Youth participation in tobacco control: From symbolic engagement to Shared governance

Youth-led interventions are increasingly recognized as vital in advancing global tobacco control, yet their ethical and strategic dimensions remain underexplored. Building on the study by Karki et al., which demonstrated that youth-led awareness and advocacy interventions can positively influence adolescents' attitudes toward tobacco products in Nepal, this letter highlights two key considerations. First, youth participation must move beyond symbolic engagement toward genuine power-sharing within decision-making structures, ensuring that adolescents are treated as co-governors rather than temporary campaigners. Second, attitudinal change should be situated within broader structural dynamics, particularly the influence of the tobacco industry. Without enforceable reforms such as taxation, advertising restrictions, plain packaging, and protection from industry interference, youth empowerment risks being undermined. We argue for an integrated approach that combines empowerment, governance, and structural reform to transform short-term attitudinal shifts into sustained intergenerational public health gains.