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Smokers and non-smokers talk about regulatory options in tobacco control

¹ Centre for Values, Ethics and the Law in Medicine, Central Clinical School, Faculty of Medicine, The University of Sydney, NSW, Australia
² School of Public Health, The University of Sydney, NSW, Australia

Correspondence to:
Dr Stacy M Carter
Centre for Values, Ethics and the Law in Medicine, Central Clinical School, Faculty of Medicine, The University of Sydney, NSW, Australia 2006; carters{at}med.usyd.edu.au

Objective: Community members are occasionally polled about tobacco control policies, but are rarely given opportunities to elaborate on their views. We examined laypeople’s conversations to understand how 11 regulatory options were supported or opposed in interactions.

Design: Qualitative design; purposive quota sampling; data collection via focus groups.

Setting: Three locations in Sydney, Australia.

Participants: 63 smokers and 75 non-smokers, men and women, from three age groups (18–24, 35–44, 55–64 years), recruited primarily via telephone.

Measurements: Semi-structured question route; data managed in NVivo; responses compared between groups.

Results: Laypeople rejected some regulatory proposals and certain arguments about taxation and the cost of cessation treatments. Protecting children and hypothecating tobacco excise for health education and care were highly acceptable. Plain packaging, banning retail displays and youth smoking prevention received qualified support. Bans on political donations from tobacco corporations were popular in principle but considered logistically fraught. Smokers asked for better cessation assistance and were curious about cigarette ingredients. Justice was an important evaluative principle. Support was often conditional and unresolved arguments frequent. We present both sides of these conflicts and the ways in which policies were legitimised or de-legitimised in conversation.

Conclusions: Simple measures of agreement used in polls may obscure the complexity of community responses to tobacco policy. Support was frequently present but contested; some arguments that seem self-evident to advocates were not so to participants. The detailed understanding of laypeople’s responses provided through qualitative methods may help frame proposals and arguments to meet concerns about justice, effectiveness and feasibility.

Abbreviations: ETS, environmental tobacco smoke; NRT, nicotine replacement therapy; SES, socioeconomic status

Keywords: public policy; qualitative research; evaluation; smoking; tobacco control