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Türkiye has made significant strides in tobacco control over the over the last 20-30 years. During this period, many regulations affecting the demand and supply sides of the market have been made by implementing measures such as public smoking bans, advertising restrictions, plain packaging policies, health warnings on cigarette packs, and high taxes on tobacco products. However, smoking rates remain high. About 1 in 4 women and 1 in 2 men in Türkiye are smokers. According to nationwide surveys in 2022, about 35% of adults (44% of men and 27% of women) were current regular/daily users, and about 6% were occasional users (TEPAV, 2022). The persistent prevalence highlights the necessity for a more innovative and determined approach to curb smoking. 

A new draft bill is coming to the parliament

On July 2, 2024, newspapers in Türkiye announced that a new draft bill is coming to the parliament. “Coming to the Parliament: Those born after 2009 will not be able to buy cigarettes”. (Odatv, 2024). The news announced that studies have begun in Türkiye for the draft bill that was passed earlier by the British parliament. The bill stipulates that those born after January 1, 2009, will not be able to legally buy cigarettes again in their lives (BBC, 2024), thereby creating a tobacco-free generation (TFG). 

What is the TFG idea?

It is well-known that smoking is associated with many deadly diseases and disabilities. For example, in Australia, it was found that up to two-thirds of deaths in current smokers can be attributed to smoking (Banks, et al. 2015).

Numerous restrictive measures on tobacco consumption have been implemented worldwide, with a certain amount of success; however, given the present situation, a clear path to a tobacco-free society seems out of reach. Tobacco products are generally treated as legal products for adults. In addition, due to the addictive nature of the product, an immediate overall ban on consumption would likely be perceived as unacceptably harsh. To eliminate smoking for good in the long run and to achieve a tobacco-free society, tobacco control advocates have been proposing ‘tobacco endgame’ strategies.

Puljević et al. (2022) summarizes tobacco endgame policies as follows: 1) product-focused policies (such as mandatory very low nicotine content standards, product standards that reduce smoking or remove cigarettes from the market, reduced-risk products); 2) user-focused policies (such as purchaser licenses, tobacco sales restricted by year of birth); 3) market/supply-focused policies (such as the end of commercial retail sales, the imposition of a ‘sinking lid’ on supply, increases in tobacco taxes, restrictions on tobacco retailers); 4) institutional structure-focused policies (such as transferring the management of tobacco supply to an agency with a mandate to phase out tobacco sales). 

The TFG proposal is a user-focused endgame strategy that aims to phase in a ban on the sale of tobacco products to people born in or after a specified year (Khoo et al., 2010) to achieve the low smoking prevalence target (generally referred to as a goal to reduce smoking prevalence to less than 5% by a certain year). TFG means that some people will never be able to legally buy cigarettes again in their lives. By limiting the availability of tobacco products and reducing their addictiveness, TFG regulation aims to prevent future generations from becoming addicted to smoking and to assist current smokers in quitting​.

A related but different idea, known as tobacco-21 laws, is a one-time raise in the minimum legal age of purchasing tobacco products to age 21. An increasing number of US states have adopted these laws in the last decade, with the aim to reduce youth smoking and improve population health.  

Other countries have also considered TFG legislation

In the UK, the members of parliament have voted to back the government’s plans to create a “smoke-free generation” and reduce the number of smoking-related deaths. The restrictions will apply to the sale of cigarettes in the UK rather than the act of smoking itself. Once imposed, the restrictions will prevent people born in or after 2009 from ever being able to legally buy cigarettes. The new system is stipulated to come into force by 2027; therefore, under the new law, each year the legal age for cigarette sales, which is currently 18, will increase by one year. The law will not affect older individuals, i.e., those who are already allowed to buy cigarettes (BBC, 2023). Discussions surrounding the legislation have gained traction, particularly following recommendations from the All-Party Parliamentary Group on Smoking and Health. Although these discussions signify a growing interest in tobacco control measures, no specific legislation has been enacted to date.

New Zealand enacted the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill in December 2022. This groundbreaking legislation, similar to the one in the UK, aimed to create a “smoke-free generation” by banning the sale of tobacco products to anyone born on or after January 1, 2009. The law also includes provisions to reduce the number of retailers permitted to sell tobacco and to lower nicotine levels in smoked tobacco products. These measures are part of New Zealand’s broader strategy to cut smoking rates to less than 5% across all population groups by 2025​ (Independent, 2022)​​ (Beehieve, 2022)​. The New Zealand Ministry of Health highlights that this legislation will significantly decrease the accessibility of tobacco, especially in low-income communities where tobacco retail outlets are densely clustered. By limiting the availability of tobacco products and reducing their addictiveness, the law aimed to prevent future generations from becoming addicted to smoking and to assist current smokers in quitting​ (Independent, 2022).

In Tasmania, Australia, there have been proposals to implement a similar Tobacco-Free Generation law, targeting individuals born after the year 2000. Despite substantial public and political debate, the proposal has not yet been enacted because of the challenges in gaining legislative consensus and public support for the proposal.

Singapore’s approach involves progressively raising the minimum legal age for smoking, aiming to gradually reduce the initiation of smoking among younger cohorts and eventually establish a smoke-free generation. The Health Promotion Board has proposed annual increases in the legal smoking age until it reaches 21 years. In addition to increasing legal smoking age, some other measures like taxation, legislation, public education, partnerships, and the provision of quit smoking services were implemented. These strategies have proven effective and smoking rates dropped from 13.9% in 2010 to 10.1% in 2020 ​ (Ministry of Health, 2022). The survey conducted in Singapore by Khoo et al. (2010) suggested strong public support for the TFG idea. Although Singapore is somewhat unique in its regulatory climate, and the findings may not be replicated in other country settings, the idea offers a new and fresh perspective on preventing the access of the youth.

In the Nordic countries, tobacco consumption patterns illustrate the significant impact of national regulations and cultural preferences. In Norway and Sweden, snus, a smokeless tobacco product, is legally available and extensively used, unlike in other Nordic countries and the European Union, where its sale is prohibited. In Finland, the Tobacco Act reform in 2016 defined the goal as reaching less than 5 % of daily use of nicotine-containing products, including cigarettes and e-cigarettes. In 2018, a working group proposed that the Tobacco Act be amended to make it illegal to sell, otherwise supply or pass on tobacco products, nicotine-containing liquids and nicotine-containing tobacco substitutes to people under the age of 20; and the minimum age for the import and possession of such products also be raised to 20. However, the legal age of the sale of tobacco products remains at 18 (Ministry of Social Affairs and Health, 2018).

Why is this deemed to be necessary?

Smoking tobacco releases many components that are poisonous and up to 70 components cause cancer. Smoking has also been linked to other serious illnesses, such as lung disease, heart disease, and strokes and it can affect fertility and pregnancy. The government of the UK says, “smoking is still the number one preventable cause of death, disability and ill health, causing about 80,000 deaths per year across the UK and costing the NHS and the economy an estimated £17bn every year”. According to the government, creating a “smoke-free generation” could prevent more than 470,000 cases of heart disease, stroke, lung cancer and other diseases by the end of the century (Foster, 2024).

The “tobacco endgame” includes some strategies to drastically reduce or eliminate tobacco use in society. These efforts combine policies, regulations, and public health initiatives to curb consumption and prevent new users, aiming for near-zero tobacco use levels. One of the most important strategies involves creating TFG by implementing some restrictions to ensure that younger people never start smoking. Although creating a tobacco-free generation may not seem to directly affect current smokers, it can affect future smokers, which is important to curb consumption of tobacco products. 

The idea is to prevent future generations from smoking, as smoking initiation at early ages is very common. The report by the Surgeon General (1994) shows that a big portion of smokers, nearly 90% of smokers, started smoking at early ages, before the age of 19. Early initiation typically leads to more frequent use and extended exposure to nicotine, heightening the risk of addiction. This connection is influenced by a mix of biological, psychological, and social factors. In Türkiye, about 65% of men and 50% of women smokers started smoking before the legal age of 18; and about 27% of men and 33% of women smokers started at ages 18-24 (TEPAV, 2022).

What are the potential and expected pitfalls of imposing smoke-free generation rules?  What measures need to be taken?

Implementing a TFG environment presents several challenges. These can be mitigated by enforcing substantial fines for non-compliance and providing incentives for adherence, such as reduced licensing fees or recognition programs for compliant retailers (Ministry of Health, 2022).

In the UK, the Tobacco and Vapes Bill proposes to prohibit the sale of tobacco products to individuals born on or after January 1, 2009, and to make it illegal for anyone over 18 to buy tobacco products on behalf of those born on or after January 1, 2009. Retailers will be required to update their age of sale notices to clearly state that it is illegal to sell tobacco products to anyone born on or after 1 January 2009. The bill grants minister the authority to regulate vaping products (their flavors, ingredients, packaging, presentation, and point-of-sale displays). It introduces an offense for selling non-nicotine vaping products to individuals under 18 in England, Wales, and Northern Ireland, like existing laws in Scotland. Furthermore, it bans the free distribution of vaping products to individuals under 18 in England and Wales, with provisions for Northern Ireland to adopt similar measures. Ministers will also have the power to extend these regulatory measures to other nicotine products, such as nicotine pouches.

To enhance enforcement against underage sales, the proposed bill allows enforcement authorities in England and Wales to issue Fixed Penalty Notices of £100 for underage sales of tobacco and vaping products. It also continues existing penalties, enabling Trading Standards to impose level 4 fines (up to £2,500) and enforce restricted premises and sales orders for repeat offenders in England and Wales. The revenue from these fines will be retained by local authorities to enhance law enforcement efforts (Department of Health and Social Care, 2024).

The government has allocated £30 million for enforcement. This includes efforts to combat the availability of black-market cigarettes. The new regulations will apply to all duty-free shops in the UK, but individuals will still be able to bring legally purchased cigarettes from abroad back into the country (Department of Health and Social Care, 2024).

In Singapore, the government created hotlines and public online form to detect and report illegality in the sale of tobacco product to those below age 21. This measure reportedly contributed to a slight decline in smoking prevalence among young adults, from 9.8% in 2017 to 8.8% in 2020 (Legislative Council of the Hong Kong Special Administrative Region). The country also  addresses youth smoking through comprehensive educational efforts and robust smoking cessation programs. By focusing on preventive education and support for cessation, Singapore aims to curb smoking initiation among young people and assist those attempting to quit, thereby creating a multifaceted strategy to control smoking within the younger demographic (Ministry of Health, 2021).

What are the potential and expected benefits of TFG legislation?

Gradually raising the legal age for smoking aims to reduce the likelihood of youth starting to smoke. This measure is expected to prevent young people from accessing tobacco products during critical years when they are most likely to begin smoking. By delaying the age at which individuals can legally purchase tobacco, and shaping peer access and behavior, a significant reduction may be achieved in the number of youths experimenting with tobacco products. This may result in lower smoking rates within the population over time, given that the legislation can be properly implemented.

The importance of protecting children from the harms of tobacco smoke exposure is well-known.  Tobacco smoke exposure can have detrimental effects on children’s health and development. In addition to TFG laws, comprehensive tobacco control policies, such as smoke-free legislation and tobacco taxation have the potential to achieve clear health benefits for both adults and children. Other policies, such as reducing tobacco outlets, and banning tobacco advertising can help reduce smoking initiation by youth (Been et al., 2021).

Increasing the legal age to buy tobacco may also be effective. Tobacco-21 laws that raise the minimum legal age to 21 have been reported to be associated with a decline in the use of tobacco products. Friedman et al. (2019) find that, compared to similar 21–22-year-olds (who are not affected by the law), tobacco-21 policies are associated with a 39% reduction in the odds of both recent smoking and current established smoking among 18-20-year-olds who have ever tried a cigarette or e-cigarette. Moreover, this relationship was amplified among those whose close friends smoked or vaped at age 16. Such a finding is consistent with a social multiplier effect through which tobacco-21 restrictions influence young adult smoking both directly and indirectly, via peer responses to the policy.

To sum up, the implementation of the tobacco-free generation concept in countries offers advantages across three key domains: enhanced public health, long-term financial savings, and cultural evolution. The first domain involves establishing smoke-free societies to mitigate the impact of tobacco-related diseases. The second domain pertains to improving societal economic well-being by reducing healthcare expenditures associated with such diseases. Lastly, the concept aims to catalyze a cultural shift away from tobacco use, promoting healthier societal norms and behaviors. These three points highlight how adopting a TFG approach can lead to broad benefits across public health, economics, and cultural norms.

What are the arguments of those who would oppose such a proposal?

The TFG idea is not without opponents. For example, in the UK, the proposal to ban young people from ever being able to legally smoke tobacco had opposition from some MPs. The bill was passed with the approval of 383 MPs; however, 67 MPs opposed it (Guardian News and Media, 2024).

Critics of the TFG concept raise concerns primarily in two areas: economic impact and individual rights. Economic impact concerns two key points. First, implementing such legislation could drive tobacco sales underground, leading to an increase in illicit or black-market activities. This can be challenging for enforcement and could undermine the intended health benefits. Moreover, it can also damage tobacco industries. The tobacco industry, a significant economic player and tax revenue generator in many countries, could face substantial losses if demand for legal products decreases due to regulatory measures. This can impact jobs, tax revenues, and overall economic stability in regions dependent on tobacco production.

The individual rights argument is that the legislation violates personal freedoms and the right to make choices about tobacco use. Balancing public health goals with economic considerations, individual freedoms, and ethical issues is indeed complex and often contentious in policymaking. An analysis of the legal and ethical issues around the TFG proposal finds it compatible with human rights principles and supports fundamental rights like life, health, and a clean environment, without unduly violating other rights (van der Eijk & Porter, (2013). Yet, each perspective brings valid concerns that need careful consideration in crafting effective and socially acceptable tobacco control strategies.

Türkiye will certainly face challenges in implementing a TFG proposal

As stated in the beginning of this article, Türkiye is a country with a high rate of smoking prevalence. Among adults, 1 in 2 men and 1 in 4 women are current smokers.   Packaged cigarettes dominate as the most used tobacco product among adults, yet a significant portion of consumers opt for loose tobacco to roll their own cigarettes. A nationwide survey by the Economic Policy Research Foundation of Türkiye (TEPAV) in 2022 revealed that when asked about the tobacco products used daily, 76.5% of adult smokers reported using packaged cigarettes and 28.6% reported using roll-your-own (RYO) cigarettes. Other products such as waterpipes, cigars, cigarillos, and e-cigarettes have notably lower daily usage rates. 

Despite the use of various policy tools in Turkey in the last 10 years, ranging from advice given by experts in the field of smoking to media campaigns and clinics that provide free nicotine replacement therapy, the use of smoking cessation services by individuals is quite low. Despite all these comprehensive practices, a significant percentage of those who quit smoking in Turkey do so without assistance. While this indicates a good approach in theory, it shows that this approach is inadequate in practice. Since most current smokers do not intend to give up their consumption, addiction rates are expected to increase in the future; it is obvious that more innovative policies are needed to prevent new generations from starting to use tobacco (TEPAV, 2020). In this way, it will be possible to achieve a healthier society.

Türkiye is also a country with a non-negligible rate of illicit use of nicotine products. First, RYO cigarettes offer smokers a lower cost alternative to packaged cigarettes. Unrecorded, under-the- counter sale of loose tobacco and RYO cigarettes is quite common. In 2022, about 79-84% of smokers reported that the product they consume has a banderole/tax stamp on it. In the highest income group, this percentage was close to 20% of smokers, whereas the figure went up to 40% in the lowest income group (TEPAV, 2022).

Secondly, a presidential decree on 25 February 2020 (Presidential Decree number 2149) banned the import of cigarette-like products such as electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs), regardless of their nicotine content, as well as electronic devices, apparatus, spare parts and solutions to be used with e-cigarettes and HTPs. An exception was provided (via Circular No. 2020/7) for imports for personal use, including one device per person and cartridges or solutions up to 30 ml, or 10 disposable electronic cigarettes in total. The domestic production of cigarette-like products is subject to the approval of the Ministry of Agriculture and Forestry; however, no approvals have been granted. Therefore, the combination of import and production bans effectively prohibits the sale of cigarette-like products. Despite the illegality of sales, these products are being used in the country. According to TurkStat, daily or occasional vaping rates in Türkiye are estimated to be at 1.90% of the 15-24 age group, 1.82% of the 25-34 age group, 1.32% of the 35-44 age group, and 1.19% of the 45-54 age group (Turkish Health Research Survey, 2022).

Therefore, if TFG legislation is approved, preventing the under-the-counter sale of tobacco products to those who are not supposed to have access to them will be a challenge to policymakers and administrators.

Another important issue about the regulation of tobacco products in Türkiye is about tax revenues. The fiscal impact of tobacco on Turkish economy is noticeable, with tobacco products contributing 7.6% to the nation’s total tax revenue and 34% to its total excise tax revenue (2019 figures). This means that tobacco-related taxation plays an important role in governmental revenue structure of Türkiye (TEPAV, 2020) For this reason, if TFG legislation is approved, the tax revenue consequences of a possible decline in sales should be taken into consideration.

It should also be noted that if TFG regulation is properly implemented and compliance is monitored, tobacco-related health expenditures should decline in the medium to long term and this decline should be compared to the possible decline in tobacco tax revenues. Although further research is needed to obtain these estimates, a comparison between total public healthcare expenditure and tobacco tax revenue can be shared here, to provide an analytical base. For example, in 2018 and 2017, tobacco tax revenue was equivalent to 41.8 percent of the country’s total public health expenditure. In 2016 it was 42.1 percent of the country’s total public health expenditure. Clearly, the considerable amount of tax collection from tobacco products is an important component of public revenue that must be taken into consideration in policymaking (TEPAV, 2020).

The success of TFG regulation will also depend on the extent of public support for a proposal to prohibit the sale of tobacco products to people born after a certain year. We currently do not have any information on how the Turkish public might react to such a regulation. Studies conducted in other countries may not be very helpful in this respect, since public perceptions of the products may differ widely across countries and cultures.

Concluding Remarks 

In conclusion, the “tobacco end game” represents a critical juncture in global public health policy, with the potential to drastically reduce or even eliminate tobacco use within societies. Central to this initiative is the concept of the Tobacco-Free Generation (TFG), which seeks to prevent younger generations from ever starting to smoke through stringent age restrictions and other regulatory measures. The case of New Zealand, with its 2022 legislation banning tobacco sales to individuals born on or after January 1, 2009, exemplifies a pioneering approach that combines reduced retailer numbers and lowered nicotine levels to curb addiction and smoking initiation. This approach underscores a multifaceted strategy aimed at enhancing public health, generating long-term financial savings, and fostering cultural shifts away from tobacco use.

Despite the promising benefits of tobacco-free policies, such as improved health outcomes, economic gains from reduced health care costs, and a cultural shift toward healthier norms, significant challenges will be faced in implementation. Critics point to potential economic consequences, such as the rise of the black market and the financial impact on tobacco/cigarette manufacturers and tax revenues, as well as concerns about individual rights and freedoms. A delicate balance will be needed in policymaking to ensure that public health goals do not infringe on personal freedoms or economic stability.

Türkiye has made significant progress in establishing tobacco control regulations through various measures it has been taking over the past 20-30 years. The government’s proactive stance and readiness to implement comprehensive measures, particularly targeting the younger generation, point to the potential for Turkey to make significant progress in reducing smoking prevalence through sustained and enhanced efforts. In an article on the subject, the readiness of countries for a “tobacco end” policy was evaluated, and Turkey was included in the category of “countries almost ready to end tobacco use” (Tamil Selvan et al., 2024). Even though the prevalence of smoking is high in our country, Turkey can be considered a pioneer country because the government is ready to take all measures against smoking. It is thought that the written and verbal warnings that are frequently published in the media about the harmful effects of e-cigarette use on health are aimed especially at young people and are aimed at preventing the spread of these new products among young people.

However, despite not being accepted by health authorities and even though it is harmful to health and has a carcinogenic effect, smoking is a legal right for individuals who have reached a certain age and is still used by a significant portion of the population. Such legal regulations shape the perception of the society regarding the product, the habits and expectations of individuals. Therefore, it is not easy to predict how a regulation that will gradually increase the legal age for smoking and prevent a group of people from ever being able to legally purchase cigarettes will be perceived by the society in general and how willing individuals will be to comply with the rules. Before a regulation is made, it would be beneficial to inform the society and convince them that the regulation will be very beneficial for both our youth and our country. Another important point that should not be forgotten is that the attempt to keep young people from starting to smoke should be integrated with the efforts to provide smoking cessation support to those who are already smoking. In this way, a more holistic approach will be demonstrated against smoking in society.

The main problem that will be experienced with the implementation of a possible “Tobacco-Free Generation” regulation is the possibility that this implementation will increase the illegal tobacco and cigarette sales. Turkey is a country where the unregistered use of tobacco products is widespread. In our country, products such as open tobacco, roll-up cigarettes, and electronic cigarettes continue to be sold unregistered, untaxed, and uncontrolled. Therefore, for this regulation to be successful, it must be determined in detail in advance by which units and how the inspections regarding compliance with the written rules will be carried out and what kind of sanctions will be implemented in case of non-compliance with the rules.

Disclosure Note:

This (report/research/study) was funded with a grant from Global Action to End Smoking (formerly known as Foundation for Smoke-Free World), an independent, U.S. nonprofit 501(c)(3) grantmaking organization, accelerating science-based efforts worldwide to end the smoking epidemic. Global Action played no role in designing, implementing, data analysis, or interpretation of the (report/research/study) results, nor did Global Action edit or approve any presentations or publications from the (report/research/study). The contents, selection, and presentation of facts, as well as any opinions expressed, are the sole responsibility of the authors and should not be regarded as reflecting the positions of Global Action to End Smoking.

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