Is the public ready for a tobacco-free Ireland? A national survey of public knowledge and attitudes to tobacco endgame in Ireland

Abstract

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.

Public Support for Tobacco Endgame Policies: A Systematic Review and Meta-analysis

“…[55] Among the 47 included studies, 7 reported support estimates for an endgame goal. [21 27 31 38 46 49 50]…”

“…Of the 21 studies on product-focused policies, 14 related to mandating a VLNC standard for smoked tobacco products. [20 21 24 26 29 40 43 46 47 53 54 59-61] Among the six studies related to setting product standards to make products less appealing, five pertained to banning all additives,[20 21 23 29 30 46] and one to banning filters. [46] Only one study focused on a policy intended to promote the use of ‘clean’ nicotine products (e.g., e-cigarettes, nicotine gum, etc.)…”

“…as a substitute for cigarettes. [25] Six studies evaluated user-focused policies; two pertained to the requirement for a licence or prescription to purchase tobacco[46 65] and four to restricting tobacco sales and supplies by birth year (i.e., tobacco-free generation, TFG). [46 52 63 65]…”

“…Twenty-four studies measured support for banning cigarette sales. [12 21 22 28 31-35 39 41 42 44-46 48 50 51 55 57 58 62 64 65] One study provided estimates for AYA in each of the 27 European Union member states for 2008, 2011, and 2014 (81 estimates),[32] resulting in 134 support estimates for banning cigarette sales. Eight studies focused on reducing the commercial viability of tobacco companies,[28 36-38 42 46 56 58] and three on increasing tobacco tax to an unaffordable level.…”

“…[12 21 22 28 31-35 39 41 42 44-46 48 50 51 55 57 58 62 64 65] One study provided estimates for AYA in each of the 27 European Union member states for 2008, 2011, and 2014 (81 estimates),[32] resulting in 134 support estimates for banning cigarette sales. Eight studies focused on reducing the commercial viability of tobacco companies,[28 36-38 42 46 56 58] and three on increasing tobacco tax to an unaffordable level. [21 38 46] Among the four studies on restricting retailers, three were about restricting their density[21 45 46] and one pertained to restricting their type.…”