BACKGROUND: The concept of a 'tobacco free generation' (TFG) emerged in 2010 as a way to phase out tobacco supply to future generations. Some states in Australia are currently considering implementing a TFG policy. However, there are likely greater benefits if a TFG policy were implemented at a country level, with reduced interstate supply to youth. This project aims to quantify the future health and economic impacts of a TFG policy, in comparison to both business-as-usual (BAU) and a less radical ‘T21’ policy in which the legal age of purchasing tobacco is increased to 21, in Australia.
METHODS: A Markov model calibrated to daily smoking forecasts reflecting historic trends across multiple sociodemographic strata (sex, age, remoteness, socioeconomic status [SES]), acts as the BAU scenario. A Proportional Multi-state Life-table is used to quantify the impacts of 31 smoking-related diseases, in health-adjusted life years (HALYs), mortality, and healthcare expenditure. The two interventions were parameterised based on existing policy analyses in the US and logical assumptions regarding illicit/social supply.
RESULTS: In comparison to BAU, the TFG policy is expected to result in an estimated 56,000 HALYs being gained (discounted 3%), and 210 deaths being averted, between 2025-2085, yielding approximately four times the health gains under the T21 policy. Across sociodemographic groups, the largest health gains under the TFG were for the remote and most disadvantaged populations. The TFG policy additionally resulted in $287 million in healthcare savings (discounted 3%) over 60-years, compared to $75 million under the T21 policy.
CONCLUSIONS: Our findings show the potential population health gains under TFG policy in Australia and highlight the importance of having equity at the forefront of tobacco control policy. It is important that these occur in conjunction with efforts to reduce existing smoking rates (and produce more immediate health gains) through novel efforts targeting cessation.