By Bunmi Yekini
As the tobacco landscape continues to evolve, public health experts are sounding the alarm on new threats and celebrating hard-fought victories. From declining cigarette use among U.S. youths to the rise of nicotine pouches and flavoured e-cigarettes, the fight against nicotine addiction is entering uncharted territory. At a recent media briefing hosted by the Johns Hopkins Bloomberg School of Public Health, leading researchers Joanna Cohen and Johannes Thrul shed light on these shifting trends, the power of graphic warning labels, and the relentless tactics of the tobacco industry.
Here’s a closer look at the state of tobacco control and what it means for the future of public health.
Signs of Progress in the U.S.
Professor Joanna Cohen, a leading authority on global tobacco control, highlighted notable advancements in the U.S.
“We’ve seen significant strides, such as the adoption of 100 per cent smoke-free policies in public spaces like Baltimore City stadiums and innovative measures like Massachusetts’ proposed ‘nicotine-free generation’ bill,” Cohen shared.
She celebrated the dramatic reduction in youth cigarette use, from 37 per cent of 12th graders in 1997 to just 1.9 per cent of high schoolers in 2023.
However, Cohen warned against complacency, emphasizing that tobacco companies continue to exploit marketing loopholes.
“Despite the Family Smoking Prevention and Tobacco Control Act mandating graphic warnings on cigarette packs, industry-driven delays mean the U.S. is still waiting, 15 years later, to implement this critical policy,” she explained.
With the Supreme Court recently declining to hear the latest challenge, Cohen is optimistic that these warnings, already required in 138 countries, will finally make their U.S. debut by the end of 2024.
New Products, Old Problems
While cigarette use declines, newer products like e-cigarettes and nicotine pouches are on the rise. Professor Johannes Thrul underscored the growing popularity of nicotine pouches, flavoured, tobacco-free products marketed as a “safer” alternative. “These pouches are particularly appealing to young people,” Thrul noted, citing their discreet design and attractive flavours. However, he stressed that their rapid nicotine delivery raises serious concerns about addiction and long-term health risks.
E-cigarettes, while touted as harm reduction tools, pose their own set of challenges. “The industry markets these products as safe, but e-cigarette aerosol contains harmful substances, including heavy metals and cancer-causing chemicals,” Cohen explained. Both experts emphasized the dangers of dual-use, combining e-cigarettes with traditional cigarettes, a behavior that undermines harm reduction goals.
The Global Impact of Graphic Warnings
Graphic warning labels have proven effective worldwide in reducing tobacco use, particularly among youths. Cohen displayed examples from countries like Australia and Pakistan, illustrating how vivid images and blunt messaging can discourage smoking initiation.
“These warnings transform cigarette packs from marketing tools into truthful representations of the product’s deadly consequences,” she said.
Cohen acknowledged the tobacco industry’s relentless efforts to delay these measures in the U.S. but remains hopeful. “Once implemented, these warnings will not only educate but also shift perceptions, especially among younger generations, deterring future smokers,” she added.
Flavored Product Bans and Regulatory Gaps
Flavored tobacco and nicotine products remain a flashpoint in the tobacco control debate. Thrul referenced Massachusetts’ statewide ban on flavored products as a model of success, noting significant reductions in sales. However, he noted that partial bans often lead to loopholes and shifts to alternative flavored products. “Comprehensive policies, coupled with robust enforcement, are essential to curbing the appeal of these products,” he emphasized.
The Role of Healthcare Providers
Both experts stressed the importance of primary care physicians in tobacco cessation efforts. “Even brief advice from a physician can make a significant impact,” Cohen noted. Thrul echoed the same sentiment, advocating for the “five As” approach: ask, advise, assess, assist, and arrange follow-up. Combined with behavioral counseling and FDA-approved nicotine replacement therapies, this strategy offers the best chance for success.
Looking Ahead
The tobacco epidemic is far from over, but the tools to combat it are evolving. From graphic warnings to tighter regulations on emerging products, the fight requires vigilance and a commitment to evidence-based policies. As Cohen aptly concluded, “Every step we take brings us closer to protecting future generations from the deadly grip of tobacco and nicotine addiction.”