Lifestyle
Tobacco is still one of the world’s top killers – here are the key obstacles to enacting generational smoking bans
Marie Helweg-Larsen, Dickinson College
Smoking is really bad for you. Most people know that. Even smokers think smoking is bad for one’s health. But most people don’t know just how bad it is.
More people in the United States die every year from smoking than from alcohol, illegal drug use, car accidents, suicides and murders combined. Cigarette smoking costs an estimated US$240 billion annually in health care costs, which harm not only smokers but also nonsmokers, communities and the economy. Smoking is the top preventable cause of death and disease in the U.S. and worldwide.
The number of smokers in the U.S. has declined from 41% in 1944 to 11% in 2024. However, over 25 million Americans still smoke.
This drop is partly the result of many smoking laws enacted in the past 50 years. They include national bans on cigarette advertising on television and radio (1971), smoking on commercial flights (2000), sale of fruit- or candy-flavored cigarettes (2009), and sale of cigarettes to people ages 18 to 20 (2019). New policies might seem as strange or unfamiliar as these measures did at the time.
One potentially transformative idea – creating a tobacco-free generation – would build on these past laws. It would phase out smoking by banning it permanently for anyone born after a specific date. For example, a law could make it illegal for anyone under 21 to ever buy cigarettes, whereas people age 21 or older at the time would not be affected. The focus would be on tobacco sales, which already require age verification in the U.S., not on criminalizing tobacco use.
As a psychological scientist, I have studied for decades how people think about smoking. In my view, the key obstacle to creating future generations of nonsmokers is that people do not fully understand how dangerous smoking is and do not realize the formidable influence of the tobacco industry.
Creating a tobacco-free generation
The idea of creating a tobacco-free generation was first proposed by health researchers in 2010. In 2021 the town of Brookline, Massachusetts, became the first U.S. community to adopt it. Brookline’s ordinance prohibits tobacco and vape sales to anyone born on or after Jan. 1, 2000. It has survived a legal challenge and has been emulated in 22 more Massachusetts towns.
As of early 2026, Hawaii and Massachusetts are considering statewide tobacco-free generation bills. Abroad, the Maldives enacted the first countrywide ban in 2025.
Similar proposals have faced pushback elsewhere. In New Zealand, a ban was adopted in 2022 but repealed in 2024. The United Kingdom is considering a similar bill after an earlier version was scrapped due to a snap election.
Why people underestimate harm from cigarettes
It is hard to visualize what exactly it means that 480,000 people in the U.S. die from smoking every year or that each cigarette that you smoke shortens your life by 20 minutes. It is also easy to feel optimistically biased about one’s personal risk as a smoker and believe that others are more likely to become addicted or die prematurely.
Studies show that nonsmokers, former smokers and current smokers underestimate smoking risks. One likely reason is messaging by the tobacco industry, which claimed for decades that cigarettes were safe, even though tobacco industry scientists knew as early as 1953 that smoking caused lung cancer.
Another factor is glamorization of cigarettes in movies. Fully half of the top films released in 2024 showed tobacco imagery, typically of cigarettes. Research shows that adolescents and young adults who watch smoking in movies are more interested in taking up smoking.
Finally, smoking deaths may seem to be unremarkable because some of the illnesses that cigarette smoking causes, such as heart disease or cancer, are commonplace. And unlike deaths from drug overdoses, we do not always see the consequences of a lifetime of smoking. https://www.youtube.com/embed/2mKyosQbFNY?wmode=transparent&start=0 Smoking imagery is widespread in popular culture and may be one driver of tobacco use, especially among young Americans.
What about freedom of choice?
A common argument against laws that regulate personal choices, such as whether to smoke or wear seat belts, is that people prize their autonomy and don’t like governments telling them how to live. This isn’t a new challenge for public health policies, which often restrict private citizens’ freedom to do as they wish.
People can be persuaded that community action should trump individual choice if a behavior, such as smoking cigarettes or driving while drunk, harms others who don’t engage in it. Many public health laws are designed to protect people who are innocent or vulnerable. For example, current smoking laws have been enacted in part to protect nonsmokers who are exposed to secondhand smoke, especially children. And smoking increases health care costs for everyone, not just smokers.
By preventing people in the U.S. who cannot legally buy cigarettes now from ever doing so, generational smoking bans balance the rights of current adult smokers against the major public health benefits of a phased smoking ban that will eventually end the smoking epidemic.
Arguments against generational smoking laws
The tobacco industry’s attempts to undermine tobacco health policies are well documented and follow a predictable pattern. For example, when the U.K. government considered a generational smoking policy in 2023, tobacco companies and their supporters argued that smoking was a minor problem, that individuals should be responsible for their own choices, and that a nationwide ban would lead to illegal behavior or hurt business profits.
In a 2025 study assessing how Belgian politicians viewed generational smoking bans, researchers heard similar arguments. Respondents across the political spectrum valued personal freedom and informed individual choice more highly than protecting children. The politicians also believed that young people could understand how smoking affected their health, and that raising awareness was more important than bans. These arguments aligned with tobacco industry positions.
However, research shows that young people hold many optimistic beliefs about smoking, especially with respect to the addictiveness of nicotine and the likelihood that they will avoid becoming lifelong smokers. Studies have also found that adolescents don’t know enough to make an informed choice to smoke. These findings matter because the tobacco industry routinely targets young people in an effort to create lifelong smokers.
The tobacco industry’s harm reduction approach frames e-cigarettes, also known as vapes, as a way to create a smoke-free future by transitioning smokers to other nicotine products. But research shows that the tobacco industry actively markets nicotine products such as vapes to young people to create a new generation of nicotine users.
Not a silver bullet
Curbing the use of an addictive product is challenging, and there are ways for young people to obtain cigarettes illegally, as they do now in places where cigarette buyers must be at least 21. Tactics include shopping at stores that don’t check IDs, having older friends buy cigarettes and purchasing cigarettes illegally online.
Tobacco-free generation policies aren’t a silver bullet. They work most effectively in conjunction with other measures, such as plain packaging; high prices; bans on displays, advertising and flavored products; smoking cessation support; and public health messages making clear that cigarettes are unsafe at any age.
Still, health experts and groups including the American Heart Association and the American College of Cardiology argue that creating a tobacco-free generation could dramatically reduce preventable deaths and secure a healthier future for today’s children and future generations. In my view, understanding the obstacles to change is a critical step toward achieving this goal.
Marie Helweg-Larsen, Professor of Psychology, Dickinson College
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Food and Beverage
Beyond Protein: 2 Nutrients Your Plate Might Be Missing
Nutrients: Everyone is talking about protein these days whether watching their weight or managing a disease like type 2 diabetes. However, fiber and healthy fats are nutrients many people are overlooking. One food that makes it easier to invest in your health, according to nutrition experts: avocados.
Beyond Protein: 2 Nutrients Your Plate Might Be Missing
(Feature Impact) Everyone is talking about protein these days whether watching their weight or managing a disease like type 2 diabetes. However, fiber and healthy fats are nutrients many people are overlooking. The latest reports show most Americans already meet or exceed recommendations for protein while nearly all (about 95%) do not eat enough fiber, and many people consume too much saturated fat versus unsaturated fat, according to the 2025 Dietary Guidelines Advisory Committee. Prioritizing ways to get more fiber and healthy fats on your plate could be key to managing weight and type 2 diabetes goals this summer.
One food that makes it easier to invest in your health, according to nutrition experts: avocados.
A growing body of research and materials from Avocados – Love One Today, a science-based resource, suggests fresh avocados offer weight management benefits, help with type 2 diabetes management and are good for blood sugar management.
According to a study* of more than 27,000 adults published in the journal “Internal Medicine Review,” people who ate just over half of an avocado per day weighed 7.5 pounds less, had smaller waist sizes and tended to have healthier overall eating habits, including higher intakes of fiber and healthy fats, compared to people who didn’t eat avocados. Among the list of benefits, this delicious and healthy fruit uniquely contains fiber and healthy fats in each nutrient-dense bite which slows digestion, helping you feel satisfied and fuller longer which can help you consume fewer calories overall. In fact, if you’re using a GLP-1, avocados are one of the foods to add to your menu to make small meals feel more filling and satisfying while supporting nutrient needs.
Scientists also recently took a second look at the largest study* about avocado consumption to-date involving close to 1,000 adults, per the journal “Current Developments in Nutrition,” and found that consistently eating one avocado every day for six months (no other diet changes required) significantly reduced dietary glycemic load (GL) by nearly 14 points, a metric that evaluates how what you are eating is affecting your blood sugar levels. GL may be an important consideration in the management of chronic diseases like type 2 diabetes. By slowing digestion, fiber and healthy fats also support stable blood sugar levels.
There are many ways to enjoy avocados, including chopped, sliced, mashed, blended, in baked goods or even frozen. Avocados add flavor, variety and nutrition across the day.
Try these recipes for Avocado and Blueberry Chia Pudding, Avocado Breakfast Bowl with Leafy Greens for your next breakfast or snack.
*Remember: Small, consistent food choices can add up over time. Research suggests regularly eating avocados may support weight management and blood sugar targets while providing the fiber and healthy fats that many Americans are overlooking. These studies were supported by the Avocado Nutrition Center. While these findings are encouraging, the studies highlighted show an association, not cause and effect, and thus more research is needed to confirm these findings in other populations.
To explore evidence-based avocado nutrition information, along with practical tips and easy recipes, visit Avocados – Love One Today, a leading resource for avocado nutrition information.
Avocado and Blueberry Chia Pudding
- 1 1/2 cups plain, unsweetened soy milk (or milk of choice)
- 1 ripe, fresh avocado, halved, pitted and peeled
- 3/4 cup frozen blueberries
- 1/2 cup unsweetened vanilla Greek yogurt
- 1 tablespoon maple syrup
- 1/3 cup chia seeds
To Serve:
- 1/3 cup granola
- 1/3 cup fresh blueberries
- 1 kiwi, chopped
- 1/2 fresh, ripe avocado, halved, pitted, peeled and chopped
- In blender, puree soy milk, avocado, blueberries, yogurt and maple syrup until smooth. Pour mixture into storage container or bowl and add chia seeds. Whisk well to combine. Cover with lid or plastic wrap and refrigerate 4 hours or overnight, until thickened.
- To serve, divide into bowls and top with granola, fresh blueberries, kiwi and avocado.
- Notes: Use any milk (dairy or non-dairy) that you prefer in pudding. Use fresh blueberries or conventional frozen blueberries. Other topping options include: nuts, seeds, hemp hearts, sliced banana or strawberries, or nut butter.
Avocado Breakfast Bowl with Leafy Greens
Bowl:
- 1 medium sweet potato, chopped (about 1 3/4 cup)
- nonstick cooking spray
- 1/4 teaspoon smoked paprika
- 1/4 teaspoon garlic powder
- 1/4 teaspoon salt
- 1/2 cup quinoa
- 1 cup water, plus additional for boiling eggs, divided
- 2 eggs
- 2 cups arugula
- 1 ripe, fresh avocado, halved, pitted, peeled and chopped
- 1/4 cup pickled red onions
Avocado Tahini Dressing:
- 1/2 large avocado
- 1/4 cup tahini
- 1 lemon, juice only (2 tablespoons)
- 3/4 cup water
- 1 tablespoon fresh chives
- salt, to taste
- pepper, to taste
- Preheat oven to 400 F. Add chopped sweet potato to baking sheet. Spray with cooking oil then add smoked paprika, garlic powder and salt. Toss to coat in spices. Bake 22-25 minutes, or until tender.
- In medium saucepan, add quinoa and water. Bring to simmer and cover, cooking 12-15 minutes, or until quinoa is tender and fluffy.
- Fill small saucepan with water and bring to boil. Use slotted spoon to lower eggs into water. Cook 8 minutes then transfer eggs to bowl of ice water to cool before peeling.
- To make dressing: In small blender, puree avocado, tahini, lemon juice, water and fresh chives until smooth. Add more water, 1 tablespoon at a time, if needed, to thin until pourable. Season with salt and pepper, to taste.
- Assemble bowls, each with 1/2 sweet potato, 1/2 cup quinoa, 1 egg, 1 cup arugula, 1/2 avocado, 2 tablespoons pickled red onion and 3 tablespoons dressing. Reserve remaining dressing in refrigerator.
Heart-Healthy Frozen Avocado Banana Paleta
- 1 ripe, fresh avocado, halved, pitted, peeled and diced
- 4 cups orange juice
- 2 medium bananas, peeled and sliced
- 1 tablespoon lime juice
- 8 paper cups (5 ounces)
- 8 wooden craft sticks
- In blender, blend avocado, orange juice, bananas and lime juice on high until smooth. Divide into paper cups. Cover cups with aluminum foil. Insert one stick through center of each foil. Freeze 4 hours until firm.
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health and wellness
Zepbound Linked to Lower Healthcare Costs in Adults 55+ With Obesity, Real-World Study Suggests
A new real-world study of adults over age 55 with overweight or obesity found that sustained use of Zepbound (tirzepatide) for weight management was associated with lower healthcare costs over time compared with similar adults who were not treated. Eli Lilly and Company said the findings were driven in part by lower rates of hospital admissions and emergency department visits, and were published in Diabetes, Obesity and Metabolism.
What the study found
According to Lilly, researchers estimated healthcare cost differences over time (excluding the cost of Zepbound itself) using two established analytic methods. Across both approaches, monthly healthcare costs were lower, on average, among older adults who stayed on Zepbound.
Key estimates reported in the release include:
- At six months: costs were up to 15% lower (up to $181 per patient, per month).
- At 12 months: the estimated difference widened to as much as $607 per patient, per month, reflecting up to 38% lower costs than those not treated (estimates varied by model).
In the primary analysis, adults over 55 treated with Zepbound had lower rates of hospital admissions and emergency department visits across every follow-up period, along with numerically higher rates of routine outpatient and office visitsa pattern the company said was consistent with greater engagement in routine care.
Why Medicare is part of the conversation
Lilly said the cost findings may be relevant for older adults, including those in Medicares GLP-1 Bridge program. The company noted that beginning at six months, estimated healthcare savings nearly covered the programs monthly treatment cost of $195 per patient, per month, and by 12 months the estimated savings exceeded the reported monthly treatment cost.
Its important to note the release also emphasizes a limitation: claims data do not capture Zepbounds net price, and the study excluded the cost of Zepbound from total treatment costs. That means the reported differences reflect potential savings elsewhere in care that could offset treatment costs, not the full net cost impact.
Who was included in the analysis
The retrospective observational cohort study used Komodos Healthcare Map, a database of de-identified claims data from more than 330 million individuals enrolled in U.S. healthcare plans. The analysis included 15,843 adults over age 55 (mean age 64.5) with obesity or overweight plus at least one obesity-related complication who initiated Zepbound between November 2023 and September 2025. Each Zepbound user was matched 1:1 with a control participant who met the same eligibility criteria but did not initiate GLP-1 or GIP/GLP-1 receptor agonist medication.
What Zepbound is
Zepbound (tirzepatide) is a dual GIP and GLP-1 receptor agonist indicated for adults with obesity, or some adults with overweight who also have at least one weight-related medical problem, to lose weight and keep it off. Lilly also noted Zepbound is FDA-approved to treat adults with moderate-to-severe obstructive sleep apnea and obesity, and should be used alongside a reduced-calorie diet and increased physical activity.
Safety summary (high level)
The release includes an indications and safety summary with warnings. Among other risks, Lilly notes Zepbound carries a warning about thyroid tumors, including thyroid cancer, and may cause serious side effects such as severe stomach problems, dehydration leading to kidney problems, gallbladder problems, pancreatitis, serious allergic reactions, and low blood sugar (especially when used with certain diabetes medicines). Patients should talk with a healthcare provider about risks and whether the medication is appropriate for them.
Related Links
- Zepbound (official product site): https://zepbound.lilly.com/
- Lilly newsroom: https://www.lilly.com/news
- Journal page (publisher hub): https://dom-pubs.onlinelibrary.wiley.com/journal/14631326
- Medicare (official): https://www.medicare.gov/
- FDA MedWatch (side effect reporting): https://www.fda.gov/medwatch
Source
- PRNewswire / Eli Lilly and Company press release (Aug. 26, 2026): Zepbound linked to lower healthcare costs in adults over age 55 with obesity according to a real-world study
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(Feature Impact) When it comes to stroke, time matters. Recognizing the warning signs and calling 911 quickly can help with receiving time-sensitive, life-saving treatment. Recovery should begin early, too.
Having a stroke can divide life into a stark before and after, affecting many aspects of daily life. While it’s easy to focus on the things a stroke can take away, it’s important to remember there’s life after stroke. Recovery isn’t just about relearning skills. It’s about adapting to new challenges, finding purpose in a different reality and continuing to move forward.
Navigating the aftermath of a stroke means balancing short-term and long-term plans. Once medically stable, rehabilitation should ideally begin within 48 hours, according to the 2026 Guideline for Adult Stroke Rehabilitation and Recovery from the American Stroke Association. Recovery doesn’t have a fixed end. Meaningful progress can continue for months or years after survivors leave the hospital or complete formal therapy.
“Stroke rehabilitation is complicated,” said Lorie Gage Richards, Ph.D., FAHA, volunteer chair of the new guideline, associate professor at the University of Utah and an occupational therapist. “Each person faces a different set of challenges and care should be personalized to fit each person’s needs. The goal is to help individuals gain as much independence as possible to perform everyday activities while improving their overall quality of life.”
Approximately 800,000 people have a stroke each year in the U.S, according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics. Whether you’re navigating recovery yourself or supporting someone you love, connecting with a coordinated healthcare team is an important first step. Ask about a comprehensive assessment, develop a rehabilitation plan based on what matters to you and set small, achievable goals throughout recovery.
Building Skills and Independence
After a stroke, familiar parts of a daily routine may take more effort or require a new approach. A rehabilitation team can assess how stroke has affected movement, communication, thinking, vision, hearing and other abilities then develop a plan based on individual needs and goals.
Recovery doesn’t look the same for everyone. For one person, a meaningful goal may be dressing independently. For others, it could be returning to work, driving safely or participating in favorite activities. Start with manageable goals, evaluate progress and reassess the plan as needs change.
Understanding the Invisible Impacts
Some of the most challenging parts of recovery may be the ones others can’t see. For instance, you might lose confidence or sense of identity, have trouble concentrating or experience anxiety or depression. Along with mental and emotional changes, you may notice ongoing physical symptoms like pain, difficulty sleeping, changes in sexual function or difficulty with bladder control.
Invisible challenges don’t have to stay that way. Ask your healthcare team to assess your physical and emotional health, including depression and anxiety, during the hospital stay and throughout recovery. Speaking up about new or changing symptoms can help identify appropriate treatment and support.
Navigating Changing Relationships
When you have a stroke, your life isn’t the only one that changes. A partner, parent or friend may suddenly take on new responsibilities, making honest conversations about support especially important.
Family responsibilities may also look different. Parenting young children, supporting loved ones or balancing work and family can bring new challenges during recovery. Give yourself permission to slow down, accept care and connect with the people who matter most.
Finding Purpose and Redefining Success
Recreation, hobbies, social connections and other meaningful activities are an important part of recovery and can help people regain confidence, participate in their communities and improve quality of life. That may mean returning to music, art, exercise or time with friends. It could also mean modifying favorite activities, discovering new interests or connecting with a support group.
Life after stroke may look different, but different doesn’t mean less meaningful. Recovery isn’t measured by how closely someone returns to who they were before. It’s about finding new ways to pursue what matters most and continuing to move forward.
Learn more about recognizing stroke, preparing for rehabilitation and adjusting to life after stroke by visiting Stroke.org.
Photos courtesy of Shutterstock
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