A grocery store sign informs shoppers that IDs are checked for tobacco purchases. In Massachusetts, some towns are phasing out the ability to buy tobacco products by birth date.
Photo by Michele Late
“It’s a completely unique product that would never be approved for sale now. So the question is, why is it still for sale? And the answer is because people are dependent on it.”
— Katharine Silbaugh
Nearly 30 years after becoming the first Massachusetts municipality to adopt an indoor smoking ban, the town of Brookline reached another milestone recently, with leaders hoping it will help pave the way toward a tobacco-free generation.
With tobacco use still the nation’s leading cause of preventable death, the metropolitan Boston-area town passed a measure in 2020 to ban the sale of nicotine products to anyone born on or after January 1, 2000 — the first of its kind in the nation. Since then, three other towns in the state — Melrose, Stoneham and Wakefield — have passed similar measures.
“We think this product should be viewed as if it were asbestos and lead paint,” Katharine Silbaugh, JD, a Boston University law professor and a Brookline resident who co-sponsored the town’s ordinance, told The Nation’s Health. “It’s a completely unique product that would never be approved for sale now. So the question is, why is it still for sale? And the answer is because people are dependent on it.”
Use of combustible tobacco, which includes cigarettes, cigars and hookah, costs the U.S. health care system $300 billion annually. Each year, cigarette smoking alone kills about 480,000 people, according to the Centers for Disease Control and Prevention. E-cigarettes, often touted as an alternative to combustible tobacco, contain chemicals that harm the developing brains of youth, who are drawn to the products.
While hailed by public health supporters, the passage of Brookline’s measure was not without controversy. Retailers sued, claiming state law on purchasing ages for tobacco and nicotine products preempted the town’s bylaw. However, the Massachusetts Supreme Judicial Court ruled in March that local laws can coexist with state laws, allowing Brookline’s phaseout to continue.
Policies to create a tobacco-free generation are not new. The idea to phase out tobacco sales by date of birth has been discussed and debated for more than a decade in the U.S. and around the world. In 2016, Philippines’ Balanga City became the first municipality globally to pass such a policy, ending tobacco sales to people born after 2000 and establishing a smoke-free zone within its borders. New Zealand passed a similar phaseout law, but it was repealed in February by newly elected officials. Balanga City’s phaseout was repealed in 2018, though supporters are appealing.
Birth date-based phaseouts of tobacco sales have also been under discussion recently in Australia, Malaysia, Norway, Singapore and beyond. In April, a proposed phaseout was introduced in Parliament in the United Kingdom.
While Balanga City’s actions on tobacco control have been credited with reducing smoking rates there, such policies have been criticized by some as an impediment to personal freedom, said Anthony Chui, MPH, director of health and human services for a Massachusetts region that includes Melrose, Wakefield and Stoneham. But he argues that through their addiction, smokers already lack freedom.
“We talk to people who have or are actively using tobacco or are fighting addiction, and the biggest takeaway we get from them is that choice is a bit of an illusion with tobacco,” Chui told The Nation’s Health. “For those who have become addicted to tobacco products, it’s not really a choice at that point.”
Action on Smoking and Health, an advocacy group, uses its Project Sunset campaign to help jurisdictions create tobacco-free generation policies. Cities and towns that consider adopting such policies should focus on the supply of tobacco, rather than penalizing the people who purchase tobacco products, and offer resources for people who want to quit, according to Chris Bostic, MSFS, JD, Action on Smoking and Health’s policy director.
“There’s 29 million adult smokers in the U.S.,” Bostic told The Nation’s Health. “More than half of them will die (from it) unless we can help them quit. Most of them want to quit, and more than half try to quit every year and fail. We need to do a lot better on that.”
Tobacco cessation policies should also target youth who are already addicted to the products, according to Ginny Chadwick, MPH, MA, a member of APHA’s Alcohol, Tobacco and Other Drugs Section.
People who use tobacco in their youth are more likely to become dependent and have trouble quitting the products.
Photo by Beata Zawrzel, courtesy NurPhoto/Getty Images
“It’s absolutely absurd we don’t have a tested, proven message to help kids with cessation,” said Chadwick, the Section’s program co-chair and a Brandeis University doctoral student in behavioral health. “We adults let an industry target, market and sell these products to our kids. They became addicted and now we don’t know how to get them off it.”
It will take time before bylaws phasing out tobacco sales by birth year gain traction in states beyond Massachusetts, Chadwick predicted. The first Tobacco 21 policy that raised the tobacco purchasing age from 18 to 21 passed in Needham, Massachusetts, in 2005, but it did not become federal policy until 2019. Another factor is that some state governments limit local municipalities from creating their own public health measures.
But advocates have suggested that municipalities in California, which have had success at using innovative methods to restrict and end tobacco sales, might be a good fit for phaseout policies.
Ultimately, Brookline’s success will be measured by how many other jurisdictions adopt similar policies, said Sigalle Reiss, MPH, the town’s director of public health and human services. When more towns adopt similar policies, people will not be able to easily travel to buy nicotine products. And greater adoption could spur a statewide phaseout.
“It wasn’t all of a sudden we decided to have a tobacco-free generation,” Reiss told The Nation’s Health. “It was Tobacco 21, flavor bans, restricting certain locations like pharmacies and health care institutions. There were these incremental steps of policy development all really on the local level, starting in a few communities and then spreading across the majority of cities and towns in Massachusetts.”
In St. Paul, Minnesota, the Association for Nonsmokers-Minnesota hopes to build on the momentum of nicotine-free generation policies, said Jeanne Weigum, the association’s president. Weigum said student surveys reveal nicotine use is high among young people due to vaping, which she said has wiped out 10 years of progress on tobacco prevention. Her newest concern is nicotine pouches that contain high concentrations of nicotine.
“This industry’s whack-a-mole,” Weigum told The Nation’s Health. “You punch them down one place, they pop up another. Which is why we’re saying we’re not dealing with cigarettes anymore, we’re dealing with nicotine. Because nicotine is what sells.”
For more, visit https://ash.org/sunset.
- Copyright The Nation’s Health, American Public Health Association
