Vision for tobacco endgame in Korea: suggestions for countries with endgame aspirations

Abstract

Tobacco endgame is a focal point of discussion at both national and international levels. We aimed to describe efforts related to achieving the tobacco endgame in the Republic of Korea, an exemplar of a country with endgame aspirations, and compare them with the efforts of other nations. We reviewed the tobacco endgame efforts of three nations considered tobacco control leaders: New Zealand (NZ), Australia and Finland. The efforts/attempts of each country were described using an endgame strategy category. The tobacco control leaders had explicit goals to achieve a smoking prevalence of <5% before a target date and had legislation and research centres for tobacco control and/or endgame. NZ is implementing a mixture of conventional and innovative endgame interventions; the others use incremental conventional approaches. In Korea, there has been an attempt to ban the sale and manufacture of combustible cigarettes. The attempt led to the filing of a petition, and a survey of adults showed 70% supported the legislation banning tobacco. The Korean government mentioned a tobacco endgame in a 2019 plan, yet a target and an end date were absent. The 2019 plan in Korea included incremental FCTC strategies. Practices in the leading countries show that legislation and research are key to ending the tobacco epidemic. The MPOWER measures must be strengthened, endgame objectives must be set and bold strategies must be adopted. Key endgame policies include those with evidence of effectiveness, such as retailer reductions.

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

“…That said, the opinions of people who smoke should not be disregarded. In countries with endgame goals, smoking prevalence is low,[73] and people who smoke make up a minority with a weak public voice. [74 75] However, because people who smoke would be most affected by the implementation of endgame policies, priority policies and implementation plans should be accompanied by investigation of their views to facilitate and enhance implementation and effectiveness.…”

Epidemiological Model for Conventional Tobacco Control Measures and Tobacco Endgame Policies

“…The key endgame policies include reducing nicotine content in cigarettes, promoting tobacco-free generations, and restricting retailer availability. These measures are part of the Smokefree Aotearoa 2025 Action Plan of New Zealand, a leading country in the tobacco endgame [ 3 ]. The model also incorporates endgame policy categories that encompass these key policies.…”

“…Endgame policies include product, user, market/supply, and institutional structure-focused measures [ 2 ]. Specifically, proposals including limiting nicotine in cigarettes, banning tobacco sales by birth year, and restricting the density, location, or types of tobacco retailers are under consideration [ 3 ]. Some conventional measures, such as tax increases, are also considered endgame policies when implemented at sufficient intensity (e.g., a 20% increase per year) [ 2 ].…”

“…In Korea, tobacco control efforts based on the MPOWER framework have been implemented ( Supplemental Material 1 ), but progress in reducing smoking prevalence has been insufficient, with the target prevalence unmet ( Supplemental Material 2 ). Given the increasing discussions on the tobacco endgame and how to accelerate prevalence reductions in Korea, one study has offered suggestions for adopting the tobacco endgame in Korea [ 3 ]. These proposals include strengthening MPOWER measures and generating evidence on preferred endgame policies.…”

“…As number of countries seek to implement endgame policies alongside conventional MPOWER measures [ 3 ], an integrated conceptual model would be beneficial. Furthermore, generating evidence for endgame policies remains challenging due to a lack of clarity regarding the characteristics of policies with the potential to phase out smoking.…”