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New Zealand community pharmacists’ perspectives on supplying smoked tobacco as an endgame initiative: a qualitative analysis
  1. Janet Hoek1,
  2. Charika Muthumala1,
  3. Elizabeth Fenton2,
  4. Coral E Gartner3,
  5. Frederieke Sanne Petrović-van der Deen1
  1. 1Department of Public Health, University of Otago, Wellington, New Zealand
  2. 2Bioethics Centre, University of Otago Bioethics Centre, Dunedin, New Zealand
  3. 3School of Public Health, University of Queensland, Herston, Queensland, Australia
  1. Correspondence to Professor Janet Hoek, Public Health, University of Otago, Wellington, New Zealand; janet.hoek{at}otago.ac.nz

Abstract

Introduction Tobacco endgame strategies often include measures to reduce tobacco availability by decreasing retailer numbers. Recently, some US pharmacies have delisted tobacco, though overall retailer numbers have not reduced markedly. Paradoxically, others have suggested limiting tobacco sales to pharmacies, to reduce supply and support cessation. We explored how pharmacists from Aotearoa New Zealand, a country planning to reduce tobacco supply, perceived supplying tobacco.

Methods We undertook in-depth interviews with 16 pharmacists from Ōtepoti Dunedin; most served more deprived communities with higher smoking prevalence. We probed participants’ views on supplying tobacco, explored factors that could limit implementation of this policy, and analysed their ethical positions. We used qualitative description to analyse data on limiting factors and reflexive thematic analysis to interpret the ethical arguments adduced.

Results Most participants noted time, space and safety concerns, and some had strong moral objections to supplying tobacco. These included concerns that supplying tobacco would contradict their duty not to harm patients, reduce them to sales assistants, undermine their role as health experts, and tarnish their profession. A minority focused on the potential benefits of a pharmacy supply measure, which they thought would use and extend their skills, and improve community well-being.

Conclusions Policy-makers will likely encounter strongly expressed opposition if they attempt to introduce a pharmacy supply measure as an initial component of a retail reduction strategy. However, as smoking prevalence falls, adopting a health-promoting supply model, using pharmacies that chose to participate, would become more feasible and potentially enhance community outreach and cessation support.

  • end game
  • public policy
  • cessation

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Our ethics approval limits data access to members of the research team. We have provided data relevant to the study in an online supplemental file.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Our ethics approval limits data access to members of the research team. We have provided data relevant to the study in an online supplemental file.

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Footnotes

  • Twitter @CoralGartner

  • Contributors JH conceptualised the study, obtained funding, supervised CM, co-led data collection, coding and interpretation and led development of the manuscript. CM co-led data collection, coding and interpretation, and prepared a report that informed the manuscript development. EF advised on the ethical framework, CEG offered feedback on the literature review and FSP-vdD provided background information that informed the study design. EF, CG and FSP-vdD gave feedback on a later version of the manuscript. All authors have reviewed and approved the manuscript. JH is the guarantor.

  • Funding The research was funded by a programme grant from The Health Research Council of New Zealand (19/641).

  • Competing interests No, there are no competing interests.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.