Building a Tobacco-free Tomorrow: Policies and Strategies

Multifaceted approaches, such as youth prevention, cessation support, and radical policies like Tobacco-Free Generation laws, are necessary for a tobacco-free future (WHO, 2021). Between 2010 and 2017, adult tobacco use in India decreased from 34% to 28%, indicating successful control measures (MoHFW, 2017). However, further research is still required to evaluate the long term impact of emerging tobacco control policies and adapt strategies for diverse populations in the society.  Some good literature in the domain are listed below: 

1. Ministry of Health and Family Welfare (MoHFW). (2017). Global Adult Tobacco Survey (GATS) 2: India 2016–17. Government of India.

2. Thomson, G., Wilson, N., Edwards, R., & Blakely, T. (2018). Tobacco-free generation policy: Next steps for tobacco control. Public Health, 154, 98–101.

3. World Health Organization (WHO). (2021). WHO report on the global tobacco epidemic 2021: Addressing new and emerging products. World Health Organization.

There were more than one billion smokers globally in the year 2019 consuming 7.4 trillion cigarettes. About 7.7 million deaths and 200 million disability adjusted life years (DALYs) were attributed to smoking and was the leading risk factor for death among males in that year . According to the Global Adult Tobacco Survey (2018), smoking prevalence in India has decreased from 13.9% to 10.7% (males 24.3% to 19.0%, females 2.9% to 1.9%) during the period 2010 to 2017. Despite this decrease, there were 130.9 million smokers (116 million males and 14.9 million females) in India in 2019 (1-3).

The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is the first international public health treaty developed under the auspices of the World Health Organization which aims to reduce tobacco consumption and exposure to tobacco smoke through evidence-based measures, including restrictions on advertising, promotion, and sponsorship, as well as initiatives to curb illicit trade and promote cessation programs. The government of India ratified the WHO FCTC in 2004, the first ever international public health treaty focusing on the global public health issue of tobacco control. 

The WHO in 2008 introduced MPOWER that comprised six high impact but cost effective measures to combat use of tobacco.

M – monitoring use of tobacco

Data are required to evaluate and implement successful anti-tobacco policies. Hence, countries who are party to Framework-Convection on Tobacco Control (FCTC) are required to continually monitor patterns, determinants, magnitude, and consequences of using tobacco. Monitoring and collection of data should be done using scientific standard and evidence-based methods. The Global Adult Tobacco Survey (GATS) was undertaken in India for the 1^st time in 2009–2010 and then again in 2016–2017. It used a multistage sampling technique to include those aged 15 years and over through household survey

P – protection of people from tobacco smoke

Exposure to tobacco smoke is known to cause various diseases such as cancer, heart diseases, and even death in non-smokers. Passive smoking is known to kill more than 1 million people worldwide every year and especially poses a higher risk to children and newborns. FCTC advocates creation of smoke free zones in workplaces and public places. Completely banning smoking indoors have been proven to protect from the harms of passive smoking and also considerably reduce smoking among adolescents.

O – offer aid to quit use of tobacco

Most tobacco users are unaware of its harmful effects and health risks. Advise and counseling from health professionals can aid in quitting tobacco habit. Use of medication along with counseling is known to increase the chance of quitting by double. FCTC mandates establishment of tobacco cessation systems by all governments. Training packages and capacity building material are provided by the WHO.

W – warning regarding the dangers of tobacco

Smoking and chewing of tobacco causes extensive damage to the body but most tobacco users underestimate these harms. In addition, attractive packaging and advertising of tobacco products distracts its users from the real harm caused by them. Article 11 of FCTC provides guidelines on including health warning on tobacco products to discourage its use. This along with anti-tobacco drives and awareness campaigns are found to reduce tobacco use.

E – enforcing bans on advertising, sponsorship, and promotion of tobacco products

In general, use of tobacco is associated with glamour, success, and being trendy. This is the result of competent and successful advertising of tobacco products. Article 13 of FCTC proposes complete ban on advertising and sponsorship associated with tobacco. The WHO strongly pushes for a complete ban as otherwise it could lead to mushrooming of other small local tobacco products.

R – raise taxes on tobacco products

Article 6 of FCTC calls for increasing excise taxes on tobacco products. Raising costs of tobacco products will discourage its use, especially by adolescents and those from lower income groups, in whom actually the use of tobacco is high. The WHO proposes this measure as one of the most cost-effective method of cutting tobacco use. An increase in taxes saves the health-care sector millions of dollars that would otherwise be spent on providing long-term health care to tobacco users.

References

• GBD 2019 Tobacco Collaborators: Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. 2021;397(10292):2337–2360. 10.1016/S0140-6736(21)01169.
• Sreeramareddy CT, Aye SN: Changes in adult smoking behaviours in ten global adult tobacco survey (GATS) countries during 2008-2018 - a test of 'hardening' hypothesis'. BMC Public Health.2021;21(1):1209. 10.1186/s12889-021-112.
• Edwards R: Hardening is dead, long live softening; time to focus on reducing disparities in smoking. Tob Control. 2019;tobaccocontrol-2019-054937. 10.1136/tobaccocontrol-2019-055067 
• //fctc.who.int/ (Accessed on 27 May 2025)
• //nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1052&lid=607 (Accessed on 27 may 2025)

The global tobacco epidemic remains one of the leading causes of preventable death, necessitating comprehensive policies and strategies to curb its use and protect public health. Building a tobacco-free tomorrow requires a multi-pronged approach that combines policy enforcement, public education, cessation support, and community engagement. A cornerstone of global tobacco control is the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC), which outlines evidence-based strategies such as raising tobacco taxes, enforcing smoke-free laws, and regulating tobacco advertising, promotion, and sponsorship (WHO, 2021).

Governments have a critical role in implementing these measures at the national and local levels. For example, increasing taxes on tobacco products not only reduces consumption, especially among youth, but also generates revenue for health promotion programs (Chaloupka et al., 2012). Smoke-free policies in public places protect non-smokers from secondhand smoke and help de-normalize tobacco use. Moreover, plain packaging and graphic health warnings have proven effective in reducing the appeal of tobacco products and informing users of health risks (Australian Department of Health, 2016).

In addition to policy, supporting individuals through cessation services is crucial. Access to quitlines, counseling, and pharmacological aids significantly increases the likelihood of quitting successfully (Fiore et al., 2008). Furthermore, engaging communities through school programs, media campaigns, and youth advocacy initiatives helps foster a culture of prevention and empowers the next generation to stay tobacco-free.

In conclusion, eliminating tobacco use requires sustained political will, collaboration across sectors, and ongoing innovation in public health strategies. By reinforcing and scaling proven interventions, countries can move closer to a tobacco-free future and significantly reduce the burden of tobacco-related disease and death.

References

• World Health Organization. (2021). WHO report on the global tobacco epidemic 2021: Addressing new and emerging products. Geneva: WHO.

• Chaloupka, F. J., Yurekli, A., & Fong, G. T. (2012). Tobacco taxes as a tobacco control strategy. Tobacco Control, 21(2), 172–180.

• Australian Department of Health. (2016). Post-Implementation Review: Tobacco Plain Packaging 2016.

• Fiore, M. C., Jaén, C. R., Baker, T. B., et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. U.S. Department of Health and Human Services.

Tobacco use is a leading risk factor associated with several diseases, premature death and disability. It is a major threat to developing and low income/middle-income countries such as India, where tobacco use results in 1.35 million deaths, annually. Furthermore, of all deaths related to non-communicable diseases in India, in 2019, approximately 1.08 million deaths (17.7%) were due to tobacco use. The Government of India (GoI) has implemented various policies and programmes to prevent tobacco uptake among children and adolescents. Section 6a of the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA) 2003,11 stipulates the prohibition of the sale of tobacco products to and by minors; and Section 6b, prohibits the sale of tobacco products within the surrounding 100 yards of educational institutions.11 As part of the ‘National Tobacco Control Programme’ (NTCP), India also launched the School Programme across public and private schools, to equip young people with the knowledge and appropriate skills to make informed decisions related to tobacco consumption and build understanding on the consequences of tobacco use.12 To reinforce such efforts, the Ministry of Health and Family Welfare (MoHFW)-GoI also introduced ‘Tobacco-Free Educational Institution’ (ToFEI) guidelines,13 for all education establishments, across India, to generate awareness about the harmful and long-term effects of tobacco use and to create healthy tobacco-free educational institutes. 

References

1. WHO. India loses 1% of its GDP to diseases and early deaths from tobacco use, finds WHO study. n.d. Available: //www.who.int/ india/news/detail/09-02-2021-india-loses-1-of-its-gdp-to-diseasesand-early-deaths-from-tobacco-use-finds-who-study
2 Tobacco in India. n.d. Available: //www.who.int/india/healthtopics/tobacco
3 GBD results tool | Ghdx. n.d. Available: //ghdx.healthdata.org/gbd-results-tool

4. COTPA. Government of India. 2003. Available: //legislative.gov. in/sites/default/files/A2003-34.pdf

Effective health communication strategies play an integral role in curbing the increasing use of tobacco products among the population. The underlying gap between existing cessation tools and public awareness and perception highlights the need for informed and targeted communications. Health communication is a cost-effective intervention that, if used strategically, can involve all key demographics, particularly young people, through ATL and BTL communications channels. Targeted communications can highlight various tobacco harm reduction (THR) methods (example: nicotine replacement therapy, group counseling) that can help tobacco users overcome misinformation, cultural barriers, and poor outreach.

Effective tobacco control for a tobacco-free tomorrow not only requires credible and consistent messaging but also active involvement of the community, youth, advocates, and policymakers to ensure culturally relevant, accessible, and persuasive communication.

References:

1. Oke, G.I., Ademola, P.S., Utaka, E.N. et al. Knowledge, perception, and willingness of emerging Public Health Advocates to effectively communicate about smoking cessation and Tobacco Harm Reduction in Africa. Discov Psychol 4, 6 (2024). //doi.org/10.1007/s44202-023-00102-5

2. Aienobe-Asekharen, C., Norris, E., & Martin, W. (2024). A Scoping Review of Tobacco Control Health Communication in Africa: Moving towards Involving Young People. International Journal of Environmental Research and Public Health, 21(3), 259. //doi.org/10.3390/ijerph21030259

The world needs to take strong action against the harm caused by the tobacco industry and aim to end the sale of tobacco products by 2040. The goal is to have less than 5% of adults using tobacco by then. There are three possible paths: continuing current efforts, speeding up existing tobacco control policies, or taking a much stronger "turbo-charged" approach. Only the turbo-charged option—using full global cooperation, stronger leadership, and more investment—can make this goal possible.

To succeed, four big steps are needed:

Set a bold global tobacco target in future health goals.

Make all countries fully carry out tobacco control policies.

Update global rules to include a clear goal to cut tobacco use.

Hold a major UN meeting to boost global efforts and support.

If these actions are taken now, millions of lives can be saved, and future generations can grow up free from tobacco addiction.

References : Beaglehole, R., Bonita, R., Yach, D., Mackay, J., & Reddy, K. S. (2015). A tobacco-free world: A call to action to phase out the sale of tobacco products by 2040. The Lancet, 385(9972), 1011–1018. //doi.org/10.1016/S0140-6736(15)60133-7

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Every year, the tobacco pandemic kills more than 8 million people worldwide, making it one of the biggest public health issues. More than 7 million of these deaths are directly related to tobacco use, while another 1.3 million are caused by secondhand smoke exposure for nonsmokers [1]. Despite a plethora of national and international control measures throughout the years, tobacco smoking remains a leading cause of early mortality.  Being exposed to tobacco through active or passive smoking poses significant risks for non-communicable illnesses, especially diabetes, cancer, cardiovascular disease, and chronic respiratory conditions, which together cause over three-quarters of all deaths worldwide each year.  Numerous control strategies, like as taxes, mass media campaigns, health warnings on packaging, marketing limitations, and smoke-free legislation, have been put forth and put into practice to reduce the demand for smoking and enhance public health [2]. Setting population-based tobacco cessation programs as a top priority is essential for optimizing health outcomes while lowering expenses. These methods may effectively reach the greatest number of tobacco users, which will greatly lower the prevalence of tobacco use in the general population. The World Health Organization's (WHO) Global NCD Action Plan 2023–2030 recommends that governments implement the three "best-buy" interventions: offering national toll-free quit line services, integrating brief cessation advice into primary healthcare, and providing cessation support via mobile text messaging platforms (mCessation) (WHO, 2023). Implementing these therapies within a dynamic, integrated cessation environment that supports users across many healthcare system touchpoints maximizes their impact [3,4]. The most successful tobacco quitting assistance is paired with more comprehensive demand-reduction measures, such as increased tobacco costs, smoke-free legislation, advertising prohibitions, visual health warnings, and public awareness campaigns. These actions not only promote cessation but also cultivate a supportive atmosphere. The application of tailored tactics, evidence-based treatments, and contemporary technology has the potential to lower tobacco rates even further, support quitting initiatives, and eventually lessen the burden of tobacco-related illnesses worldwide.

References:

1. Onwuzo CN, Olukorode J, Sange W, Orimoloye DA, Udojike C, Omoragbon L, et al. A Review of Smoking Cessation Interventions: Efficacy, Strategies for Implementation, and Future Directions. Cureus. 2024;16(1):e52102.
2. Akter S, Rahman MM, Rouyard T, Aktar S, Nsashiyi RS, Nakamura R. A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour. Nature Human Behaviour. 2024;8(12):2367-91.
3. Fu D, Xiao L. The Progress of the Global Tobacco Cessation Strategies. China CDC weekly. 2023;5(21):475-8.
4. Pagano, A., McCuistian, C., Fokuo, J. K., Le, J., & Guydish, J. Evaluating a Tobacco-free Policy Intervention in Residential Substance Use Disorder Programs. Journal of Drug Issues, (2025): 0(0).

The adoption of comprehensive, evidence-based policies that reduce the allure and accessibility of tobacco products is essential for achieving a tobacco-free future. According to a recent pooled analysis of international studies published in Tobacco Control (2024), the implementation of a complete ban on tobacco advertising, promotion, and sponsorship (TAPS) is one of the most effective interventions. Such bans are linked to a 20% decrease in smoking prevalence and a 37% decrease in smoking initiation, particularly among youth and young adults who are especially susceptible to marketing influences. In India, Cigarettes and Other Tobacco Products Act (COTPA, 2003) and National Tobacco Control Programme (NTCP, 2007- 08) introduced strategies such as prohibition of advertising (both direct and indirect) and pictorial health warnings on 85% of the package for decreasing tobacco use. Initiatives like mCessation, Tobacco Free Campaign and National Tobacco Quitline have been helpful in increasing awareness at grassroots level. Under the Crop Diversification Programme (CDP), the farmers in tobacco growing states of India, are supported to switch to alternate crops/cropping systems. Similarly, skill development programs have been initiated for bidi rollers, to encourage tobacco workers to shift to other occupations. Framework Convention on Tobacco Control (FCTC) by World Health Organization (WHO) has recommended strategies such as high excise taxation, the establishment of smoke-free public spaces, and the provision of easily accessible cessation services. Use of plain packaging on tobacco products and stricter laws governing digital media marketing have also shown promising results in limiting tobacco use. These multipronged strategies can prove to be effective in curbing the menace of tobacco use, and in preventing related morbidity and mortality.

References

BMJ Group. (2025, January 14). Tobacco advertising + sponsorship bans linked to 20% lower odds of smoking. BMJ Group. //bmjgroup.com/tobacco-advertising-sponsorship-bans-linked-to-20-lower-odds-of-smoking/

Press Information Bureau. (2025, February 11). Steps taken by the Government to restrict marketing and sale of alcohol and tobacco products near educational institutions. Ministry of Health and Family Welfare. //www.pib.gov.in/PressReleasePage.aspx?PRID=2101735

Press Information Bureau. (2020, September 23). Reduction in tobacco usage. Ministry of Health and Family Welfare. //www.pib.gov.in/PressReleseDetailm.aspx?PRID=1658278

Building a tobacco-free tomorrow requires strong policies backed by solid research. As highlighted by Warner and Tam (2012), tobacco control research has significantly influenced key policies like smoke-free laws, higher tobacco taxes, and support for quitting. These evidence-based strategies have led to real progress, especially in high-income countries. To sustain momentum, it's vital to invest in research, implement proven measures, and ensure that policies are continuously monitored and adapted to changing needs, especially in low and middle-income regions. Research and policy must work in tandem to protect future generations from the harm caused by tobacco.

Reference:

Leading health organizations recommend a mix of proven policies to reduce smoking. These include significantly raising tobacco taxes, enforcing 100% smoke-free indoor air laws to protect people from deadly secondhand smoke, and running hard-hitting education campaigns to warn the public about smoking’s dangers. Officials also endorse plain (standardized) packaging on all tobacco products, stripping away colors and logos to make them less attractive, and comprehensive bans on tobacco advertising and promotion. When combined, these strategies have been shown worldwide to sharply lower tobacco use and save lives.

References: 

Centers for Disease Control and Prevention. (n.d.). Guidelines and resources for tobacco control programs. U.S. Department of Health and Human Services. //www.cdc.gov/tobacco/php/tobacco-control-programs/guidelines-and-resources.html

World Health Organization. (2003). WHO framework convention on tobacco control. //fctc.who.int/publications/i/item/9241591013