Closing the gaps in tobacco endgame evidence: a scoping review

Abstract

ObjectiveTobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities.Data sourcesGuided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched.Study selectionTwo reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation.Data extractionWe report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Data synthesisEight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26); product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1); moving consumers to reduced risk products (n=8); tobacco-free generation (n=4); ending sales (n=2); sinking lid (n=2); tax increases (n=7); and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised.ConclusionsVLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.

Progress, challenges and the need to set concrete goals in the global tobacco endgame

“…Endgame planning in the form of setting ambitious prevalence goals and dates began in 2010 in New Zealand, leading to a healthy race to the top as multiple countries followed; Canada, England, Finland, Ireland, Scotland and Sweden have all set explicit endgame targets. Other countries, including Australia, Bangladesh and the United States, have what are effectively endgame targets for the prevalence of tobacco use even if they are not explicitly stated as such (8).…”

“…Tobacco products are an even more worthy candidate for elimination: not only do they serve no useful purpose but also they are a leading cause of death and disability and impose a global economic burden equivalent to nearly 2% of global gross domestic product (7). Furthermore, there is growing evidence of public support for endgame policies, including ending the sale of tobacco products (8).…”

The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics

“…A review paper, looking at the far-reaching initiatives required to set firm tobacco-free target dates, has developed some “minimum requirements” that include public health consensus, public support, political champions to push through contentious legislation and collaboration across high and low-income communities to ensure equity [ 48 ]. Several countries so far have set endgame dates ( Table 1 ) with aim to reduce smoking prevalence to 5% or less over the next 3 to 18 years [ 49 ]. Ireland aims to become tobacco free by 2025 through multiple initiatives including ‘denormalizing” tobacco use for upcoming generations [ 50 ].…”

“…Key policies ( Box 1 ) for the tobacco endgame may include those based on the product (low nicotine content, product standards to reduce appeal), on the user (licences or prescriptions, restriction by age/year of birth), on the market (ending commercial retail, reducing imports, markedly increasing tax), on regulatory straitjackets for the tobacco industry (such as fines for exceeding smoking prevalence targets) [ 49 ] and even criminal liability [ 58 ]. An interesting conceptual switch has been proposed, from prohibition (with the “spectres” of restriction and loss of choice) towards abolition (representing freedom) as a way to counter the rhetoric of the tobacco industry [ 59 ].…”

Tobacco endgame intervention impacts on health gains and Māori:non-Māori health inequity: a simulation study of the Aotearoa-New Zealand Tobacco Action Plan

“…To date, the implementation of endgame interventions has been minimal and, consequently, the evidence base of their potential effects is weak. 18 For example, none of the endgame interventions included in the A/NZ Action Plan have been implemented at country-level, with the possible exception of substantial reductions in retail supply in Hungary. This paper aimed to estimate the future tobacco smoking prevalence, mortality and health adjusted life year (HALY) impacts (including changes in Māori/non-Māori inequalities) of tobacco endgame strategies outlined in the A/NZ Government's proposed Action Plan.…”