Massachusetts towns ban nicotine for a generation. Public health win or overreach?
If you were born after 2003, you will never be old enough to buy cigarettes in Chelsea, Massachusetts. And as of Jan. 1, in at least eight other towns.
Municipalities in the Bay State are determined to create a “nicotine-free generation.” And three Massachusetts legislators recently announced they plan to file a statewide version of the bill in 2025.
The regulations have set up an ideological battle, as local officials and their constituents wrestle with how far governments should go to protect public health. Proponents see such rules as a way to save lives and eliminate a major societal ill. Detractors see a Prohibition-style overreach that undermines personal freedom and threatens small businesses.
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Who is responsible for the health of young people? Tobacco bans in Massachusetts towns have residents weighing public health concerns against individual freedoms and considering what it means to have a “nicotine-free generation.”
Similar attempts to sunset tobacco are picking up steam worldwide. The United Kingdom plans to ban cigarette sales for anyone born after 2008. Earlier this year, members of South Australia’s parliament introduced a law that would do the same for those born after 2006.
It’s not yet clear if these regulations will spread elsewhere in the United States. But in Massachusetts, which has a long history of public health innovation, supporters seem optimistic.
“We’re at a level of readiness that is really the envy of most other states,” says Mark Gottlieb, a lawyer who runs Northeastern University’s Public Health Advocacy Institute. “This is a really good place to see where this policy can go.”
In 2020, Brookline, Massachusetts, became the only place in the world to enforce a nicotine-free generation bylaw. Anyone born on or after Jan. 1, 2000, will never be able to buy cigarettes there, according to the rule co-sponsored by Anthony Ishak, a pharmacist, and Katharine Silbaugh, a law professor. A group of convenience stores sued, arguing that the rule was unconstitutional and conflicted with state law.
In March, the Massachusetts Supreme Judicial Court dismissed that lawsuit, ruling that municipalities have the authority to regulate tobacco as they see fit. Since then, 11 other places have passed bans, including Concord, Reading, Needham, and Malden.
Adult smoking rates in the U.S. have declined precipitously in the past six decades, falling from 42% in 1965 to 12% in 2022. Youth rates have hovered in the single digits since 2017.
Yet tobacco remains the leading cause of preventable death in the U.S. Cigarette smoke kills some 480,000 Americans each year, according to the Centers for Disease Control and Prevention. That accounts for nearly 20% of all U.S. deaths annually, and outstrips deaths from opioids, gun violence, suicides, and car accidents combined.
What about personal choice?
Todd Taylor, a Chelsea city councilor, says he’s glad he quit smoking 18 years ago. He encourages policies like community outreach and education to cut smoking rates. Yet he thinks nicotine-free generation bans infringe on choices that should belong to individuals – or, at a minimum, elected officials.
“These decisions should not be taken up by local boards of health,” he said at a Nov. 19 board of health hearing in Chelsea. “This belongs in the legislature.”
Local boards of health, which can be either elected or appointed, have largely led the charge in enacting generational tobacco bans.
“Whether you’re in favor or opposed, it deserves a little bit more discussion,” says Peter Brennan, executive director of the New England Convenience Store and Energy Marketers Association. “People are tired of the government – in this case, a local, unelected board of health – telling them what they can and can’t do.”
Yet proponents see banning nicotine as a boon for personal freedom. In interviews and at public hearings, they argue that addiction, not regulation, is a threat to freedom of choice.
In a 2022 survey, 53% of smokers had tried to quit in the past year. Only 9% succeeded.
“Adult choice was taken away by addiction,” says Chris Bostic, policy director at anti-tobacco group Action on Smoking and Health. “And almost all [people who smoke] became addicted as children.”
The vast majority – about 87% – of people who smoke have their first cigarette before they turn 18.
Concerns about stepping on individual freedoms in the name of the greater good is a perennial tension for public health officials. In some ways, today’s debates about nicotine recall those that roiled the country during the COVID-19 pandemic, when cities imposed lockdowns and mask mandates. Then, as now, detractors sharply criticized government intervention that supporters said was necessary to save lives.
“Many Americans have died for individual freedom. Some things may not be good for you, and other things may be worse, but it’s up to adults to have that freedom,” Stephen Helfer, co-founder of the group Cambridge Citizens for Smokers’ Rights, says at Chelsea’s hearing.
Massachusetts is also one of 24 states, along with D.C., that have legalized recreational marijuana. That approach stands in contrast with these cities’ hard line on tobacco.
Mr. Bostic says that’s comparing apples to oranges. “We can’t equate them just because the main way of using them is to light them on fire,” he says. “We can at least address the product that by far kills the most people.”
Not all Massachusetts health experts agree that generational bans are the way forward. Vaughan Rees, director of Harvard University’s Center for Global Tobacco Control, cites doubts that the rules will reach marginalized groups.
“I don’t see any evidence or reason to assume that a generational-style law is going to support or promote advantages in some of the marginalized populations that we’ve been talking about,” Dr. Rees says. He points specifically to people who use illicit drugs, who also tend to smoke tobacco at higher rates. “Imposing yet another regulatory burden on marginalized communities may not yield the effects that we hope it might.”
Mike Siegel, a professor at Tufts University School of Medicine, agrees that such a law is unlikely to stop people who want to smoke. Yet he supports a ban, arguing that it may change social norms among young people.
“It’s not just ‘Don’t smoke because it’s harmful.’ It’s, ‘We have declared you to be a smoke-free generation,’” Dr. Siegel says. “That creates a tremendous disincentive – because, essentially, if you smoke, you’re rallying against your generation.”
This isn’t the first time that the Bay State has found itself at the cutting edge of tobacco control. The Commonwealth was also the first to restrict the sale of all flavored tobacco products, and to ban tobacco sales in health-care establishments. At 10.4%, Massachusetts has one of the lowest smoking rates in the country.
Additionally, Massachusetts health boards are powerful compared with those in other states, according to Mr. Gottlieb. Their regulations carry the same legal weight as those enacted by local lawmaking bodies, giving them broad regulatory discretion.
In Brookline, Mr. Ishak sees phasing out tobacco as building on that legal history. “Historically, Massachusetts has been at the forefront of tobacco legislation,” he says. “It was firm territory to be able to try something like this.”
Mr. Ishak’s father took up smoking when he was young. His son says the habit almost killed him before he was able to leave it behind for good.
He recounts his father’s story at a Chelsea’s public hearing, held at a middle school.
The health board was convinced. The bylaw passed unanimously on Dec. 10.
“I’m paying the price”
Under most nicotine-free generation laws, those who have already turned 21 can still buy tobacco products. Ms. Silbaugh believes this is a sensitive approach to regulating nicotine while acknowledging that some 23.6 million Americans have a dependency on it.
“Most adults who use nicotine or tobacco products don’t want to be,” she says. A 2022 survey by the CDC found that 68% of people who smoke want to quit. “So the question is, how could we regulate it to be compassionate toward people who need it, but without adding to their ranks?”
In Ms. Silbaugh’s eyes, it’s also compassionate toward retailers. Rather than take products off shelves immediately, phased bans shrink retailers’ customer base over decades.
But in Brookline, at least one business is feeling the squeeze. Waseem Heriki says his father’s convenience store is doing “one-third as well as it used to.”
“I’m hoping that the law gets changed,” Mr. Heriki adds. “I’m paying the price.”
Previous tobacco control initiatives also started small. In 2005, the board of health in Needham, Massachusetts, voted to make the town the first place in the country to raise its tobacco purchasing age to 21 – a policy that became federal law over a decade later.
Yet detractors say that health boards’ reliance on expert opinions creates a blind spot to constituents’ wants. “These boards of health are very biased in favor of the proposal, and they’re biased in favor of their public health professionals that they interact with,” Mr. Brennan, of the convenience stores association, says.
Will generational bans work?
It’s too early to tell how successful these policies will be. Because they’ve never been tried before with tobacco, research is scant. Questions remain about whether they could contribute to the creation of an illicit market, as happened when Massachusetts banned flavored tobacco products.
Mr. Gottlieb acknowledges those concerns – though he maintains that this is different. “In the case of the flavors, you have strong existing demand for these products, and then they were taken away,” he says. “Here, you’re not really taking anything away from somebody where there’s a strong demand.”
It’s possible, however, that people who can’t buy tobacco in one town will simply travel to another where they can.
Supporters argue that it’s what’s local that matters. When Needham raised its buying age in 2005, smoking rates in the town fell at triple the rate of its neighbors whose age remained 18, according to a study in the New England Journal of Medicine.
In Chelsea, where the smoking rate is 1.5 times the state average, young public hearing attendees seemed to revel in the idea that theirs could be the first generation for whom tobacco is not an option. Of the four who spoke, all were in favor of the ban.
“This law challenges the prevailing notion that tobacco is a rite of passage,” Bhavika Kalia says. She’s a high school student from nearby Somerville, which is also mulling a ban. “It is about taking bold action to protect the well-being of those who will lead our communities tomorrow.”
