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TC Online First, published on October 24, 2016 as 10.1136/tobaccocontrol-2016-053267 Research paper
Smoking as an ‘informed choice’: implications for endgame strategies Janet Hoek,1 Jude Ball,2 Rebecca Gray,2 El-Shadan Tautolo3 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ tobaccocontrol-2016-053267). 1
Department of Marketing, University of Otago, Dunedin, New Zealand 2 Department of Public Health, University of Otago, Wellington, New Zealand 3 Director of the Centre for Pacific Health and Development, AUT University, Auckland, New Zealand Correspondence to Professor Janet Hoek, Department of Marketing, University of Otago, P. O. Box 56, Dunedin 9054, New Zealand; janet.hoek@otago. ac.nz Received 23 June 2016 Revised 26 September 2016 Accepted 4 October 2016
To cite: Hoek J, Ball J, Gray R, et al. Tob Control Published Online First: [please include Day Month Year] doi:10.1136/ tobaccocontrol-2016053267
ABSTRACT Objective Tobacco companies often assert that adults should be free to make an ‘informed choice’ about smoking; this argument influences public perceptions and shapes public health policy agendas by promoting educative interventions ahead of regulation. Critically analysing ‘informed choice’ claims is pivotal in countries that have set endgame goals and require new, more effective policies to achieve their smoke-free aims. Methods In-depth interviews with 15 New Zealand politicians, policy analysts and tobacco control advocates examined how they interpreted ‘informed choice’ arguments. We used a thematic analysis approach to review and explicate interview transcripts. Results Participants thought ‘informed choice’ implied that people make an active decision to smoke, knowing and accepting the risks they face; they rejected this assumption and saw it as a cynical self-justification by tobacco companies. Some believed this rhetoric had countered calls for stronger policies and thought governments used ‘informed choice’ arguments to support inaction. Several called on the government to stop allowing a lethal product to be widely sold while simultaneously advising people not to use it. Conclusions ‘Informed choice’ arguments allow the ubiquitous availability of tobacco to go unquestioned and create a tension between endgame goals and the strategies used to achieve these. Reducing tobacco availability would address this anomaly by aligning government’s actions with its advice.
companies hold individuals personally responsible for actively choosing to smoke.9 This stance enables them to promote education as the most appropriate tool to reduce smoking prevalence, thus pre-empting policy measures, and reinforcing perceptions that individual smokers are responsible for harms they experience. In principle, providing people with information should promote informed decision-making; however, in practice, personal and environmental factors exert a more powerful influence on behaviour than education.10–13 Recognising the challenge of modifying ingrained cognitive biases and entrenched behaviours, many tobacco control researchers have called for environmental changes that actively support cessation and discourage smoking initiation.6 8 14 These calls challenge tobacco companies’ reliance on a flawed ‘rational consumer’ model and question their emphasis on education and youth prevention programmes that have been ineffective.15 16 Yet despite the serious logical limitations undermining ‘informed choice’ arguments, many industries still use this reasoning to deflect attention from the harms their products cause and influence policy development.17 18 To explore how these arguments have affected government measures to reduce smoking, we probed New Zealand stakeholders’ interpretation of ‘informed choice’ and then analysed implications for tobacco control policy.
INTRODUCTION
METHODS Sample and recruitment
New Zealand has traditionally shown strong leadership in tobacco control and, until recently, has been at the vanguard of innovative policy measures. In 2011, New Zealand became the first country to set a tobacco endgame goal and declare its aim to become smoke free (
TC Online First, published on October 24, 2016 as 10.1136/tobaccocontrol-2016-053267 Research paper
Smoking as an ‘informed choice’: implications for endgame strategies Janet Hoek,1 Jude Ball,2 Rebecca Gray,2 El-Shadan Tautolo3 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ tobaccocontrol-2016-053267). 1
Department of Marketing, University of Otago, Dunedin, New Zealand 2 Department of Public Health, University of Otago, Wellington, New Zealand 3 Director of the Centre for Pacific Health and Development, AUT University, Auckland, New Zealand Correspondence to Professor Janet Hoek, Department of Marketing, University of Otago, P. O. Box 56, Dunedin 9054, New Zealand; janet.hoek@otago. ac.nz Received 23 June 2016 Revised 26 September 2016 Accepted 4 October 2016
To cite: Hoek J, Ball J, Gray R, et al. Tob Control Published Online First: [please include Day Month Year] doi:10.1136/ tobaccocontrol-2016053267
ABSTRACT Objective Tobacco companies often assert that adults should be free to make an ‘informed choice’ about smoking; this argument influences public perceptions and shapes public health policy agendas by promoting educative interventions ahead of regulation. Critically analysing ‘informed choice’ claims is pivotal in countries that have set endgame goals and require new, more effective policies to achieve their smoke-free aims. Methods In-depth interviews with 15 New Zealand politicians, policy analysts and tobacco control advocates examined how they interpreted ‘informed choice’ arguments. We used a thematic analysis approach to review and explicate interview transcripts. Results Participants thought ‘informed choice’ implied that people make an active decision to smoke, knowing and accepting the risks they face; they rejected this assumption and saw it as a cynical self-justification by tobacco companies. Some believed this rhetoric had countered calls for stronger policies and thought governments used ‘informed choice’ arguments to support inaction. Several called on the government to stop allowing a lethal product to be widely sold while simultaneously advising people not to use it. Conclusions ‘Informed choice’ arguments allow the ubiquitous availability of tobacco to go unquestioned and create a tension between endgame goals and the strategies used to achieve these. Reducing tobacco availability would address this anomaly by aligning government’s actions with its advice.
companies hold individuals personally responsible for actively choosing to smoke.9 This stance enables them to promote education as the most appropriate tool to reduce smoking prevalence, thus pre-empting policy measures, and reinforcing perceptions that individual smokers are responsible for harms they experience. In principle, providing people with information should promote informed decision-making; however, in practice, personal and environmental factors exert a more powerful influence on behaviour than education.10–13 Recognising the challenge of modifying ingrained cognitive biases and entrenched behaviours, many tobacco control researchers have called for environmental changes that actively support cessation and discourage smoking initiation.6 8 14 These calls challenge tobacco companies’ reliance on a flawed ‘rational consumer’ model and question their emphasis on education and youth prevention programmes that have been ineffective.15 16 Yet despite the serious logical limitations undermining ‘informed choice’ arguments, many industries still use this reasoning to deflect attention from the harms their products cause and influence policy development.17 18 To explore how these arguments have affected government measures to reduce smoking, we probed New Zealand stakeholders’ interpretation of ‘informed choice’ and then analysed implications for tobacco control policy.
INTRODUCTION
METHODS Sample and recruitment
New Zealand has traditionally shown strong leadership in tobacco control and, until recently, has been at the vanguard of innovative policy measures. In 2011, New Zealand became the first country to set a tobacco endgame goal and declare its aim to become smoke free (
