The tobacco endgame: It's all about behavior

• Tobacco-caused diseases are the side effects of tobacco use and addiction.
• Light cigarettes, menthol, and other cigarette designs contributed to addiction.
• Appropriately regulated electronic nicotine delivery systems may help end smoking.
• Behavioral research by the tobacco industry helped spread the tobacco epidemic.
• Behavioral research is contributing to the beginning of the decline of the epidemic.
• The foundation of the tobacco endgame will rest heavily on behavioral science.

One of the ten great public health achievements in the 20th century was turning the tide on one of the greatest public health disasters of that century: the tobacco use and related disease epidemic. The premature death and disease caused by tobacco can be considered largely as a side-effect of tobacco use behavior and the disease of addiction. The spread of that disease was fostered by an industry that researched the behavioral and biological basis of tobacco use and addiction and applied its findings and knowledge to develop products and marketing approaches to increase the likelihood that people, especially young people, would try tobacco products and develop persistent use and addiction. Researchers outside of the tobacco industry also investigated the behavioral biology of tobacco use and their research has been critical in turning the tide of the tobacco and disease epidemic. The behavioral factors are considered vital to understand and address by United States Food and Drug Administration and Surgeon General, as well as the World Health Organization in their tobacco control efforts. This commentary discusses key behavioral factors in the rise and fall of the epidemic, as well as some of those increasingly discussed as potential contributors to the endgame.