Drawing on Adolescent Psychology to Achieve Tobacco-Free Generations

Guidance for Introducing the Tobacco-Free Generation Policy

This article serves as a guide to the Tobacco-Free Generation policy (TFG) for policy-makers, drawing on experiences of negotiations regarding TFG in a wide number of jurisdictions. It explains the underlying concept: the highly addictive nature of nicotine prompts policy focus on preventing initial use by forbidding sales to those born after a prescribed cut-off birthdate, while resisting prohibition for those in older cohorts who may already be nicotine-dependent. The policy signals that there is no safe age for tobacco products. We examine how to assess whether a jurisdiction is ready for TFG, and then, how to maximise its effectiveness. That involves considering preparatory steps. Implementation of TFG is discussed, including which tobacco or nicotine products should be covered, on which actions there should be focus, choice of a suitable cut-off birthdate, and the most helpful companion measures. We also outline potential pushback from the tobacco industry and others, and indicate appropriate responses.

What measures are needed to achieve a tobacco endgame target? A Singapore-based simulation study

BACKGROUND

An increasing number of countries are pursuing a tobacco 'endgame'. We sought to determine the combination of measures it would take to achieve a tobacco endgame in the city-state of Singapore.

METHODS

Using an open-cohort microsimulation model, we estimated the impact of existing measures (quit programmes, tobacco taxes, flavours ban) and more novel measures (very low nicotine cap, tobacco-free generation, raising the minimum legal age to 25 years), and combinations thereof, on smoking prevalence in Singapore over a 50-year horizon. We used Markov Chain Monte Carlo to estimate transition probabilities between the states of never smoker, current smoker and former smoker, updating each individual's state across each year with prior distributions derived from national survey data.

RESULTS

Without new measures, smoking prevalence is expected to rebound from 12.2% (2020) to 14.8% (2070). The only scenarios to achieve a tobacco endgame target within a decade are those combining a very low nicotine cap with a flavours ban. A nicotine cap or tobacco-free generation alone also achieve endgame targets, but after 20 and 39 years, respectively. Taxes, quit programmes, a flavours ban and minimum legal age increase do augment the impact of other measures, but even when combined are insufficient to achieve a tobacco endgame target within 50 years.

CONCLUSION

In Singapore, achieving a tobacco endgame within a decade requires a very low nicotine cap coupled with a tobacco flavours ban, although this target can also be achieved in the long term (within 50 years) with a tobacco-free generation.

Tobacco endgame measures and their adaptation in selected European countries: A narrative review synthesis

Due to the continued detrimental effects of tobacco use, a growing number of countries are embracing the idea of tobacco endgame, meaning ending the tobacco epidemic instead of controlling it. This narrative review aims to synthesize and update the evidence from earlier scientific reviews on effective tobacco endgame measures, as well as to assess their integration to current national strategies among European countries with official tobacco endgame goals. The synthesis of the prior scientific literature found most evidence on product-focused and some evidence for supply-focused policies. Little evidence was detected for user- and institutional-focused measures. An update for the tobacco-free generation measure showed uncertainty in reducing smoking prevalence, especially for adolescents' reactions to age-restrictive laws. All the countries that established a tobacco endgame strategy have included product standards in their measures, predominantly based on European Union regulations on conventional tobacco products, yet standards above this level and considering other products were also common. Cessation measures were given strong emphasis in strategies, yet none of the countries linked these to specific endgame measures. Despite commonly mentioning vulnerable groups, such as youth and pregnant women, adoption of measures to reduce tobacco use among these groups was scarce. Lastly, the decline in tobacco use seems to be modest, implying challenges in meeting the endgame goals. To meet these goals, European countries should reinforce the implementation of known effective tobacco control measures such as tax increases. Furthermore, new innovative strategies and measures to meet the objective of an endgame should be explored.