Time to raise the minimum purchasing age for tobacco in Australia

Increasing the minimum purchasing age may be the most straightforward way towards a tobacco-free generation

Australia is often described as a global leader in tobacco control. While this is true, it has taken two generations to reduce current smoking rates to around 15% of the population, and there is still a long way to go, especially in disadvantaged communities.

Tasmania’s tobacco-free generation

One innovative idea on the road towards minimising smoking rates is currently before the Parliament of Tasmania. Put simply, passage of the Public Health Amendment (Tobacco-free Generation) Bill 20141 would ensure that people born after 1999 could not lawfully purchase tobacco at retail outlets within Tasmania in their lifetimes.2

The Tobacco-free Generation Bill was introduced into the Legislative Council by independent member Ivan Dean, whose father was a chain smoker and who suffered terribly before dying from lung cancer.2 The Bill is currently being considered by a Parliamentary Committee, and public submissions can be viewed online.3

The Tobacco-free Generation Bill defines a member of the tobacco-free generation as “a person born on or after 1 January 2000”.1 Although the Bill does not prohibit smoking by a member of the tobacco-free generation, it does create a new offence for retailing tobacco within Tasmania to such a person, with a first-time penalty of up to $7700.1 By contrast, there would be no offence for retailing tobacco to adults born before 2000. As time passes, the legislation would create two distinct classes: adults who, by virtue of being born before the year 2000, would be entitled to continue to purchase tobacco during their lives; and adults of the tobacco-free generation, born after 31 December 1999, who would be forever unable to purchase tobacco lawfully in Tasmania.

The Bill would create an offence for a member of the tobacco-free generation to use a false proof of age to purchase tobacco, with a fine of up to $540. However, it would not penalise friends or family members from purchasing tobacco that was subsequently consumed by a member of the tobacco-free generation, provided that the tobacco was given, rather than sold, to that person.1,2

In its submission to the Committee, the Tasmanian Government raised concerns that the Bill would encourage interstate and internet purchases of tobacco by smokers who were members of the tobacco-free generation, thereby undermining the goals of the Bill. It pointed to the Tasmanian Population Health Survey as evidence that current policies were reducing smoking rates effectively.4

Predictably, the Bill has been opposed by tobacco manufacturers. One submission by a retailer on Flinders Island suggests that Imperial Tobacco systematically urged retailers to lobby the Legislative Council against the Bill.5

Seizing the opportunity for leadership in tobacco control in Tasmania

Tobacco is more than just the “risky product” that tobacco companies claim it to be. If today’s smokers do not quit, a majority will die prematurely from tobacco-related diseases. A study by Banks and colleagues published in 2015 suggests that about two-thirds of deaths among current smokers are caused by smoking.6 The authors followed more than 200 000 smokers aged over 45 years, for 4 years, showing that even ten cigarettes daily doubles a person’s risk of dying prematurely. As Tasmania’s popular former Premier, Jim Bacon, said in 2004, when he quit politics following a diagnosis of lung cancer: “The message from me to everyone is please don’t be a fool like me, don’t keep smoking, try and give it up and if you are young and you haven’t started, don’t start”.7

The idea of legislating for a tobacco-free generation is one of a growing number of tobacco endgame scenarios promoted by tobacco control advocates.8 While it is plausible that the Bill could discourage smoking initiation by members of the tobacco-free generation, it is possible that the Bill might also inadvertently create a permanent “outlaw class” of adults addicted to tobacco but unable to purchase it lawfully within Tasmania. Achieving acceptance about why two adults of different ages should be treated differently in terms of their right to access tobacco is one of the challenges the Bill faces.

If the Tobacco-free Generation Bill does not succeed, the opportunity remains for Tasmania to show national leadership by raising the minimum purchase age for tobacco to at least 21 years. A higher minimum purchase age would make it more difficult for youth to access tobacco at the ages when they are most vulnerable to smoking initiation.

The case for raising the minimum purchasing age for tobacco

The case for a higher minimum purchasing age is supported by four key factors. According to the National Drug Strategy Household Survey (NDSHS), in 2013 Tasmania’s daily smoking rate for people aged 14 years and above was 16.1%. This is second only to the Northern Territory (21.3%) and well above the national average of 12.8%.9 The same survey found that 31.6% of Tasmanians aged 18–24 years were daily smokers — more than twice the Australian average of 13.4% for this age category.9 In its submission to the Parliamentary Committee, the Tasmanian Government quoted the Tasmanian Population Health Survey 2013, which estimated a 19.7% smoking rate for 18–24-year-olds, and a 15% smoking rate overall.4 The Tasmanian Department of Health and Human Services has acknowledged that due to its methodology, the Tasmanian survey significantly under-represented males and younger age groups.10 NDSHS estimates suggest that smoking rates remain alarmingly high in young adults and that innovative strategies are needed to ensure that Tasmania does not fall further behind the mainland states.

Second, a higher minimum purchasing age for tobacco could help to reduce high smoking rates among young pregnant women. In 2013, the average rate of smoking while pregnant was 12% nationally,11 but was 15% in Tasmania and in excess of 33% among pregnant Tasmanian women aged under 20 years.12

Third, a higher minimum purchasing age for tobacco could go a long way towards encouraging the creation of a tobacco-free generation, since few people begin smoking for the first time after their mid-20s. A 2013 study of smoking initiation rates in New Zealand confirmed that while initiation after age 24 is rare, the highest initiation rates occur among those aged 15–21 years. Over a 4-year period, the rate of smoking initiation for those aged 15–17, 18 and 19, and 20–24 years was 14.2%, 7.0% and 3.1%, respectively.13

Finally, in the United States, at least 30 cities and counties, including New York City, have set 21 years as the minimum purchasing age for tobacco products.14 Four states have raised the minimum purchase age to 19 years,14 and in June 2015, Hawaii raised it to 21 years for both tobacco products and e-cigarettes.15 If linked to a proof-of-age swipe card or so-called smoker’s licence, the right to purchase tobacco could be verified instantaneously.16

In its recent report, an expert committee of the US Institute of Medicine concluded that raising the minimum purchasing age for tobacco would delay initiation by adolescents, with the largest proportion of reductions being among teenagers aged 15–17 years.14 Based on modelling, the Committee concluded that while raising the minimum purchase age to 19 years would likely yield only a modest reduction in smoking initiation by 18-year-olds, raising it to 21 years would substantially reduce smoking prevalence and smoking-related mortality, given the numerous life transitions that young adults experience between 18 and 20 years. The Committee concluded that increasing the minimum purchasing age would also improve fetal, maternal and infant health outcomes by reducing the likelihood of maternal or paternal smoking.14

A survey of Australian secondary school students’ use of tobacco found that in 2014, nearly 18% of 16–17-year-old smokers purchased their last cigarette from a commercial source.17 This finding underscores the need for rigorous enforcement of existing laws to further reduce the retail availability of tobacco to underage youth. However, the fact that current underage smokers mostly obtain their tobacco from non-commercial sources does not demonstrate that current age restrictions have no impact on youth smoking rates, nor that a higher minimum age would be similarly ineffective. Rigorously enforced age restrictions reduce tobacco purchase attempts and youth smoking rates,14,18,19 although their impact is likely to be strengthened when integrated within a comprehensive set of tobacco control policies that maintain high retail prices and de-normalise tobacco use.14,20 These features would likely boost the impact of youth access laws by reducing or interrupting sources of social supply, inhibiting initiation and leading to decreased tobacco use rather than mere substitution of purchased tobacco with tobacco from social sources.20

Summary

The time has come for Australian state governments to seriously consider raising the minimum purchasing age for tobacco. If the Tasmanian Parliament fails to support the Tobacco-free Generation Bill, as seems likely, a higher minimum purchasing age could reinforce efforts to reduce smoking initiation and help to address the significant health inequalities that Tasmanians experience relative to the mainland states. Simple amendments to the provisions in the Public Health Act 1997 (Tas) that govern underage smoking could raise the minimum purchasing age and encourage the creation of a tobacco-free generation. In late December 2015, the Tasmanian Government released a 5-year strategic plan for health that includes raising the minimum legal smoking age to 21 or 25 as an option for consideration.21 This is welcome news. Rigorous monitoring and enforcement of legislative amendments to raise the minimum purchase age for tobacco would strengthen social norms against youth smoking, and generate data that could inform tobacco control policies in other states.