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Health Promot Chronic Dis Prev Can. 2020 Feb;40(2):47-57. doi: 10.24095/hpcdp.40.2.03.

Using the intervention ladder to examine policy influencer and general public support for potential tobacco control policies in Alberta and Quebec.

[Article in English, French; Abstract available in French from the publisher]

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Policy, Location, and Access in Community Environments (PLACE) Research Lab, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.


in English, French


To assess general public and policy influencer support for population-level tobacco control policies in two Canadian provinces.


We implemented the Chronic Disease Prevention Survey in 2016 to a census sample of policy influencers (n = 302) and a random sample of members of the public (n = 2400) in Alberta and Quebec, Canada. Survey respondents ranked their support for tobacco control policy options using a Likert-style scale, with aggregate responses presented as net favourable percentages. Levels of support were further analyzed by coding each policy option using the Nuffield Council on Bioethics intervention ladder framework, to assess its level of intrusiveness on personal autonomy.


Policy influencers and the public considered the vast majority of tobacco control policy options as "extremely" or "very" favourable, although policy influencers in Alberta and Quebec differed on over half the policies, with stronger support in Quebec. Policy influencers and the public strongly supported more intrusive tobacco control policy options, despite anticipated effects on personal autonomy (i.e. for policies targeting children/youth and emerging tobacco products like electronic cigarettes). They indicated less support for fiscally based tobacco control policies (i.e. taxation), despite these policies being highly effective.


Overall, policy influencers and the general public strongly supported more restrictive tobacco control policies. This study further highlights policies where support among both population groups was unanimous (potential "quick wins" for health advocates). It also highlights areas where additional advocacy work is required to communicate the population-health benefit of tobacco control policies.


Previous research has demonstrated that policy and environmental interventions are high-impact approaches to reducing smoking and tobacco consumption at the population level. Understanding the attitudes of policy influencers and members of the general public is essential, as their support can hinder or promote effective policy action. This study provides recent evidence on the attitudes of policy influencers and the public towards population-level tobacco control policies in two Canadian provinces. These findings will be useful for health advocates to identify policy areas where support is unanimous i.e. potential “quick wins”) as well as areas where support is weak or lacking consensus.


Canada; Nuffield intervention ladder; attitudes and beliefs; health policy; knowledge; population studies; public opinion; survey research; tobacco control

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Conflict of interest statement

All authors declare no conflicts of interest.

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