A Report on Tobacco Control and its Alignment with the Sustainable Development Goals

The significant reduction in adult cigarette smoking in the United States, from 40% in the 1970s to 11% in 2023, represents a major public health achievement. This progress directly contributes to Sustainable Development Goal 3 (SDG 3): Good Health and Well-being, particularly Target 3.4, which aims to reduce premature mortality from non-communicable diseases. However, persistent challenges and emerging threats, such as the youth vaping epidemic and disparities in smoking rates, require continued focus to ensure equitable health outcomes for all.

Disparities in Tobacco Use: A Challenge to SDG 10 (Reduced Inequalities)

The burden of tobacco use is not evenly distributed, creating significant health inequities that contravene the principles of SDG 10 (Reduced Inequalities). Vulnerable populations are disproportionately affected, hindering progress towards universal well-being.

The Intersection of Mental Health and Nicotine Dependence

A strong correlation exists between mental illness and continued smoking, undermining efforts to promote mental health and well-being as stipulated in SDG 3. This disparity highlights a critical area for targeted intervention.

• The smoking rate among U.S. adults with any mental illness (25%) is more than double the rate for those without.
• Smoking rates among individuals with serious mental illnesses are substantially elevated, reaching as high as 80-90% in cases of schizophrenia.
• A reported 37% of individuals with major depression are current smokers.

Socioeconomic Factors in Cessation Success

Studies indicate that individuals of low socioeconomic status (SES) face greater barriers to quitting. Addressing these socioeconomic determinants of health is essential for achieving the equity-focused targets of the 2030 Agenda.

Regulatory and Harm Reduction Strategies in Support of SDG 3.a

Policy interventions and harm reduction strategies are central to fulfilling SDG Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control. Recent developments focus on both traditional cigarettes and emerging nicotine products.

Federal Regulatory Proposals

In 2022, the U.S. Food and Drug Administration (FDA) proposed a landmark policy to mandate the reduction of nicotine in cigarettes to minimally addictive levels. If implemented, this regulatory action would be a transformative intervention, directly supporting SDG 3 by lowering consumption and toxic exposure.

Evaluating Electronic Nicotine Delivery Systems (ENDS) for Harm Reduction

The role of vaping products in tobacco control is a subject of ongoing debate, with conflicting evidence on their efficacy as a cessation tool.

Evidence Supporting Vaping as a Cessation Aid

• A 2025 Cochrane Review concluded that nicotine-containing e-cigarettes may help adult smokers reduce or quit smoking more effectively than traditional nicotine replacement therapy (NRT).
• A study in the Annals of Internal Medicine found that vaporized nicotine products led to a 28.4% six-month abstinence rate among low-SES smokers, compared to 9.6% for NRT.
• Recent 2025 studies, including one in JAMA Network Open, associated daily vaping with a higher likelihood of long-term smoking cessation.

Countervailing Evidence and Public Health Concerns

• Research by Quach et al. (2025) concluded that vaping was not associated with an increased likelihood of quitting smoking.
• Experts like Dr. Stanton Glantz argue that analyses often overestimate vaping’s benefits and that smokers who use e-cigarettes may be 25-30% less likely to quit.
• The phenomenon of “dual use” (smoking both conventional and e-cigarettes) may prolong nicotine dependence, undermining public health goals.

Emerging Threats to Sustainable Development

New challenges related to nicotine products pose a direct threat to progress on the SDGs, particularly concerning the health of younger generations.

The Youth Vaping Epidemic: A Setback for SDG 3 and SDG 4

The rise of vaping among youth is a significant public health crisis that jeopardizes the long-term health of adolescents (SDG 3) and points to gaps in health education and the promotion of sustainable lifestyles (SDG 4: Quality Education).

• Approximately 25% of youth use e-cigarettes.
• A 2023 survey found that 44% of daily vapers aged 15–24 self-identified as addicted.
• The high nicotine delivery of popular devices can lead to rapid dependence in adolescents, whose brains are more vulnerable.

Unassessed Health Risks of Vaping

While e-cigarettes emit fewer toxins than combustible cigarettes, their long-term health effects remain unknown. This uncertainty, particularly regarding cardiovascular health, represents a risk to achieving the targets for reducing non-communicable diseases under SDG 3. The fact that e-cigarettes generate ultrafine particles that enter the bloodstream is a primary concern requiring further research.

Recommendations for Aligning Tobacco Control with the 2030 Agenda

To advance the Sustainable Development Goals, a multi-faceted approach combining proven interventions with cautious clinical guidance is required. This requires robust partnerships between government, research, and public health bodies, in line with SDG 17 (Partnerships for the Goals).

Proven Cessation Methodologies

1. Comprehensive Tobacco Control Interventions: Continue implementing taxation, smoke-free laws that improve urban air quality (SDG 11: Sustainable Cities and Communities), and public awareness campaigns.
2. Pharmacologic Aids: Utilize proven medications such as bupropion (Zyban) and varenicline. Varenicline has demonstrated high efficacy as a cessation treatment for both cigarette smoking and nicotine vaping addiction, particularly in young adults.

Policy and Clinical Guidance

• Vaping should not be recommended as a first-line cessation treatment for adult smokers.
• Vulnerable populations, including adolescents and individuals with mental illness or substance use disorders, should be strongly counseled against initiating or continuing vaping due to high addiction potential and low cessation rates. This targeted approach is crucial for promoting health equity (SDG 10) and ensuring good health for all (SDG 3).

SDGs Addressed in the Article

• SDG 3: Good Health and Well-being – The article’s central theme is public health, specifically focusing on the health risks of smoking and vaping, the connection between mental illness and smoking, and strategies for cessation. It discusses non-communicable diseases caused by tobacco, substance abuse (nicotine addiction), and public health policies aimed at controlling tobacco use.

Identified SDG Targets

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   The article directly addresses this target by discussing the significant reduction in cigarette smoking in the U.S. (from 40% in the 1970s to 11% in 2023), which is a primary prevention strategy for non-communicable diseases like heart disease and cancer. It also highlights the strong link between mental illness and smoking, noting that “Mental illness is a major driver of continued smoking,” and points out the high smoking rates in individuals with schizophrenia, bipolar disorder, and depression. Promoting smoking cessation in these groups is a key aspect of promoting their health and well-being.

2. Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.

   This target is relevant as the article extensively discusses nicotine addiction, a form of substance abuse. It examines various treatment and cessation methods, including nicotine replacement therapy (NRT), varenicline, and the controversial role of e-cigarettes (vaping) as a cessation aid. The article also highlights the growing problem of vaping addiction among youth, stating that “About 25 percent of youths use e-cigarettes” and that many self-identify as addicted, which points to the need for stronger prevention and treatment strategies for this demographic.

3. Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.

   The article supports this target by detailing various tobacco control measures. It mentions the success of past interventions like “taxation, smoke-free laws, stigmatizing media campaigns, cessation services, and regulatory restrictions.” Furthermore, it highlights a current, significant regulatory proposal: the FDA’s 2022 plan “mandating the reduction of nicotine content in cigarettes to minimally addictive levels,” which is described as a potentially “transformative regulatory intervention in tobacco control.”

Implied or Mentioned Indicators

1. Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease.

   While the article does not provide mortality rates, it implies this indicator by discussing the diseases caused by smoking. It states, “cigarettes cause more heart and cardiovascular deaths than lung cancer deaths.” The reduction in smoking prevalence from 40% to 11% is a direct measure of prevention that would lead to a decrease in this mortality rate.

2. Indicator related to Target 3.5 (Treatment for substance use disorders):

   The article provides several data points that can be used to measure the coverage and effectiveness of treatment for nicotine addiction. It cites specific abstinence and quit rates for different cessation methods, such as “vaporized nicotine products (VNPs) led to a 28.4 percent six-month abstinence rate versus 9.6 percent for NRT” and “varenicline led to a 51 percent quit rate at 12 weeks” in young vapers. These statistics serve as direct measures of treatment success.

3. Indicator 3.a.1: Age-standardized prevalence of current tobacco use among persons aged 15 years and older.

   The article explicitly provides data for this indicator. It states that “Only 11 percent of U.S. adults were cigarette smokers in 2023,” down from 40% in the 1970s. It also provides prevalence data for specific populations, such as “25 percent” of adults with any mental illness and “as high as 80 to 90 percent” in patients with schizophrenia. Additionally, it gives prevalence for e-cigarette use among youth: “1.6+ million middle and high school students using e-cigarettes in 2024.”

SDGs, Targets, and Indicators Analysis

Source: psychologytoday.com