Smokefree generation law could slash youth smoking decades earlier

New research, led by experts at the University of Nottingham, has found that smoking prevalence among 12 to 30-year-olds in England could drop below 5% decades earlier than expected, if the government progressively raises the age of tobacco sale.

With less than a year to go until the planned introduction of the "smokefree generation" law, researchers at the University have modeled the policy's potential impact on smoking rates and health inequalities. The findings are published in the BMJ-owned journal Tobacco Control.

The proposed legislation, part of the Government's Tobacco and Vapes Bill, would progressively raise the age of sale so that anyone born in 2009 or later can never legally be sold tobacco, starting from 2027.

Using detailed modeling, the team projected how smoking prevalence among 12 to 30-year-olds in England could change over the coming decades if the law is implemented, compared with a scenario in which it is not. The project was funded by the National Institute for Health and Care Research (NIHR).

They found that the smokefree generation law could push smoking prevalence below 5% in the 2040s, decades earlier than would be expected without the law. However, males and the most deprived communities are forecast to reach this milestone later unless the law and support is effectively targeted. 

The key findings of the report were:

• The policy could meaningfully accelerate declines in smoking prevalence.
• Smoking prevalence among 12 to 30-year-olds falls below 5% in the 2040s, with prevalence continuing to decline thereafter. 
• Health gains build over time, with tens of thousands of extra healthy years of life. By 2075, the policy could deliver around 88,000 additional years of healthy life compared with no new law, reflecting substantial long-term benefits from fewer people regularly smoking. 
• Benefits are biggest in disadvantaged communities where smoking remains highest. Around 30% of total healthy life years gained are projected to occur in the most deprived 20% of neighbourhoods. 
• Modelling suggests that tailored communication and greater targeted investment in enforcement may reduce both absolute and relative inequalities and bring smoking prevalence below 5% sooner. 

Nathan Davies, lead author and researcher in the School of Medicine at the University of Nottingham, said: "This modeling suggests the smokefree generation law could help stop young people from ever starting to smoke, accelerating progress towards a tobacco-free future. But how the policy is implemented will matter. Stronger enforcement, communication and stop smoking support in communities where smoking remains most common could help ensure the benefits are shared across the country and achieved more rapidly."

The research team's projections differ from the government's published impact assessment because they use more cautious assumptions about how much the policy will reduce smoking initiation year-on-year.

The UK government's modeling assumes a 30% cumulative annual reduction in smoking initiation based on the decline seen when the age of sale increased from 16 to 18 in England. The University of Nottingham team's central scenario uses a more conservative assumption of a 5% cumulative annual reduction, informed by evidence from international age of sale laws, alongside a scenario aligned with government assumptions. Even under these more cautious assumptions, the modelling still suggests the policy could deliver substantial reductions in prevalence and large long-term health gains compared to no law. If declines are in line with the government's assumptions, then the 5% prevalence target could be reached in the 2030s. 

We cannot yet be certain of the full impact of the smokefree generation law, but this modelling shows it could be a once-in-a-generation opportunity to transform the nation's health for the long term. It also sends a clear warning: without further action, some people will be left behind. As this law comes into force, the Government must set out how it will ensure every smoker has the support they need to quit, so that no one is excluded from the benefits of a truly smokefree generation."

Hazel Cheeseman, Chief Executive of Action on Smoking and Health (ASH)

Alizée Froguel, prevention policy manager at Cancer Research UK, said: 

"Smoking is the leading cause of cancer deaths in England. This study highlights what a landmark step the age of sale legislation will be in helping protect future generations from a lifetime of deadly, costly addiction. Strong enforcement and effective implementation of this policy will also be critical to its success. 

"The UK Government must now swiftly pass and implement the Tobacco and Vapes Bill alongside sustainable funding for stop smoking services. Smoking rates are three times higher in the most deprived areas of the country, so it's vital that this support is tailored to people who need it the most."