AimIreland will not meet the tobacco endgame goal set in its 2013 Tobacco-Free Ireland (TFI) policy of reducing smoking prevalence to less than 5% by 2025. Public opinion on tobacco endgame, a key lever to realise this goal, is uncharted in Ireland. This study aimed to measure public knowledge and attitudes to tobacco endgame.MethodsA telephone-administered cross-sectional survey of 1000 randomly dialled members of the general public was conducted in 2022. Prevalence of awareness, perceived achievability and support for the TFI goal and tobacco endgame measures was calculated and compared across tobacco product use status. Logistic regression identified factors independently associated with goal support.FindingsAlthough TFI goal awareness was low (34.0%), support was high (74.6%), although most (60.2%) believed it achievable beyond 2025. Product-focused measures were popular while support for supply-focused measures was mixed: for example, 86.1% supported nicotine content reduction while 40.3% supported user licencing. Phasing out tobacco sales was highly supported (82.8%); for most, this was contingent on support for currently addicted users. TFI goal support was independently associated with female sex (adjusted odds ratio (aOR) 1.47, 95% CI 1.05 to 2.07), higher education (aOR 1.80, 95% CI 1.21 to 2.66) and non-tobacco product use (aOR 2.67, 95% CI 1.66 to 4.30).ConclusionsDespite low awareness, tobacco endgame support is strong in Ireland. Public appetite for radically reducing tobacco product appeal and availability combined with public views on endgame achievability subject to extended timelines should be used to re-invigorate tobacco endgame discussion and planning in countries at risk of failing to meet declared targets.

Tobacco-Free Ireland (TFI) policy sets a tobacco endgame goal to reduce smoking prevalence to less than 5% by 2025. However, public opinion on this goal, an important policy lever, is uncharted in Ireland. This study aimed to inform policy planning by measuring public knowledge and attitudes to tobacco endgame. A telephone-administered cross-sectional survey of 1,000 randomly-dialled members of the general public was conducted. Prevalence of awareness, perceived achievability, and support for the TFI goal and potential tobacco endgame measures was calculated and compared across tobacco/e-cigarette user status. Logistic regression identified factors independently associated with TFI goal support. Although TFI goal awareness was low (34.0%), support was high (74.6%), albeit most (60.2%) believed it achievable beyond 2025. Goal support was higher among non-tobacco/e-cigarette users (adjusted Odds Ratio (aOR) 2.68, 95%CI 1.83-3.90), women (aOR 1.55, 95%CI 1.13-2.14) and higher social class members (aOR 1.48, 95%CI 1.03-2.12). Product-focused measures were popular while views on user-focused measures were mixed: e.g. 86.1% supported nicotine content reduction while 40.3% supported user licensing. Phasing-out tobacco sales was highly-supported (82.8%); however, for most, this was contingent on support for currently addicted users. Despite low awareness, there is strong support for tobacco endgame in Ireland and views on achievability are more realistic than the current goal of 2025. Supporting currently addicted tobacco users and engaging groups with lower support will be important policy planning and communication considerations. The Irish public are ready for tobacco endgame. These findings should re-invigorate policy planning to translate endgame ambition into action.

Background In 2013 ‘Tobacco-Free Ireland’ (TFI) shifted Irish national policy from tobacco control to “tobacco endgame”: policies, plans and interventions seeking to end the tobacco epidemic completely. Recent trends suggest the current 2025 TFI goal will not be achieved. This cross-sectional study is a timely assessment of public knowledge and attitude to re-focus Irish “tobacco endgame” planning. Methods A literature-informed, pre-tested survey instrument was telephone-administered to a representative sample of 1000 members of the Irish public aged ≥15 years recruited via random digit dialling in February 2022. Prevalence of “tobacco endgame” views was measured; logistic regression determined factors associated with key responses. Results Response rate was 30% (n = 1,000, post-hoc weighting applied). While TFI goal awareness was low (34%), support was high (75%), albeit most (61%) recognised postponement beyond 2025 was required for achievability. There was majority support for 18/22 endgame measures assessed. Product-focused tactics were popular, while views on targeting users were mixed: e.g. 86% supported a reduction in tobacco-product nicotine content; 40% supported introduction of a tobacco-user license. Phasing-out tobacco sales was highly-supported (83%); however, this was contingent on special supports for those currently addicted. Support for the TFI goal was higher among non-tobacco users (aOR 2.66, 95%CI 1.89-3.76), females (aOR 1.57, 95%CI 1.17-2.11) and those of higher social class (aOR 1.72, 95%CI 1.25-2.35). Conclusions While achievement by 2025 is increasingly unrealistic, findings strongly affirm Irish public opinion is ready for “tobacco endgame”. Recognition of the needs of currently addicted tobacco users and focusing on subgroups with lower support levels should be integral to equitable “tobacco endgame” planning and communication. This study should mobilise renewed Irish political commitment to bold actions aimed at ending smoking-related harm. Key messages • There is strong support for tobacco endgame measures among the Irish population, which is a supportive factor for bold political leadership to make these radical ideas a reality. • Public preference for product and non-user-focused measures aligns with tobacco endgame discourse and should aid policy reframing to tackle structures and dynamics sustaining the tobacco epidemic.

INTRODUCTION While promising evidence from trials of social-media-based stop smoking support informs service-planning, there is a need for more prospective, observational studies of smoking cessation interventions to build 'real-world' evidence. Specifically, user experiences have been under-explored with qualitative methods to date. This mixed-method evaluation of a closed Facebook group-based behavioral stop smoking support program, which was conducted in Ireland in 2018, aimed to address these issues. METHODS Pre-and post-program surveys measured smoking abstinence (selfreported 7-day point prevalence), changes in smoking attitudes and behavior, and participant experiences. Engagement with Facebook was measured through counting 'likes' and comments, and was used to categorize groups as 'more active' and 'less active' over a 12-week period of support. Thematic content analysis of semi-structured participant interviews explored program experience in depth. RESULTS In total, 13 of 52 participants reported smoking abstinence post-program (25.0%, 95% CI: 14.0-39.0). Participant engagement with Facebook was variable and decreased over the program. Membership of a 'more active' group was associated with better reported participant experience (e.g. 90.9% agreeing 'Facebook group helped me to quit or reduce smoking', versus 33.3% in the 'less active' group, p<0.05). Qualitative analysis identified three over-arching themes: importance of social interactions; perception of health information; and appeal of online support. CONCLUSIONS Facebook can be used to deliver group-based behavioral stop smoking support in the real world. In Ireland, the one-month post-program abstinence outcomes achieved by other stop smoking services is approximately 50%, and while the outcomes for this service was lower (25%), it is still better than outcomes estimated for unassisted quitting. Engagement and peer-to-peer interactivity should be maximized to support positive participant experience.

INTRODUCTION: Financial incentives improve stop smoking service outcomes. Views on acceptability can influence implementation success. To inform implementation planning in Ireland, public attitudes to financial incentives in stop smoking services were measured. METHODS: A cross-sectional telephone survey was administered to a random digit dialled sample of 1000 people in Ireland aged 15 years and older in 2022. The questionnaire included items on support for financial incentives under different conditions. Prevalence of support was calculated with 95% Confidence Intervals (CIs) and multiple logistic regression identified associated factors using Adjusted Odds Ratios (aORs, with 95% CIs). RESULTS: Almost half (47.0%, 95% CI 43.9%-50.1%) supported at least one type of financial incentive to stop smoking, with support more prevalent for shopping vouchers (43.3%, 95% CI 40.3%-46.5%) than cash payments (32.1%, 95% CI 29.2%-35.0%). Support was similar for universal and income-restricted schemes. Of those who supported financial incentives, the majority (60.6%) believed the maximum amount given on proof of stopping smoking should be under euro250 (median=euro100, range=euro1-euro7000). Versus comparative counterparts, those of lower educational attainment (aOR 1.49 95% CI 1.10-2.03, p=0.010) and tobacco/e-cigarette users (aOR 1.43 95% CI 1.02-2.03, p=0.041) were significantly more likely to support either financial incentive type, as were younger people. CONCLUSIONS: While views on financial incentives to stop smoking in Ireland were mixed, the intervention is more acceptable in groups experiencing the heaviest burden of smoking-related harm and most capacity to benefit. Engagement and communication must be integral to planning for successful implementation to improve stop smoking service outcomes.