BBeyond the usual memorable factors—fears of the Millennium Bug, dawn of the 21st century—January 1, 2000 is a significant date in Brookline, Massachusetts. In the city on the outskirts of Boston, vendors are prohibited by law from selling tobacco products and e-cigarettes to anyone born after the year 2000.
The legislation went into effect last September after a November 2020 vote, making Brookline the first US city implement such a law in hopes of phasing out smoking for younger generations.
It’s not clear how effective the policy will be in Brookline, given the city’s proximity to other jurisdictions where sales are legal. But similar proposals – often referred to as ‘tobacco-free generations’ (TFG) policies – are now being considered nationally by several countries.
New Zealand will introduce a law this year that would bar anyone under the age of 14 – when the law goes into effect in 2023 – from ever legally buying smoking products. Unlike Brookline, New Zealand’s policy does not ban the sale of e-cigarettes. Legislators in Denmark are considering a similar proposal for everyone born after 2010, and in recent months both those Malaysian and Singaporean Health ministries have indicated their intention to follow New Zealand’s lead in aiming for a tobacco endgame. Should Australia consider similar legislation?
“No Safe Age”
Tobacco smoking is the leading cause of premature death and disability in Australia. It kills more people in this country every year than alcohol, car accidents, murders, suicides or – in the last two years – Covid, points out Jon Berrick, professor emeritus at Yale-NUS College in Singapore, who now lives in Sydney.
A mathematician by training, Berrick developed a personal interest in tobacco policy and was among a group of researchers who developed the TFG idea in a 2010 paper. It proposed 2000 as the threshold birth year for a “long-term phasing-in of a total ban”.
Unlike laws that ban sales to under-18s or under-21s, “send the message if you have it based on a birth cohort: There’s no safe age to smoke,” says Berrick.
Smoking rates in Australia have steadily decreased since the 1990s to 11.6% of adults in 2019. Between 2001 and 2019, the proportion of daily smokers aged 18 to 39 increased halvedalthough the numbers have not improved in the 50s and 60s.
Proponents of the TFG laws believe it’s a more palatable option than an outright ban on all smoking products.
“You can’t just ban it overnight. What happens to the people who depend on it?” says Berrik. Date-of-birth-based sales restrictions would instead focus on discouraging youngsters from starting to smoke in the first place, he says.
So far there has been one attempt to implement the TFG legislation in Australia – an unsuccessful one Private members bill in Tasmania, introduced in 2014 by Independent MP Ivan Dean.
The state would be well positioned to implement a TFG proposal, says Dr. Kathryn Barnsley, Assistant Researcher at the University of Tasmania and organizer of SmokeFree Tasmania. “We have a very good licensing system and highly efficient enforcement of underage sales in Tasmania that some of the other states don’t have.”
The sale of tobacco products and enforcement of regulations are the responsibility of state governments, “except for some Commonwealth laws related to advertising and packaging,” Barnsley says.
However, references to age restrictions can be found in the latest consultation draft 2022-2030 national tobacco strategywhich proposes to “assess the feasibility of raising the minimum age for purchasing tobacco products and to monitor international developments on this matter”.
Fear of the black market
TFG proposals are not without criticism. dr Brendan Gogarty of the University of Tasmania wrote The conversation in 2016 that while smoking “poses a significant social hazard,” the legislative response to social risks “must be evidence-based and respect constitutional limits and civil liberties.”
“Directing laws against people who cannot hold the legislature accountable in the election is undemocratic. It’s also unfair when one generation tells the other to do what I say, not what I do,” Gogarty wrote.
He also criticized the effectiveness of tobacco bans: “Laws that rely on prohibition to reduce the spread and harm of drugs tend to fail in their goals. That was true of historic liquor prohibition laws. The statutory narcotics ban continues to apply.”
But Berrick points this out two historical precedents for generational phase-out, in regulations that successfully curbed opium smoking in Taiwan, then known as Formosa, in 1900 and in Sri Lanka – then a British colony – in 1911.
“You have to have demand to create a black market,” says Barnsley. “Tobacco would remain glutted in Australia or Tasmania or any other state if you brought the tobacco-free production proposal forward because it would still be legitimately sold in outlets.”
Marita Hefler, associate professor at the Menzies School of Health Research in Darwin, also rejects the criticism of the ban. “It’s a lame argument to say ‘prohibition never works,’ or to use the 1920s US experiment or even the ‘War on Drugs’ as evidence,” she says.
“After more than 30 years of policies to reduce smoking, the Australian public has overwhelmingly negative attitudes towards cigarettes and the tobacco industry.
“A majority of smokers want to quit and wish they had never started. Most smokers do not want the young people in their lives to ever smoke.”
A downside to the TFG proposal is that “this measure alone will not achieve Australia’s goal less than 5% smoking prevalence by 2030because it is a very slow phase-out,” says Coral Gartner, Associate Professor at the University of Queensland and international tobacco control policy expert.
“In New Zealand, it’s a policy that’s being introduced with a range of other policies that are likely to have a bigger and faster impact on the spread of smoking, such as a very low nicotine standard for cigarettes,” she says.
Gartner and Hefler are among the public health experts who have done so advocated stricter regulation of tobacco sales in Australia and calls for a ban on the sale of cigarettes in general retail outlets.
“If the level of potential harm from vaping products is deemed unacceptable to sell as consumer products [nicotine vapes are now prescription-only in Australia] — that should also make everyone wonder why it’s acceptable to sell tobacco cigarettes…when they have a much stronger evidence base in terms of health risk,” says Gartner.
An alternative could be the design of a “pharmaceutical” regulatory framework, she suggests, where the products are supplied in pharmacies and “a healthcare professional can advise on the risks and benefits”.
According to Hefler, any TFG proposal would “need to prevent a new epidemic of e-cigarette use emerging among young people and non-smokers” – a potential risk in New Zealand. “But cigarettes still need to be more tightly regulated than e-cigarettes and need to be abolished overdue,” she says.
More than a decade after he and his colleagues proposed the TFG idea, Berrick seems pleased that lawmakers around the world are now seriously considering it as an end-game approach to tobacco. “I joke that peer influence is just as important among health ministers as it is among teenagers,” he says.