BACKGROUND: Many countries have set targets to reduce tobacco use to <5%; thus, some are considering more aggressive measures to end tobacco use (known as “endgame”). Understanding support across social groups is key for informing advocacy efforts concerning these policies. Our study examined population-level support among adults who smoke for banning smoked tobacco products (STP) in 10 years, restricting sales to anyone <18 for life (tobacco-free generation, TFG), and introducing a very low nicotine standard for cigarettes (VLNC) to make them less addictive.
METHODS: Data were from adults who smoked (≥ monthly) from the 2022 International Tobacco Control Four Country Smoking and Vaping Survey in Australia (n=1167), Canada (n=1578), England (n=1857) and the United States (US, n=1400). Weighted prevalence of support was estimated, and weighted logistic regression models assessed support (vs no support) overall and by gender, age group, income and education, controlling for country, smoking frequency, and nicotine dependence.
RESULTS: Across all countries, 51.9% of adults who smoked supported VLNC (95%CI: 49.3%-54.4%), 50.5% a TFG (47.9%-53.1%), and 26.2% a STP ban (24.0%-28.4%). Support differed significantly by country and gender; however, no differences were found by income nor education. Support was lower in the US compared to Canada for VLNC (aOR: 0.59; 95%CI: 0.43-0.81), a TFG (0.54; 0.39-0.74) and a STP ban (0.39; 0.26-0.55). The odds of support were higher among women (1.44; 1.14-1.84) than men for VLNC, but significantly lower (0.73; 0.56-0.95) for a STP ban. There were no differences by gender for support towards a TFG.
CONCLUSIONS: Results identify significant levels of support towards endgame policies among people who smoke across social groups, which can help inform education and advocacy efforts for these initiatives. Additional research on what might make phasing out of STP sales more widely accepted, especially among women who smoke, may be beneficial.