Associate Professor Marita Hefler‘s journey in tobacco control began with a deep concern over the tobacco industry’s deceptive practices and their impact on marginalised communities. Over time, her work has shifted from individual-focused strategies to targeting the industry itself, advocating for reduced tobacco availability and tighter regulations. As a leader in global tobacco control, she co-founded Project Sunset, aiming to phase out cigarette sales worldwide. Living in Larrakia country (Darwin) since 2013 has also profoundly influenced her research, particularly in supporting First Nations-led initiatives to close health gaps through tobacco reduction.
Join Marita at FHMRI’s Inspiring Leaders Seminar Series on Wednesday 21 August (12:30 – 1:45pm ACST)
What inspired you to dedicate your career to tobacco control research, and how has your journey evolved, particularly in developing paradigm-shifting policies and ‘endgame’ strategies?
Before I started working in tobacco control, I knew tobacco companies had denied their products were both harmful and addictive for decades, and the tobacco industry was one of the most reviled and least trusted. However, I didn’t truly understand the extent of its mendacity or how much it has engineered its products for maximum addiction. Nor did I understand how smoking is increasingly concentrated among people who experience structural disadvantage and marginalisation. Like many people, I had often wondered “Why don’t governments just ban the sale of cigarettes?” Often the answer was a variation of “Prohibition never works”.
As I began to learn from inspiring leaders in global tobacco control, much of my work focused on strategies where there is a strong evidence base: smoke-free areas, social marketing and supporting people to be smoke-free, particularly among groups with higher smoking prevalence. These are absolutely essential to ending the tobacco epidemic. However, I have increasingly questioned the focus on individual and community behaviour change, instead of the tobacco industry as the driver of smoking. Every early death from smoking can be counted in profit accrued to tobacco companies. As a result, my work now has more of a systems focus to reduce the ability of the tobacco industry to operate like a normal business, and reduce supply and availability. It isn’t a normal business and the sale of its products should not be accepted as such. I’m privileged to have received NHMRC funding to work with NT stores and communities to co-design strategies to reduce tobacco availability, as well as being part of an NHMRC Centre for Research Excellence and Synergy grant focused on the tobacco endgame, collaborating with leading scholars nationally and internationally.
Could you share some of the most impactful findings from your research on youth smoking prevention and how they have influenced public health policies and initiatives?
Apart from my PhD, very little of my research has been youth-specific. While it is important to stop young people from starting to use tobacco, my research has generally taken a whole of population approach.
Cigarettes are a uniquely dangerous consumer product – they don’t meet minimum safety standards and should not be on sale to anyone, regardless of age. Most people who smoke regret that they ever started and want to stop. Some of my early NT research was a preliminary evaluation of the tobacco-free correctional facilities policy. In interviews with people who were incarcerated, I was surprised how much the policy was supported – often by people who had smoked since they were young children.
The NT was the first state or territory in Australia to introduce such a policy, so it generated a lot of interest nationally. Our evaluation was an important resource for other jurisdictions to plan and implement similar policies. Today, smoke-free correctional facilities are the norm in Australia. I also led a project in partnership with three NT Aboriginal Community Controlled Health Services to explore how social media could be used to enhance tobacco control. The findings from that research informed training for over 700 workers in the National Tackling Indigenous Smoking Program.
As Editor-in-Chief of the BMJ specialist journal Tobacco Control, what emerging trends or innovations in tobacco control are you most excited about, especially regarding social media’s role in reducing smoking among First Nations peoples?
To me the most exciting trend is the increasing number of papers we are receiving about the many pathways to the tobacco endgame from across the world – with initiatives at the local, state and national government level, as well as international cooperation. While social media certainly has a role to play to help with reducing smoking, the challenge is keeping up with the constantly changing landscape – and unfortunately, the tobacco industry is always ahead of tobacco control advocates!
At Tobacco Control we constantly receive papers about the new ways the tobacco industry is operating in this space and across different platforms. Younger people who grew up with social media are more likely to use multiple platforms and change their patterns of use as the landscape evolves. I think the key is to ensure that those young people are aware of tobacco industry tactics and build their skills to resist them. Older people who smoke are often likely to be using Facebook where there are many established strategies to connect with and support people to be smoke-free. Our social media research with First Nations communities found that even people who smoke are willing to support others in their quitting journeys, and social media is an important way of networking particularly among people who may be socially or geographically isolated.
Project Sunset aims to phase out cigarette sales globally. What are some of the key strategies and milestones that the coalition has achieved so far, and how do you see these contributing to achieving equity in smoking prevalence reductions?
Project Sunset is a network of tobacco control researchers and advocates which started in 2019. It is led by ASH USA, and I co-founded and co-chair the international group. The network has helped change the global conversation about tobacco. One of the early achievements was a letter signed by 154 organisations from around the world calling on governments to plan for phasing out cigarette sales. We have run webinars to raise awareness and training for advocates. There have been some notable achievements in the US, with two cities in California ending tobacco sales, and several cities in Massachusetts introducing tobacco-free generation policies which mean it will never be legal to sell tobacco products to people born this millennium.
Several countries have started to move towards tobacco endgame policies, and Project Sunset collaborates with researchers and advocates in many of them. We have also raised awareness about Article 2.1 of the Framework Convention on Tobacco Control (FCTC), which encourages countries to go beyond the minimum measures outlined in the treaty. We were at the 10th FCTC Conference of the Parties in Panama earlier this year, where a decision was adopted to establish an Article 2.1 expert group – laying the groundwork for moving the FCTC and global tobacco control policy into a new era.
Living on Larrakia country (Garramilla/Darwin) since 2013, how has the local community influenced your research, particularly your work with Indigenous peoples and participatory community programs?
Great question – it’s been a decade of continuous learning and critical reflection! Since I’ve moved to Larrakia country, I’ve come to understand at a much deeper level the sovereignty that First Nations peoples exercise over their lands and seas, and how embedded those connections are in kinship, community and daily life. I’ve learnt about relationality and accountability in research and to appreciate the many different ways of knowing, being and doing and what that means for how we generate knowledge. Unfortunately, I’ve also deepened my understanding of the extent of institutionalised and systemic racism that exists in Australia and how it shapes the lives of First Nations peoples.
I’ve learned so much about the history of tobacco use in First Nations communities and how it was part of trading with Macassans across northern Australia – but in many other communities, high smoking prevalence is linked with colonisation and racism. Dramatically reducing smoking prevalence is absolutely vital to closing the gap in health outcomes between First Nations and non-Indigenous Australians – and First Nations peoples need to be driving the strategies that work for their communities.