Mental health and support for rigorous tobacco control strategies in South Australia.

Introduction: Tobacco endgame strategy includes policies to end the tobacco epidemic. As tobacco smoking prevalence is higher among people with mental health conditions (MHC), understanding the impact of rigorous tobacco control strategies for this group is critical. This study examined support for five tobacco control strategies among people with MHCs: increasing tobacco product tax, reducing tobacco retail locations, ending tobacco sales in alcohol-licensed venues, limiting retailers to one tobacco point of sale and reduced nicotine in smoked tobacco.

Methods: Cross-sectional surveying of a representative sample of 3006 South Australians in 2021 aged ≥15 years included demographic, tobacco control strategy, smoking status and mental health indicators. Multivariable logistic regression was used to examine the influence of mental health on strategy support.

Results: Support was high for all tobacco control strategies, highest for reducing nicotine content (80.4%) and lowest for increasing tobacco tax (67.2%). Support for increased tobacco tax was lower among people with MHCs than for those without by 7.8% (aged 18+ years) to 9.5% (aged 15+ years). People who smoked had significantly lower support for all strategies, and smoking status and MHC did not interact in influencing support.

Conclusions: Support for tax-focused strategies was lower among people with MHCs. Retail and product-focused strategies may support equity in public acceptability of tobacco control action. Policy-makers must aim to maximise tobacco endgame support from populations most impacted by tobacco harms when implementing tobacco control strategies. Tax-focused approaches might be enhanced with consultation and advocacy for people with MHCs.