Public support for phasing out the sale of cigarettes in Australia

Field: Social Sciences (Social Sciences)

As smoking rates continue to decline in some countries, including Australia,1 a goal once unthinkable is now being considered: phasing out the retail sale of combustible tobacco products.2, 3 In 2009, 72% of Victorian adults and 57% of smokers felt it would be good if there came a time when cigarettes were no longer available for sale.4 In 2019, we assessed support among Victorian adults for phasing out retail sales, and canvassed their views on timeframes for doing so. During 21 October ‒ 4 December 2019, Cancer Council Victoria recruited a representative sample of 4191 adults, using random digit dialling to landline and mobile phones, for the cross-sectional Victorian Smoking and Health Survey (VSHS; survey response rate, 49.1%). Our target population included members of private households in Victoria aged 18 years or more. For the landline sample, we used "youngest male" respondent selection to reduce the over-representation of older people in our sample, which was structured to provide 75% of interviews in Melbourne and 25% in the rest of Victoria. For the mobile phone sample, the respondent was deemed the target respondent and no geographic quotas were applied. A multi-stage weighting procedure (design and post-stratification weights) adjusted for differences between survey respondents and the general Victorian population. The Cancer Council Victoria Human Research Ethics Committee approved the survey (HREC 1008); respondent consent was obtained at the start of their participation in the survey. Two questions about phasing out cigarette sales, added to the VSHS after fieldwork had commenced, were put to 2774 respondents (66%). Support by smoking status and age was assessed in logistic regression analyses, applying an unconditional approach (Stata 14 command: subpopulation) to estimate standard errors for the subsample included in the weighted analyses. We report odds ratios with 95% confidence intervals. A total of 1466 respondents (52.8%) — including 145 of 457 current smokers (31.7%), 367 of 682 adults under 30 years of age (53.8%), and 599 of 1122 adults aged 50 or more (53.4%) — thought it would be good were selling cigarettes in retail outlets phased out; 533 (19.2%), including 181 smokers (39.6%), thought it would be bad. A total of 1779 respondents (64.2%) thought it fair to implement the phase-out within the next ten years (Box 1). Support for phasing out sales and for doing so within five years was greatest among never smokers and lowest among smokers; age group did not influence support for phasing out sales, but affirming that doing so within five years was fair was higher among respondents aged 30 years or more (Box 2). Total Smoking status† Age (years) Current smokers Former smokers Never smokers 18–29 30–49 50 or more Some people believe that there may come a time when it will no longer be legal to sell cigarettes in retail outlets in Australia. Do you think this would be… Number of respondents 2774 457 723 1594 682 970 1122 A good thing 1466 (52.8%) 145 (31.7%) 385 (53.2%) 937 (58.8%) 367 (53.8%) 501 (51.6%) 599 (53.4%) A bad thing 533 (19.2%) 181 (39.6%) 141 (19.5%) 212 (13.3%) 111 (16.2%) 194 (20.0%) 229 (20.4%) Neither a good or a bad thing 695 (25.1%) 116 (25.5%) 180 (24.9%) 399 (25.0%) 186 (27.3%) 251 (25.9%) 258 (22.9%) Don't know/can't say 79 (2.8%) 15 (3.3%) 17 (2.3%) 47 (2.9%) 18 (2.7%) 24 (2.5%) 37 (3.3%) What timeframe do you think is fair in relation to the proposed phasing out of the sale of cigarettes from retail outlets? Would you say… Number of respondents 2770 456 722 1591 682 968 1120 Within the next 5 years 1059 (38.2%) 124 (27.1%) 275 (38.1%) 661 (41.5%) 204 (29.9%) 384 (39.7%) 471 (42.1%) Within the next 10 years 720 (26.0%) 80 (18%) 189 (26%) 450 (28.3%) 217 (31.8%) 257 (26.5%) 246 (22.0%) Within the next 20 years 329 (11.9%) 58 (13%) 76 (11%) 194 (12.2%) 109 (16.0%) 111 (11.4%) 110 (9.8%) Yes, but not within the next 20 years 93 (3.4%) 26 (5.6%) 17 (2.3%) 51 (3.2%) 32 (4.7%) 31 (3.2%) 30 (2.7%) No, not ever 461 (16.6%) 151 (33.0%) 140 (19.4%) 170 (10.7%) 100 (14.7%) 153 (15.8%) 207 (18.5%) Don't know/can't say 108 (3.9%) 18 (3.9%) 25 (3.5%) 65 (4.1%) 20 (2.9%) 32 (3.3%) 56 (5.0%) Smoking status Age (years) Current smokers Former smokers Never smokers 18–29 30–49 50 or more Phasing out retail sale of cigarettes "a good thing" 1 2.45 (1.79–3.35) 3.08 (2.30–4.11) 1 0.92 (0.71–1.19) 0.99 (0.79–1.23) — 1 1.25 (1.02–1.54) — 1 1.07 (0.87–1.32) Phasing out within the next 5 years "fair" 1 1.65 (1.19–2.31) 1.91 (1.41–2.60) 1 1.54 (1.18–2.02) 1.71 (1.34–2.16) — 1 1.15 (0.94–1.42) — 1 1.10 (0.90–1.36) As the goal of phasing out cigarette sales has not been widely discussed in Australia, it is encouraging that such a strategy is broadly supported by the Victorian public. Support in 2009 was higher (72%).4 A major tobacco control media campaign, new graphic health warnings, and new smoke-free laws may have increased awareness of tobacco control in 2009, and the phrasing of the question (2009: "will no longer be available", 2019: "it will no longer be legal" to sell cigarettes) may also have influenced the willingness of respondents to approve the goal. A June 2020 survey of 1000 Western Australian adults, commissioned by the Australian Council on Smoking and Health and funded by Healthway (the WA government health promotion agency), found that 60% of respondents thought it good and 14% bad should a time come when cigarettes could not be legally sold in retail outlets; 67% thought a 10-year timeframe for the phase-out fair.6 One limitation of our study was that the two questions were added after VSHS data collection had commenced, and were consequently not put to one-third of the original survey sample, selected to be representative of the Victorian adult population. Our survey did not include people who were homeless or being treated in psychiatric institutions, groups with higher smoking rates. Phasing out retail tobacco sales would be favourably received by most Australians. Effective messages for bolstering support, especially among smokers and tobacco retailers, would be required. Policy pathways for successfully implementing a phase-out also require investigation. The Victorian Smoking and Health survey was supported by Quit Victoria, with funding from VicHealth, the Victorian Department of Health and Human Services, and Cancer Council Victoria. We acknowledge the contribution of Linda Hayes, Andrea Nathan and Emily Bain (Cancer Council Victoria) to the collection and analysis of the Victorian Smoking and Health Survey data. Emily Brennan, Sarah Durkin, Michelle Scollo and Melanie Wakefield received funding from VicHealth, the Victorian Department of Health and Human Services, and Cancer Council Victoria during the study.