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.

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 has received funding from the National Institutes of Health.