Shaping the end of the Australian commercial tobacco epidemic: insights from Indigenous and non-Indigenous tobacco control policy actor interviews.

Background: Smoking is the leading preventable cause of death in Australia, with disproportionate harms experienced by Aboriginal and Torres Strait Islander peoples. Recognising Indigenous perspectives provided impetus for a commercial tobacco endgame in Aotearoa/New Zealand, and Indigenous perspectives may assist policy adoption in Australia.

Purpose: The study aimed to identify the necessary conditions for the adoption of endgame policies in Australia, with an emphasis on Indigenous perspectives.

Methods: Semi-structured interviews with Australian tobacco control policy actors were conducted between November 2023 and April 2024. We analysed data from 28 people (26 interviews, two written responses), including 6 Indigenous people. Template analysis was guided by endgame goals and policies, the Multiple Streams Framework and the Decolonising Framework. Indigenous perspectives were prioritised in the interpretation.

Results: Policy failures, particularly the vaping epidemic, were a key theme. There was broad consensus among Indigenous peoples and non-Indigenous members of the dominant policy community for stronger tobacco and vape supply restrictions, and varied views on other endgame policies. Political barriers included tobacco tax revenue and resistance from the commercial sector. Facilitators included the tobacco control playbook, a favourable political environment, the popularity of tobacco-free generation policy and opportunities to broaden the lobby base.

Conclusion: The tobacco control playbook will remain important in promoting policy innovation, as will resisting the influence of the commercial sector. Indigenous leadership is essential for all Australians and may open additional policy windows and drive reforms that are equitable, effective, community-driven and commensurate with the scale of harms.