BACKGROUND: Some countries are exploring policies that might help lower cigarette smoking prevalence to below 5% by 2030. This study assesses support for three policies among adults who smoke: (1) ending smoked tobacco sales within 10 years; (2) limiting cigarette nicotine content to make them less addictive; and (3) restricting smoked tobacco sales for life to anyone currently under 18 (Smoke-Free Generation, SFG).

METHODS: Data were from the 2022 International Tobacco Control Four Country Smoking and Vaping Survey, including 2723 adults who smoked at least monthly in Australia, Canada, England and the USA. We estimated the weighted prevalence of support and used logistic regression to assess whether support (vs no support) differed by sociodemographic variables (country, gender, age, race/ethnicity, education, income).

RESULTS: Support was 27.1% for ending smoked tobacco sales within 10 years, 53.5% for limiting the nicotine content of cigarettes and 51.7% for an SFG law. US adults had consistently lower odds of support compared with those in Canada and England (all policies: p<0.01). Women and white individuals had lower odds of supporting an end to smoked tobacco sales (adjusted OR (aOR): 0.63, p=0.02; 0.68, p=0.03) and an SFG law (aOR: 0.72, p=0.04; 0.66, p=0.01). Women (aOR: 1.41, p<0.01) were more supportive of nicotine reduction. Individuals with moderate (aOR vs high: 1.34, p=0.03) and low (aOR: 1.41, p=0.03) education, and those with financial difficulties (aOR: 1.36, p=0.04) showed higher support for an SFG law. No differences in support were observed by age in the pooled data.

CONCLUSIONS: Support for policies to reduce the use of commercial cigarettes was moderate-to-high among adults who smoke, although it varied significantly by country, gender and income. Tailored communication strategies could help increase support and promote policy adoption.