Citation, extracts and comment from me below.
CITATION: Availability, appeal, and addictiveness by design: Tobacco and nicotine industry deliberate targeting of youth
Raglan Maddox ,Becky Freeman,Charlotta Pisinger,Emily Banks
Published: May 29, 2026
https://doi.org/10.1371/journal.pmed.1005133
EXTRACTS
'Contemporary tobacco and nicotine products, particularly e-cigarettes, are deliberately designed, marketed, and distributed to maximize youth appeal, uptake, dependence, and use. Youth uptake is a predictable outcome of systems designed to maximize product availability, appeal, and addictiveness...
'Conclusions: Unmasking appeal requires recognizing that attractiveness is not incidental but a deliberate strategy within commercial and regulatory systems that enable this harm. Youth uptake is not a failure of individual choice or a lack of awareness of harms, but a predictable outcome of an industry structured and incentivised to generate and sustain addiction. Effective protection depends on governing commercial practices, and more fundamentally, on addressing the systems that allow harmful products to be created, promoted, and made widely available [6,11,12,14]. This shifts policy from managing risk to addressing its source: the commercial tobacco and nicotine industries.'
COMMENT (NPW): It is clear that the tobacco industry is manufacturing addiction by design. But it's wrong to implly that this is the only factor that drives youth uptake. A low awareness of health risks among youth is also an important driver. Indeed, a young person may be aware of one or two of the long-term health risks (such as lung cancer) while being unaware of other diseases caused by smoking (and there are more than 50 recognised). A greater challenge is that young people have a low capacity to project their own health decades into the future. Distant harms feel abstract and irrelevant. Misinformation (including manipulation by the tobacco industry) further distorts this perception.
One known factor is the diagnosis and/or death of a parent from lung cancer. A parent’s lung cancer diagnosis can act as a powerful deterrents to youth smoking.
More research is needed not only to inform, but to enable deep understanding, of the long-term health risks of smoking.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org