Perceptions of Facilitators and Barriers to National Tobacco Endgame Policies among European Stakeholders: a Qualitative Analysis.

BACKGROUND:The idea of adopting tobacco endgame policies is gaining ground in the tobacco control community. This paper explores European stakeholders' perceptions and appraisal of facilitators and barriers in achieving national endgame policies. METHODS:Semi-structured qualitative interviews with 23 participants from eight countries with different tobacco control contexts were conducted in 18 individual and two focus group interviews from February to December 2023. Participant selection was based on experience and competence in tobacco control. Participants represented government agencies, research institutes and civil society from Cyprus, Finland, Italy, Lithuania, Norway, Serbia, Slovenia and Spain. Thematic analysis was used to generate key themes. RESULTS:Facilitators identified for succeeding in pursuing endgame strategies include having a context of favourable international developments and modelling 'pressure' on global and regional level, active civil society groups and effective coordination of key players, little or no industry in the country and support across political party lines with strong-willed individuals leading the way. Frequently mentioned barriers are lobbying and strong presence of industry, emergence of new products (often promoted in social media), a stagnated denormalisation process of smoking and few or weak non-governmental organisations. CONCLUSION:Structured national network collaboration with a common focus over time, combined with strong engagement from supranational entities, especially the European Union, is needed to proceed with successful implementation and dissemination of tobacco endgame policies in Europe.