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Smoking as an ‘informed choice’: implications for endgame strategies
  1. Janet Hoek1,
  2. Jude Ball2,
  3. Rebecca Gray2,
  4. El-Shadan Tautolo3
  1. 1 Department of Marketing, University of Otago, Dunedin, New Zealand
  2. 2 Department of Public Health, University of Otago, Wellington, New Zealand
  3. 3 Director of the Centre for Pacific Health and Development, AUT University, Auckland, New Zealand
  1. Correspondence to Professor Janet Hoek, Department of Marketing, University of Otago, P. O. Box 56, Dunedin 9054, New Zealand; janet.hoek{at}otago.ac.nz

Abstract

Objective Tobacco companies often assert that adults should be free to make an ‘informed choice’ about smoking; this argument influences public perceptions and shapes public health policy agendas by promoting educative interventions ahead of regulation. Critically analysing ‘informed choice’ claims is pivotal in countries that have set endgame goals and require new, more effective policies to achieve their smoke-free aims.

Methods In-depth interviews with 15 New Zealand politicians, policy analysts and tobacco control advocates examined how they interpreted ‘informed choice’ arguments. We used a thematic analysis approach to review and explicate interview transcripts.

Results Participants thought ‘informed choice’ implied that people make an active decision to smoke, knowing and accepting the risks they face; they rejected this assumption and saw it as a cynical self-justification by tobacco companies. Some believed this rhetoric had countered calls for stronger policies and thought governments used ‘informed choice’ arguments to support inaction. Several called on the government to stop allowing a lethal product to be widely sold while simultaneously advising people not to use it.

Conclusions ‘Informed choice’ arguments allow the ubiquitous availability of tobacco to go unquestioned and create a tension between endgame goals and the strategies used to achieve these. Reducing tobacco availability would address this anomaly by aligning government's actions with its advice.

  • Advocacy
  • End game
  • Public policy
  • Tobacco industry

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Footnotes

  • Contributors JH conceptualised and designed the project, and obtained research funding. JB had substantial input into the interview guide; ES-T and RG also provided feedback. JB and E-ST conducted the interviews. JB and JH led the manuscript development and JH responded to the reviewers' comments. JB, ES-T and RG provided feedback on iterations of the revised manuscript. All authors have seen and approved the final version. JH is the guarantor of the manuscript. Authors are listed in descending order of contribution.

  • Funding This research was funded by a grant from the Royal Society Marsden Fund (grant number 11/134).

  • Competing interests Although the authors do not consider it a competing interest, for the sake of full transparency they note that all authors have previously undertaken work for health sector agencies working in tobacco control.

  • Ethics approval University of Otago Human Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Participants were given an assurance that their data would only be available to the research team. Unpublished data are thus not available to those outside the research team.

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