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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Three new studies shared this week at the Society of NeuroInterventional Surgery (SNIS) 23rd Annual Meeting deliver a clear message: stroke care in the U.S. is improving, but those gains are not reaching everyone equally. Researchers found persistent disparities tied to race, geography, and socioeconomic status—factors that can shape whether a patient receives advanced treatment, how quickly they reach specialized care, and ultimately, whether they survive.
Stroke remains one of the nation’s leading causes of death and long-term disability. In recent years, breakthroughs in emergency response systems and minimally invasive procedures have expanded what’s possible in the critical first hours after a stroke. But the latest findings suggest that access to those life-saving advances still depends too heavily on who you are and where you live.
Study 1: Treatment gaps widen as strokes get more severe
The first study, “Racial Disparities in Endovascular Thrombectomy Widen with Stroke Severity: A National Inpatient Sample Analysis,” examined more than 325,000 acute ischemic stroke patients treated at U.S. teaching hospitals between 2018 and 2022.
The focus was endovascular thrombectomy (EVT), a minimally invasive procedure in which specialists remove a clot from a blocked artery in the brain. EVT can be a game-changer for eligible patients—but researchers found Black patients were less likely than white patients to receive it across all levels of stroke severity.
What stood out most: the disparity grew as stroke severity increased. At a National Institutes of Health Stroke Scale (NIHSS) score of 20, the predicted probability of receiving EVT was:
- 33% for white men
- 32% for white women
- 28% for Black men
- 26% for Black women
Co-first author Muhammed Amir Essibayi, MD, MSc, FRCP, noted that timely access becomes even more critical as severity rises—yet the treatment gap becomes more pronounced. The study also highlighted an intersectional pattern, with Black women consistently least likely to receive EVT.
Study 2: Hemorrhagic stroke deaths are falling—but disparities persist
The second study, “Reducing Inequalities in Stroke Events-Hemorrhagic Disparities (RISE-HD): A 10-year Statewide Analysis of Social Determinants of Mortality in Hemorrhagic Stroke,” analyzed more than 120,000 patients hospitalized with hemorrhagic stroke in Florida between 2013 and 2024.
There was good news: mortality rates declined significantly over the decade, suggesting real progress in stroke systems and hospital care.
But after adjusting for age, sex, and comorbidities, disparities remained. Black patients had higher odds of in-hospital mortality than white patients. Higher mortality was also associated with:
- Living in rural areas
- Having Medicaid or other non-commercial insurance
Researchers also found regional differences across Florida, pointing to uneven access to specialized stroke care.
Primary author Natália Vasconcellos, MD, MSc, emphasized that improving outcomes for everyone will require addressing barriers to specialized stroke systems—especially in underserved communities.
Study 3: The “Stroke Belt” has two different access problems
The third study, “Dual Pathways to Hemorrhagic Stroke Mortality Across the U.S. Stroke Belt: Rural Neurointerventional Isolation and Urban Structural Vulnerability,” looked at hemorrhagic stroke mortality across 433 counties in the “Stroke Belt,” a region long associated with higher stroke rates and worse outcomes.
Researchers compared factors linked to mortality in rural versus urban counties, including:
- Distance to the nearest Comprehensive Stroke Center
- Community-level socioeconomic disadvantage
- Racial and economic segregation
- HIV burden
They found the drivers of mortality differed sharply by setting:
- In rural counties, longer travel times to Comprehensive Stroke Centers were more strongly associated with higher mortality.
- In urban counties, racialized economic segregation and HIV burden were more strongly associated with poorer outcomes—even when specialized care was geographically closer.
Dylan Yates, a medical student at Tulane University School of Medicine, summarized the takeaway: the neurointerventional access gap in the Stroke Belt is “not one problem, it is two.” Solutions need to match the reality on the ground—strengthening transfer networks and specialty connections in rural areas, while addressing structural disadvantage and underinvestment in urban communities.
What to watch for: where the system can improve
Across all three studies, the common thread is that medical innovation alone doesn’t guarantee equitable outcomes. Researchers pointed toward targeted interventions that could help close the gap, including:
- More consistent, equitable treatment pathways for advanced stroke procedures like EVT
- Stronger stroke transfer networks to reduce delays—especially in rural regions
- Expanded access to specialty stroke care and Comprehensive Stroke Centers
- Community-level investment and structural reforms in underserved urban neighborhoods
For patients and families, these findings also reinforce the importance of recognizing stroke symptoms quickly and calling 911 immediately. Time is brain—yet the system must ensure that “time” and “access” don’t vary based on race, ZIP code, or insurance status.Source: Society of NeuroInterventional Surgery (SNIS), July
Related Links
- Society of NeuroInterventional Surgery (SNIS) — https://www.snisonline.org
- NIH: Stroke (overview, symptoms, treatment) — https://www.ninds.nih.gov/health-information/disorders/stroke
- CDC: Stroke (risk factors, prevention, data) — https://www.cdc.gov/stroke/
- American Stroke Association (ASA): Stroke resources — https://www.stroke.org/
- NIH Stroke Scale (NIHSS) basics (clinical context) — https://www.stroke.nih.gov/resources/scale.htm
- Find a certified stroke center (The Joint Commission) — https://www.qualitycheck.org/
SOURCE Society of NeuroInterventional Surgery
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Family
Teach and Inspire Your Kids by Exploring History as a Family
History as a Family: During back-to-school season, education is naturally at the forefront of most parents’ minds. While a lot of important learning is accomplished in the classroom, there are so many opportunities to continue challenging and developing children’s minds and hearts in family life as well.
Teach and Inspire Your Kids by Exploring History as a Family
(Feature Impact) During back-to-school season, education is naturally at the forefront of most parents’ minds. While a lot of important learning is accomplished in the classroom, there are so many opportunities to continue challenging and developing children’s minds and hearts in family life as well. Learning about history together is a practical way to inspire deep, meaningful conversations about the world, whether from books, documentaries or visits to museums.
Watch this video to learn more
Now is an opportune time to explore the story of Anne Frank, a Jewish teenager evading Nazi capture during the Holocaust. Families can read her famous diary together then visit “Anne Frank The Exhibition,” presented by the Anne Frank House at the Griffin Museum of Science and Industry. This comprehensive exhibition immerses visitors in the context that shaped Frank’s life, from her early years in Frankfurt through her tragic death and how her father ensured her legacy. The centerpiece is the first full-scale recreation of the Annex where the Frank family and four other Jews hid during the Nazi occupation of the Netherlands. The exhibition, recommended for visitors ages 10 and older, is open through early 2027.
No matter what piece of history families choose to delve into together, they should take the time to discuss with their kids what they’re thinking and feeling about everything they’re discovering. Then together they can figure out what lessons from the past can be taken into the future.
“Anne Frank ’s story is a powerful reminder of what happens when fear and hatred are
allowed to take root,” said Dr. Chevy Humphrey, Griffin Museum of Science and Industry
president and CEO. “At the same time, it reveals the quiet but enduring strength of
curiosity, creativity and resilience, values that sit at the heart of our mission. We hope this
exhibition offers meaningful moments of reflection for our guests, particularly young
people, and encourages them to think critically about their role in the world they are
inheriting.”
Learn more about the exhibit and other experiences that bring history and science to life at GriffinMSI.org.
SOURCE:
Griffin Museum of Science and Industry
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Lifestyle
If You’re Feeling Stressed by Pricey Meds, Pharmacists Can Help
Stressed by Pricey Meds? If your wallet is feeling the squeeze of prescription drug costs as other living expenses like grocery and energy prices rise, you’re not alone. That’s where a powerful ally can help you manage drug costs: a health-system pharmacist.
If You’re Feeling Stressed by Pricey Meds, Pharmacists Can Help
(Feature Impact) If your wallet is feeling the squeeze of prescription drug costs as other living expenses like grocery and energy prices rise, you’re not alone.
More people are worrying about affording essential medications these days. In fact, more than 40% of adults said they skipped doses or didn’t fill prescriptions in the past year due to cost, according to a KFF Health survey.
People who take multiple drugs to manage chronic conditions often feel this pinch even more severely. They’re also more likely to make more frequent visits to their clinic or health system for care. That’s where a powerful ally can help them manage their drug costs: a health-system pharmacist.
These medication experts work side-by-side with the clinicians who prescribe drugs in health care practices – and sometimes prescribe medications themselves. Their deep knowledge can help people get the most out of the drugs they take.
“Pharmacists really know the full picture of medications, including pricing, insurance coverage, alternative therapies and potential side effects,” said Lindsey Amerine, PharmD, chief pharmacy officer for the Cleveland Clinic. “That’s why it’s helpful to not only count on your doctor to diagnose your condition and prescribe therapies, but also your pharmacist to optimize your medications.”
Get a Comprehensive Review of Your Medications
Asking the pharmacist on your health-system care team to go over your medications may reveal opportunities to save, Amerine said. Health-system pharmacists are uniquely qualified to provide this service because they keep close track of medication costs as well as approvals of new drugs and how those compare to older options.
A full review might reveal:
- Drugs once needed may not be as useful anymore. People often continue taking medications unaware that something new could offer greater benefits or their condition no longer requires the same therapy.
- Changes in your condition may mean you could safely take a lower dosage of a drug, thereby reducing costs.
- There may be less costly alternatives that would work as well such as a generic or older medication.
Get Help Exploring Discount Options
You’ve probably heard about programs that can help lower prescription costs, including discount and patient assistance programs. Pharmacists can help you understand how to navigate these programs and access potential discount programs and opportunities, Amerine said. Here’s how:
- Pharmacists can guide you through discount programs your health system offers.
- They can check your eligibility for drug maker discounts and help you understand how those discounts work with your insurance, especially if you have a high-deductible plan.
- Pharmacists can help you navigate the various prescription cost-savings programs and how they work.
- They can also help you learn about patient assistance programs that provide free or discounted medications to people who cannot afford them.
Medications are a vital part of your health care. Before you try to stretch a costly medicine or give it up altogether, talk to the medication expert on your health care team: your health-system pharmacist. For more information, visit yourpharmacist.org.
Why It Pays to Talk Meds with a Pharmacist
“My doctor prescribed it, so I must need it.” Often this is true, but not always. People sometimes take drugs longer than they need to, at doses higher than necessary or that may interact with other medications.
Just as you’d see a heart specialist about an odd pulse rate, it can help to see a pharmacist – your medication specialist – to discuss your prescriptions.
Of all health care professionals, pharmacists have the deepest knowledge of drug interactions and safety issues. They’re experts on how the effectiveness of different medications – brand name and generic – compare. They also closely track changes in prices and know when a drug’s cost has dropped or if an effective, less costly alternative is available.
Health-system pharmacists’ expertise is especially helpful for those with multiple chronic conditions who typically take several medications with more benefits, costs and side effects to balance.
Talking with a pharmacist can ensure your prescriptions are best for you and that you have access to the most affordable options.
SOURCE:
American Society of Health-System Pharmacists
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