Abstract
Introduction: Despite decades of research-informed policy implementation, tobacco smoking remains a leading cause of preventable death worldwide, disproportionately affecting disadvantaged populations. In Aotearoa New Zealand, ethnic inequities in smoking prevalence have become a driver of public health policy. In 2021, the government introduced the Smokefree Aotearoa 2025 Action Plan to minimise smoking prevalence for all population groups, including the indigenous Māori population. Key policies included denicotinisation of tobacco products, reductions in tobacco retailers and a smoke-free generation law. The aims of this study were to identify and evaluate strategies used by tobacco control advocacy groups to support the introduction of the Action Plan.
Methods: A qualitative study was conducted using semistructured interviews with 20 stakeholders from different sectors of the tobacco control community. Data collection and directed content analysis were guided by the coalition theory of change framework.
Results: Three primary strategies were identified: coordination with decision-makers, generation and translation of evidence to influence policy and changing public opinion. Māori leadership was critical to successful outcomes which included changes in smoking norms, strengthened coalitions, broadened alliances and increased political will.
Discussion: While evidence-based advocacy, public engagement and Māori leadership were effective in influencing tobacco policy reform and changing public norms, the subsequent repeal of smoke-free legislation raises questions about how to sustain progressive health policies in the face of industry-driven political pressure.
Conclusion: New Zealand’s tobacco control strategies can provide valuable insights for global health coalitions. Future research should focus on the sustainability and resilience of science-driven public health policies.