Dr. Helen McAvoy:

Broadly speaking, we know that most people who try tobacco products do so before they are aged 25. We also know that the average age at which children try their first cigarette is going up, which is good. That is what we were trying to do, but we are also aware that many countries have now introduced a minimum legal age of 21 for the sale of tobacco. This is in recognition of the addictive and toxic nature of the product and the fact that one in two smokers will die of a tobacco-related disease. It is that serious and that is why an age of approximately 21 is appropriate.

Legislation was introduced to change the legal age of sale in the United States. It started at state localities and moved into national legislation in 2019. Singapore has introduced phased implementation of this starting with 19- to 20-year-olds in 2020 and increasing the age to 20- to 21-year-olds in 2021. A comprehensive review of this was conducted in 2016. Some modelling was done that demonstrated the legislation can result in fewer tobacco attributable deaths. It also demonstrated a reduction in adverse maternal and child health outcomes, including pre-term births, low birth weight and sudden infant death. The implementation of the Tobacco 21 law in California was evaluated. It was found that after the implementation there was very high awareness and support of the legislation among the community and retailers. Some 60% of young people in the area agreed that raising the minimum age for tobacco sales to 21 reduced tobacco use.

There is a concern that this is paternalistic medicine or nanny statism but it is, in fact, a very proportionate measure in the context of the harmfulness of this product. Other countries are now looking at what is called the sinking lid, where they state they will prohibit the sale of tobacco to anyone born after a certain date, whether it is 2008 or 2020, because they are very committed to an endgame that after a certain point they do not want to see any child or young person having access to these products and becoming addicted.

The argument against this was always that it would increase illicit sales. The evaluation from the California programme was that did not happen. The all-party parliamentary group on smoking and health in the UK recommended raising the age for the sale of tobacco to 21. It has also been raised for discussion at European level so it is certainly in the ether. The estimates are that it would result in a reduction of approximately 7% or 8% in smoking prevalence by 2030, if it was introduced. We could get quite a quick return from that policy in a short period. We do not yet have modelling for that in Ireland.

I talked a little about the adolescent brain. It is an interesting space in terms of decision-making, impulse control, peer pressure and sensation seeking. If we can protect children and adolescents through that period, we will have done a lot to crack this problem of tobacco use and tobacco-related harm. The adolescent brain is also uniquely vulnerable to the effects of nicotine and nicotine addiction so there is a neuroscience argument to this as well.