• Posted December 30, 2021

New Zealand Aims for Zero Smokers in a Generation: Could Plan Work Elsewhere?

Nearly all countries agree: Smoking is bad, and getting people to kick the habit is a worthy public health goal.

But no country has ever attempted what New Zealand is about to try: an outright ban on all cigarette sales.

The plan is to let those who already smoke retain the right to keep buying cigarettes if they wish, but as of 2023, anyone under 15 would be prohibited for life from doing so, according to the island nation's associate health minister, Dr. Ayesha Verrall.

And because the ban is permanent, 10, 20 or 30 years down the road -- as the population ages -- fewer and fewer New Zealanders will have any legal access to cigarettes.

Vaping products would not be covered as the law is now envisioned. But Verrall made clear in a speech to New Zealand's Parliament earlier this month that the intent is to make sure young people never start smoking.

"So we will make it an offense to sell or supply smoked tobacco products to new cohorts of youth," she said, according to the New York Times. That means anyone under 15 when the law goes into effect will never be able to legally buy tobacco products.

The population of New Zealand is roughly 5 million, a little more than half the size of New York City.

A 'next logical step'?

So can a smoking cessation plan designed for a tiny nation serve as a useful template for much larger countries?

"In theory, I think it could work," said Patricia Folan, director of the Center for Tobacco Control for Northwell Health in Great Neck, N.Y. "Especially if the gradual strategy used by New Zealand was employed."

The United States has already found considerable success on several fronts when it comes to tobacco control, Folan pointed out.

Those regulatory moves include significant cigarette tax hikes; increasing the minimum age for legal purchase of cigarettes, and banning smoking in particular indoor and/or outdoor settings, she said.

Since the U.S. Surgeon General's first report linked smoking to lung cancer in 1964, tobacco controls have made important strides, Folan noted.

"Decades ago, many tobacco control policies were thought to be impossible to implement," she recalled. "At one time smoking was permitted on airplanes, hospitals, restaurants and in workplaces. Tobacco ads were permitted to air on TV. Cigarette machines were prevalent."

None of that is true today, Folan pointed out. So, she said, an outright age-related ban "may be the next logical step, given that 75% of smokers indicate they want to quit but need help to do so."

As a practical matter, however, Folan said that in a country like the United States, a sales ban like that planned in New Zealand would likely prove an uphill battle, given "the power of the tobacco industry and the reluctance among some states to forgo the taxes generated by tobacco sales."

The Brookline experiment

Americans already have a small-scale example of an effort to get just such a ban off the ground -- in Brookline, Mass. (population: 60,000).

Last year, the Boston suburb passed an age-based cigarette ban that went into effect in September 2021. It's now illegal for anyone born after Jan. 1, 2000, to purchase any type of tobacco or vaping products in the city.

The eventual impact of Brookline's move has yet to be seen. Nor is it clear that a small-town example could inform larger-scale efforts.

According to an NBC News report on the Brookline ban, less than 7% of the town's adults now smoke.

That's far lower than nationwide and worldwide figures. In 2019, 14% of American adults smoked, according to the U.S. Centers for Disease Control and Prevention. Meanwhile, the World Health Organization estimates that 1 in 6 adults worldwide -- about 1.3 billion -- smoked that same year.

For any larger-scale smoking ban to succeed, an American Lung Association spokesman said, a concerted campaign is needed to make sure that young people are strongly encouraged to view smoking as a supremely unattractive and undesirable habit.

That, said Dr. Panagis Galiatsatos, means "building a culture of smoking prevention," with the aim of ensuring that cigarettes are not only no longer legally accessible, but also no longer appealing. He is director of the Tobacco Treatment Clinic at Johns Hopkins Medicine in Baltimore and a volunteer medical spokesman for the American Lung Association.

Many smokers agree

To be sure, Galiatsatos does agree that the kind of gradual ban New Zealand is implementing "can be pulled off anywhere" -- at least in theory.

But both he and Folan stress that any nationwide policy that aims to eliminate smoking will need to be accompanied by effective programs to help current smokers quit.

And, Galiatsatos said, tobacco cessation programs will need to be rooted in a "no stigma, no judgment" stance, so smokers clearly understand that the advice they receive is not an anti-smoker attack, but rather an anti-smoking strategy.

Still, a sales ban does have an appeal all its own, Folan said, given that "many of the patients we see in our tobacco cessation program state that they wish cigarettes would not be sold" in the first place.

"They feel that there is a drug/nicotine/cigarettes dealer on every corner, triggering their cravings to smoke," Folan noted. So over the long haul, she said, "getting rid of the trigger could be the answer."

More information

There's more information on smoking bans and related policies at the U.S. Centers for Disease Control and Prevention.

SOURCES: Panagis Galiatsatos, MD, MHS, director, Tobacco Treatment Clinic, Johns Hopkins Medicine, Baltimore, and volunteer medical spokesman, American Lung Association; Patricia Folan, RN, DNP, director, Center for Tobacco Control, Northwell Health, Great Neck, N.Y.; New York Times