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Cohort (i.e., generational) effects reflect the impact of macro-level contextual (e.g., environmental, social, cultural) pressures across the life course on a group of individuals born within a specified period (i.e., birth cohort) 5

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Grey literature was also searched April 2, 2024 (updated September 8, 2025), including clinical trial registries (ClinicalTrials.gov, WHO ICTRP) and pre-print servers (EuropePMC and Dimensions.ai)

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However, there appears to be an irrational aspect to the reactions of smokers to the changes