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Graham-DeMello A, Hoek J. How do people who smoke perceive a tobacco retail outlet reduction policy in Aotearoa New Zealand? A qualitative analysis. Tob Control 2024; 33:e25-e31. [PMID: 36720649 PMCID: PMC10958291 DOI: 10.1136/tc-2022-057834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/20/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aotearoa 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. METHODS We 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. RESULTS Most 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. CONCLUSIONS Many 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.
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Affiliation(s)
| | - Janet Hoek
- Public Health, University of Otago, Wellington, New Zealand
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Yao Y, Cheung YTD, Wu YS, Guo Z, Chan SK, Zhao SZ, Tong HSC, Lai VWY, Lam TH, Ho SY, Wang MP. Association between tobacco industry denormalisation beliefs and support for tobacco endgame policies: a population-based study in Hong Kong. Tob Control 2024:tc-2023-058393. [PMID: 38458757 DOI: 10.1136/tc-2023-058393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To examine the associations between tobacco industry denormalisation (TID) beliefs and support for tobacco endgame policies. METHODS A total of 2810 randomly selected adult respondents of population-based tobacco policy-related surveys (2018-2019) were included. TID beliefs (agree vs disagree/unsure) were measured by seven items: tobacco manufacturers ignore health, induce addiction, hide harm, spread false information, lure smoking, interfere with tobacco control policies and should be responsible for health problems. Score of each item was summed up and dichotomised (median=5, >5 strong beliefs; ≤5 weak beliefs). Support for tobacco endgame policies on total bans of tobacco sales (yes/no) and use (yes/no) was reported. Associations between TID beliefs and tobacco endgame policies support across various smoking status were analysed, adjusting for sociodemographics. RESULTS Fewer smokers (23.3%) had strong beliefs of TID than ex-smokers (48.4%) and never smokers (48.5%) (p<0.001). Support for total bans on tobacco sales (74.6%) and use (76.9%) was lower in smokers (33.3% and 35.3%) than ex-smokers (74.3% and 77.9%) and never smokers (76.0% and 78.3%) (all p values<0.001). An increase in the number of TID beliefs supported was positively associated with support for a total ban on sales (adjusted risk ratio 1.06, 95% CI 1.05 to 1.08, p<0.001) and use (1.06, 95% CI 1.05 to 1.07, p<0.001). The corresponding associations were stronger in smokers than non-smokers (sales: 1.87 vs 1.25, p value for interaction=0.03; use: 1.78 vs 1.21, p value for interaction=0.03). CONCLUSION Stronger TID belief was associated with greater support for total bans on tobacco sales and use. TID intervention may increase support for tobacco endgame, especially in current smokers.
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Affiliation(s)
- Ying Yao
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yee Tak Derek Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yongda Socrates Wu
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ziqiu Guo
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sik Kwan Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sheng Zhi Zhao
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Gendall P, Gendall K, Branston JR, Edwards R, Wilson N, Hoek J. Going 'Super Value' in New Zealand: cigarette pricing strategies during a period of sustained annual excise tax increases. Tob Control 2024; 33:240-246. [PMID: 36008127 DOI: 10.1136/tc-2021-057232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 08/09/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Between 2010 and 2020, the New Zealand (NZ) Government increased tobacco excise tax by inflation plus 10% each year. We reviewed market structure changes and examined whether NZ tobacco companies shifted excise tax increases to maintain the affordability of lower priced cigarette brands. METHODS We cluster-analysed market data that tobacco companies supply to the NZ Ministry of Health, created four price partitions and examined the size and share of these over time. For each partition, we analysed cigarette brand numbers and market share, calculated the volume-weighted real stick price for each year and compared this price across different price partitions. We calculated the net real retail price (price before tax) for each price partition and compared these prices before and after plain packaging took effect. RESULTS The number and market share of Super Value and Budget brands increased, while those of Everyday and Premium brands decreased. Differences between the price of Premium and Super Value brands increased, as did the net retail price difference for these partitions. Following plain packaging's implementation, Super Value brand numbers more than doubled; contrary to industry predictions, the price difference between these and higher priced brands did not narrow. CONCLUSIONS Between 2010 and 2020, NZ tobacco companies introduced more Super Value cigarette brands and shifted excise tax increases to reduce the impact these had on low-priced brands. Setting a minimum retail price for cigarettes could curtail tobacco companies' ability to undermine tobacco taxation policies designed to reduce smoking.
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Affiliation(s)
- Philip Gendall
- Public Health, University of Otago Wellington, Wellington, New Zealand
| | | | | | - Richard Edwards
- Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Nick Wilson
- Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Janet Hoek
- Public Health, University of Otago Wellington, Wellington, New Zealand
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Chaffee BW, Donaldson CD, Couch ET, Andersen-Rodgers E, Guerra C, Cheng NF, Ameli N, Stupplebeen D, Farooq O, Wilkinson M, Gansky S, Zhang X, Hoeft K. "I think we can do without [tobacco]": support for policies to end the tobacco epidemic among California adolescents. Tob Control 2023:tc-2023-058288. [PMID: 38148144 PMCID: PMC11199374 DOI: 10.1136/tc-2023-058288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION The tobacco endgame, policies aiming to end the commercial tobacco epidemic, requires sustained public support, including among youth. We assessed endgame support among California (USA) adolescents, including their reasons and associated participant and policy-specific factors. METHODS Teens, Nicotine and Tobacco Project online surveys (n=4827) and focus groups were conducted in 2021 and 2022 among California residents aged 12-17 years. Cross-sectional survey participants were asked their agreement level with eight policy statements related to tobacco and/or cannabis sales restrictions, use in public places and use in multiunit housing. Ordered logistic regression modelled level of agreement according to respondent characteristics, behaviours and statement content. Qualitative data were collected through focus groups (n=51 participants), which were analysed to provide insight into support for different policies. RESULTS Most survey participants agreed or strongly agreed with tobacco product sales restrictions (72%-75%, depending on the policy), bans on use in public spaces (76%-82%) and smoke-free (79%) and vape-free (74%) apartment buildings. Support was stronger among younger, female, Asian and tobacco non-using participants and for policies directed at 'tobacco' (vs 'vapes' or cannabis), at flavoured tobacco (compared with all tobacco), and when statements featured 'should end' (vs 'not allowed'). Focus group participants who were supportive viewed policies as protecting children from harmful products, while those less supportive cited concerns about limiting adults' freedoms and unintended consequences. CONCLUSIONS Most participants supported strong tobacco control policies. Public communication that promotes broader endgame benefits besides protecting youth and accelerates industry denormalisation may counter youth concerns and further bolster their support.
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Affiliation(s)
- Benjamin W Chaffee
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Candice D Donaldson
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Elizabeth T Couch
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Andersen-Rodgers
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Claudia Guerra
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Nancy F Cheng
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Niloufar Ameli
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - David Stupplebeen
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Omara Farooq
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Monica Wilkinson
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Stuart Gansky
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Xueying Zhang
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, California, USA
| | - Kristin Hoeft
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
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Trigg J, Rich J, Williams E, Gartner CE, Guillaumier A, Bonevski B. Perspectives on limiting tobacco access and supporting access to nicotine vaping products among clients of residential drug and alcohol treatment services in Australia. Tob Control 2023:tc-2023-058094. [PMID: 37821220 DOI: 10.1136/tc-2023-058094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Tobacco endgame strategies aim to drive down population smoking rates, the success of which can be improved with public buy-in, including from populations with high smoking rates such as alcohol and other drug (AOD) service clients. This study aimed to explore acceptability of tobacco retail and nicotine reduction, and subsidised nicotine vaping to support AOD service clients following a smoking cessation attempt. METHODS We interviewed 31 Australian AOD service clients who currently or previously smoked, following a 12-week randomised trial comparing nicotine replacement therapy with nicotine vaping product (NVP) for smoking cessation. Participants were asked how effectively three scenarios would support tobacco cessation: tobacco retailer reduction, very low-nicotine cigarette standard and subsidised NVP access. We thematically analysed participant views on how each approach would support tobacco abstinence. RESULTS Tobacco retailer reduction raised concerns about increasing travel and accessing cigarettes from alternate sources, with generally lower acceptability, though a range of perspectives were provided. Reducing nicotine in tobacco products was described as reducing appeal of smoking and potentially increasing illicit purchases of non-reduced nicotine products. Clients of AOD services were highly accepting of subsidised NVP access for tobacco cessation, as this would partly address financial and socioeconomic barriers. CONCLUSIONS Australian tobacco control policy should consider how these approaches impact ease and likelihood of tobacco access by AOD service clients in relation to the general population. Understanding clients' acceptability of tobacco control and endgame measures can inform how to avoid potential unintended consequences for these clients.
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Affiliation(s)
- Joshua Trigg
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Jane Rich
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Edwina Williams
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Coral E Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Ashleigh Guillaumier
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Bhatia G. Tobacco Endgame: Can India Share the Dream? Indian J Psychol Med 2023; 45:189-192. [PMID: 36925499 PMCID: PMC10011840 DOI: 10.1177/02537176221139144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Gayatri Bhatia
- Dept. of Psychiatry, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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Puljević C, Feulner L, Hobbs M, Erku D, Bonevski B, Segan C, Baker A, Hefler M, Cho A, Gartner C. Tobacco endgame and priority populations: a scoping review. Tob Control 2023:tc-2022-057715. [PMID: 36720648 DOI: 10.1136/tc-2022-057715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
AIM To summarise the research literature on the impacts or perceptions of policies to end tobacco use at a population level (ie, tobacco endgame policies) among people from eight priority population groups (experiencing mental illness, substance use disorders, HIV, homelessness, unemployment or low incomes, who identify as lesbian, gay, bisexual, transgender, queer or intersex (LGBTQI+) or who have experienced incarceration). METHODS Guided by JBI Scoping Review Methodology, we searched six databases for original research examining the impacts or perceptions of 12 tobacco endgame policies among eight priority populations published since 2000. We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. RESULTS Of the 18 included studies, one described perceptions of five endgame policies among people on low incomes in Aotearoa (New Zealand), and 17 focused on the effectiveness or impacts of a very low nicotine content (VLNC) cigarette standard among people experiencing mental illness (n=14), substance use disorders (n=8), low incomes (n=6), unemployment (n=1) or who identify as LGBTQI+ (n=1) in the USA. These studies provide evidence that VLNC cigarettes can reduce tobacco smoking, cigarette cravings, nicotine withdrawal and nicotine dependence among these populations. CONCLUSIONS Most of the tobacco endgame literature related to these priority populations focuses on VLNC cigarettes. Identified research gaps include the effectiveness of endgame policies for reducing smoking, impacts (both expected and unexpected) and policy perceptions among these priority populations.
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Affiliation(s)
- Cheneal Puljević
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Leah Feulner
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maria Hobbs
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Erku
- Menzies Health Institute, Centre for Applied Health Economics, Griffith University, Brisbane, Queensland, Australia
| | - Billie Bonevski
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Amanda Baker
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Marita Hefler
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Ara Cho
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral Gartner
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Stone E, Paul C. The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics. Curr Oncol 2022; 29:6325-6333. [PMID: 36135066 PMCID: PMC9497727 DOI: 10.3390/curroncol29090497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Smoking cessation represents an untapped resource for cancer therapy. Many people who smoke and have cancer (tobacco-related or otherwise) struggle to quit and as a result, jeopardise response to treatment, recovery after surgery and long-term survival. Many health care practitioners working in cancer medicine feel undertrained, unprepared and unsupported to provide effective smoking cessation therapy. Many institutions and healthcare systems do provide smoking cessation programs, guidelines and referral pathways for cancer patients, but these may be unevenly applied. The growing body of evidence, from both retrospective and prospective clinical studies, confirms the benefit of smoking cessation and will provide much needed evidence for the best and most effective interventions in cancer clinics. In addition to reducing demand, helping cancer patients quit and treating addiction, a firm commitment to developing smoke free societies may transform cancer medicine in the future. While the Framework Convention for Tobacco Control (FCTC) has dominated global tobacco control for the last two decades, many jurisdictions are starting to develop plans to make their communities tobacco free, to introduce the tobacco endgame. Characterised by downward pressure on tobacco supply, limited sales, limited access and denormalization of smoking, these policies may radically change the milieu in which people with cancer receive treatment, in which health care practitioners refine skills and which may ultimately foster dramatic improvements in cancer outcomes.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital Sydney, Darlinghurst 2010, Australia
- School of Clinical Medicine, University of New South Wales, Sydney 2052, Australia
- School of Public Health, University of Sydney, Camperdown 2006, Australia
- Correspondence:
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan 2308, Australia
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Waa AM, Edwards R. Full From evidence to action: Building the case for commercial tobacco endgames. NICOTINE & TOBACCO RESEARCH : OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON NICOTINE AND TOBACCO 2022; 24:1693-1694. [PMID: 35965385 DOI: 10.1093/ntr/ntac198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew M Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
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Wamamili B, Gartner C, Lawler S. Factors associated with support for reducing and ending tobacco sales among university students in Queensland, Australia and New Zealand. Aust N Z J Public Health 2022; 46:477-481. [PMID: 35616405 DOI: 10.1111/1753-6405.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/01/2021] [Accepted: 03/01/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the factors associated with support for reducing tobacco retail availability and ending the legal sale of cigarettes in Australia and New Zealand (NZ). METHODS Cross-sectional surveys were conducted in NZ (eight universities, n=1,932) and Queensland (University of Queensland or UQ, n=5,172). Participants were asked how much they agreed or disagreed with reducing the number of places allowed to sell cigarettes/tobacco and ending the legal sale of cigarettes within 10 years. Multinomial logistic regression models assessed associations between support with student characteristics. RESULTS More than half the respondents in both samples supported reducing the number of tobacco outlets (NZ 69.3%; UQ 62.3%), and ending the legal sale of cigarettes within 10 years (NZ 53.3%; UQ 51.6%) with marginally more support among NZ students. Men and students who smoked or vaped had lower odds of supporting both strategies compared with women and non-users. CONCLUSIONS The results suggest widespread support for reducing tobacco retail availability among university students in NZ and Queensland, and sex, and smoking and vaping status were strong predictors for support. Around half supported phasing out tobacco sales within 10 years. IMPLICATIONS FOR PUBLIC HEALTH Collaborative research should be encouraged to enhance cross-country approaches on tobacco control.
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Affiliation(s)
- Ben Wamamili
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Coral Gartner
- School of Public Health, University of Queensland, Brisbane, Queensland
| | - Sheleigh Lawler
- School of Public Health, University of Queensland, Brisbane, Queensland
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Morphett K, Gartner C. Informed choice in the context of tobacco use disorder. Nicotine Tob Res 2021; 24:1-2. [PMID: 34648625 DOI: 10.1093/ntr/ntab215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Kylie Morphett
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Coral Gartner
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia
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