LETTER
Vol. 138 No. 1613 |
DOI: 10.26635/6965.6867
Notes from a small island: Ireland passes Tobacco 21 (T21) legislation
Tobacco-related disease continues to be a major burden of disease globally. Smoking is particularly prevalent in low socio-economic and minority ethnic groups and is a significant factor in health inequalities.
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Tobacco-related disease continues to be a major burden of disease globally.1 Smoking is particularly prevalent in low socio-economic and minority ethnic groups and is a significant factor in health inequalities.2,3 Ireland set a target in 2013 of becoming Smokefree, which is having a smoking prevalence of <5%, by 2025.4 However, as shown in Figure 1, Ireland has had a relatively stable smoking rate in recent years and has not achieved this target by a considerable margin.5,6
View Figure 1.
Critics have suggested that the World Health Organization’s (WHO’s) MPOWER strategy (monitoring tobacco use; protecting people from tobacco smoke; offering help to people quitting tobacco; warning about the dangers of tobacco; enforcing tobacco advertising, promotion and sponsorship bans; raising taxes on tobacco) is not enough to achieve Smokefree status in Ireland.5 Recent projections suggest that Ireland might at best have been on a trajectory to meet its Smokefree target by 2037,8 although even this projection may be overly optimistic.9
However, in a bold move that once again has Ireland “punching above its weight” in tobacco control,10 Ireland has just passed the Public Health (Tobacco) (Amendment) Act 2024. Section 11(3) of the Act provides that the Act will come into operation on 1 February 2028.11 From then on, the minimum purchase age for tobacco products in Ireland will be 21. Ireland is the only country within the European Union to have taken such a step, although Latvia has enacted legislation to raise the minimum age of sale to 20 in 2025. On the global stage, Ireland now follows in the footsteps of countries such as Ethiopia, Honduras, Kazakhstan, Mongolia, the Philippines, Singapore and the United States (US) in raising the minimum purchase age for tobacco to 21.12,13
Unlike the US, it must be acknowledged that the Irish legislation does not include vapes.13 However, moving the minimum tobacco purchasing age to 21 is a significant step forwards. The benefits of such a move are manifold. Such policies have been proven to reduce smoking rates elsewhere in the 18–20 age group.14 This is particularly important, as few people start smoking after their teenage years.14 In addition, as most underage smokers access their cigarettes via informal social avenues, evidence has found that such routes are also impacted. Evidence suggests, therefore, that such laws also reduce smoking prevalence among 16- and 17-year-olds.15
Delays in smoking initiation may be crucial, as it has been argued that adolescent brains are highly susceptible to rapid nicotine addiction.16 The US Department of Health and Human Services suggests that early initial onset of smoking leads to addictive behaviours, making it extremely challenging for an individual to quit and, hence, is more likely to result in heavy tobacco use as an adult.17 Concerns have also been raised about the possible long-term cognitive impacts of nicotine exposure during adolescent brain development.18 Further protections for children and young persons are required, given Big Tobacco’s ongoing marketing to this vulnerable demographic.19,20
The Tobacco 21 (T21) legislation in Ireland, although important, is only a partial amelioration strategy compared with Aotearoa New Zealand’s game-changing legislation that would have effectively eliminated smoking within a generation.21 That legislation appeared to herald a template to end the tobacco scourge, a factor particularly important for Māori.22 The abrupt U-turn by the newly elected Government in Aotearoa New Zealand in early 2024 on this important legislation is best described by Edwards et al. as “public health vandalism.”23,24 Although Ireland has also just had a general election in late November 2024, such a U-turn here seems highly unlikely. The now-leader of the largest party in Ireland was formerly the minister for health who introduced ground-breaking smokefree workplace legislation in 2004.9,25
Ireland’s legislation will not herald the tobacco endgame in the short term. However, to quote Otto von Bismarck, it may reflect the reality that “Politics is the art of the possible, the attainable—the art of the next best.”26 Public health, tobacco control and community advocates in Aotearoa New Zealand must now decide whether to hold firm and try once again to launch their revolutionary tobacco endgame legislation or, alternatively, campaign for a Tobacco 21 approach, at least as an intermediate step.
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Authors
Frank Houghton: Social Sciences ConneXions, Technological University of the Shannon, Limerick, Ireland. ORCID: 0000-0002-7599-5255.
John Lombard: School of Law, University of Limerick, Limerick, Ireland. ORCID: 0000-0003-2201-5441.
Correspondence
Dr Frank Houghton: Social Sciences ConneXions, Department of Applied Social Sciences, Technological University of the Shannon, Moylish, Limerick, Ireland.
Correspondence email
Frank.Houghton@TUS.ieCompeting interests
JL is a committee member of the Pharmaceutical Society of Ireland. He has received funding from the Health Service Executive for development of a national DNACPR Policy.
1) Reitsma MB, Kendrick PJ, Ababneh E, et al. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet. 2021;397(10292):2337-60. doi: 10.1016/S0140-6736(21)01169-7. Erratum in: Lancet. 2021;397(10292):2336. doi: 10.1016/S0140-6736(21)01282-4.
2) Valentelyte G, Sheridan A, Kavanagh P, et al. Socioeconomic Variation in Tobacco Smoking Among the Adult Population in Ireland. Nicotine Tob Res. 2024;ntae245. doi: 10.1093/ntr/ntae245.
3) Walsh M, Wright K. Ethnic inequities in life expectancy attributable to smoking. N Z Med J. 2020;133(1509):28-38.
4) Government of Ireland. Tobacco Free Ireland [Internet]. Dublin (IE): Government Publications Office; 2013 [cited 2024 Dec 10]. Available from: https://assets.gov.ie/19465/0c99a96e05c54b249c7d53b93b17437c.pdf
5) Li S, Levy D, Clancy L. Tobacco Free Ireland 2025: SimSmoke prediction for the end game. Tob Prev Cessat. 2018;4:23. doi: 10.18332/tpc/91427.
6) Houghton F, Houghton S, O’Doherty D, et al. The tobacco endgame: the importance of targets and geography. Can J Public Health. 2018;109(5-6):900-901. doi: 10.17269/s41997-018-0150-6.
7) Healthy Ireland. Healthy Ireland Survey 2024 [Internet]. IE: Government Publications Office; 2024 [cited 2024 Dec 10]. Available from: https://assets.gov.ie/313378/4ea7ec06-47e4-40b6-b8a9-c92984d9022e.pdf
8) HSE Tobacco Free Ireland Programme. The State of Tobacco Control in Ireland – Second Report [Internet]. Dublin (IE): HSE; 2022 [cited 2024 Dec 10]. Available from: https://www.hse.ie/eng/about/who/tobaccocontrol/state-of-tobacco-control-report-2022.pdf
9) Houghton F, O’Doherty D, McInerney D, Duncan B. Response to Tobacco Free Ireland 2025: SimSmoke prediction for the end game. Tob Prev Cessat. 2019;5:1. doi: 10.18332/tpc/102277.
10) Studlar DT. Punching above their weight through policy learning: tobacco control policies in Ireland. Ir Pol Stud. 2015;30(1):41-78. doi: 10.1080/07907184.2014.981162.
11) Public Health (Tobacco) (Amendment) Act 2024 (IE).
12) Tobacco Control Laws. Find By Policy [Internet]. Washington, DC (US): Campaign for Tobacco-Free Kids; 2025 [cited 2024 Dec 10]. Available from: https://www.tobaccocontrollaws.org/legislation/find-by-policy?policy=sales-restrictions&matrix=srMinimumLegalSalesAge&handle=sales-restrictions-mimum-age&status=Y&minimumAge=21
13) Kim SCJ, Martinez JE, Liu Y, Friedman TC. US Tobacco 21 is Paving the Way for a Tobacco Endgame. Tob Use Insights. 2021;14:1179173X211050396. doi: 10.1177/1179173X211050396.
14) Grube JW, Lipperman-Kreda S, García-Ramírez G, et al. California’s tobacco 21 minimum sales age law and adolescents’ tobacco and nicotine use: differential associations among racial and ethnic groups. Tob Control. 2022;31(e2):e126-e133. doi: 10.1136/tobaccocontrol-2020-056219.
15) Hansen B, Sabia JJ, McNichols D, Bryan C. Do tobacco 21 laws work? J Health Econ. 2023;92:102818. doi: 10.1016/j.jhealeco.2023.102818.
16) DiFranza JR, Wellman RJ, Mermelstein R, et al. The natural history and diagnosis of nicotine addiction. Curr Pediatr Rev. 2011;7(2):88-96. doi: 10.2174/157339611795735648.
17) Centers for Disease Control and Prevention Office on Smoking and Health. Preventing tobacco use among youth and young adults: A report of the surgeon general [Internet]. Atlanta, GA (US): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012 [cited 2024 Dec 10]. Available from: https://www.cdc.gov/tobacco/sgr/2012/consumer_booklet/pdfs/consumer.pdf
18) U.S. Department of Health and Human Services. The health consequences of smoking—50 years of progress: A report of the surgeon general. Atlanta, GA (US): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014 [cited 2024 Dec 10]. Available from: https://www.hhs.gov/sites/default/files/consequences-smoking-exec-summary.pdf
19) Brown JL, Rosen D, Carmona MG, et al. Spinning a global web: tactics used by Big Tobacco to attract children at tobacco points-of-sale. Tob Control. 2023;32(5):645-51. doi: 10.1136/tobaccocontrol-2021-057095.
20) Isip U, Calvert J. Analyzing big tobacco’s global youth marketing strategies and factors influencing smoking initiation by Nigeria youths using the theory of triadic influence. BMC Public Health. 2020;20(1):377. doi: 10.1186/s12889-020-8451-0.
21) Canty R, Gartner CE, Hoek J, Hefler M. Global policy scan of commercial combustible tobacco product retailing regulations by WHO region. Tob Control. 2024;tc-2023-058523. doi: 10.1136/tc-2023-058523.
22) Ait Ouakrim D, Wilson T, Waa A, et al. Tobacco endgame intervention impacts on health gains and Māori:non-Māori health inequity: a simulation study of the Aotearoa/New Zealand Tobacco Action Plan. Tob Control. 2024;33(e2):e173-e184. doi: 10.1136/tc-2022-057655.
23) Edwards R, Bullen C, Hoek J, et al. Public health vandalism: new Government scraps world-leading smokefree legislation. N Z Med J. 2023;136(1587):9-11. doi: 10.26635/6965.e1587.
24) Houghton F. Prolonging the Tobacco Endgame in Aotearoa/ New Zealand: A Tragedy with Global Implications. Medicina Internacia Revuo. 2024;31(122):16-19.
25) Howell F. Ireland’s workplaces, going smoke free. BMJ. 2004;328(7444):847-48. doi: 10.1136/bmj.328.7444.847.
26) von Poschinger H. Fürst Bismarck: Neue Tischgespräche und Interviews, Vol. 1. Berlin (DE): Deutsche Verlags-Anstalt; 1923.
