New Zealand is considering a change in law to permit euthanasia and/or assisted dying (EAD). We reviewed 20 years of research to investigate New Zealanders' attitudes towards EAD, including those of health professionals. A systematic search was conducted using relevant databases. We identified 21 quantitative and 5 qualitative studies. For quantitative data, descriptive analyses were used to examine any demographic patterns that influenced attitudes. We reviewed the circumstances under which people think that EAD should be accessible, and which forms of EAD they support. All public attitude studies reported that the majority (68%) of respondents support EAD. There are few statistically significant demographic associations with attitudes toward EAD; exceptions include religiousity, educational attainment, and some ethnic groups. Health professionals' attitudes varied by speciality. Qualitative research was analysed for reoccurring themes; 'feeling like a burden' was evident across most studies. We conclude from the quantitative research that public attitudes are stable and a majority are open to legislative change. However, the qualitative research reveals the complexity of the issue and indicates a need for careful consideration of any proposed law changes. It is unclear what safeguards people expect if the law changes. We found little research involving vulnerable and marginalised populations.

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Introduction Tobacco companies claim that substantially reducing tobacco retail outlets in Aotearoa New Zealand will increase illicit tobacco trade and crime. However, we know little about whether people who smoke anticipate using illicit tobacco once this measure is implemented. Exploring current illicit tobacco use and expected market development would clarify the likely scale of this potential problem. Methods We undertook online in-depth interviews with 24 adults who smoke and explored their experiences of illicit tobacco, perceptions of illicit market growth once legal tobacco became less available, intentions to engage in this market, and potential measures that could curb illicit market development. We interpreted the data using a qualitative descriptive approach. Results Few participants had purchased illegally imported or stolen tobacco. While most did not know how to access illicit tobacco products, many expected illicit trade and crime would increase if legal tobacco became difficult to access. While cheaper tobacco appealed to many, most perceived illicit supply routes as unsafe and saw products obtained via these as likely to be poor quality. Few suggested measures to control illicit markets, though a minority called for social reforms to reduce poverty, which they thought fuelled illegal practices. Conclusions Although illicit trade may appear to threaten new policy initiatives, participants’ limited knowledge of these markets and concerns regarding product safety suggest illegal tobacco may pose less of a threat than tobacco companies have claimed. Policy makers should not be deterred from reducing tobacco availability by industry arguments. Implications Although participants believed illicit trade would increase if the number of tobacco retailers was substantially reduced, few anticipated purchasing illegal tobacco. They viewed supply routes as unsafe and product quality as likely to be low. Industry predictions that illicit tobacco trade will grow if tobacco becomes less available do not reflect how people who smoke expect to engage with these markets and should not deter the introduction of retail reduction measures.

BackgroundAotearoa New Zealand plans to greatly reduce tobacco retail outlets, which are concentrated in areas of higher deprivation and perpetuate health inequities caused by smoking and borne particularly by Māori. However, we lack in-depth analyses of how this measure could affect people who smoke.MethodsWe undertook in-depth interviews with 24 adults from two urban areas who smoke. We used a novel interactive mapping approach to examine participants’ current retail outlets and their views on a scenario where very few outlets would sell tobacco. To inform policy implementation, we probed participants’ anticipated responses and explored the measure’s wider implications, including unintended impacts. We used qualitative description to interpret the data.ResultsMost participants anticipated accommodating the changes easily, by using alternative outlets or bulk-purchasing tobacco; however, they felt others would face access problems and increased costs, and greater stress. They thought the policy would spur quit attempts, reduce relapse among people who had quit and protect young people from smoking uptake, and expected more people to switch to alternative nicotine products. However, most foresaw unintended social outcomes, such as increased crime and reduced viability of local businesses.ConclusionsMany participants hoped to become smoke-free and thought retail reduction measures would prompt quit attempts and reduce relapse. Adopting a holistic well-being perspective, such as those developed by Māori, could address concerns about unintended adverse outcomes and provide comprehensive support to people who smoke as they adjust to a fundamental change in tobacco availability.