“The youth can be ruined” – Unheard Adolescent Voices in the Global Tobacco Debate: Findings from the FRESHAIR4Life Study

Tobacco use remains the leading global risk factor for disease and mortality. Despite reductions in prevalence, the tobacco industry continues targeting adolescents as "replacement smokers," ensuring the continuation of its harmful business. While tobacco control efforts have grown, adolescent perspectives are rarely included in the debate or policymaking. This abstract presents findings from the FRESHAIR4Life situational analysis, capturing the voices of adolescents from four countries on tobacco use and advocating for their inclusion in tobacco control strategies. Methods: We conducted thematic analysis of focus groups and interviews with adolescents aged 14–21 across Greece, Kyrgyzstan, Pakistan, and Romania. Themes were triangulated with quantitative data and contextualized using insights from teachers, healthcare workers, and family members. Results: Using installation art, we amplify adolescents’ voices on the following key themes: Tobacco as a threat: Adolescents viewed tobacco as a (health) threat, though normalization or stigma varied per setting. Many were informed by family rather than schools and desired more relatable, detailed information. Direct impacts, such as reduced physical endurance or disproportionate harm to vulnerable groups, were noted: “They’ll say they don’t have money for food, but they’ll have money for smoking.” Individual responsibility: While recognizing tobacco addiction, adolescents largely framed smoking as a “free choice,” influenced by marketing tactics but rarely blaming the tobacco industry. Demand for stricter regulations: Adolescents advocated for stronger laws or full bans but doubted enforcement. One noted a school smoking ban’s potential impact: “I guess I wouldn’t smoke because I wouldn’t have anywhere else.” Discussion: Adolescents require education on addiction and industry tactics, delivered through mandatory school programs and (social media) campaigns. Their voices must inform global tobacco control policies to counter industry influence and empower youth. Conclusion: Adolescents, actively targeted by the tobacco industry, deserve a voice in policymaking to shape effective, youth-focused tobacco control strategies. Funding: FRESHAIR4Life is funded by Horizon Europe. UK participants are supported by UKRI grant numbers 10063681, 10060974 and 10064407 as part of the call for NCD prevention in adolescents.