Using communications to promote momentum toward tobacco endgame.

Background and aimsAdolescents represent the next generation and have the greatest amount to gain from the tobacco endgame. They will provide the future momentum to achieve the tobacco endgame, thus...

Tobacco endgame strategies aim to reduce smoking prevalence to minimal levels (<5%) through measures that expand traditional tobacco control approaches. Although some countries have set endgame targets, most still report prevalence rates >15%, and practical guidance on how to assess readiness for endgame implementation remains limited. This study aims to synthetise the key determinants of jurisdictions' readiness for tobacco endgame and proposes a self-assessment tool to evaluate it. A narrative review of peer-reviewed and grey literature published between January 2010 and September 2025 was conducted. Publications were identified through targeted searches of academic databases and relevant organisational websites. A thematic synthesis of evidence on political, social and structural determinants of readiness was undertaken to identify recurring domains, which were later used to inform the development of a self-assessment tool. Nine readiness domains were identified: relatively low smoking prevalence; advanced implementation of WHO Framework Convention on Tobacco Control measures; robust enforcement infrastructure; social denormalisation of smoking; broad public understanding and support for ending tobacco use; a positive political climate and strong political will and leadership; a cohesive tobacco control community and civil society; minimal tobacco industry interference with strong protective mechanisms; and sufficient resources to implement tobacco endgame action plan. These domains guided the development of an evidence-informed self-assessment tool to help jurisdictions evaluate readiness, identify gaps and prioritise strategic actions. The Assessment of Readiness for Tobacco Endgame tool offers an evidence-informed framework to assess tobacco endgame readiness, helping jurisdictions assess capacities, identify gaps and guide strategic decision-making.

We used a simulation model to assess the feasibility of reaching the tobacco endgame target (reducing the smoking prevalence to below 5% by 2050) and explored potential implementation strategies. The impact of strengthened tobacco-control policies on smoking prevalence was analyzed using Korea SimSmoke, a discrete-time Markov process. We considered the effects of various scenarios from 2023 and predictions were conducted until 2050. To confirm the stability of the results, deterministic and probabilistic sensitivity analyses were carried out by increasing and decreasing parameter estimates. The implementation of tobacco-control policies in accordance with the WHO MPOWER (Μonitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco smoking; Warn of the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; Raise taxes on tobacco) measures were insufficient to achieve the tobacco endgame objective of 5% by 2050. The overall predicted smoking prevalence in 2050 is 4.7% if all policies are fully implemented in accordance with the FCTC guidelines together with a complete ban on the sale of cigarettes to people born after 2003 and annual 10% increases in price. Sensitivity analyses using the varying policy effect assumptions demonstrated the robustness of the simulation results. For a substantive reduction in smoking prevalence, it is essential to strongly implement the MPOWER strategy. Beyond this foundational step, the eradication of smoking requires a paradigm shift in the perception of conventional tobacco-control policies, including a tobacco-free generation strategy and radical increases in the price of tobacco products.

BackgroundOne possible supply-side strategy for the tobacco endgame is a government-mandated ‘sinking lid’ on tobacco supply (tradeable but decreasing quotas on sales or imports).MethodsWe considered literature on quota systems and...

BackgroundConventional tobacco control is dominated by demand-reduction measures, whereas commercial tobacco endgame (endgame) policies address the key drivers that maintain the tobacco epidemic, such as Tobacco Industry interference in policymaking,...

What Does the American Heart Association Do (and How Can You Help)?

BackgroundMany countries have started pursuing tobacco ‘endgame’ goals of creating a ‘tobacco-free’ country by a certain date. Researchers have presented models to attain this goal, including shifting the supply of tobacco to a monopoly-oriented endgame model (MOEM), wherein a state-owned entity controls the supply and distribution of tobacco products. Although not designed to end tobacco use, the Regie in Lebanon exhibits some of the key features identified in MOEM and hence can serve as a practical example from which to draw lessons.MethodsWe comprehensively review previous literature exploring tobacco endgame proposals featuring a MOEM. We distil these propositions into core themes shared between them to guide a deductive analysis of the operations and actions of the Regie to investigate how it aligns (or does not) with the features of the MOEM.ResultsAnalysing the endgame proposals featuring MOEM, we generated two main themes: the governance of the organisation; and its operational remit. In line with these themes, the investigation of the Regie led to several reflections on the endgame literature itself, including that it: (i) does not seem to fully appreciate the extent to which the MOEM could end up acting like Transnational Tobacco Companies (TTC); (ii) has only vaguely addressed the implications of political context; and (iii) does not address tobacco growing despite it being an important element of the supply chain.ConclusionThe implementation of tobacco endgame strategies of any type is now closer than ever. Using the Regie as a practical example allows us to effectively revisit both the potential and the pitfalls of endgame strategies aiming to introduce some form of monopoly and requires a focus on: (i) establishing appropriate governance structures for the organisation; and (ii) adjusting the financial incentives to supress any motivation for the organisation to expand its tobacco market.

The tobacco endgame: It's all about behavior

The available literature on tobacco endgames tends to be limited to discussing means, targets and difficulties. This article offers additional ideas on the key elements of endgame strategies and the...

ObjectivesFinland boldly legislated the end of tobacco use in its 2010 Tobacco Act, and subsequently expanded the goal in 2016 to eradicate other nicotine-containing products. This study explored stakeholders’ perceptions...

An increasing number of countries are adopting the tobacco endgame goal. High levels of public support can accelerate momentum towards implementing tobacco endgame policies. We aimed to conduct a systematic review of public support for tobacco endgame policies and to examine the geographical distribution of studies, support among key populations (adolescents and young adults, people who smoke), and the association between survey design and support. We searched Embase, PubMed, Scopus, Web of Science, and Google Scholar for studies published from 2013 onwards. Google was used to search the gray literature. The reference lists of included articles were hand-searched. Studies were included if they reported the proportions of people supporting one or more endgame policies. Risk of bias was assessed using the JBI checklist for prevalence studies. Forty-seven articles were included. Aotearoa/New Zealand and the United States were the countries with the most studies (n = 11, respectively). Three-level meta-analyses showed the highest support for mandating a very low nicotine content in tobacco products (76%, 95% CI: 61% to 87%). Meta-regressions were performed to assess the associations of population subgroup and survey design with support levels. The level of support was lower among people who smoke compared to the general population (β range: -1.59 to -0.51). Support for some policies was lower when neutral or don't know response options were included. Public support for most tobacco endgame policies was high. Assessing public support can assist with progressing tobacco endgame policies. Policies that are widely supported by the public may be more politically feasible to implement. Qualitative studies and trial studies can further inform communication and implementation strategies for tobacco endgame policies.

Tobacco endgame is hotly debated worldwide as one of the effort by the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) towards tobacco-free future. Tobacco epidemic involve dynamic interrelationships between multi-disciplinary elements. Hence, it become increasingly difficult to identify the root of the problem in order to solve the issues. System dynamics (SD) has been recognized with its ability to capture the flow and feedback as well as the dynamic relationships between components in a system under study. The holistic view offered by SD will portray the impact of anti-smoking strategies implementation. In order to identify the driving forces in tobacco epidemic, Enhanced Analytic Hierarchy Process (EAHP) has advantages over normal Analytic Hierarchy Process (AHP) based on its capability to eliminate inconsistency in prioritizing the driving forces in tobacco epidemic which is the initiation factors of smoking. SD and EAHP have different strengths and weaknesses, therefore, integrating both modelling approaches will provide more realistic projections of a tobacco control system. This paper uses SD and EAHP to model the complexity of the problem and to identify the dominant linkages between the initiation factors and anti-smoking strategies in assessing the effectiveness of anti-smoking strategies that have been implemented in Malaysia. We proposed a multi-method modelling framework that served as a basis in understanding the complexity of tobacco epidemic due to the interconnections of multiple elements that may range from qualitative to quantitative aspects. Also, we describe the potential benefits of integrating SD and EAHP in demonstrating the interaction between the smoking causes (initiation factors) and its corrector (anti-smoking strategies).

ObjectivesTo examine the associations between tobacco industry denormalisation (TID) beliefs and support for tobacco endgame policies.MethodsA total of 2810 randomly selected adult respondents of population-based tobacco policy-related surveys (2018–2019) were...

IntroductionVape use is increasing, particularly among young people who have never been cigarette smokers. Stealth vaping, that is, discrete use in places where it is prohibited, is also reported to be increasing. Regular vape use is high among those who identify as Māori, with the Tobacco Industry reported to be targeting Indigenous communities, thus continuing long-running harmful, colonial practices.Aims and MethodsThis qualitative study, using group interviews within a kaupapa Māori framework, explored stealth vaping with 19 young adults, of whom 18 identified as Māori in the Indigenous context in New Zealand.ResultsThe results showed that hiding vape use is enhanced by the features of devices, while the nicotine content drives the need to vape nearly anywhere.ConclusionsThe tobacco and nicotine endgame approach is favored by Māori leaders, meaning stricter regulation on vaping devices alone does not adequately protect young people. Instead, stronger measures must be implemented to reduce the appeal of vaping. Vaping does not align with Māori worldviews. Addiction and their easy concealment sustain their use, highlighting the tension between alternative nicotine products that benefit the Tobacco Industry, with the goals of Māori and other Indigenous peoples to eradicate nicotine entirely.ImplicationsThe study results reinforce that priority must be given to culturally led and culturally safe regulatory and policy changes and advocacy for both smoke- and vape-free environments. Regulating the features of devices to negate their stealth use, as their invisibility was facilitated by their manipulability, should enable the existing smoke-free environment spaces to again deter vape use. Advocates must understand Māori history and context to extend the spaces where the strength that comes from being Māori will overcome the need to vape.

Smoking is a public health problem worldwide and in Malaysia. According to serial Malaysian data, the age of initiation of smoking are at a younger age and the prevalence of smoking in Malaysia among adults and adolescents have not reduced much over the years. Smoking has a detrimental heath effect to smokers as well as those passively smoking. Younger age of smoking is linked to increased dependence of nicotine and many other high-risk behaviours. The two main issues which is addressed here is younger age of initiation of smoking and smoking bans in Malaysia. The factors which contribute to younger age of smoking initiation is tobacco factors, school factors, family factors and social factors. Challenges to smoking bans in Malaysia includes poor enforcement and innovation of tobacco products in Malaysia. A comprehensive approach including the mPOWER strategy should be carried out to address this problem towards achieving Tobacco Endgame.