Recently, the Somerville Board of Health unanimously passed a Nicotine-Free Generation (NFG) ordinance that prohibits anyone born on or after January 1, 2005, from purchasing nicotine products. They join 14 other Massachusetts towns with NFG policies. This policy is, in effect, an incremental prohibition on nicotine.
Say “Group A” is people born before 2005, and “Group B” is people born after. Each year, more people will be born into Group B who will never be able to buy vapes, cigarettes, or nicotine pouches in Somerville, and Group A will dwindle over time until no one can legally purchase nicotine in the city.
Our generation rolls its eyes at substance-restricting policies. After years of learning about the prohibition era, the prejudiced War on Drugs, and the empirical evidence supporting the inefficacy of drug bans, we are quick to condemn them. And considering their poor track record, we are right to do so. There is no arguing that these policies are historically ineffective deterrence measures. Or at least, they are ineffective on their own.
In the past, we have largely relied on legislatures enacting restrictive rules to address substance-abuse epidemics. But public health science has advanced and institutionalized. Rather than legislatures, research centers and public health organizations are on the frontlines of the battle against the nicotine epidemic. They actively develop and implement evidence-based interventions that target the underlying cognitive and behavioral mechanisms of substance use, which have produced measurable reductions in nicotine and tobacco use among high school and college populations.
So if legislation is no longer at the frontlines of the battle against substance abuse, why revisit a prohibitive policy with nicotine?
If community treatments are the “frontlines” of the nicotine battle, then access reduction efforts like NFG may be the auxiliary forces. That is to say, the efficacy of prohibitive policies may rely on there being substance use interventions already in place in the community where the policy is being applied. And now that Somerville has such interventions in place for “Group B,” a prohibitive policy could support deterrence for these individuals, where it couldn’t for “Group A.”
Take an average individual in Group A. A 45-year-old man who has been using nicotine for decades. If nicotine were banned for him in Somerville, he would not hesitate to take the 10-minute Red Line from Davis to Harvard Square to buy his ZYNs. The best drug education he ever got was probably from D.A.R.E. in high school or the detention he got from the cigarette he smoked under the stairwell between classes. Obviously, a municipal ban would not do much to deter his use.
Now, take an individual from Group B, let’s say a recent Somerville High School graduate. Somerville High School has social workers trained to facilitate iDECIDE, a Massachusetts General Hospital-developed, school-based prevention and early-intervention program grounded in motivational interviewing, cognitive behavioral principles, and normative feedback. It is designed to strengthen adolescents’ decision-making around substance use by increasing risk perception, correcting misperceived social norms, and building refusal and behavior-change skills. The program is particularly targeted toward students experimenting with or at elevated risk for nicotine and other substances.
For a person who has gained these meaningful skills from such a data-backed intervention, not having access to a place to buy vapes in their city—or even just the visual stimuli of a nicotine vendor on their walk home—might very well be the final push they need to avoid using.
This may sound delicate, but it has real empirical support. Research shows laws restricting the licensing of tobacco retail outlets around residential areas, even by just 50 meters, complement existing efforts to reduce tobacco use, since residential proximity to a tobacco outlet was associated with significantly lower odds of maintaining abstinence during quit attempts. Notably, the effectiveness of reducing proximity to retailers presupposes there are people attempting to quit, but that is why research-backed public health interventions must be implemented first, which Somerville does.
Reducing proximity to retailers is not the primary mechanism for deterrence, but rather a reinforcing component of a broader substance-deterring strategy. Yes, determined users will cross borders, but we know from tobacco taxation studies that even small frictions reduce use rates, especially among adolescents. The goal is marginal improvement.
Future generations ideally won’t experience drug prohibition as any more of a “restriction” than today’s teens experience being unable to drive without a seatbelt as an infringement on personal freedom. Further, marginal loss of a subset of retailers selling a uniquely harmful product is economically rational when weighed against the healthcare costs accrued from nicotine use, and the incremental model gives businesses time to adjust their sales model to a gradually decreasing demand.
The NFG policy is not a ground-level nicotine deterrence effort, but rather a small piece of a coordinated and empirically-researched fight against the nicotine epidemic. At this point in our society, we universally agree that nicotine and tobacco are, in fact, bad. At the very least, we are testing a model we haven’t tested before, which in today’s painfully slow and divided legislative playing field is a scarce virtue.
Artwork by Cindy Qi