BACKGROUND: Tobacco 'endgame' proposes moving beyond traditional tobacco control measures towards a tobacco-free future where commercial tobacco products are phased out or their use and availability significantly restricted. This study investigated the perceptions of tobacco control stakeholders in Africa on a range of endgame approaches that could be suited for the region.
METHODS: A web-based cross-sectional survey was hosted on Redcap. Participants were from the Africa Tobacco Control Alliance database of stakeholders and rated agreement with 11 proposed endgame approaches on a 5-point Likert scale. Descriptive analysis explored level of agreement with each approach while bivariate (chi-square and Fishers exact tests) and logistic regression analyses examined association between agreement/disagreement to endgame approaches and demographic factors. Data were analyzed using STATA v17 with p<.05.
RESULTS: Total participants were 146 from 28 African countries. There was strong support for endgame approaches in Africa. All participants agreed with an integrated endgame approach while six measures (having non-addictive cigarettes, making cigarette unappealing, tobacco-free generation, regulated market model, quota/sinking lid and specific approaches for Africa) received over 90% agreement. Agreement ranged from 70-85% for price caps, performance-based regulation, and considering non-combustible nicotine products, while only 35% supported government takeover of tobacco companies. Males and participants with <10years’ experience working in tobacco control were more likely to favor price caps and tobacco-free generation. Regression results show that stakeholders from Central Africa and those with >20years experience working in tobacco control were less likely to support tobacco-free generation and price caps while females were less likely to support price caps and making cigarettes unappealing. Stakeholders from Southern Africa were less likely to support state takeover of tobacco companies and performance-based regulation.
CONCLUSIONS: There is widespread support for endgame approaches in the African region. Advocates should work with policymakers to implement new and multifaceted approaches to eliminate commercial tobacco use in Africa.