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Which tobacco control policies do smokers support? Findings from the International Tobacco Control Four Country Smoking and Vaping Survey

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Tracy T. Smith, Georges J. Nahhas, Ron Borland, Yoo Jin Cho, Janet Chung-Hall, Robert T. Fairman, Geoffrey T. Fong, Ann McNeill, Lucy Popova, James F. Thrasher, K. Michael Cummings

Original languageEnglish
Article number106600
JournalPreventive Medicine
PublishedAug 2021

Bibliographical note

Funding Information: The ITC Four Country Smoking and Vaping Survey was supported by grants from the US National Cancer Institute ( P01 CA200512 and P30 CA138313 ), the Canadian Institutes of Health Research ( FDN-148477 ), and the National Health and Medical Research Council of Australia ( APP1106451 ). This research was partially supported by the National Cancer Institute of the National Institutes of Health and Food and Drug Administration Center for Tobacco Products ( R01 CA239308 ). The funders had no role in the design, analysis, preparation, or decision to publish the manuscript. Publisher Copyright: © 2021 Elsevier Inc. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


As governments consider policy action to reduce smoking, a key factor in creating political will is the level of public support, particularly among smokers who are most affected by the policies. The goal of this paper is to assess and compare the level of support in Canada, the United States, England, and Australia for five smoking control policies: 1) banning menthol in cigarettes, 2) banning cigarette additives, 3) reducing nicotine in cigarettes to make them less addictive, 4) raising the minimum age to purchase cigarettes to 21 years and older, and 5) requiring pictorial warning labels on cigarette packs (examined in the US only). Data for these analyses come from 8165 daily cigarette smokers who responded to the 2016 International Tobacco Control Four Country Smoking and Vaping Survey. In all countries, the highest level of support was for raising the legal age for purchase to 21 years and older (62–70%) and reducing the nicotine content of cigarettes to make them less addictive (57–70%). Smokers who were less dependent on cigarettes and those expressing interest in quitting were more likely to support all policies. When asked how they would respond to a nicotine reduction policy, the most common response given was to try the non-nicotine cigarettes to see how they liked them (42–48%), with the next most common response being to quit smoking entirely (16–24%). The high level of support for these proposed policies among daily smokers provides important evidence for policymakers to counteract claims that such policies would be unpopular.

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