Barbalich Ivana, Gartner Coral, Edwards Richard, Hoek Janet
Otago School of Medicine, University of Otago, Dunedin, New Zealand.
School of Public Health, University of Queensland, St Lucia, QLD, Australia.
Nicotine Tob Res. 2022 Jan 1;24(1):93-99. doi: 10.1093/ntr/ntab161.
New Zealand's equity-focused endgame goal (Smokefree 2025) aims to reduce smoking prevalence to minimal levels (ie, <5%) in all population groups by 2025. Inadequate progress has stimulated discussion of innovative measures to reduce prevalence; because few studies have explored how marginalized groups perceive these measures, we addressed this knowledge gap.
In November and December 2020, we conducted 20 in-depth interviews with people who smoked daily, were aged between 21 and 53, earned less than the median income (NZD33 900), and had marginal or inadequate income sufficiency. We explored participants' smoking history and used an elicitation exercise to probe their views on smokefree policies, including potential endgame measures. We used qualitative descriptive analysis and reflexive thematic analysis to interpret the data.
Participants favored increasing personal support to quit and reducing nicotine levels in cigarettes, but generally opposed tobacco excise tax increases and paying people to quit. While many privileged their right to "choose," some recognized that stronger policies could restore the loss of agency addiction caused. Participants felt smoking's powerful addictiveness remained poorly understood, and called for smoking to be recognized and treated as an addiction.
Several participants supported intensifying existing measures or introducing new measures. However, their use of tobacco industry rhetoric to frame smoking as a choice they had made could inadvertently reinforce the stigma they experienced. Reframing cigarettes as an addictive product engineered by a deceptive industry, may make it easier for participants to access the expanded support and compassion they sought.
Policy measures, such as reducing the nicotine level in cigarettes, could support endgame goals; however, greater public understanding of addiction is needed to reduce stigma, support self-efficacy, and foster smoking cessation. Industry denormalization campaigns could challenge views of smoking as a personal choice, decrease self-blame among people who smoke, and present endgame goals as likely to enhance agency.
新西兰以公平为重点的最终目标（2025年无烟）旨在到2025年将所有人群的吸烟率降至最低水平（即<5%）。进展不足引发了对降低吸烟率创新措施的讨论；由于很少有研究探讨边缘化群体如何看待这些措施，我们填补了这一知识空白。
2020年11月和12月，我们对21至53岁、日吸烟、收入低于中位数收入（33900新西兰元）且收入充足程度处于边缘或不足水平的人群进行了20次深入访谈。我们探究了参与者的吸烟史，并通过启发式练习来探究他们对无烟政策的看法，包括潜在的最终措施。我们采用定性描述性分析和反思性主题分析来解释数据。
参与者赞成增加个人戒烟支持并降低香烟中的尼古丁含量，但普遍反对提高烟草消费税和付钱让人们戒烟。虽然许多人看重他们“选择”的权利，但一些人认识到更强有力的政策可以恢复因成瘾而丧失的自主能力。参与者认为吸烟强大的成瘾性仍未得到充分理解，并呼吁将吸烟视为一种成瘾行为并加以治疗。
一些参与者支持强化现有措施或引入新措施。然而，他们使用烟草行业的言辞将吸烟描述为他们做出的选择，可能会无意中强化他们所遭受的耻辱感。将香烟重新定义为由欺骗性行业制造的成瘾产品，可能会使参与者更容易获得他们所寻求的更多支持和同情。
降低香烟中尼古丁含量等政策措施可以支持最终目标；然而，需要公众对成瘾有更深入的了解，以减少耻辱感、支持自我效能并促进戒烟。行业去规范化运动可以挑战将吸烟视为个人选择的观点，减少吸烟者的自责，并将最终目标呈现为可能增强自主能力。
