Friedman_et_al-2019-Addiction (1)

Frequently Asked Questions

PUBLIC HEALTH AMENDMENT (PREVENTION
OF SALE OF SMOKING PRODUCTS TO UNDERAGE PERSONS) BILL 2018

Overview

The proposal is to prohibit the sale or supply of tobacco products to any person born since July 2002, until they turn 21 years.

The Amendment will not penalise or criminalise smokers or those in possession of tobacco products, nor will it prohibit the growing of tobacco. This is not “prohibition”; it is a gradual phase out of the commercial sale of tobacco products in Tasmania.

Under present laws, a child born in 2002 can legally be provided with cigarettes from 2020 onwards. Under the proposed law, when 2020 arrives, it will continue to be illegal to sell them tobacco products.

The legislation will be reviewed.

The purpose of the Amendment is to protect younger Tasmanians from ever becoming smokers, and to protect future generations from the terrible diseases caused by smoking.

What research is available in Tasmania on T21?

Background

• The Menzies Institute was engaged to locally analyse the prevalence of smoking in Tasmania an examine the attitudes and beliefs of stakeholders impacted by the proposed T21 legislation.
• They undertook the following investigations:
  • Secondary analysis of existing data sources - examined trends in the prevalence of smoking across different surveys over time in target age groups, factors associated with smoking status in young Tasmanians, attitudes and beliefs related to smoking among younger people in Tasmania and the characteristics of people attending compared to not attending school in Tasmania using data from a school-based survey, the National Health Survey and Tasmanian Smoking and Health Survey.
  • Youth online survey – online survey of more than 50 Tasmanians aged 15 to 25 years to provide an understanding of young Tasmanian’s attitudes and beliefs regarding why young people smoke, where they access tobacco, and their understanding of tobacco control strategies, including Tobacco 21.
  • Stakeholder survey – online survey of almost 200 government, non-government and retail representatives to understand attitudes and their beliefs regarding why young people smoke, where they access tobacco, and their understanding of tobacco control strategies, including Tobacco 21.
  • Interviews stakeholders and young people – a total of 29 stakeholder and 12 youth interviews were conducted to provide a deeper understanding of stakeholder and young people’s beliefs regarding why young people smoke, where they access tobacco, and their understanding of tobacco control strategies, including Tobacco 21.

Key findings

• Smoking prevalence has decreased over time but there is evidence of a plateau in some groups with the Tasmanian prevalence higher than the national average.
• The factors associated with smoking uptake in Tasmania are the same as other places in Australia and around the world.
• Most Tasmanians, including young people and stakeholders, support or agree with tobacco 21.
• There is, however, limited understanding of how the proposed Tobacco 21 (T21) legislation would work in practice including implementation and evaluation.
• Most people agree that T21 would make it harder to access cigarettes, that the tobacco industry target young people and that most adults regret starting smoking.
• There is evidence that raising the age of purchase or sale of tobacco to 21 has decreased the prevalence of smoking in several regions in the USA. The effect appears greater when there is evidence of compliance with underage sales laws, e.g. through identification checks at point of sale.
• There is indirect evidence of the effectiveness of T21 from studies examining increases in the age of purchase or sale from 16 to 18 in UK and between regions with age of sale at 18 versus 19 in Canada.
• Concerns about T21 focus on the potential creation of a black market, that supply will continue to occur from other adults, the effects on young people who are addicted to smoking and that 18 years is seen as the age of majority.
• Evaluation of T21 will be important including on smoking prevalence, access to cigarettes, attitudes and beliefs about smoking (particularly social norms) and other non-smoking behaviour related effects such as a black market or penalties will be important.

The Amendment will not penalise or criminalise smokers or those aged 18 to 21 in possession of tobacco products, nor will it prohibit the growing of tobacco. This is not “prohibition”.

What other research is available?

Reports from Deakin can be found at Deakin Report Overview (T21) highlighted and Deakin Health Economics Report 2018 - Copy

The Campaign for Toboacco Free Kids in the USA has information on T21 and a bibliography of research material.

The first place in the USA to raise the tobacco sales age was Needham T21 2003 to 2019, a suburb of Boston. Research report at: https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2019.305209

No retailer went out of business in Needham. No retailers gone out of business Winikoff

Friedman et al have completed a research report, which concludes “Tobacco-21 laws appear to reduce smoking among 18–20-year-olds who have ever tried cigarettes.” Friedman_et_al-2019-Addiction (1)

Is this Prohibition? Will there be a ‘black market”?

What does the Bill say?

It will prevent retailers and the tobacco industry from selling or supplying tobacco to persons in Tasmania over the age of 21 years. It does not affect anyone currently legally able to smoke or buy cigarettes.The 75,000 plus current smokers in Tasmania will still be able to buy cigarettes – indefinitely. 650 Tobacco sellers can continue to sell tobacco products.In effect, year-by-year, it raises the age at which cigarettes can be sold to a person, from 18 years to 21 years, at which time the legislation will be reviewed. For those concerned about what might happen in future there is an opportunity to amend the legislation.

The only penalties for the public are for those producing false proof of age. This penalty is to protect retailers who need to know that they can sell the product legally.

Where did the idea come from?

T21 has been successfully introduced in the US in 18 states, and federally, and demand for tobacco products has fallen in the 18-21 age groups. Furthermore, there has been a decline in the use of vape products by young people in only a few months after the introduction of national legislation, as a result of a bi-partisan bill.

09.16.20

Huge Decline in Teen Vaping Follows McConnell Legislation Raising Tobacco Purchase Age to 21

‘According to the 2020 National Youth Tobacco Survey administered by the FDA and the CDC, the number of American youth using e-cigarettes has dropped by 1.8 million since just last year… That’s a win. And it has happened largely because the Senate stepped up.’

WASHINGTON, D.C. – U.S. Senate Majority Leader Mitch McConnell (R-KY) delivered the following remarks today on the Senate floor regarding the Tobacco-Free Youth Act:

“A few days ago, the country got something that’s been in too-short supply in 2020: Some great news.

“Specifically, great news on the subject of public health.

“According to the 2020 National Youth Tobacco Survey administered by the FDA and the CDC, the number of American youth using e-cigarettes has dropped by 1.8 million since just last year.

“Let me repeat that: 1.8 million fewer young Americans are using e-cigarettes and vaping devices than one year ago.

“This victory for young Americans’ health is no accident. The experts say a number of factors are at play. But one major contributing factor unfolded right here in the Senate.

Last December, the president signed the Tobacco-Free Youth Act into law. It was a bill I wrote and introduced to stem the tide of what was a rapidly-growing public health crisis among our nation’s young people.

“The bipartisan bill that I wrote with my friend Senator Kaine, and with the help of other colleagues including Senator Young, raised the minimum age to purchase tobacco products — including e-cigarettes and vaping devices — from 18 to 21.

“This was based on clear-cut science. Public health experts tell us the harmful effects of nicotine are most potent on bodies and brains that are still developing. Nearly 9 out of 10 adult smokers started by the age of 18.

“So we knew it was time to take action. I’m proud to have led the legislation that took another leap forward in getting nicotine addiction away from our nation’s youth. And by the looks of these data, it has not taken long for our legislation to pay major dividends.

“Nearly two million fewer teens in Kentucky, and Virginia, and Indiana, and across the country are having their future put in jeopardy by these products. That’s a win. And it has happened largely because the Senate stepped up.”

How much of a health problem is tobacco?

Around 560 Tasmanians die every year from the ill effects of smoking tobacco products. There are many illnesses and diseases caused by smoking or which smoking aggravates.

The latest 2014 Report from the US Surgeon General lists a number of diseases now known to be linked to smoking, as well as the ones we already were aware of, such as lung cancer, emphysema and heart disease. These include many cancers as well as stroke, blindness, age-related macular degeneration, congenital defects from maternal smoking, coronary heart disease, pneumonia, vascular disease, chronic obstructive pulmonary disease, asthma, tuberculosis, diabetes, reproductive effects, hip fractures, ectopic pregnancy, male erectile sexual dysfunction and rheumatoid arthritis.

Age 18 is the age of majority for drinking , voting, marriage, joining the armed forces and younger for driving - why not tobacco and smoking products?

• Tobacco is different to all these social choices.
• Nicotine is addictive
• - and alters the structure of the human brain in adolescents under age 25
• - The human brain is not fully developed until age 25 years, and risk assessments are difficult for young people (few believe they will be addicted)
• All these other social decisions can be reversed, or modified
  • voting - you can vote for one party then change your vote at the next election
  • drinking - you can drink alcohol - or not - or drink in moderation
  • driving - you can choose to drive- or not
  • you can get a divorce if you marry unhappily
  • you can leave the armed forces

Legalisation of Vaping nicotine would be better - wouldn’t it?

• Vaping nicotine is a matter for the federal government as it falls within their purview.
• This argument has been put forward by the tobacco industry and their front groups and has nothing to do with T21.
• The Bill covers both e-cigarettes and tobacco products. Only non-nicotine e-cigarettes are lawful to be sold in Tasmania.
• See our page on e-cigarettes and vaping for more information.

Why not get the federal government to do this or get national agreement?

• Tobacco sales age is a matter for State Public Health laws - raising the tobacco sales age from 16 years to 18 years in Tasmania was done under the Public Health Act in the 1990s - as well as other states in the 1980s to 90s. There was no phase in period and 17 year olds were able to smoke one day - and not the next. There were no difficulties experienced with this legislation, and there was little enforcement for the first couple of years - mostly warnings given.
• We have seen the inability to gain national agreement on public health issues play out in relation to COVID19. It is almost impossible to get agreement between states and the Commonwealth on such matters. Some states may have low smoking rates and see T21 as not necessary. Other states do not have effective licensing or enforcement systems in place. These are essential pre-conditions for effective operation of T21 laws. The model policy as set out in the USA reflects these pre-conditions which Tasmania meets.
• Tasmania legislated to ban fruit flavoured cigarettes a few years ago, but not all other States followed, therefore the legislation lapsed - as content and engineering of tobacco products IS a federal matter.

Is it appropriate to deny this century’s Tasmanians the “right” to be sold tobacco?

There is no inherent right to smoke or sell tobacco.

In any society there are limits on individuals’ rights, and this proposal limits retailers from selling tobacco to young people. Eventually, there will be no sales.

Tasmanians already don’t have the right to use or buy or sell other harmful substances like opium, heroin and crack cocaine. Even alcohol, explosives, guns, poisons and prescription medicines have many restrictions on their sale or supply.

In view of the overwhelming evidence of the harm caused by tobacco, it would be inconsistent not to similarly protect future generations from tobacco.

Will prevention of legal sales encourage a black market in cigarettes?

No, because current nicotine addicts will not be deprived of cigarettes, so there won’t be any desperate buyers.

There are 70,500 smokers in Tasmania who will be unaffected by this legislation. There are 650 licensed tobacco sellers in Tasmania. Tasmania will have plenty of tobacco.

For a black market to succeed you need demand. Demand will be reduced gradually over time and smoking rates will fall. This is not a sudden measure, it is a very slow phase in over forty years and more.

As there would be fewer than 800 Tasmanian adolescent smokers achieving the age of 18 years in the year 2020 (depending on smoking rates at that time), then around three people per day, would have their 18th birthday, and may seek to purchase cigarettes. Therefore there would be no more than three people around Tasmania each day who would have been seeking to buy cigarettes. From Burnie to Launceston to Scottsdale to Dover and in between. This widely scattered group would not be located in any one place, and would have little or no impact on individual sales outlets.

Young people who smoke now mostly “bot” cigarettes from their friends or family, around 62%. That might continue for the first couple of groups who turn 18 and 19 , however, it is expected that the numbers of children taking up smoking will continue to fall, and this need to get cigarettes will soon decline. The tobacco industry say that this new generation will get cigarettes online. The fact is they won’t need to, because it fewer of them will be smoking, and those that are will still be able to get cigarettes from friends without penalty.

The process of the T21 implementation is very slow, over three years, and so there is no immediate impact likely to trigger a sudden demand for cigarettes.

The advantage of the T21 proposal is that it avoids any problems that might otherwise be associated with an end to sales of tobacco products, because it is so slow and gradual. It allows retailers to have many years to adjust to selling other products, and in fact most purchasers will buy consumer goods other than tobacco with the money freed up from tobacco.

In the USA where T21 is now law federally and in all states, there is no evidence of a black market relating to T21.

Isn’t there a case for personal choice?

The tobacco industry use the term “choice” in relation to smoking tobacco products, when in fact this is a highly addictive substance that once commenced, especially by children, is extremely difficult to give up. Until the late 1980s when the US Surgeon General affirmed that nicotine is addictive, the scientific contest was whether or not tobacco use was habituation or addiction. Since then, authoritative bodies, including the UK Royal College of Physicians have indicated that nicotine in tobacco is more addictive than banned substances such as heroin.

Therefore it is misleading to say people should have a “choice” to smoke. People, especially adolescents and children, lose any ability to choose soon after they become addicted and they have to make monumental efforts to quit as an adult. For many it is too late and they die or suffer terrible problems as a result.

Aren’t there smokers who live to 90?

The Doll et al. study says:

• 30% of nonsmokers live to 90
• 4% of smokers live to 90

Is smoking a paediatric disease?

Smoking has been described as a paediatric disease by former FDA Director Dr David Kessler, because it is taken up by children, who are then unable to quit as adults, or find it difficult to do so. Adolescent and child smokers rarely think they are addicted, and most think they can quit any time. This is a false belief.

As we now know the tobacco industry lied about the addictiveness of nicotine and tobacco for many decades. They still push the term “choice” and name their tobacco outlets “Free Choice” and similar titles to try to promote this idea.

A person at the age of 18 years is now suddenly permitted to smoke, however, we know that the human brain does not complete its development until around the age of twenty five years, therefore these young people may commence to smoke when they are not fully cognisant of the risks and problems associated with tobacco smoking.

“The development and maturation of the prefrontal cortex occurs primarily during adolescence and is fully accomplished at the age of 25 years. The development of the prefrontal cortex is very important for complex behavioral performance, as this region of the brain helps accomplish executive brain functions. ”

Arain M, Haque M, Johal L, Mathur P, Nel W, Rais A, Sandhu R, Sharma S. Maturation of the adolescent brain. Neuropsychiatric disease and treatment. 2013;9:449.

When does smoking begin?

Most smokers begin smoking as teenagers. A person who smokes cigarettes as a teenager is more likely to become a daily smoker and become addicted than someone who has one or two cigarettes as an adult. About three-quarters of teenagers who smoke regularly continue to smoke as adults. People who start smoking as teenagers smoke more often, on average, than those who start smoking when they are older. The risk of smoking related diseases is increased by this smoking pattern.

Addiction seems to happen more quickly in teenage smokers, even when they do not smoke often. Some research indicates that teenagers have no autonomy over smoking within two months of starting to smoke. Even two cigarettes per day, smoked only once a week, can trigger dependency. Occasional smokers found it easier to quit.

Smoking is not a choice, once started. Most people who smoke want to quit smoking and wish they had never started.

Will the measure affect tourism?

The Bill does not provide exemptions, however, if it appears that this may be a problem for tourists then an exemption for foreign passport holders could be provided.

Tasmania already attracts tourists with its image of being clean, green and safe. Being clean, green, safe and healthy will attract more people, especially those young people interested in outdoor pursuits and older travellers who tend to have lower smoking rates, and who find smoking annoying. Tourists are accustomed to adapting to countries with different laws, such as the ban on alcohol in many Islamic countries. Fewer than half of one per cent of tourists to Tasmania are likely to be smokers in the age group 18-21.

How will the public react?

In Australia several polls have shown support for T21, including a You Gov Galaxy Poll which showed 78% support.

Won’t the tobacco companies fight this?

Of course. The tobacco industry has fought every tobacco control reform in Tasmania, sometimes in questionable circumstances. The industry took legal action in Tasmania to disallow tobacco guidelines. The Tasmanian Government subsequently amended the legislation and made it stronger.

The tobacco industry have been involved in smuggling in other countries, including Canada where BAT and Imperial were fined $(CA)200 million for smuggling.

The WHO Framework Convention on Tobacco Control to which Australia is a signatory provided guidelines on dealing with the tobacco industry.

In the 1970s the Liberal Tasmanian Attorney General, Sir Max Bingham, laid criminal conspiracy charges, later dropped, against the CEO of British Tobacco. The industry was involved in illegal land deals in north-east Tasmania.

Also in the 1970s British Tobacco paid a politician to write his “memoirs”. The politician then crossed the floor and brought down the Liberal government, just as that government was drafting legislation for a tobacco tax.

The tobacco industry has been found guilty of misleading and deceptive conduct in Australia by the ACCC.

Tasmanian governments of all persuasions have stood up to tobacco industry tactics in the past. We hope they do again.

What is the intended process for the Public Health Amendment (Prevention Of Sale Of Smoking Products To Under-Age Persons) Bill 2018 (45 of 2018) ?

The Bill was introduced as a Private Members Bill by the Honourable Ivan Dean MLC in November 2018 to the Legislative Council, the upper house of Parliament in Tasmania, where it will be debated in 2021. Should it pass the Legislative Council it will go the House of Assembly for consideration. Members of the public can see progress of the Bill online, and the detailed fact sheet and clause notes which will explain what it is about. The Second Reading Speech is also available.