Category - In the News

Time to look at how TFG may be applied


Tobacco-free generation laws ban the sale of tobacco to those born after a specific year and prevent future generations from ever starting to smoke, while not affecting existing smokers.

The tobacco-free generation proposal was made in Singapore as early as 2010, but is now set to be adopted by a foreign country instead. The cities of Balanga in the Philippines and Brookline in the United States also have laws supporting a tobacco-free generation.

Former MP Lee Bee Wah has said that she believes such a generational approach could work.

Laws like Singapore’s that set a minimum age for using tobacco products make smoking seem like something that is acceptable for people of a certain age, when in reality, it is harmful for everyone. Some young people may even see smoking as an act that marks a person’s coming of age, and that is even worse.

TFG in the International Association for the Study of Lung Cancer News Jan2021

Million-dollar ad campaign characters such as the Marlboro Man and Joe Camel lured many people to take up the tobacco habit through magazine ads and TV commercials. Gimmicks such as “Camel Cash” that could be mailed in, in exchange for prizes such as cigarette lighters and t-shirts, made tobacco users walking advertisements, perpetuating an ethos of cool. Eventually, advertising standards were altered so as not to be so kid-friendly and enticing to young people. 

Although ads to promote tobacco products have been curtailed during the past few decades, cancer from using tobacco products still kills more than 8 million people each year, according to the World Health Organization (WHO).1 It is also known that second-hand smoke is also dangerous and contributes to 1.2 million deaths around the world. 

The challenge now is preventing future generations from ever becoming users. 

Presenter Heng Nung Koong, MD, founder and director of the Tobacco Free Generation International, discussed this topic during the Education Session “The ‘How To’ of Modern Tobacco Control” (ES21). In 2010, Dr. Koong wrote a journal article, “Phasing-Out Tobacco: Proposal to Deny Access to Tobacco for Those Born from 2000” as a way to think about new generations of never smokers and how best stop them from ever becoming tobacco users.2 One way is to limit the supply and retail operations of tobacco and to create new policies around obtaining and publicly using tobacco in order to eradicate the initial desire or demand for tobacco products. 

The ‘Tobacco Endgame’

Tobacco control researcher and policy analyst Ruth Malone, RN, PhD, FAAN, coined the term “tobacco endgame” in 2011 to propel tobacco-free priorities across the globe. 

This Tobacco Endgame concept, “replaces the globally accepted, flawed minimum age [to legally purchase products]” Dr. Koong said. Children receive mixed messages; they are told about the dangers of smoking, and yet they see adults smoking. They are exploited by advertising, which promotes the idea that using these products makes one cool or glamorous. Teenagers, many of whom are eager to appear like adults, may engage in risky behaviors to be like the adults in their life and also their peers. The industry capitalizes on the rebellious psyche of teenagers by continuing to say that it only markets to adult smokers, leading many to accept the legitimacy of the industry and its claims.  

Additionally, many young people do not suffer immediate health issues. The dangers of smoking increase over time, so many do not experience the health consequences until decades from their first cigarette, vape, or chew. 

Improving Education

Saito et al,published in the British Medical Journal in 2013, an analysis of 40 textbooks that covered the dangers of tobacco usage and found that very few books presented ways to resist the allure of tobacco (Table).

The movement “needs to go beyond saying ‘smoking is bad and causes various diseases.’ Instead it is the peers who need to stand up in front of a group and advocate to thousands of children,” Dr. Koong said. 

“It needs to be an ecosystem that gets permanent internalization in mass education in schools,” he added.

He suggested ways to accomplish this through positive peer pressure. Ideally, schools will develop youth leadership programs within education systems, especially targeting the teenage years, when youth are vulnerable and eager to fit in with peers.

Tobacco-Free Ordinances

As of 2015 in the Philippines, 23.8% overall (16.6 million adults; 41.9% of men and 5.8% of women), were current tobacco users.4)

Dr. Koong developed the world’s first tobacco-free ordinance in 2016 with the support of legislative leaders in the Philippines. In Balanga City, Bataan, the mayor approved this ordinance “as a novel preventive measure against tobacco abuse and tobacco’s harmful effects in the Philippines. It aims to regulate the sale of tobacco to any citizen born on or after January 1, 2000,” per the ordinance. The ordinance is being explored by the other municipalities within the province. 

More recently, in November 2020, in Brookline Massachusetts, the Tobacco-Free Generation initiative was passed during a town meeting in a 139 (yes) to 73 (no) vote. This is the first initiative passed in the United States. This measure to prevent the sale of tobacco to anyone born on or after January 1, 2000, is awaiting approval from Massachusetts Attorney General Maura Healey. 

These ordinances do not shame or condemn current tobacco users in any way. The idea is to prevent the next generation from starting in the first place. 

“This is a phased-in, non-antagonist social movement that will result in no new smokers in future generations,” Dr. Koong said. 

The hope is that this compelling initiative will catch on other states as well as globally. Currently more than 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries.1 To become sustainable as a country, inform your local municipalities and mayors on the Tobacco Free Generation merits. Get them to contact the Tobacco Free Generation team to start this better nicotine prevention ecosystem within your education system. The training workshops can be completed within 3-4 days. 

For further information: 
A related abstract (Abstract 1039), “Achieving the Tobacco Free Generation Endgame: #1 Reimagining the Implementation of Better Mass Tobacco Prevention Education,” was presented by Lynn Ong.


  1. Tobacco. World Health Organization. Published May 27, 2020. Accessed January 16, 2021.
  2. Khoo D, Chiam Y, Ng P, Berrick AJ, Koong HN. Phasing-out tobacco: proposal to deny access to tobacco for those born from 2000. Tob Control. 2010;19(5):355-360. 
  3. Saito J, Nonaka D, Mizoue T, et al. Limited potential of school textbooks to prevent tobacco use among students grade 1–9 across multiple developing countries: a content analysis study. BMJ Open. 2013;3: e002340.
  4. Global Adult Tobacco Survey 2015. Published February 14, 2017. Accessed January 16, 2021.


WHO Categories for Tobacco Prevention EducationPercentage of Topics Included in Text
Consequences of tobacco use73%
Not social norms46%
Reasons not to use tobacco10%
Social influences10%
Resistance and life skills1.2%





Lauren Evoy Davis

British Medical Journal on the FCTC Treaty

“We did not, in the end, find that this treaty accelerated decline in tobacco consumption.”

“…our methods, which represent – to our knowledge – the most rigorous evaluation of any international law ever conducted. We did not find any of the 3 kinds of effects.”

– Steven Hoffman, 2020

WHO Director-General Dr. Tedros recently said “Since it came into force 13 years ago, the Framework Convention on Tobacco Control remains one of the world’s most powerful tools for promoting public health,”.

But is it?

That’s what a study just published on tried to investigate – one of which pulls together all the data we have on smoking rates, from 1970 to 2015, and then a quasi-experimental study which tries to model what the effect of the FCTC has had.

Steven Hoffman, and Matthieu Poirier from the Global Strategy Lab at York University join us to explain what their research means, and why it’s time to double down on our attempts to reduce smoking.

DepEd, government agencies support tobacco-free generation initiative : SunStar Pampanga 2018

The TFG Movement in Bataan started in 2016, and has completed its information campaign this year with 44,173 students from 44 junior high schools who committed to never smoke in their lifetime. (PR)

United to promote the positive and youth engaging, TFG ecosystem
for The Free Generation, our future generations..

Philippines News Agency 2018

“Those who were born in year 2000 pledged not to smoke, sell or attempt to use tobacco. All those who were born before year 2000, however, are expected to support the new generation,” Bea Camille Santos, 18, said.

The student from Balanga City said that the new generation should not discriminate against smokers, rather show them care in the hope that they will stop smoking. (PNA)

Myanmar Health Digest 2016

We thank the People’s Health Foundation for hosting TFG at the

Asia Sub-Regional Tobacco Control Leadership Program

“Enhancing Tobacco Control Leadership and Policy Implementation”
19 to 25 June, 2016, MingalarThiri Hotel, NayPyi Taw, Myanmar.

The International Union Against Tuberculosis and Lung Disease (The Union) and Johns Hopkins Bloomberg School of Public Health (JHSPH), in collaboration with the Ministry of Health, Myanmar and People’s Health Foundation, developed and implemented a one-week regionalTobacco Control Leadership Program suited to the capacity building needs of these countries in the region. 

Y.O.U.T.H.S’ O.P.I.N.I.O.N

Read these opinion pieces from Singapore youths.

21 Jan 2019 “Implementing no-smoking zones could be problematic as enforcement actions could generate unhappiness and anger among smokers. This may even lead to physical assault or injuries.”

4 Feb 2019 “Birth year-based policymaking sets more ideal standards on the younger generation while still respecting older policies implemented on preceding generations.”

Massachusetts, Brookline Article Aims to Create a ‘Tobacco Free Generation’

The notion of creating a Tobacco Free Generation is gaining traction worldwide.

2 doctors from Brookline, Massachusetts, are proposing a ban on sales to all persons in Brookline born after 1995, forever.

Balanga City in the Philippines is already way ahead in this, declaring their city to be the first Tobacco Free Generation city in the world on 18 March 2016. Step by step, we are moving towards being a Tobacco Free Generation!

Article from

6th April 2016
By Jenna Fisher for

BROOKLINE – As groups across the state move to increase restrictions on the sale and use of tobacco, two Brookline health professionals want to convince the town to be the first in the country to adopt a “tobacco free generation” policy.

Petitioners John Ross and his wife Megan Sandel are area doctors and see a number of patients with tobacco-related problems. Their warrant article for May’s Town Meeting calls for a ban on the sale of tobacco products to anyone born after 1995. Such a ban would encourage a generation of nonsmokers, they said.

“This is out of character for us,” said Ross. “I never really got involved in Brookline government. I just got fed up with seeing so many patients dying and felt this was a way to get involved and change something.”

Ross is a doctor at Brigham and Women’s Hospital in Boston. In addition to being a pediatrician who sees a number of children suffering from smoke-related problems, Sandel is an associate professor of pediatrics at the Boston University Schools of Medicine and Public Health, the medical director of National Center for Medical-Legal Partnership, and a principal investigator with Children’s Health Watch.

In 2014, Brookline raised the smoking age to 21, which some experts say helped lower smoking rates among teenagers at Brookline High School, the TAB reported.

According to a recent survey put out by Brookline’s Health Department, the rate of tobacco use among high school students in Brookline sits at about 5 percent, compared to about an 11 percent in the state and 16 percent in the US.

Still, Ross said the number is still too high.

“I would take the position that tobacco is a drug. It’s a defective consumer product. If it were a new consumer product, there is no way that it would be considered [safe for] sale,” he said.

On average a smoker lives 10 years less than a nonsmoker. And tobacco caused more than 480,000 deaths each year (including deaths from secondhand smoke), according to the Centers for Disease Control and Prevention.

In Massachusetts, tobacco use contributes to the death of 9,300 people and costs $4.08 billion in health care bills each year, according to activist campaign group Tobacco Free Kids, which led a march last month at the capital.

Cigarettes are the number one cause of preventable death in the United States, said Ross.

“People may talk about consumer choice, but this is really an addictive drug on the level of an opiate,” he said. “Tobacco is the only consumer product that kills you when used as directed. There’s no equal in terms of disease and harm it causes.”

At first, the couple hoped to ban the sale of tobacco to everyone in Brookline. But after some thought they decided to scale back.

“We don’t have any desire to put anybody out of business,” Ross said.

Ross and Sandel are proposing a ban of sales to all persons in Brookline born after 1995, forever. That would mean if you are currently of legal age to smoke, you would still be able to smoke, but if not, you wouldn’t be allowed to start.

This would mitigate some of the impact to retailers by decreasing sales by about 2 percent a year, he said, at the same time protecting youth by making it more difficult to start smoking.

“Every day that I come to work, I see people who have been damaged in one way or another by tobacco, COPD, new diagnoses of cancer, heart disease or many of the ways that tobacco can impact your health. At some point I realized the most effective way to treat the ravages of tobacco is to prevent them from happening at all,” he said. “If [the warrant article] did pass, it would be another example of Brookline breaking ground in the fight against tobacco.”

Ross said reaction in the medical and public health circles has been positive. The Public Health Advocacy Institute at Northeastern University – which has defended municipalities in the state that have enacted various restrictions on tobacco – has agreed to defend the town pro bono should it run into serious opposition.

“Of course the town has the right to handle its own defense of its legislation, but we would be able to go into court and do the written work and handle that on behalf of that or in conjunction with Brookline if there is a challenge from either retailers or another part of the tobacco industry,” said Mark Gottlieb, executive director of the public health advocacy institute at Northeastern University School of Law.

And there’s a chance of litigation.

“This would be a first of it’s kind. In general the more restrictive a piece of legislation or health policy regarding a tobacco, the more likely it is to be challenged, usually by retailers,” he said.

But he’s optimistic.

“Legally we’re quite confident that this is a strong approach that would be successful,” he said.

In Brookline, small convenience stores are the primary source of cigarettes. It’s unclear what the impact might be on them.

“That’s something that the community carefully needs to review. How does it affect existing businesses?” said National Association of Convenience Stores’ Jeff Lenard, based in Virginia. Lenard added that about a third of convenience store revenue comes from tobacco products.

Ross and Gottlieb seem to have given it some thought.

In late 2014, the town of Westminster toyed with the idea of banning all tobacco sales. That was met with an unpleasant backlash against the board of health, said Gottlieb. The meeting to discuss it was overwhelmed with protestors, he said.

“The Tobacco free generation concept is a much more moderate and very gentle phase out. It’s really just affecting a tiny amount of sales each year. It’s something that gives the retail company a lot of time to adapt to. And ultimately achieve the same goal which is to stop the cycle of youth addiction.”

Some 95 percent of users start using tobacco products before the age of 21, said Gottlieb. “I think this proposal is a very elegant way of achieving a very important health goal. If Brookline adopts this and becomes the first in the nation it will open a lot of eyes across Massachusetts.”


This original article can be viewed here.


Singapore 2015 Youth Summit in zbComma

COMMA article on TFG Youth Summit

zbComma publishes an article on TFG’s 2015 Youth Summit. zbCOMMA is distributed to schools together with Lianhe Zaobao on Wednesdays, acting as the “ bridge ” for students to get in touch with Zaobao (ZB). It consists of follow-ups on news in ZB, articles written by ZB reporters and blurbs for ZB news that serve to connect students with ZB.

Make the Young Snub It


Every research publication attracts scrutiny. TFG’s publication in Tobacco Control Journal in 2010 entitled “Phasing-out tobacco: proposal to deny access to tobacco for those born from 2000” is no exception. Singapore’s print media The New Paper as well as Singapore Press Holding’s AsiaOne portal published an article highlighting some of the issues surrounding the proposal. As our school program pick up momentum, this publication is not only timely publicity for TFG but more importantly, it paves the way for society to start exploring “end game” ideas seriously. Regardless of the outcome, our mission of going to the schools and educating the young about risks of tobacco addiction remains a key priority for the team.…/simple-and-innovative-way-m…

Healthy Living for All

TFG works with the new Sengkang General Hospital and other government organizations to encourage healthy lifestyle in North East Singapore.

Sengkang Health & TFG2000


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