For those who face difficulties in smoking cessation counselling in your daily practice, you are not alone. Experts studying cigarette consumption after the adoption of the World Health Organization Framework Convention on Tobacco Control (FCTC) treaty found that the FCTC did not achieve its intended outcome of reducing global cigarette consumption.1 It will be rejuvenating for practitioners to learn of a global nicotine control trend pioneered in Singapore in 2010, and that it is gaining increasing momentum with jurisdictions across the world enacting Tobacco-Free Generation (TFG) laws.
Key elements of TFG
TFG is a birth-year-based protective approach where generations born after a predefined birth year are encouraged and educated such that they no longer want to smoke and would have no legal access to tobacco regardless of age. This can be legislated with massive support from the different stakeholders across society, including youths, educational and health experts, and legislative and political leaders. The fact that TFG does not target older, addicted smokers (as they are born before the predefined birth year) makes TFG a more harmonious approach and avoids the smoker versus non-smoker divide in society.
The current legislation of a minimum legal age (MLA) to purchase cigarettes aims to protect children by prohibiting them from smoking before a certain age. This approach has two key pitfalls. Firstly, the MLA legislation has clearly been taken full advantage of by the tobacco industry, while secondly, global public health has failed to recognise a major blind spot in the MLA for decades.
MLA legislation allows the tobacco industry to repeatedly claim that their marketing to only adults is a legitimate right, enabling them to carry on their business as usual when their product kills one in every two users. They take legal actions against governments using trading rights. Furthermore, this same law sends a forbidden fruit lure to curious teenagers who are in a vulnerable, experimenting phase of their lives. Smoking gains a rite of passage effect, wherein youths succumb to tempting encounters while seeking peer recognition to do something which “only adults” are allowed to do.
The TFG endgame replaces the MLA structure and its unrecognised, global pitfalls with the definite and consistent public health position that smoking and vaping are both harmful. We need to start protecting the future generations as these activities are harmful irrespective of age. By starting with a generation defined by a birth year, TFG would be similar to many other Singapore policies, such as CareShield Life (which applies to those born from 1 January 1980)2 and compulsory primary school education (six years of which are legally required for children born after 1 January 1996)3.
Global TFG trends
A province-wide TFG social movement has blossomed in the City of Balanga in Bataan province, the Philippines, where TFG education is structured into the local Health Promotion Board. In 2016, 32,000 Balanga citizens signed a petition in support of the first ever TFG2000 ordinance in the world.4 The city of Brookline in Massachusetts, USA, followed suit with local doctors petitioning since 2016, leading to the state attorney general approving the TFG law in 2021 to ban the sale of all tobacco products to those born after 1 January 2000.5
Progressively positive responses are gaining traction worldwide. New Zealand had intended to implement in 2024 a TFG law for those born after 2009,6 though it has since reversed the policy. As of May 2024, there are six towns in Massachusetts, USA,7 which ban tobacco sales, including electronic cigarettes, to anyone born after the respective specified dates. In the UK, two cities and even King Charles are in favour of the TFG law.8 TFG policy has also been considered in Denmark, Malaysia and the Netherlands This topic has also been raised in the Singapore Parliament multiple times since 2015,9,10 with the Ministry of Health replying that this approach is being studied carefully.
Singapore’s pioneering leadership
It is exciting to trace how Singapore has initiated and contributed to the formulation of this global public health narrative.
TFG was formally acknowledged as an endgame approach by tobacco control experts when it was first presented at Suntec City during the 15th World Conference on Tobacco or Health in 2012. The audience included tobacco control experts from New Zealand and the USA, who went on to push for TFG progress in their own countries after understanding TFG’s fundamental benefits.
We have also initiated TFG education activities across 28 Singapore schools since 2012, supported by the Ministry of Education. Teachers have given feedback that these hour-long sessions included relevant and insightful tobacco prevention content, instilling ownership and pride among students in being the Millennial generation to stay smoke- and vape-free. This experience was then translated to public health consultancy and public education in the Philippines in 2016, helping the City of Balanga to formulate the world’s first TFG policy.
Setbacks in TFG implementation
In moving global agendas, any step forward is positive even though there may be resistance to the implementation. Here are a couple of setbacks faced in our journey thus far.
Labelling TFG as slow in pick-up and effectiveness
Experts using simulation models have estimated a long runway of 38 years for countries to reach a smoking prevalence of 5% or less.11 However, by identifying a birth year for implementation of TFG law (eg, birth year 2015), TFG would achieve zero smoking and vaping incidence immediately among this target generation by educating this ten-year-old cohort across Singapore in 2025. This cohort thus becomes the generation that is able to confidently say “NO” to cigarettes and vaping. They will be the positive role model to inspire their junior batches, which leaves a more long-lasting impact.12 So, the perceived setback of a long runway requirement arises from experts not being aware of actual advocacy efforts on the ground that are conducted directly to the targeted cohort.
With the implementation of the TFG education ecosystem, which also covers how TFG is in line with international human rights documents,13 our experience is that all stakeholder groups will gain a much clearer perspective and support TFG. As different communities require different timelines to achieve this education outreach, each country can identify its own target birth year, aligned with the pace of their community support.
TFG does not address vaping
Worldwide statistics show decreasing smoking incidence, but the new trend is vaping. The Indonesia Vape Expo saw a rise from one million participants in 2017 to 6.6 million in 2023.14 Although vaping has been illegal in Singapore since 2018, 5,480 vapers have been caught in the first half of 2024, three times the number of cases in the entire year of 2017.15,16
While evidence on the health consequences of vaping is contentious, vaping is observed to be a gateway to smoking and other more harmful drugs among youths. Focusing on whether smoking or vaping is better, current tobacco control approaches have failed to see how the tobacco industry has time and again pushed new products (be it cigarettes or vapes) in various flavours to attract the youth. Our current tobacco prevention education sorely lacks in highlighting the role of the tobacco industry, which is like missing the forest for the trees. In our 14 years of TFG work, our tobacco prevention work covers both smoking and vaping.
Moving forward
Ultimately, this social movement that we have designed is meant to protect our future generations, political leaders and even victimised smokers from being targeted by the tobacco industry. Whether you are inspired or sceptical about the feasibility of TFG, we invite you to join us in discovering its benefits and our successes in engaging the younger generation with better and more positive mindsets. We welcome open discussion about any support or concerns about its implementation, so that we can achieve a Tobacco-Free Generation and a Tobacco-Free World!