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Readiness for and obstacles to California's tobacco endgame

Institution: University of California, San Francisco
Investigator(s): Ruth Malone, Ph.D., R.N.
Award Cycle: 2017 (Cycle 26) Grant #: 26IR-0003 Award: $375,526
Subject Area: State and Local Tobacco Control Policy Research
Award Type: High Impact Research Project Award

Initial Award Abstract

For decades, tobacco was regarded almost exclusively as a problem of individual behavior. Interventions focused primarily on discouraging use and helping individuals who wanted to quit tobacco. More recently, public health has identified the tobacco industry as the vector of the tobacco disease epidemic. This shift has opened new avenues for intervention, including the idea of a tobacco “endgame,” which has gained prominence in the last five years. Proponents of a tobacco “endgame” argue for moving beyond tobacco control (which assumes the continued presence of tobacco as a common, widely-available consumer product) toward an explicit plan to achieve a tobacco-free future within a set time period. What it would mean to be tobacco-free, and how a jurisdiction might achieve that goal, are issues currently being explored by tobacco control advocates. Advancing an endgame will require further tobacco control policy innovation, which has usually come from cities or counties. Localities pioneered such efforts as smoke-free laws, which later were adopted at higher levels of government. Thus, it is important to examine the prospects for endgame initiatives at the local level. Moreover, local policy innovators will need to understand how the tobacco industry – with its long history of vigorously opposing most tobacco control policy changes – is likely to respond. Although much is known about tobacco industry strategies against common tobacco control measures, no research to date has documented how the industry has anticipated and prepared for the prospect of a tobacco endgame. The aims of this project are to: 1) conduct a set of case studies of selected California locales (n=8) identified as strong candidates for implementing tobacco control policy innovations to assess community readiness to initiate tobacco endgame planning and identify obstacles to doing so; and 2) retrieve and analyze tobacco industry documents in order to describe the industry’s understanding of endgame-oriented measures and its plans and strategies for opposing them. California is uniquely positioned to achieve a tobacco endgame, due to the effectiveness of its state tobacco control program in changing public views of tobacco and of the tobacco industry, public support for stronger policy measures, and dedicated resources. This study will create a body of knowledge for advocates and policymakers to draw upon as they consider next policy steps to advance an endgame in their own cities and counties.