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What public health strategies are needed to reduce smoking initiation?
  1. John P Pierce1,
  2. Victoria M White2,
  3. Sherry L Emery3
  1. 1Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California, USA
  2. 2Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Victoria, Australia
  3. 3Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
  1. 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}


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
  • prevalence
  • taxation and price
  • cessation
  • advertising and promotion
  • uptake risk factors
  • genetics
  • adolescents
  • economics

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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.

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