 and some recent studies have not found this price increase associated with the expected high adolescent elasticity. Nonnemaker et al (2011) found a significant but smaller effect of tax and price on youth smoking initiation. 55 In this study, higher price responsiveness among minorities explained a lot of the price elasticity. It may be that price elasticity is influenced by the number of tobacco control strategies implemented in the community. A recent European study examined the influence of price along with several other tobacco control policies on smoking participation and did not find the expected association between increased price and lower smoking. 56 However such a study is an outlier in the literature. A recent Australian study found that increases in the price of cigarettes over a 12-month period were associated with lower likelihood of smoking after adjusting for other policy factors including point-of-sale advertising restrictions, clean indoor air laws and tobacco control funding. 57

Mass media in tobacco control programmes

There have been numerous studies of the role of mass media counter-advertising campaigns in preventing smoking initiation. 58 These have included randomised as well as interrupted time series studies of smoking, before and after implementation of an anti-smoking campaign. Media channels commonly used for tobacco control advertising include television, radio, print and billboards. Themes that are commonly used in this advertising include health consequences of smoking, tobacco industry manipulation, dangers of secondhand smoke (SHS) and the declining social acceptability of smoking. As the frequency of exposures over time is critical to effectiveness, paid television advertisements tend to be the most costly component of a comprehensive tobacco control programme. The National Cancer Institute's report 19 on the role of media in tobacco use concluded that there is a consensus that advertising that arouses a strong negative emotion is more likely to be associated with changes in youth attitudes about tobacco (social norms) and lower smoking initiation compared to other advertising messages. However, the largest effects are present when anti-smoking media campaigns are combined with school and/or community-based programmes within comprehensive tobacco control programmes.

Adolescent receptivity (favourite advertisement, identification with brand logo etc) to counter-advertising is an important way of assessing the likely impact of media campaigns. In 2005 and 2008, Californians nominated their favourite anti-smoking advertisement; strong health consequences messages and those focused on the manipulative strategies of the tobacco industry were most salient to teens and young adults. 35 However, while there is considerable willingness to name a favourite anti-smoking advertisement, there is no evidence to suggest that clothing with an anti-smoking brand logo is likely to be a popular dress item with adolescents. Analyses of California surveys suggest that having a favourite anti-smoking advertisement will reduce the probability that a favourite cigarette advertisement will lead to future smoking. However, mass media strategies are very costly. As media channels have proliferated in recent years (especially with widespread availability with the internet), the cost of traditional mass media programmes has increased dramatically and most tobacco control programmes need to limit their level of commitment to this area and carefully choose channels.

Smoke-free policies

The health consequences of SHS became evident in the 1980s and, in 1992, the Environmental Protection Agency of the USA categorised SHS as a class A carcinogen. 59 Local jurisdictions in the USA responded by increasing the number of laws and ordinances requiring smoke-free workplaces and in 1994, California passed a state law. Evidence of the effectiveness of this policy in reducing SHS exposure led to its inclusion in the unprecedented WHO treaty, the Framework Convention for Tobacco Control (FCTC). As a result of this treaty, smoke-free laws are expected to increase significantly over the next few years. The introduction of strong smoke-free regulations in public spaces such as restaurants and cafes contributes to the denormalisation of tobacco in a community, 60 and reduces the likelihood of an adolescent becoming a regular smoker. 61 The implementation of smoke-free workplace and public space laws has been associated with the voluntary adoption of smoke-free homes, which has resulted in increased protection of children from exposure to SHS. 61 62 There are numerous cross-sectional surveys that have demonstrated the association between smoke-free homes and lower initiation rates among teens 63 although these results are awaiting confirmation in ongoing longitudinal studies. 61

Restricting access to cigarettes by minors

Perhaps the most controversial intervention to reduce smoking initiation are policies focused on restricting adolescents' access to purchase cigarettes. 24 Many USA states had laws dating back to the early 20th century (mostly not enforced) that limited purchase of cigarettes to people over the age of 18 years. The California experience 64 has demonstrated that, as cigarette smoking becomes increasingly denormalised, adults are more likely to express opinions that enforcement of sales to minors laws are inadequate. However, adolescent smokers are adept at ensuring that these laws do not limit their ability to obtain cigarettes by knowing which stores have lax monitoring or by paying older teens to purchase for them. 65 Indeed, most experimenters and occasional smokers obtain their cigarettes from social sources. 66 While these laws may not influence an adolescent's ability to obtain cigarettes, significant declines in the proportion of never smokers who thought it was easy to get cigarettes was associated with enforcement of the laws. 64

Case studies

Summarised below are two case studies of long-term smoking prevention programmes which have had detailed evaluations. In each case, a major decline in smoking initiation has been documented since 1996. Both examples involve a large population in which tobacco control policy required government policy and funding.

Case study 1: California

In the USA, a federal law banned tobacco advertising on the broadcast media in 1971. There were no additional national restrictions on tobacco marketing until 1998 when the state attorneys general settled their lawsuits against the tobacco companies. The resulting Master Settlement Agreement significantly restricted marketing that could be construed as targeting minors. 23 Weak warning labels were implemented in 1966 without any significant upgrade until 2011.

California was one of the first states to implement tobacco control initiatives 2 and, although these were unfunded for over 20 years, these efforts resulted in a differential decline (compared to the rest of the nation) in smoking across birth cohorts. Starting in 1990, California increased this effort by introducing a comprehensive programme focused on changing social norms regarding tobacco use, using monies from a population-wide voter initiative that increased the excise tax on tobacco. 40 Although per capita funding levels fluctuated considerably over time, interventions included an ongoing mass media anti-smoking advertising campaign, and local programmes that (a) countered pro-tobacco influences in the community, (b) reduced exposure to SHS, (c) reduced availability of tobacco products for minors and (d) increased services to help smokers successfully quit. In addition, the Department of Education had its own funding from this initiative. 67 In 1996, all K-12 grade schools were required by law to have smoke-free campuses. After 1996, two-thirds of school funding was allocated to local educational agencies provided that they fully implemented the tobacco-free school policy. This provided funding for programmes in grades 6–12 through a competitive application process for tobacco-specific student instruction, reinforcement activities, special events, intervention and cessation programmes for students.

Once every decade since the 1960s, California increased excise taxes to raise cigarette prices above those of the rest of the nation, a factor associated with California's more rapid decline in cigarette consumption. 2 However, the last such price increase was in 1999 and, from 2005 to 2011, cigarettes have been cheaper in California than the rest of the nation. 2 In 1994, California passed the world's first smoke-free workplace law, which included bars and taverns. Further, in 1996, the tobacco control programme implemented a unique and apparently effective programme to enforce the federal ban on sale of cigarettes to minors. 68

These activities were associated with social norm change at the population level and, in conjunction with the innovative school education programme, were associated with halving the proportion of California youth who smoked in the prior month between 1996 and 2004 (from 28% in 10th graders). 69 California then led the nation with the lowest school smoking prevalence in 2004 at 13%. 70 This reduction in smoking prevalence resulted from a reduction in experimentation in each younger birth cohort, 71 which was achieved by an apparent inoculation effect on adolescents, preventing the development of the known risk factors for smoking. 72 However, these large year-to-year reductions in California smoking were not maintained after 2004. This loss of effect cannot be attributed to changes in school curricula or policy, declines in the effectiveness of SHS policies, differences in enforcement of laws restricting teen purchase of cigarettes, or to warning labels on the cigarette pack. What did change was the level of tobacco control expenditures and the relative price of cigarettes. 2 The price issue may have been exacerbated by evidence that tobacco industry marketing expenditures are often targeted to states with tobacco control programmes.

Case study 2: Australia

The Australian federal government banned direct tobacco marketing from the electronic media in 1976 and from the print media in 1991. Large text-based health-warning labels were required on all cigarette packs in 1995. In 2006, these were updated to include large and graphic pictures of the health consequences of smoking, with the health warnings taking up 90% of the back of the pack and 30% of the front. 50 In 2006, the last remnants of allowable tobacco industry sponsorship of sporting and cultural events were phased out.

State governments in Australia introduced the first community-wide comprehensive tobacco control programmes, and all states had such programmes by the mid 1990s. 36 73 In 1987, the state of Victoria was the first to use a tobacco tax to fund their tobacco control programme, and this model was subsequently replicated in several other Australian states. Mass media advertising was a key component of tobacco control programmes, and Australia was the first to use emotionally strong health consequences advertising. 74 In addition to mass media, these programmes have had a strong advocacy component and state governments have legislated restrictions on youth access to cigarettes, clean indoor air and restrictions on the promotion of tobacco products including at point-of-sale. Recent progress in the latter area includes state governments banning the display of cigarettes at point-of-sale.

Since the early 1990s, state government schools have had smoke-free buildings, with these restrictions extending to school ground campuses during the 2000s. The last state restricting smoking on school campuses occurred in 2009. Smoking prevention activity has been included in the curriculum of primary and secondary schools across Australia since the early 1990s. 75

Increasing the price of tobacco has also been a focus of Australian tobacco control programmes and advocates. Taxation on tobacco products became the sole remit of the federal government in 1997, and in 1999, the government changed the system of levying excise and customs duty on cigarettes from a per-weight of tobacco basis to a per-stick system. This and other taxation changes in 1999 increased the average price of cigarettes by 30% to 40%. However, there has been little real increase in the price of cigarettes since 2001. 75

The level of funding for tobacco control programmes in Australia has fluctuated substantially over the past 25 years. The period with the lowest funding levels (1990–1996) was the time when adolescent smoking increased, 76 leading Hill et al (1998) to conclude that smoking prevalence may respond directly to tobacco control funding levels. 77 In 1997, Australia introduced a nationally coordinated approach to tobacco control that included an increase in funding for tobacco control activities from AUS$0.63 in 1996 to peak at AUS$1.63 per capita in 2002 (in 2005 AUS$). Smoke-free workplace laws were introduced in Australian states in the mid to late 1990s and quickly disseminated in the 2000s, with estimates suggesting that smoke-free laws influenced 96% of the Australian population by 2008. 58

Past month smoking prevalence among Australian secondary students aged 12 to 17 years decreased from a national average of 26% in 1996 to 13% in 2005 57 and 10% in 2008. 78 The major reductions in smoking prevalence have been associated with higher funding levels to tobacco control programmes, higher cigarette prices and greater restrictions on smoking in public spaces. 57

There is strong evidence from these two case studies that comprehensive tobacco control programmes are able to denormalise cigarette smoking and have a dramatic impact in reducing the proportion of adolescents who start to smoke. Both of these case studies implemented multiple interventions; both had powerful mass media anti-smoking campaigns, increased the price of cigarettes, and had school programmes, SHS policies and restrictions on youth access to cigarettes. In addition, both had significant restrictions on tobacco marketing practices. Australia had much stronger warning labels on cigarette packets than California. The California case study, however, demonstrates that a sharp decline in youth prevalence will not continue if there is a major drop in tobacco control expenditures and a reduction in the relative price of cigarettes.

Recommendations

Nations need to implement the comprehensive tobacco control strategies aimed at smoking initiation that are outlined in the WHO's Framework Convention on Tobacco Control. These include: raising excise taxes in order to deincentivise smoking and raise revenue for tobacco control, implementing policies to protect their populations from SHS, introduce laws and regulations that reduce the capability of the tobacco industry to use mass marketing strategies to promote use of their products, and laws/regulations that require vivid pictorial warnings on cigarette packages. Future research needs to focus on evidence that demonstrates that introduction of harm reduction products does not lead to an increase in smoking initiation rates and on developing the evidence base that removing advertising from cigarette packages leads to declines in initiation rates.

What this paper adds

This paper notes the evidence on the effectiveness of each individual tobacco control intervention.

There are two geographic locations (California and Australia) with major documented declines in smoking initiation in the past 20 years. Each has achieved this effect using comprehensive interventions involving multiple effective interventions.

This evidence provides nations with a strong rationale for implementing all the elements of the Framework Convention on Tobacco Control.

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Funding This study was funded by the University of California Tobacco Related Disease Research Program grants 18CA-0134, 18ST-0202 and 19ST-0181.

Competing interests None.

Provenance and peer review Commissioned; externally peer reviewed.

Linked Articles

Editorial Tobacco control at twenty: reflecting on the past, considering the present and developing the new conversations for the future Ruth E Malone Kenneth E Warner Tobacco Control 2012; 21 74-76 Published Online First: 16 Feb 2012. doi: 10.1136/tobaccocontrol-2012-050447

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Int J Environ Res Public Health

Effects of Tobacco Taxation and Pricing on Smoking Behavior in High Risk Populations: A Knowledge Synthesis

Pearl bader.

1 Consultants in Behavior Change, 250 Heath Street East, Toronto, ON M4T 1T2, Canada

David Boisclair

2 Consultant in Economics and Public Health, 5946 de Bordeaux, Montreal, QC H2G 2R7, Canada; E-Mail: ac.oohay@rialcsiobdivad

Roberta Ferrence

3 Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 33 Russell Street, Toronto, ON M5S 2S1, Canada; E-Mail: ten.hmac@ecnerref_atrebor

Tobacco taxation is an essential component of a comprehensive tobacco control strategy. However, to fully realize the benefits it is vital to understand the impact of increased taxes among high-risk subpopulations. Are they influenced to the same extent as the general population? Do they need additional measures to influence smoking behavior? The objectives of this study were to synthesize the evidence regarding differential effects of taxation and price on smoking in: youth, young adults, persons of low socio-economic status, with dual diagnoses, heavy/long-term smokers, and Aboriginal people. Using a better practices approach, a knowledge synthesis was conducted using a systematic review of the literature and an expert advisory panel. Experts were involved in developing the study plan, discussing findings, developing policy recommendations, and identifying priorities for future research. Most studies found that raising cigarette prices through increased taxes is a highly effective measure for reducing smoking among youth, young adults, and persons of low socioeconomic status. However, there is a striking lack of evidence about the impact of increasing cigarette prices on smoking behavior in heavy/long-term smokers, persons with a dual diagnosis and Aboriginals. Given their high prevalence of smoking, urgent attention is needed to develop effective policies for the six subpopulations reviewed. These findings will be of value to policy-makers and researchers in their efforts to improve the effectiveness of tobacco control measures, especially with subpopulations at most risk. Although specific studies are needed, tobacco taxation is a key policy measure for driving success.

1. Introduction

If it were totally up to me, I would raise the cigarette tax so high the revenues from it would go to zero. – Michael Bloomberg (New York mayor)

Significant gains have been made in reducing the prevalence of smoking for the general population in North America and other high-income countries. However, smoking rates remain high for some subpopulations. Responses to tobacco control interventions and pathways to change in smoking behavior can vary substantially among subgroups of smokers. Even for those who benefit from these measures, they do not gain equally and major disparities exist.

Tobacco taxation, passed on to consumers in the form of higher cigarette prices, has been recognized as one of the most effective population-based strategies for decreasing smoking and its adverse health consequences [ 1 – 4 ]. On average, a price increase of 10% on a pack of cigarettes would reduce demand for cigarettes by about 4% for the general adult population in high income countries [ 4 ]. Tobacco taxes can benefit smokers who quit, reduce the overall consumption of tobacco, and put smoking cessation on the radar of those who continue to smoke. Increased taxes also have a positive impact on non-smokers by reducing their exposure to second-hand smoke. However, much less is known about the impact of taxation on specific subgroups. Are they influenced to the same extent as the general population? Do they need additional measures and initiatives to reduce smoking?

Using a better practices approach to knowledge synthesis, this study illustrates the value of using two complementary approaches (systematic review of literature and expert opinion) in an area of high importance but with varying degrees of empirical studies across subpopulations. The Better Practices Model, developed by the Canadian Tobacco Control Research Initiative [ 5 ], provides a structure for integrating variable, but complementary, sources of information which can lead to enhanced understanding of chronic diseases. Integral to this approach is the belief that “good solutions to complex problems draw upon both science and experience.” Broad sources of information (e.g., peer-reviewed studies, grey literature, expert opinion) are synthesized to increase knowledge of a particular topic.

We systematically reviewed and synthesized evidence regarding the effects of tobacco taxation and pricing (tobacco taxation and pricing hereafter referred to as “price”) on smoking behavior in six high-risk subpopulations. They were selected based on continued high rates of smoking ( Table 1 ) and greater risk for the health consequences of smoking (note: these are not always distinct categories and there may be considerable overlap with some of these subpopulations. For example, heavy and long-term smoking is characteristic of smokers with dual diagnoses; low socioeconomic status is more common among Aboriginals, dual diagnosis individuals, and heavy smokers).

Subpopulation size and smoking prevalence (2006–2008) [ 28 – 32 ].

Subpopulation	% of Total population		Smoking prevalence (%)

	Canada	US	Canada	US
General Population	33,212,696 (total population)	303,824,640 (total population)	19	20.8
Youth	6.8	7.2	15	22
Young Adults	9.2	9.9	25	26
Low SES	11.4	17
Income
Education
Dual Diagnosis	5–10	5–10	38–57	41–62
Heavy and/or Long-term Smokers
Aboriginals	3.8	1.5	60	32

1.1. Youth (<19 years)

Youth (<19 years) are a critical focus for tobacco control policy. Because most adult smokers report smoking onset before the age of 20 years [ 6 – 8 ], if one can reach adulthood without smoking, then the probability of smoking onset is greatly reduced. Although youth continue to smoke, O’Loughlin and colleagues [ 9 ] found that 70% of teens express a desire to quit. However, only 19% making a quit attempt remained smoke-free for 12 months or more by the end of the five-year study. Because cessation strategies have not been very effective for youth populations, the research suggests that more needs to be done in terms of legislation, programming and taxation [ 10 ].

1.2. Young Adults (18–24 years)

Young Adults (18–24 years) continue to smoke at high rates, despite strong public awareness of the health hazards [ 11 ]. This developmental period is a time of risk for both initiation of smoking and progression to higher levels [ 12 ]. Moreover, smoking among young adults is predictive of smoking in later adulthood. While smoking rates have decreased over the past twenty years for both adults and teens, rates for young adults aged 18 to 24 years have not substantially changed in most high-income countries.

1.3. Low Socio-Economic Status (SES)

Smoking is strongly linked to social and economic status and is a significant contributor to inequalities in health. Smoking rates in high income countries are highest among those who have had the least education and are in the lowest socioeconomic groups [ 13 , 14 ].

1.4. Dual Diagnosis

Smokers who are diagnosed with mental health and/or non-nicotine substance abuse disorders are disproportionately affected by tobacco dependence. In North America, five to 10 percent of the population has a diagnosable mental illness [ 15 ]. Yet, they carry almost half the burden of Canadian and US tobacco consumption, smoking approximately 40% of all cigarettes consumed [ 15 – 18 ].

1.5. Heavy and/or Long-Term Smokers

Heavy and/or Long-term smokers are at greater risk for the health consequences of smoking. Both intensity and duration of smoking from onset to cessation have a strong positive association with morbidity and mortality [ 19 ]. There is not a consistent definition of either “heavy smokers” or “long-term smokers” in the literature. Generally, studies describe heavy smokers as those who smoke more than 15 cigarettes per day [ 20 ], although some define “heavy” by 25 cigarettes per day [ 21 , 22 ]. A measure of “long-term” smokers was not found in the literature we reviewed.

1.6. Aboriginal People

Aboriginal people in North America have substantially higher rates of smoking than the general population ( Table 1 ). These rates have changed very little in the past 25 years. Availability of inexpensive cigarettes (in North America, access to inexpensive cigarettes is due to tax-exemption) has been cited as a major contributing factor, exacerbated by relative poor socioeconomic status, lack of access to quality health care, poor physical infrastructure and environmental factors [ 23 – 26 ].

The aim of this study was to determine the differential effects of tobacco taxation and price on six subpopulations compared to the general population, primarily in high income countries.

Main Effects : Do subpopulations respond differently than the general population to changes in tobacco taxation and pricing?
Synergistic Effects : What are the interactive effects between taxation and other tobacco control policies among the subpopulations under review?
Inadvertent Effects : Do subpopulations adopt price minimization strategies (e.g., switching to discount brands, smoking more of a cigarette, contraband) in response to increased cigarette prices?

This article focuses primarily on high-income countries. We present an overview of the main findings and key recommendations. A detailed description of the methods and results is presented in the background report [ 27 ].

2.1. Systematic Review

Search strategy.

An extensive search was conducted to identify relevant studies, both published and unpublished, on the impact of price on smoking behavior of the six subpopulations. We used the following sources published from 1975 to November 2010: electronic bibliographic databases (all EBM Reviews, EconLit, Embase, Medline, OTRULIB, PAIS Intl, PolicyFile, PsychInfo, Scopus, Web of Science), key journals in tobacco control and health economics, reference lists from retrieved articles, electronic mailing lists, and economic working papers and other unpublished works recommended by the authors, expert panel members, and colleagues in the field. Members of the expert panel reviewed the final reference list for completeness.

Study Selection and Inclusion Criteria

Two independent reviewers assessed titles and abstracts for relevance and inclusion. Disagreements were resolved through discussion. Included studies had a primary focus on the impact of price on smoking initiation, cessation, prevalence, or consumption. Some studies were included because they provided pertinent information regarding the impact of price on the general population or contained important background on the subpopulations.

Data Extraction and Quality Assessment

Citations were screened using the above criteria and full texts of all citations considered relevant to the study were obtained. To provide consistent coding of responses, data were extracted using forms adapted from Bader et al . [ 11 ], which included information on: population subgroup, study design/methods, outcome measures, results, conclusions and recommendations. A notes section for a descriptive summary and limitations of the study was also included. A systematic approach to citation management (Excel) was used to manage the review.

Quality Assessment

Each study was rated by one reviewer, and checked by the other, to assess the strength of evidence. Quality was assessed using a checklist adapted from Bader et al . [ 11 ] and the Effective Public Health Practice Project Quality Assessment Tool [ 33 ]. Studies were rated as Strong, Moderate, or Weak by summing across the individual responses coded as Strong (2), Moderate (1) or Weak (0) in the Quality Assessment Form and computing a total score (maximum = 2 times # items). A study was rated Strong if it achieved a score of at least 75% of the maximum score, Moderate with 50–75%, and Weak with 50% or less.

Data Analysis and Synthesis

Results were analyzed focusing on the question: Are “specific subpopulation” more responsive to price of cigarettes than the general population? For Youth and Young Adults, studies were analyzed according to an additional question: Are there differential responses to price of cigarettes according to various dimensions of smoking behavior—that is, by initiation, cessation, participation, consumption, or transitions to different stages of smoking uptake? For Low SES, studies were analyzed according to an additional question, If low socioeconomic populations are more price-responsive, are they sufficiently more price-responsive to counter any adverse effects of increased taxation? (If populations of low socioeconomic status cut their consumption more than the general population in response to higher prices, do they do so enough to offset their price-minimizing behaviors, such as switching to cheaper or contraband cigarettes, or smoking each cigarette more completely).

2.2. Expert Panel

An integral component of this Knowledge Synthesis was a comprehensive evaluation of evidence that included expert knowledge and advice. Experts were identified by a search of the literature for their publications, key note speakers on tobacco taxation at conferences, and recommendations of the authors and other colleagues. The 12 selected experts from Canada, the US, and Australia included: health economists, researchers, epidemiologists, a policy analyst, a psychiatrist and an addiction medicine physician (see Full Report, [ 27 ]). The Expert Panel met twice:

Initial Phase : to obtain feedback on the study plan;
Analysis Phase : to discuss findings, develop policy recommendations, and identify priorities for future research based on gaps in literature.

3.1. Main Effects

The majority of studies (67) focused on the impact of increased price on youth. In comparison, 19 studies were identified for young adults, 25 for persons with low socio-economic status, three for persons with a dual diagnosis, one for heavy and/or long-term smokers and two for Aboriginal people (7 studies examined both youth and young adults, 1 both youth and low SES, for a total of 108 discrete studies).

There was strong evidence that raising cigarette prices through increased taxes is a more effective tobacco control policy measure for reducing smoking behavior among youth, young adults, and persons of low socioeconomic status, compared to the general population. In contrast, there was a lack of evidence about the impact of price on smoking behavior in persons with a dual diagnosis, heavy and/or long-term smokers, and Aboriginal people.

Sixty-seven studies (57 published; 10 unpublished) met our selection criteria. Quality ratings for all studies were strong or moderate. Most studies were conducted in the US, six were Canadian, and eight were international (Australia, France, Ireland, Spain, Sweden, UK). Because youth smoking is mainly a function of initiation and transitions to higher levels of smoking uptake, and to a lesser extent of cessation, it is essential to understand how increased cigarette prices specifically affect youth smoking behavior. Do higher cigarette prices encourage existing youth smokers to quit? Do higher prices deter nonsmokers from starting? A few studies also posed the question, ‘Do higher cigarette prices deter youth smokers from transitioning from lower to higher stages of smoking uptake’? Twenty-one studies examined the impact of increased cigarette prices on initiation [ 34 – 54 ], seven on initiation and cessation [ 42 , 43 , 48 – 52 ], three on cessation alone [ 38 , 55 , 56 ], five on progression to different stages of smoking uptake [ 37 , 55 , 57 – 59 ], and 31 on participation and/or consumption [ 55 , 60 – 89 ]. Table 2 summarizes the results (some studies may appear more than once if they include findings for different dimensions). Studies examining the effects of increased price on youth generally found that they are two to three times more price-responsive than the general population, although price elasticity estimates vary across studies. The consensus is that increased prices decrease both smoking participation and consumption of cigarettes.

Impact of increased taxation and price on youth smoking behavior.

Results	Initiation	Cessation	Stages of smoking uptake	Participation (prevalence)	Consumption (quantity smoked by smokers)
Yes, reduces youth smoking	7	5	3	23	17
No, does not reduce youth smoking	9	3	0	4	2
It depends—reduces smoking in some cases	6	2	2	4	1

However, the impact of increased price on smoking initiation is less clear. Of 22 studies on the role of price in preventing smoking initiation, seven found that increased price prevents smoking onset [ 35 , 43 , 48 , 50 , 52 – 54 ], nine found that it does not [ 38 – 40 , 42 , 43 , 47 , 49 , 51 , 54 ], and six found that price prevents initiation in some cases [ 34 , 36 , 37 , 44 – 46 ].

Many studies recognize that youth are not a homogeneous population. The effects of price on smoking behavior depend on age, gender, income, peer and family influences, school status (high school student vs. dropout), and broader context (e.g., state sentiment). Twelve studies found differential responses to price by age—that is, younger teens (more likely to be experimental smokers) are not price-responsive, while older teens (more regular smokers) are responsive to price [ 44 , 46 , 55 , 57 , 59 , 71 , 73 – 76 , 84 , 90 ]. Explanations include the differing levels of addiction between experimental and regular smoking as well as sources from which youth acquire cigarettes—younger teens at lower levels of smoking intensity “borrowing” versus older teens at higher levels purchasing cigarettes. Eleven studies that observed gender differences had mixed results [ 35 – 37 , 42 , 45 , 48 , 52 , 65 , 71 , 77 , 84 ]. Only six studies included peer and/or family influences in their analysis [ 34 , 43 , 54 , 81 , 86 , 91 ].

Young Adults

Nineteen studies (16 published; three unpublished) focused on the impact of price on young adults. Quality ratings were strong or moderate. Sixteen studies were conducted in the US, one in Canada, and the other a meta-analysis of international studies. Table 3 summarizes the results (some studies may appear more than once if they include findings for different dimensions).

Impact of increased taxation and price on young adult smoking behavior.

Results	Initiation	Cessation	Stages of smoking uptake	Participation (prevalence)	Consumption (quantity smoked by smokers)
Yes, reduces young adult smoking	1	4	1	9	10
No, does not reduce young adult smoking	3	1	0	1	0

Eleven studies estimated elasticities for price-responsiveness for participation and/or consumption [ 7 , 42 , 55 , 60 , 64 , 71 , 92 – 96 ], eight studies attempted to discern whether decreases in smoking prevalence are due to smoking initiation or smoking cessation [ 38 , 42 , 49 , 95 , 97 – 100 ], and one investigated the impact of price on progression to different intensities of smoking behavior [ 98 ]. While most studies found that increased prices result in reductions in smoking behavior, the magnitude of the effect tends to be smaller than for youth. The majority of studies found that price is inversely related to both smoking participation and consumption. Price has an impact on encouraging cessation, but as with youth, the impact of price on smoking initiation is less clear. One study that explored transitions to higher levels of smoking uptake [ 98 ] found that all three transitions (from no daily smoking to 1/2–1+ packs/day) were responsive to price changes.

The majority of studies (rated strong or moderate) reported significant smoking participation and consumption effects for low income, low education populations. Twenty-four studies (22 published; two unpublished) met selection criteria. Nineteen published and two unpublished studies were rated as strong or moderate. Studies were conducted in Canada, the US, the UK, other European countries, New Zealand, China/Russia and Mexico. Twelve studies found that persons of low socioeconomic status are more responsive to price than the general population [ 19 , 52 , 96 , 101 – 109 ]. Five indicated that low SES groups have the same responsiveness to price as the general population, that is, increased price appears to benefit all socioeconomic groups equally in terms of reducing both smoking participation and consumption [ 13 , 110 – 113 ].

A central concern regarding the impact of increased taxes of cigarettes on low socioeconomic status groups is whether or not such a tax is equitable. It has been argued that cigarette taxes are a regressive tax on the poor. A tax is regressive if lower incomes are taxed proportionally more than higher incomes. Therefore, tobacco taxes are regressive in percentage terms, as lower income individuals devote a higher percentage of their income to paying the tobacco tax than do higher income individuals. In addition, because people of lower socioeconomic status (SES) have higher smoking rates, they pay more tobacco tax per capita than those with higher incomes [ 114 ].

However, some argue that increasing cigarette taxes is not regressive if it results in differential smoking behavior change— i.e. , quitting smoking or reducing consumption of cigarettes at higher rates than the general population. Some propose that increasing tobacco taxes is actually progressive at the population level because of the potentially greater accrued health benefits of reduced smoking [ 115 ]. This point of view is still contentious among economists, however, and some estimate that for most intents and purposes, tobacco tax increases are also regressive even at the population level [ 101 ].

While there are numerous studies that support the effectiveness of increasing prices, most declare that equity implications need to be paramount. Even studies that support increased taxes underscore the need to implement policies or measures to assist those who continue to smoke, especially for those smokers who do not quit or reduce smoking in response to increased taxes and who, as a result, may suffer from financial hardship [ 116 , 117 ]. In other words, increased prices need to be accompanied by strategies to mitigate any adverse consequences of such taxes to low SES populations.

Dual Diagnosis

Three studies examined the impact of price on populations with a dual diagnosis. Ong et al . [ 16 ] found that increased price had a significant effect on smoking participation for smokers with drug or mental disorders, but not for those with alcohol dependence. Saffer and Dave [ 17 ] found both smokers with mental disorders and those without were similarly price-responsive. Tekin et al . [ 118 ], who examined adolescents (grades 7–12), found that adolescent smokers with emotional or behavioral problems were at least as responsive to price as those without such problems.

Heavy and/or Long-Term Smokers

Only one study specifically examined the effects of price on the likelihood of quitting smoking for individuals with different smoking intensities, including heavy smokers [ 119 ]. Of three tobacco policies investigated (taxation, clean air restrictions, and media/comprehensive campaigns), higher prices had the greatest association with making a quit attempt in the past year, but price was not related to the likelihood of remaining abstinent for three or more months. This study did not look at the impact of this policy on duration of smoking.

Aboriginal Persons

Only two studies examined the impact of price on smoking behavior. A Canadian study by Wardman and Khan [ 24 ] is a commentary on the high smoking prevalence among Registered Indians, rather than an empirical study. It mentions two reserves that implemented a seven percent tax on tobacco products but found no significant decreases in smoking behavior. Another recent unpublished paper by Matheson [ 26 ] analyzes the effect of price on adult smoking behavior in Canada’s Aboriginal communities, distinguishing between direct (individual response to price increase) and indirect effects (the influence of price on an individual through changes in community smoking behavior). Findings indicate that price alone is not effective in reducing smoking (a 10% price increase decreases overall smoking by 0.73%) in the aboriginal communities examined. However, the indirect effect doubles the price elasticity over the direct effect alone.

3.2. Synergistic Effects

Only one study examined the interactions among tobacco control policies for youth [ 87 ], although 22 (of 67 studies) (Table 7a in [ 27 ]) incorporated one or more other tobacco control policies in their analysis. The two most commonly reviewed policies were: Clean Indoor Air laws (restrictions on smoking in public places, private worksites, and high schools) and Youth Access laws (e.g., limits on availability of tobacco products to youth, warning signs at point of sale, and bans on vending machine sales).

While many studies on Young Adults (10 of 18) examined the impact of various tobacco control policies in addition to price, findings related to synergistic effects among policies were quite general. For example, several studies recommended that price increases should be combined with a comprehensive tobacco control program for maximum effectiveness, but did not provide evidence regarding specific contributions from individual policies or combinations of policies.

Only three studies investigated the synergistic effects of different tobacco control policies on low SES populations [ 13 , 108 , 120 ]. No data were found on the effects of taxation policies and other tobacco control policies on populations with dual diagnosis, heavy and/or long-term smokers, and Aboriginal smokers.

3.3. Inadvertent Effects

Few studies in this review evaluated the potential unintended consequences of increased cigarette taxation, such as compensatory smoking behavior or greater use of contraband cigarettes. Indeed, it is crucial to understand the extent to which compensatory smoking behavior or use of contraband cigarettes may alter the intended impact of public health policies so that interventions can be designed with greater effectiveness.

Inadvertent effects of price increases were discussed in only one of the Youth studies [ 56 ] and not in any Young Adult studies. Two studies found that increased price resulted in greater demand for smuggled cigarettes among low SES smokers [ 107 , 113 ]. Similarly, Taylor et al . [ 121 ] found that heavy smokers are particularly likely to purchase contraband cigarettes. One study found relatively high rates of illicit cigarette consumption in three psychiatric populations in Toronto [ 122 ]. Commonly cited inadvertent effects of tax-free tobacco products in Aboriginal communities included the increase of smuggling activities and “down the road” sales of on-reserve products— i.e. , tobacco products purchased in tax-free communities and sold to residents of communities with taxes [ 23 , 24 ].

4. Discussion

Assessing the Main Effects of population strategies, such as tobacco taxation and pricing, on high-risk subpopulations is important for understanding the reach and effectiveness of such strategies. Increased tobacco taxes, passed on to consumers in the form of higher cigarette prices, provide an economic disincentive to those who smoke or may be contemplating smoking. Indeed, evidence from this knowledge synthesis strongly supports increasing cigarette prices through tobacco taxation as a powerful strategy for achieving major reductions in smoking among some, but not all, high-risk populations. This is a highly effective policy tool for reducing smoking participation and consumption among youth, young adults and persons of low socioeconomic status. In contrast, major gaps exist in our knowledge about the impact of price on persons diagnosed with mental health or non-nicotine substance abuse disorders, heavy and/or long-term smokers, and Aboriginal people.

Raising cigarette prices is an effective tobacco control policy in reducing smoking among youth. While most studies of young adults found that increased prices also result in reductions in smoking behavior, the magnitude tends to be smaller than for youth. Chaloupka and Pacula [ 64 ] argue that because tobacco is an addictive substance, response to increased prices will occur more slowly than for non-addictive goods; therefore long-term gains may be larger than short-term gains. The impact of increased price on smoking initiation among youth and young adults is less clear. Also, differential responses to price by youth and young adults were associated with other determinants, including age (younger vs . older teens), gender, income, school status, and peer and family influences.

The majority of studies found that persons of low socioeconomic status are more responsive to price than the general population. This indicates that increased price has the potential to benefitdisadvantaged groups and thereby contribute to reducing health inequalities. The issue of whether or not cigarette taxes are a regressive tax on the poor remains contentious. However, many studies strongly agree on the importance of addressing poverty and social disparities for those who continue to smoke. In other words, increased price needs to be accompanied by strategies to mitigate adverse consequences of such taxes to low SES populations.

The question remains unanswered about whether smokers with a dual diagnosis, heavy and/or long-term smokers, and Aboriginal smokers respond differently than the general population to changes in price. Since these subpopulations have especially high rates of smoking, there is a pressing need for research on effective policy measures to reduce their smoking.

Although some studies examined the independent effects of tobacco control policies in addition to price, few looked at the synergistic effects or interactions between these policies. It is complicated to separate the effects of policies when several are in place at the same time. However, it is critical to understand their main and interactive effects in order to design interventions that will improve the effectiveness of tobacco control programs. Which specific policy measures work best and in which contexts? Which combinations of policies are most effective in influencing smoking behavior in the six subpopulations examined in this study? The answers to these questions underscore the need for further research.

Few studies evaluated inadvertent effects and potential unintended consequences of increased price, such as compensatory smoking behavior or greater use of contraband cigarettes. Indeed, it is crucial to understand the extent to which compensatory smoking behavior or use of contraband cigarettes may alter the intended impact of public health policies so that interventions can be designed with greater effectiveness.

4.1. Limitations of Study

There are limitations in the evidence base of some of the subpopulations. The lack of data makes it difficult to assess the impact of taxation on certain groups or to evaluate trends across the six subpopulations. The majority of studies on youth smoking rely on data from school-based surveys. These surveys do not capture smoking rates of high school dropouts, street and homeless youth. While prevalence rates in this group are often difficult to ascertain, they are thought to be substantially higher than those of the general youth population.

Most studies reviewed are cross-sectional and do not have the methodological rigor of longitudinal research. Also, studies generally have used large datasets that are not built to address specific questions regarding taxation. Since smoking behavior is determined by a number of factors and their interactions, it is a challenge to elucidate the specific impact of price.

4.2. Recommendations

The following recommendations address policy and research needs for reducing the disproportionate burden of tobacco use among the six subpopulations ( Table 4 gives further details):

Subpopulation recommendations.

Subpopulation	Recommendations
	older)

Increase price of cigarettes through higher cigarette taxes, or by using other similar or complementary means, such as minimum prices.
♦ restricting price-based promotions, and
♦ aggressively curbing sale of contraband cigarettes.
♦ to provide a robust estimate of the magnitude of price-responsiveness, particularly for youth and young adults.
♦ to determine whether large tax increases have greater or lesser effects than smaller tax increases. Generally smaller changes in cigarette tax increases have been studied to date.
♦ to ensure that datasets can be readily accessed to facilitate research on tobacco control policies, including taxation. This would encourage consistent measures of smoking behavior and price measures.
♦ to determine whether there are important synergies between tobacco taxation and other tobacco control policies that may either enhance or moderate effects. Multivariate analyses (e.g., hierarchical linear modeling; path analyses; structural equation modeling) can help elucidate the differential and combined effects of various policies.
♦ to determine whether inadvertent effects such as price minimization strategies diminish the public health value of tax increases.
♦ to determine whether there are gender differences in the effects of increased cigarette prices on smoking behavior. While some studies in this review analyzed results by gender, the majority did not.
♦ more and better data are needed on these subpopulations because of higher smoking rates and limited research.

5. Conclusions

Significant strides have been made in reducing smoking over the past three decades, particularly in high-income countries. Nevertheless, the health toll of smoking remains a compelling global health challenge. Concerted efforts are needed to reach a higher summit in tobacco control, especially with subpopulations at most risk.

The economic literature has made unique and important contributions to our understanding of the effectiveness of tobacco taxation on ameliorating the health consequences of smoking. Increased tobacco taxes, passed on to consumers in the form of higher cigarette prices, provide an economic disincentive to those who smoke or may be contemplating smoking. Indeed, the evidence from this knowledge synthesis strongly supports increasing cigarette prices through tobacco taxation as a powerful strategy for achieving major reductions in smoking behavior among some, but not all, high-risk populations.

For instance, increasing the price of cigarettes is a very effective policy tool for reducing smoking participation and consumption among youth, young adults and persons of low socioeconomic status. In contrast, major gaps exist in our knowledge about the impact of price on persons diagnosed with mental health or non-nicotine substance abuse disorders, heavy and long-term smokers, and Aboriginal people. Given their high prevalence of smoking, urgent attention is needed to develop effective tobacco control policies for these subpopulations. A related issue is whether or not increased prices have an effect on reducing smoking initiation among youth and young adults.

The findings from this study should be of particular value to policy-makers and researchers in their efforts to design and improve the effectiveness of tobacco control measures. Although further work is needed, tobacco taxation is a key policy measure for driving success.

Benjamin Franklin once said, “In this world, nothing can be said to be certain, except death and taxes.” Yet we have a tax that could prevent hundreds of millions of premature deaths. It is time to use it more effectively [ 123 ].

Acknowledgments

We are grateful to the following 12 Expert Panel members, whose expertise contributed greatly to the quality and findings of this study: Chaloupka, F., Collishaw, N., DeCicca, P., Garcia, J., Gnam, W., Hyland, A., Stabile, M., Stephens, T., Tauras, J., Thompson, F., Wakefield, M., Wardman, D. This study was funded by the Canadian Tobacco Control Research Initiative. The funding source had no role in the writing of the paper.

Pearl Bader (Principal Author) took the lead in the study design, implementation, and analysis, and was responsible for writing the manuscript. David Boisclair (Co-Author) helped with the study design, implementation, analysis and edit of the manuscript. Roberta Ferrence (Senior Responsible Author) was responsible for the conception, funding and oversight of the study and contributed to the study design and edit of the manuscript. All authors declare that they have no conflicting interests.

Home — Essay Samples — Nursing & Health — Addictions — Smoking

Essays About Smoking

Smoking essay, types of essay about smoking.

Cause and Effect Essay: This type of essay focuses on the causes and effects of smoking. It discusses why people start smoking and the consequences of smoking on both the smoker and those around them.
Argumentative Essay: This essay type aims to persuade the reader about the negative effects of smoking. It presents an argument and provides supporting evidence to convince the reader that smoking is harmful and should be avoided.
Persuasive Essay: Similar to an argumentative essay, this type of essay aims to persuade the reader to quit smoking. It presents facts, statistics, and other relevant information to convince the reader to stop smoking.

Smoking Essay Example: Cause and Effect

Identify the causes of smoking: Start by examining why people start smoking in the first place. Is it peer pressure, addiction, stress, or curiosity? Understanding the reasons why people smoke is crucial in creating an effective cause and effect essay.
Discuss the effects of smoking: Highlight the impact smoking has on an individual's health and the environment. Discuss the risks associated with smoking, such as lung cancer, heart disease, and respiratory problems, and explain how smoking affects non-smokers through secondhand smoke.
Use reliable sources: To make your essay more convincing, ensure that you use credible sources to back up your claims. Use scientific studies, government reports, and medical journals to support your arguments.
Provide statistical evidence: Incorporate statistical data to make your essay more impactful. Use figures to show the number of people who smoke, the effects of smoking on the environment, and the costs associated with smoking.
Offer solutions: Conclude your essay by suggesting solutions to the problem of smoking. Encourage smokers to quit by outlining the benefits of quitting smoking and offering resources for those who want to quit.

Smoking: Argumentative Essay

Choose a clear position: The writer should choose a side on the issue of smoking, either for or against it, and be clear in presenting their stance.
Gather evidence: Research and collect facts and statistics to support the writer's argument. They can find data from reliable sources like scientific journals, government reports, and reputable news organizations.
Address counterarguments: A good argumentative essay will acknowledge opposing viewpoints and then provide a counterargument to refute them.
Use persuasive language: The writer should use persuasive language to convince the reader of their position. This includes using rhetorical devices, such as ethos, pathos, and logos, to appeal to the reader's emotions and logic.
Provide a clear conclusion: The writer should summarize the key points of their argument and reiterate their stance in the conclusion.

Persuasive Essay on Smoking

Identify your audience and their beliefs about smoking.
Present compelling evidence to support your argument, such as statistics, research studies, and personal anecdotes.
Use emotional appeals, such as stories or images that show the negative impact of smoking.
Address potential counterarguments and refute them effectively.
Use strong and clear language to persuade the reader to take action.
When choosing a topic for a smoking persuasive essay, consider a specific aspect of smoking that you would like to persuade the audience to act upon.

Hook Examples for Smoking Essays

Anecdotal hook.

Imagine a teenager taking their first puff of a cigarette, unaware of the lifelong addiction they're about to face. This scenario illustrates the pervasive issue of smoking among young people.

Question Hook

Is the pleasure derived from smoking worth the serious health risks it poses? Dive into the contentious debate over tobacco use and its consequences.

Quotation Hook

"Smoking is a habit that drains your money and kills you slowly, one puff after another." — Unknown. Explore the financial and health impacts of smoking in today's society.

Statistical or Factual Hook

Did you know that smoking is responsible for nearly 8 million deaths worldwide each year? Examine the alarming statistics and data associated with tobacco-related illnesses.

Definition Hook

What exactly is smoking, and what are the various forms it takes? Delve into the definitions of smoking, including cigarettes, cigars, pipes, and emerging alternatives like e-cigarettes.

Rhetorical Question Hook

Can we truly call ourselves a smoke-free generation when new nicotine delivery devices are enticing young people? Investigate the impact of vaping and e-cigarettes on the youth.

Historical Hook

Trace the history of smoking, from its ancient roots to its prevalence in different cultures and societies. Explore how perceptions of smoking have evolved over time.

Contrast Hook

Contrast the images of the suave, cigarette-smoking characters from classic films with the grim reality of tobacco-related diseases and addiction in the modern world.

Narrative Hook

Walk in the shoes of a lifelong smoker as they recount their journey from that first cigarette to a battle with addiction and the quest to quit. Their story reflects the struggles of many.

Shocking Statement Hook

Prepare to uncover the disturbing truth about smoking—how it not only harms the smoker but also affects non-smokers through secondhand smoke exposure. It's an issue that goes beyond personal choice.

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Task 2 IELTS Sample Essay: Smoking

by faysal ahmad (dhaka bangladesh)

which makes para lashed our body smoke infornt of their family member

smoking is a dangerous bad habit.it contains nicotine.it causes different diseases and damages our brain and lungs.

This is my answer

There is no doubt that tobacco smoking has serious sequlae not for the smoker himself but also for those who are nearby, so it is certainly a harmful habit. Personally, i completely agree with this.

To begin, the most important drawback of smoking is the health related problems it causes. Studies show that it is the cause of lung cancer which is the most common cancer in men. Not only this, it is related to the cancers of other body parts like mouth and throat. In addition to that , many respiratory diseases including respiratory failure are attributed to smoking. Futhermore, its health effects also affects passive smokers that is considerd unfair.

The other two negative effects are economical and social. First of all, smokers spend a large proportion of their income on buying tobacco especially for high quality ones, that is considered as a waste of money. This is particularly true for those with low income, and as result their families will be affected. Regarding social aspect, smokers usually have bad odors and this makes them unacceptable.

In conclusion, I am convinced that smoking is a serious problem and has life threating consequences. I hope that measures should be done to tackle this dangerous habit.

Apr 08, 2016

Nice attempt but you could make it up to 250 to 260 words, which is mandatory in ielts writing

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Donald J. Trump, wearing a blue suit and a red tie, walks down from an airplane with a large American flag painted onto its tail.

Trump and Allies Forge Plans to Increase Presidential Power in 2025

The former president and his backers aim to strengthen the power of the White House and limit the independence of federal agencies.

Donald J. Trump intends to bring independent regulatory agencies under direct presidential control. Credit... Doug Mills/The New York Times

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By Jonathan Swan Charlie Savage and Maggie Haberman

Published July 17, 2023 Updated July 18, 2023

Donald J. Trump and his allies are planning a sweeping expansion of presidential power over the machinery of government if voters return him to the White House in 2025, reshaping the structure of the executive branch to concentrate far greater authority directly in his hands.

Their plans to centralize more power in the Oval Office stretch far beyond the former president’s recent remarks that he would order a criminal investigation into his political rival, President Biden, signaling his intent to end the post-Watergate norm of Justice Department independence from White House political control.

Mr. Trump and his associates have a broader goal: to alter the balance of power by increasing the president’s authority over every part of the federal government that now operates, by either law or tradition, with any measure of independence from political interference by the White House, according to a review of his campaign policy proposals and interviews with people close to him.

Mr. Trump intends to bring independent agencies — like the Federal Communications Commission, which makes and enforces rules for television and internet companies, and the Federal Trade Commission, which enforces various antitrust and other consumer protection rules against businesses — under direct presidential control.

He wants to revive the practice of “impounding” funds, refusing to spend money Congress has appropriated for programs a president doesn’t like — a tactic that lawmakers banned under President Richard Nixon.

He intends to strip employment protections from tens of thousands of career civil servants, making it easier to replace them if they are deemed obstacles to his agenda. And he plans to scour the intelligence agencies, the State Department and the defense bureaucracies to remove officials he has vilified as “the sick political class that hates our country.”

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Essays About Smoking
Smoking Essay Smoking is a widespread habit that involves inhaling smoke from the burning of tobacco. It is a highly addictive habit that has numerous negative effects on the body, including lung cancer, heart disease, and respiratory issues. Writing an essay on smoking can be a challenging task, but it is an important topic to discuss. Types ...
Task 2 IELTS Sample Essay: Smoking
The other two negative effects are economical and social. First of all, smokers spend a large proportion of their income on buying tobacco especially for high quality ones, that is considered as a waste of money. This is particularly true for those with low income, and as result their families will be affected.
Journal of Free Speech Law: "Speech Regulation and Tobacco Harm
Here is the Introduction; the full article is here:. Regulatory constraints on the provision of truthful information to consumers about tobacco products may be having deadly consequences.
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On Thursday, Prime Minister Sir Keir Starmer said the government was looking at tougher outdoor smoking rules to help reduce the number of preventable deaths linked to tobacco use, and the burden ...
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The landlord of a Derby music venue and bar fears government plans to toughen rules on outdoor smoking will "kill pubs". Paul Keenan, who runs the Hairy Dog in the city centre, estimates he will ...
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Essay on Smoking

Ill-Effects of Smoking

How to Quit Smoking?

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

Essay on Teenage Smoking

100 Words Essay on Teenage Smoking

Why Do Teenagers Start Smoking?

Effects of Smoking on Teenagers

Stopping Teenage Smoking

250 Words Essay on Teenage Smoking

500 Words Essay on Teenage Smoking

Health Hazards of Teenage Smoking

Social and Psychological Effects

Preventing Teenage Smoking

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Smoking: Problems and Solutions Report

Introduction

Appointments at Mayo Clinic

Quitting smoking: 10 ways to resist tobacco cravings

1. Try nicotine replacement therapy

2. Avoid triggers

4. Chew on it

5. Don't have 'just one'

6. Get physical

7. Try relaxation techniques

8. Call for reinforcements

9. Go online for support

10. Remind yourself of the benefits

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Craft an Engaging Persuasive Essay About Smoking: Examples & Tips

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How to reduce smoking among teenagers

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Introduction

The process of smoking initiation

The role of the tobacco industry in encouraging initiation

Tobacco industry-sponsored ‘prevention’ efforts

Tobacco control interventions

School interventions

Warning labels and plain packaging

Increasing the price of cigarettes to prevent initiation

Mass media in tobacco control programmes

Smoke-free policies

Restricting access to cigarettes by minors

Case studies