Tax, smoke-free legislation, and anti-smoking campaigns linked to smoking reduction

Tobacco use remains a significant global health challenge, despite extensive control measures at both national and international levels. Smoking continues to be a leading cause of premature death, with exposure to tobacco—whether through active smoking or secondhand smoke—significantly increasing the risk of non-communicable diseases (NCDs) such as cardiovascular disease, cancer, chronic respiratory conditions, and diabetes. These NCDs account for nearly 75% of annual global deaths.

A wide range of strategies has been developed to combat smoking and promote public health, including taxation, mass media campaigns, health warnings on packaging, marketing restrictions, smoke-free legislation, youth access policies, flavor bans, and free or discounted nicotine replacement therapies (NRT). The research team conducted a comprehensive review of real-world, population-level tobacco control strategies to assess their effects on smoking behavior.

Through a systematic review and meta-analysis of 476 studies, the team led by Hitotsubashi University found that tax increases, smoke-free legislation, and anti-smoking campaigns were particularly effective in reducing smoking prevalence and cigarette consumption, as well as increasing quit rates, quit attempts, and quit intentions. Health warnings on cigarette packaging, free or discounted NRT, and flavor bans were also linked to higher smoking cessation rates. Additionally, flavor bans were shown to reduce e-cigarette use.

“Our study provides a detailed overview of the impact of various population-level interventions to curb smoking. Based on the available evidence, anti-tobacco campaigns, smoke-free legislation, health warnings, and tax increases are the most effective strategies for reducing smoking,” said Dr. Shamima Akter, lead author from Hitotsubashi University.

“The findings offer policymakers a foundation for designing and prioritizing tobacco control measures at the population level,” added Professor Ryota Nakamura from Hitotsubashi University.

The study was published today in Nature Human Behaviour and is available via open access.