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Leadership Perceptions of Endgame Strategies for Tobacco Control in California

Smith, Elizabeth A. PhD; McDaniel, Patricia A. PhD; Malone, Ruth E. PhD, RN, FAAN

Journal of Public Health Management and Practice: March 27, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000791
Research Full Report: PDF Only

Objective: To explore the perspectives of key stakeholders regarding advancement of the tobacco endgame in California.

Design: Interviews and focus groups exploring participants' knowledge of the tobacco endgame concept, their reactions to 4 endgame policy proposals (banning tobacco sales, registering smokers, retailer reduction, and permanently prohibiting tobacco sales to all those born after a certain year [“tobacco-free generation”]), and policy priorities and obstacles.

Participants: Interviews with 11 California legislators/legislative staff members, 6 leaders of national tobacco control organizations, and 5 leaders of California-based organizations or California subsidiaries of national organizations. Focus groups (7) with professional and volunteer tobacco control advocates in Northern, Southern, and Central California.

Results: Advocates were more familiar with the endgame concept than legislators or legislative staff. All proposed endgame policies received both support and opposition, but smoker registration and banning tobacco sales were the least popular, regarded as too stigmatizing or too extreme. The tobacco-free generation and retailer-reduction policies received the most support. Both were regarded as politically feasible, given their focus on protecting youth or regulating retailers and their gradual approach. Concerns raised about all the proposals included the creation of black markets and the potential for disparate impacts on disadvantaged communities.

Conclusion: Participants' willingness to support novel tobacco control proposals suggests that they understand the magnitude of the tobacco problem and have some appetite for innovation despite concerns about specific endgame policies. A preference for more gradual approaches suggests that taking incremental steps toward an endgame policy goal may be the most effective strategy.

Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco.

Correspondence: Elizabeth A. Smith, PhD, Department of Social & Behavioral Sciences, School of Nursing, Box 0612, University of California, San Francisco, San Francisco, CA 94143 (

Funding: California Department of Public Health (contract no. CG 16-10284).

The authors declare no conflicts of interest.

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