Tobacco use remains one of Europe’s largest preventable causes of disease and death and is a major cause of cardiovascular diseases, cancer, chronic respiratory diseases and other non-communicable diseases. At the same time, the tobacco and nicotine landscape is changing. E-cigarettes, nicotine pouches and other newer products are creating new pathways into nicotine dependence, particularly among children and young people.
Preventing harm therefore means more than providing information about health risks. It means preventing people from becoming addicted in the first place, supporting those who want to quit, protecting people from harmful exposure, and addressing how tobacco and nicotine products are designed, marketed, priced and made available.
The recently launched JA PreventNCD prevention campaign builds on this approach. Its aim is to provide clear, accessible and evidence-based guidance on prevention while recognising that better health depends on both individual action and the conditions in which choices are made. The campaign therefore provides practical information for the general public on avoiding or quitting tobacco and nicotine, alongside evidence-based guidance for policymakers on the policies and protections that can reduce use, exposure and addiction.
To explore what this means in practice, we spoke with Hanna Ollila, Senior Specialist at the Finnish Institute for Health and Welfare (THL) and Thematic Coordinator for Tobacco and Nicotine in JA PreventNCD, about the changing tobacco and nicotine landscape, preventing addiction, supporting people to quit, and creating stronger systems and policies for tobacco and nicotine prevention.
With so many different tobacco and nicotine products now available, what is the clearest prevention message you would give to the public?
The clearest message is that avoiding tobacco and nicotine is one of the most important things people can do to protect their long-term health.
Cigarettes and other tobacco products cause serious harm, including cardiovascular diseases, cancer and chronic respiratory diseases. At the same time, newer products such as e-cigarettes and nicotine pouches have changed the market, and the pace of product innovation is moving faster than what regulations can keep up with. This means that new nicotine products can be sold even though their health risks, especially in the long-term use, are not known.
Nicotine is highly addictive, and newer products can create and maintain dependence and harm health even when they look very different from conventional cigarettes. This is especially important to remember because people are exposed to many different messages about these products. Newer products may be marketed as tobacco-free, modern and clean. But this should not be confused with harmless, and for people who do not currently use tobacco or nicotine, the best way to avoid addiction and related harm is not to start.
For people who already smoke or use nicotine products, it is important to remember that quitting improves health and wellbeing at any age. It even improves the effectiveness of treatment in chronic diseases. Quitting is still difficult for many people because of the physical, psychological and social elements of nicotine dependence. Successful quitting often requires several attempts, but evidence-based support can significantly help.
So prevention has two equally important sides: protecting people from becoming addicted and making sure people who want to stop receive effective support to do so.
Children and young people are a major focus of tobacco and nicotine prevention. What has changed about the way products are made appealing to them, and how should prevention respond?
Protecting children and young people has always been central to tobacco control, but the ways in which products are designed and promoted continue to evolve.
Flavours, colourful or discreet packaging, modern product designs, social media, influencers, sponsorship and lifestyle branding can all make tobacco and nicotine products appear more attractive, socially acceptable or harmless. The appeal is crafted around how the product looks, how it is presented and the social identity built around it.
Digital environments make this particularly challenging. Marketing can cross borders quickly, reach young people through channels that are difficult to monitor, and blur the distinction between advertising, entertainment and ordinary social media content.
One well documented change has also taken place in the industry strategies, where multi-national tobacco companies have started to present themselves as partners for smoke-free future. For the industry, this means new access to policymakers, broader product portfolio, and increased profits through multi-product use in more and more of our everyday moments. This strategy has created a lot of distraction among regulators. JA PreventNCD research has also shown that the newer products can create blind spots in systems designed to monitor industry activity and influence.
Prevention therefore needs to look across the whole tobacco and nicotine market. We should not wait until a new product has become widely used among young people before acting.
The goal is not simply to prevent a new generation from smoking cigarettes. It is to prevent a new generation from becoming dependent on nicotine.
Prevention is often associated with stopping people from starting. For people who already smoke or use nicotine products, what does effective support for quitting look like?
Preventing initiation is extremely important, but we also need to support people who are already dependent on tobacco or nicotine.
Quitting is not simply a question of willpower. Nicotine is addictive, and many people make several attempts before they stop successfully. Evidence-based support improves the chances of quitting, which is why access to appropriate advice and treatment should be a routine part of healthcare.
Effective cessation support starts with identifying tobacco and nicotine use and giving health professionals the confidence and tools to raise the issue respectfully. From there, people should have a clear pathway to appropriate support, which can include brief advice, counselling, evidence-based treatment, digital services and more intensive support where necessary.
It is also important that services are able to respond to today's patterns of use. Healthcare professionals may encounter people who smoke cigarettes, use newer nicotine products, or use several products at the same time.
The principle should be that people do not have to manage nicotine dependence alone. If we recognise dependence as a health issue, then high-quality cessation support should be accessible, affordable and integrated into routine healthcare.
You recently co-authored a JA PreventNCD study looking at tobacco and nicotine cessation services in Finland. What did it tell you about the difference between having good recommendations and making support work in practice?
This study is a good example of why implementation matters so much. Evidence-based recommendations are essential, but they do not automatically translate into consistent practice across a health system.
We examined the infrastructure for tobacco and nicotine cessation across Finland's wellbeing service counties. There were encouraging findings. For example, structured documentation of tobacco and nicotine use in patient information systems was reported by 81% of participating counties, while digital cessation services were available in 71%.
At the same time, there was considerable variation in how cessation services were organised. Only 29% had an established entity responsible for coordinating tobacco and nicotine cessation, and one third provided annual tobacco-cessation training for healthcare professionals. Early identification, brief interventions and cessation support were not yet consistently embedded across services.
That tells us something important beyond Finland as well: effective cessation support needs infrastructure behind it. Responsibility needs to be clear. Professionals need appropriate training. Care pathways need to work. Information needs to be documented and shared, and services need systems for monitoring what is being delivered and whether it is effective.
We also saw differences in tailored cessation support for groups with particular needs. Some services had integrated support for people with lung disease, diabetes or cardiovascular diseases and for pregnant people, while support was less consistently available for groups such as people experiencing socioeconomic disadvantage or those using mental health or substance-use services.
So good cessation policy is not only about knowing which interventions work. It is about building health systems that can deliver those interventions consistently and equitably.
We already know a great deal about effective tobacco control. Why can translating that evidence into strong protection still be so difficult?
There is a substantial evidence base on what works. Measures such as taxation, smoke-free environments, comprehensive bans on advertising and sponsorship, regulation of products and packaging, reducing availability and providing cessation support are well established.
The challenge is often implementation.
New products and changing markets can expose gaps in legislation. Digital and cross-border promotion can make enforcement difficult. Different rules between countries or product categories can create loopholes. Strong legislation can also have limited impact if compliance is not monitored or enforcement is weak.
But even bigger challenge is industry interference in preventing, delaying or weakening measures that reduce the use of its products. The WHO Framework Convention on Tobacco Control (WHO FCTC) provides powerful tools to address this. Article 5.3 requires Parties to protect public health policies from the commercial and other vested interests of the tobacco industry and related entities.
Another longstanding issue is the lack of resources. This is where the Joint Actions have been so useful in tobacco control – to provide a platform for information exchange and collaboration between the EU Member States to advance the implementation and strengthening of key measures.
In Europe, we also need a stronger common baseline for regulations. Modernising the EU legislative framework on tobacco control, one of the flagship initiatives of the Safe Hearts Plan, is very timely.
This is why effective tobacco control requires more than choosing the right policy. We also need implementation, enforcement, transparency and strong governance to ensure that public health measures can actually achieve their intended effect.
JA PreventNCD has specifically examined how countries monitor tobacco and nicotine industry interference. What have you learned from moving from awareness of the problem to building practical monitoring capacity?
This has been a particularly interesting area of work because awareness of industry interference does not necessarily mean that systems are in place to detect and document it.
Within JA PreventNCD, we examined monitoring and information-exchange practices in Belgium, Estonia, Finland, Iceland and Slovenia, alongside publicly available examples of industry interference.
All participating organisations recognised the importance of regularly monitoring industry interference. However, most of the countries lacked comprehensive systems, dedicated protocols or clearly designated entities responsible for doing so.
At the same time, we identified examples of familiar tactics, including lobbying, misleading or selective use of evidence, corporate social responsibility activities and front groups. The emergence of newer tobacco and nicotine products makes this more complicated because commercial actors can exploit regulatory gaps and areas where existing monitoring systems were not designed to look.
Monitoring is important because it turns something that can otherwise remain largely invisible into information that governments, researchers and civil society can act on. It can increase transparency, support policy evaluation and act as an early-warning system for new products, marketing approaches or attempts to circumvent regulation.
It was also great to see the work also move beyond this assessment. Three participating countries were able to identify civil society organisations with the capacity to participate in industry-interference monitoring and subsequently joined the Global Tobacco Industry Interference Index.
That transition from identifying a gap to helping build capacity is important. The aim is not simply to document that industry interference exists, but to give countries stronger systems for recognising it, sharing information and protecting policymaking over the long term.
JA PreventNCD has also translated this work into practical policy recommendations through the policy brief “Sustainable tobacco control needs protection from industry interference.” It calls for regular monitoring of industry interference, clear policies and transparency protocols, stronger support for civil society involvement, and safeguards that also cover actors involved in newer consumer nicotine products.
As Thematic Coordinator for Tobacco, you work across very different areas of JA PreventNCD. What does that cross-cutting perspective add?
Tobacco and nicotine prevention is a good example of why we need to connect different types of action.
Population-wide policy remains fundamental. JA PreventNCD is also contributing work relevant to the development of tobacco and nicotine policy, including approaches to fiscal measures, monitoring the changing regulatory landscape, supporting the enforcement of youth access laws through mystery shopping and strengthening the implementation of smoke- and aerosol-free environments. But these measures need to connect with other parts of prevention. Monitoring helps us identify changes in tobacco and nicotine use, new products and emerging challenges. Cessation support ensures that people who are already dependent have access to help. Work on social inequities helps us understand who experiences the greatest harm and how we can overcome barriers to quitting. Health in All Policies and governance work help protect policymaking from industry interference and ensure that tobacco prevention is considered across sectors rather than only within health ministries. The project therefore spans action from the individual level to wider societal and policy measures.
As a cross-cutting theme coordinator, part of the role is to help make those connections visible. The different activities may look quite separate, but they contribute to the same overall objective.
The strength comes from looking at prevention as a system: preventing initiation, reducing exposure and availability, supporting cessation, monitoring change, addressing inequalities and protecting the policymaking process all need to reinforce one another.
Europe has set the ambition of achieving a tobacco-free generation, with less than 5% tobacco use by 2040. What would meaningful progress towards that goal look like to you?
Meaningful progress would first mean that fewer children and young people ever begin using tobacco and nicotine products. We need to move from controlling the tobacco epidemic, decade after decade, to really making structural changes to end it to protect future generations.
That requires a regulatory framework capable of keeping pace with the market. Products should become less affordable, less available and less appealing, and children and young people should be protected from commercial strategies that encourage uptake. Europe also needs to strengthen implementation of the measures we already know work, including taxation, smoke-free and aerosol-free environments, comprehensive advertising bans and cessation support. Tobacco-related harm and access to support are not equally distributed, so reducing inequalities has to be part of how we judge success.
We also need to think about the resilience of tobacco-control policy itself. Governments should have clear and transparent safeguards against industry interference, strong surveillance and monitoring systems, and mechanisms for sharing information between countries. The market is international, so European cooperation is essential if we want strong national measures to remain effective. Reaching a tobacco-free generation will therefore require sustained action rather than one single breakthrough.
Ultimately, I think success would be a Europe where far fewer people become dependent on tobacco or nicotine, everyone who wants to quit can access effective support, and public health policy remains firmly guided by evidence and the public interest rather than commercial interests.
Thank you to Hanna Ollila for sharing her insights on tobacco and nicotine prevention, cessation support and the policies needed to protect people from addiction and tobacco- and nicotine-related harm.
Tobacco and nicotine prevention illustrates particularly clearly why individual support and structural protection need to work together.
Avoiding or quitting tobacco and nicotine can make an important difference to health, but effective prevention also means preventing addiction before it starts, supporting people who want to quit, reducing exposure and product appeal, and ensuring that public health policies are strong enough to protect current and future generations.
