BACKGROUND: Several countries have set tobacco endgame goals and considered policies to rapidly reduce smoking to minimal levels. To anticipate endgame policy acceptability and feasibility, an increasing number of qualitative studies have explored stakeholders’ knowledge and attitudes toward endgame goals and views on implementation barriers and enablers. This review synthesized the data from these studies to inform future research and policy.
METHODS: We systematically searched academic databases (PubMed, CINAHL, Embase, Scopus, Web of Science, ProQuest). Eligible studies included interviews or focus groups with stakeholders. Descriptive analysis and thematic synthesis were conducted.
RESULTS: Thirty-four studies were included from seven countries, largely New Zealand/Aotearoa (n=15) and the US (n=13). The most frequently included stakeholders were tobacco control experts/policy makers, people who smoked, adolescents and young adults, and tobacco retailers. The most frequently explored policies were nicotine reduction (n=11), retail reduction (n=7), sales ban (n=7), and a smokefree generation (n=5). The primary themes identified were the perceived conflict between personal autonomy and protective regulation, concern about unintended consequences (illicit supply, switching to other harmful products, nicotine withdrawal), and practical barriers of enforcement and cost. Participants generally supported product-focused policies such as nicotine reduction, on the basis that they would increase quitting and protect children, but some who smoked felt such restrictions would exacerbate stress and deprive them of autonomy. Support for retail reduction was mixed; some felt this would reduce temptation to smoke, but others believed tobacco dependence would motivate people who smoked to just travel further for tobacco. Although participants felt the smokefree generation policy would denormalize tobacco, younger people thought it would be easy to circumvent by obtaining tobacco from their social network.
CONCLUSIONS: We identified common themes across stakeholders, as well as themes specific to stakeholder groups. Knowledge of perceived risks and benefits could inform endgame policy framing and communications.