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Smoking remains a massive health problem. Although smoking prevalence is declining in high-income countries, rates are still increasing in many low-income and middle-income jurisdictions.1 Internationally, the eradication of smoking would transform global health but achieving this will likely require resolute, combined individual-level and population-level approaches.2 For individuals, effective interventions like behavioural support3 and pharmacotherapy4 5 can equip people with the skills to try stopping and successfully stop. However, these interventions are of limited use if they are seldom used or not readily accessible and this is where concomitant population-level tobacco control strategies can help. For example, antismoking publicity campaigns can encourage people to try stopping and making evidence-based support, like pharmacotherapy, cost-free can encourage more quitters to use it. By reaching many people, population-level strategies can have substantial impacts.2
Smoking is probably the most comprehensively researched unhealthy behaviour. There is an abundance of robust, high-quality randomised controlled trials (RCTs) testing the efficacy of individual-level smoking cessation interventions summarised in over 80 Cochrane Tobacco Addiction Group systematic reviews.6 Evidence for what works at a population level is much thinner. It is challenging to secure the very strongest research evidence for population-level approaches; to evaluate national tobacco control policies with RCTs would require countries to accept random allocation to different policies and this is evidently unfeasible. However, in this edition of Thorax, Beard et al report an imaginative, non-RCT evaluation of population-level tobacco control strategies using national survey data collected between 1973 and 2016. This suggests that the very comprehensive tobacco control policies introduced into the UK around the millennium, including the provision of national stop smoking services, had very positive, population-level impacts on rates of starting and stopping smoking and also on smoking prevalence.
The UK has a long history of conducting large-scale, …
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