Beyond the usual memorable factors — fears about the millennium bug, the dawn of the 21st century — January 1, 2000, is a significant date for residents of Brookline, Massachusetts. In the town on the outskirts of Boston, vendors are legally banned from selling tobacco products and e-cigarettes to anyone born after Y2K.
The legislation came into effect in September last year, after a vote in November 2020, making Brookline the first US town to implement such a law, in the hopes of gradually phasing out smoking for younger generations.
It is not clear how effective the policy in Brookline might be, given the town’s proximity to other jurisdictions where sales are legal, but similar proposals — often termed policies for the “tobacco-free generation” (TFG) — are being considered at the national level by several countries.
Illustration: Mountain People
New Zealand is set to introduce a law this year that would prevent anyone aged 14 and younger — when the legislation takes effect next year — from legally buying smoking products. Unlike Brookline, New Zealand’s policy does not include a ban on e-cigarette sales.
Lawmakers in Denmark are considering a similar proposal for anyone born after 2010, and the Malaysian and Singaporean health ministries in the past few months have flagged their intention of following New Zealand’s lead in aiming for a tobacco endgame.
Should Australia consider similar legislation?
’NO SAFE AGE’
In Australia, smoking tobacco is the leading cause of premature death and disability. It kills more people in the country each year than alcohol, traffic accidents, murders, suicides or — in the past two years — COVID-19, said Jon Berrick, an emeritus professor at Singapore’s Yale-NUS College who lives in Sydney.
A mathematician by training, Berrick developed a personal interest in tobacco policies and was one of a group of researchers who floated the TFG idea in a 2010 paper. It suggested 2000 as a threshold birth year for a “long-term phasing-in of a total ban.”
Unlike laws prohibiting sales to people under 18 or 21, “if you have it on a birth cohort basis ... you’re sending out the message: there is no safe age for smoking,” Berrick said.
Smoking rates have declined steadily in Australia since the 1990s, to 11.6 percent of adults in 2019. Between 2001 and 2019, the proportion of daily smokers aged 18 to 39 halved, although figures have not improved among people aged between 50 and 70.
Proponents of TFG laws believe that it is 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 are dependent on it?” Berrick said.
Sales restrictions based on birth date would instead concentrate efforts on preventing adolescents from taking up smoking in the first place, he said.
There has been one attempt to implement TFG legislation in Australia — an unsuccessful bill introduced in 2014 by former independent member of the Tasmanian Legislative Council Ivan Dean.
Tasmania State would have been well placed for implementing a TFG proposal, said Kathryn Barnsley, an adjunct researcher at the University of Tasmania and convenor of SmokeFree Tasmania.
“We’ve got a very good licensing system and highly efficient enforcement of sales to minors in Tasmania, which some of the other states don’t have,” she said.
The sale of tobacco products, as well as enforcement of regulations, is under the purview of state governments, “with the exception of some commonwealth legislation relating to advertising and packaging,” Barnsley said.
However, there are hints at age restrictions in the latest consultation draft of the National Tobacco Strategy, which proposes to “consider the feasibility of raising the minimum age of purchase of tobacco products and monitor international developments on this matter.”
BLACK MARKET FEARS
TFG proposals are not without their critics.
University of Tasmania law professor Brendan Gogarty said in an article on the Conversation Web site in 2016 that while smoking “represents a significant social danger,” the legislative response to social risks “must be evidence-based, and considerate of constitutional limits and civil rights.”
“Targeting laws at people who cannot hold lawmakers to account at the polls is undemocratic. It is also unfair to have one generation telling the other to ‘do as I say, not as I do,’” Gogarty said.
He also criticized the effectiveness of tobacco prohibition.
“Laws that rely on prohibition to reduce the prevalence and harm from drugs generally fail to achieve their aims. That was true of historic alcohol prohibition laws. It remains true of the continued legal prohibition on narcotics,” he said.
However, Berrick points to 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, a British colony at the time, in 1911.
“You have to have demand to create a black market,” Barnsley said. “Tobacco would remain awash in Australia or Tasmania or any other state if you brought in the tobacco-free generation proposal, because it would still be sold legitimately in outlets,” he said.
Menzies School of Health Research associate professor Marita Hefler is also dismissive of prohibition criticisms.
“It’s a lazy argument to say that prohibition never works, or to use the US experiment from the 1920s or even the ‘war on drugs’ as evidence,” she said.
“After 30-plus years of policies to reduce smoking, the Australian public overwhelmingly have negative attitudes towards cigarettes and the tobacco industry,” she said. “A majority of smokers want to quit and wish they had never started. Most smokers don’t want the young people in their lives to ever smoke.”
One downside of the TFG proposal is that “this measure on its own won’t achieve Australia’s goal of less than 5 percent smoking prevalence by 2030, because it is a very slowly implemented phase-out,” said Coral Gartner, an associate professor at the University of Queensland and an international expert in tobacco control policy.
“In New Zealand, it is a policy that is being brought in with a range of other policies that are likely to have a larger and faster impact on smoking prevalence, such as a very low nicotine standard for cigarettes,” she said.
Gartner and Hefler are among public health experts who have appealed for stricter regulation of tobacco sales in Australia, calling for a ban on cigarettes from being sold in general retail outlets.
“If the level of potential harm from vaping products is considered unacceptable for them to be sold as consumer products” — nicotine vapes are prescription-only in Australia — “that should also make everyone question why is it acceptable for tobacco cigarettes to be sold ... when they have a much stronger evidence base in terms of risk to health,” Gartner said.
An alternative could be designing a “pharmaceutical-like” regulatory framework, in which the products are supplied in pharmacies and “a health professional can provide advice on risks and benefits,” she said.
Hefler said that any TFG proposal would need to “avoid creating a new epidemic of e-cigarette use among young people and non-smokers” — as is a potential risk in New Zealand.
However, “cigarettes need even tighter regulation than e-cigarettes and are overdue to be phased out,” she said.
More than a decade after he and his colleagues proposed the TFG idea, Berrick seems pleased that legislators around the world are seriously considering it as an endgame approach to tobacco.
“I joke that peer influence is just as important among health ministers as it is among teenagers,” he said.
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