Citation

Edwards, R., Johnson, E., Stanley, J., Waa, A., Ouimet, J., Fong, G.T. (2021). Support for New Zealand’s Smokefree 2025 goal and key measures to achieve it: Findings from the ITC New Zealand Survey. Australian & New Zealand Journal of Public Health, 45(6), 554-561 .

Abstract

Objectives: To assess support among smokers and recent quitters for the Smokefree New Zealand (NZ) 2025 goal and measures to facilitate its achievement. Methods: Data from CATI interviews with 1,155 (386 Māori) smokers and recent quitters in Wave 1 (August 2016–April 2017) and 1,020 (394 Māori) in Wave 2 (June–December 2018) of the International Tobacco Control (ITC) NZ Survey. Results: (Wave 2 unless stated): Almost all (95%) participants were aware of and more than half (56%) supported the smokefree goal. Support was highest (69–92%) for measures to reduce smoking uptake and protect children from exposure to secondhand smoke. Support was also high for other smokefree policies including mandated denicotinisation of smoked tobacco products (73%) and tobacco retailer licensing (70%, Wave 1). Support was lowest (<30%) for increasing the tobacco tax, but higher (59%) if additional revenue raised was used to help smokers to quit. Support for Smokefree 2025 and key measures to achieve it was generally higher among ex-smokers than smokers but mostly similar among Māori and non-Māori participants. Conclusions: There is substantial support among smokers and ex-smokers for the Smokefree 2025 goal and many measures that could help achieve it. Implications for public health: Implementing a comprehensive strategy to achieve Smokefree 2025 is likely to be acceptable among New Zealand's smokers and ex-smokers.

Citation

White, M., Edwards, R., Stanley, J., Hoek, J., Waa, A. M., Ouimet, J., Quah, A. CK., & Fong, G. T. (2020). Reasons for stopping e-cigarette use among smokers: findings from the 2018 ITC New Zealand Survey. The New Zealand Medical Journal (Online), 133(1523), 117-121.

No abstract available.

Citation

Edwards, R., Stanley, J., Waa, A., White, M., Kaai, S.C., Ouimet, J., Quah, A.C.K., Fong, G.T. (2020). Patterns of use of vaping products among smokers: Findings from the 2016-2018 ITC New Zealand Surveys. International Journal of Environmental Research and Public Health, 17(18), 6629.

Abstract

Alternative nicotine products like e-cigarettes could help achieve an end to the epidemic of ill health and death caused by smoking. However, in-depth information about their use is often limited. Our study investigated patterns of use of e-cigarettes and attitudes and beliefs among smokers and ex-smokers in New Zealand (NZ), a country with an ‘endgame’ goal for smoked tobacco. Data came from smokers and ex-smokers in Waves 1 and 2 of the International Tobacco Control (ITC) NZ Survey (Wave 1 August 2016–April 2017, 1155 participants; Wave 2, June–December 2018, 1020 participants). Trial, current and daily use of e-cigarettes was common: daily use was 7.9% among smokers and 22.6% among ex-smokers in Wave 2, and increased between surveys. Use was commonest among 18–24 years and ex-smokers, but was similar among Māori and non-Māori participants, and by socio-economic status. Most participants used e-cigarettes to help them quit or reduce their smoking. The most common motivating factor for use was cost and the most common barrier to use cited was that e-cigarettes were less satisfying than smoking. The findings could inform developing interventions in order to maximize the contribution of e-cigarettes to achieving an equitable smoke-free Aotearoa, and to minimize any potential adverse impacts.

Citation

McKiernan, A., Stanley, J., Waa, A.M., Kaai, S.C., Quah, A.C.K., Fong, G.T., Edwards, R. (2019). Beliefs among adult smokers and quitters about nicotine and de-nicotinized cigarettes in the 2016-17 ITC New Zealand Survey. Tobacco Regulatory Science, 5(5), 400-409.

Abstract

Objectives: We sought to explore understanding of addiction and nicotine, as well as support and interest in low-nicotine cigarettes among New Zealand (NZ) smokers and recent quitters.

Methods: Data came from wave 1 (August 2016-April 2017) of the International Tobacco Control (ITC) NZ Survey, comprising 1090 smokers and recent quitters, including 363 identifying as Māori (the NZ indigenous population).

Results: Most participants (74%) were interested in trying low-nicotine or nicotine-free cigarettes and 80% supported introducing a law to reduce nicotine in cigarettes and tobacco if nicotine was available through alternative products. Support was similar among demographic groups, smokers, recent quitters, and daily and occasional smokers. Nearly all participants believed smoking is addictive and nicotine is the major cause of addiction. Almost half erroneously thought nicotine is the main cause of cancer from cigarettes.

Conclusions: Findings suggest that introducing mandated low-nicotine cigarettes could be feasible in NZ where alternative nicotine delivery products are widely available. However, implementation may need to be accompanied by public education to correct misperceptions about the harmfulness of nicotine and to encourage switching to alternative nicotine delivery products among smokers who cannot quit nicotine completely.

Citation

Gravely, S., Driezen, P., Ouimet, J., Quah, A.C.K., Cummings, K.M., Thompson, M.E., Boudreau, C., Hammond, D., McNeill, A., Borland, R., Thrasher, J.F., Edwards, R., Omar, M., Hitchman, S., Yong, H-H., Barrientos-Gutierrez, T., Willemsen, M.C., Bianco, E., Boado, M., Goma, F., Seo, H.G., Nargis, N., Jiang, Y., Perez, C., & Fong, G.T. (2019). Prevalence of awareness, ever-use, and current use of nicotine vaping products (NVPs) among adult current smokers and ex-smokers in 14 countries with differing regulations on sales and marketing of NVPs: Cross-sectional findings from the ITC Project. Addiction, 114(6), 1060-1073.

Abstract

Aims: This paper presents updated prevalence estimates of awareness, ever‐use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing.

Design, setting, participants and measurements: A cross‐sectional analysis of adult (≥18 years) current smokers and ex‐smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013 to 2017. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs): not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs): not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand (NZ); (3) less restrictive policies (LRPs): legal to be sold and marketed with regulations: England, Netherlands, Republic of Korea, United States (US); (4) no regulatory policies (NRPs): Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country‐specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily vs. non‐daily).

Findings: NVP awareness and use were lowest in NRP countries. Generally, ever‐ and current use of NVPs were lower in MRP countries [ever‐use: 7.1% to 48.9%; current use: 0.3% to 3.5%] relative to LRP countries [ever‐use: 38.9% to 66.6%; current use: 5.5% to 17.2%] and RP countries [ever‐use: 10.0% to 62.4%; current use: 1.4% to 15.5%]. NVP use was highest among high income countries, followed by upper‐middle income countries, and then by lower‐middle income countries.

Conclusions: With a few exceptions, awareness and use of nicotine vaping products (NVPs) varies by the strength of national regulations governing NVP sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in NVPs in these countries where smoking populations are predominantly poorer. The higher awareness and use of NVPs in high income countries with moderately (e.g., Canada, NZ) and less (e.g., England, US) restrictive policies, is likely due to the greater availability and affordability of NVPs.

Citation

Edwards, R. (2014). Roll your own cigarettes are less natural and at least as harmful as factory rolled tobacco. British Medical Journal, 348, 7616.

Abstract

Poorer smokers may favour “roll your own” and many falsely believe that use of loose tobacco is less dangerous than factory made cigarettes, writes Richard Edwards. Specific interventions may be needed to encourage such smokers to quit.

Citation

Edwards, R., Wilson, N., Peace, J., Weerasekera, D., Thomson, G., Gifford, H. (2013). Support for a tobacco endgame and increased regulation of the tobacco industry among New Zealand smokers: Results from a National Survey. Tobacco Control, 22(1), 86-93.

Abstract

Aim: To examine the prevalence of smoker support for a ban on cigarette sales in 10 years time and increased regulation of the tobacco industry and to investigate the independent associations of support for these measures.

Methods: The authors surveyed opinions among adult smokers in two survey waves (N=1376 and N=923) from the New Zealand arm of the International Tobacco Control Policy Evaluation Survey during 2007–2009. The authors report prevalence of support stratified by age, gender and ethnicity. The authors carried out multivariate analyses to identify significant associations among potential determinants (demographics, socioeconomic status, mental health and smoking-related beliefs and behaviours) of support.

Results: Most New Zealand smokers supported greater regulation of the tobacco industry (65%) and more government action on tobacco (59%). Around half (46%) supported banning sales of cigarettes in 10 years time, provided effective nicotine substitutes were available. In a fully adjusted model, significant associations with support for greater tobacco company regulation included Māori ethnicity, experience of financial stress and greater awareness about the harms of smoking. Significant associations with support for a ban on tobacco sales in 10 years time included increasing area-based deprivation level, increasing intention to quit and greater concern about the health effects of smoking.

Conclusions: The findings suggest that most smokers will support stronger government action to control the tobacco industry and that many support radical ‘endgame’ approaches. Greater support among Māori, more deprived and possibly Pacific smokers, is an important finding, which could inform the design and implementation of new policies given the very high smoking prevalence among these groups and hence high priority for targeted tobacco control interventions. Perceived difficulties in gaining public support should not impede the introduction of rigorous tobacco control measures needed to achieve a tobaccofree New Zealand.

Citation

Wilson, N., Weerasekera, D., Kahler, C.W., Borland, R., Edwards, R. (2012). Hazardous patterns of alcohol use are relatively common in smokers: ITC Project (New Zealand). New Zealand Medical Journal, 125(1348), 34-41.

Abstract

Aims: To describe patterns of alcohol use in a nationally-representative sample of New Zealand smokers.

Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from a national survey: the NZ Health Survey (NZHS). From this sample we surveyed adult smokers (n=1376).

Results: A third (33.1%) of these smokers had a drinking pattern that was considered hazardous (i.e., AUDIT scores greater than and equal to 8). These figures were much higher than for non-smokers in the NZHS (at 13.1%). In both the univariate and multivariate analyses, hazardous drinking patterns were significantly more common among: younger smokers, male smokers, and Māori smokers (e.g., adjusted odds ratio for the latter: 1.43, 95%CI: 1.05-1.95). The same pattern of more hazardous drinking was also seen (but in the univariate analysis only), for smokers with financial stress and for moderate individuallevel deprivation.

Conclusions: These findings provide additional evidence that hazardous drinking patterns are elevated in New Zealand smokers overall and particularly in some groups of smokers. Given the international evidence that hazardous drinking may impede quitting, policy makers could consider the potential benefits of improved alcohol control as part of the national strategy to curtail the tobacco epidemic and achieve the government's "Smokefree Nation 2025" goal. Such an approach could also reduce this country's high levels of alcohol-related harm and reduce gender and ethnic health inequalities.

Citation

Borland, R., Li, L., Driezen, P., Wilson, N., Hammond, D., Thompson, M.E., Fong, G.T., Mons, U., Willemsen, M.C., McNeill, A., Thrasher, J.F., Cummings, K.M. (2012). Cessation assistance reported by smokers in 15 countries participating in the International Tobacco Control (ITC) Policy Evaluation Survey. Addiction, 107(1), 197-205.

Abstract

Aims: To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support.

Design: Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary).

Settings: Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States.

Participants: Samples of smokers from 15 countries.

Measurements: Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits.

Findings: Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (<20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available.

Conclusions: There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.

Citation

Wilson, N., Gifford, H., Edwards, R., Thomson, G. (2012). Smokefree cars to protect children and denormalise smoking: a mini-review of New Zealand literature. New Zealand Medical Journal, 125 (1355), 81-86.

Abstract

The Associate Minister of Health (Hon Tariana Turia) has signalled interest in the New Zealand Government developing legislation to protect child health by limiting smoking in cars with children.1 Such a move would be part of an international trend that has seen such laws covering most Australian states, Canadian Provinces and some US States (including California).2 3 It would also be consistent with other actions to limit hazards and improve safety within cars: compulsory seat belts, compulsory car seats for infants, and bans on mobile phone use while driving (as recently enacted by the last National Party-led Government in New Zealand). Smokefree cars would help reduce the burden of child illness, given the evidence for the role of secondhand smoke (SHS) in “sudden infant death syndrome (SIDS), asthma, altered respiratory function, infection, cardiovascular effects, behaviour problems, sleep difficulties, increased cancer risk, and a higher likelihood of smoking initiation”.4 Reducing these impacts could in turn reduce both private and tax-payer funded health system costs (given international evidence on SHS impacts on health costs5–7). It is expected that the move would help reduce smoking uptake in children by providing positive smokefree modelling (given New Zealand evidence8 and international evidence4). To provide background and context to further policy-maker discussions on this topic, we tabulate the New Zealand literature relevant to smokefree car policies that we could identify on Medline and on health organisation websites in New Zealand (Table 1).

Citation

Wilson, N., Weerasekera, D., Peace, J., Edwards, R. (2011). Smokers have varying misperceptions about the harmfulness of menthol cigarettes: National survey data. Australian and New Zealand Journal of Public Health, 35(4), 364-367.

Abstract

Objective: To describe the prevalence of menthol use and perceptions of relative harmfulness among smokers in an ethnically diverse population where tobacco marketing is relatively constrained (New Zealand).

Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) utilises the NZ Health Survey (a national sample). From this sample we surveyed adult smokers, with Wave 2 (n=923) covering beliefs around menthol cigarettes.

Results: Agreement with the statement that “menthol cigarettes are less harmful than regular cigarettes” was higher in smokers who were: older, Māori, Pacific, Asian, financially stressed and had higher levels of individual deprivation. Most of these associations were statistically significant in at least some of the logistic regression models (adjusting for socio-economic and smoking beliefs and behaviour). In the fully-adjusted model this belief was particularly elevated in Pacific smokers (adjusted odds ratio [aOR] = 7.36, 95% CI = 1.92 - 28.27) and also in menthol smokers (aOR = 4.58, 95% CI = 1.94-10.78). Most smokers in this study (56%), and especially menthol smokers (73%), believed that menthols are “smoother on your throat and chest”.

Conclusion: Various groups of smokers in this national sample had misperceptions around the relative harmfulness of menthols, which is consistent with most previous studies.

Implications: This evidence, along with a precautionary approach, supports arguments for enhanced regulation of tobacco marketing and tobacco ingredients such as menthol.

Citation

Thomson, G., Wilson, N., Weerasekera, D., Edwards, R. (2011). Strong smoker interest in 'setting example to children' by quitting: National survey data. Australian and New Zealand Journal of Public Health, 35(1), 81-84.

Abstract

Objective: To further explore smoker views on reasons to quit.

Methods: As part of the multi-country ITC Project, a national sample of 1,376 New Zealand adult (18+ years) smokers was surveyed in 2007/08. This sample included boosted sampling of Māori, Pacific and Asian New Zealanders.

Results: 'Setting an example to children' was given as 'very much' a reason to quit by 51%, compared to 45% giving personal health concerns. However, the 'very much' and 'somewhat' responses (combined) were greater for personal health (81%) than 'setting an example to children' (74%). Price was the third ranked reason (67%). In a multivariate analysis, women were significantly more likely to state that 'setting an example to children' was 'very much' or 'somewhat' a reason to quit; as were Māori, or Pacific compared to European; and those suffering financial stress.

Conclusion: The relatively high importance of 'example to children' as a reason to quit is an unusual finding, and may have arisen as a result of social marketing campaigns encouraging cessation to protect families in New Zealand.

Implications: The policy implications could include a need for a greater emphasis on social reasons (e.g. 'example to children'), in pack warnings, and in social marketing for smoking cessation.

Citation

Wilson, N., Peace, J., Edwards, R., Weerasekera, D. (2011). Smokers commonly misperceive that nicotine is a major carcinogen: National survey data. Thorax, 66(4), 353-354.

Abstract

We aimed to assess view in New Zealand (NZ) smokers, with the context being a country in which NRT is provided in a heavily subsidised form and widely distributed via the national quitline service. Data were collected through the NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) which derives its sample of smokers from the NZ Health Survey (a representative national sample).

Citation

Wilson, N., Weerasekera, D., Collings, S., Edwards, R., van der Deen, F.S. (2010). Poorer mental health in many NewZealand smokers: National survey data from the ITC Project. New Zealand Medical Journal, 123(1326), 129-132.

Abstract

There is international evidence that smoking and poorer mental health are associated.1–5 This association has also been studied in New Zealand (e.g., in longitudinal studies6–8) with the most recent work indicating that smoking has a causal role in depressive symptoms.9 Furthermore, in this country it has been estimated that 33% of all cigarettes are consumed by people with current mental disorders.10 We were able to further explore some aspects of the smoking and mental health issue in New Zealand as part of the International Tobacco Control Policy Evaluation Survey (ITC Project).

Methods: The ITC Project (NZ arm) surveyed a nationally representative sample of adult smokers (n=1376 in Wave 1 in 2007/8, n=923 in Wave 2 in 2008/9). This study derives its sample from the New Zealand Health Survey (NZHS) which is a national sample with boosted sampling of Māori, Pacific and Asian New Zealanders. We measured their mental health and alcohol use status using the SF-36, the Kessler-10 (K10), and the AUDIT. Also assessed were smoking-related beliefs and behaviours, including quit rates. Some comparisons were made with non-smoking participants in the NZHS. All results are weighted and adjusted for the complex sample design. Further details of the methods (including response rates, attrition and weighting processes) are available in online Methods Reports11-13 and related publications.14 15

Results: In terms of overall mental health, smokers had significantly lower SF-36 (mental health) scores (i.e., poorer mental health status) than the general adult population (80.6, 95%CI: 79.6–81.6; vs 82.2, 95%CI: 81.9–82.6). Reporting ever having been diagnosed with a mental disorder was significantly more common for adult smokers than for non-smokers (at 20.3%, 95%CI: 17.4% – 23.1%; vs 11.5%, 95%CI: 10.8%–12.2%). Here the non-smoker comparison group was from the full NZHS sample and “mental disorders” were any in a list of eight items used in the NZHS.

Citation

Hoek, J., Wilson, N., Allen, M., Edwards, R., Thomson, G., Li, J. (2010). Lessons from New Zealand's introduction of pictorial health warnings on tobacco packaging. Bulletin of the World Health Organization, 88 (11), 861-866.

Abstract

While international evidence suggests that featuring pictorial health warnings on tobacco packaging is an effective tobacco control intervention, the process used to introduce these new warnings has not been well documented. We examined relevant documents and interviewed officials responsible for this process in New Zealand. We found that, despite tobacco companies’ opposition to pictorial health warnings and the resource constraints facing health authorities, the implementation process was generally robust and successful. Potential lessons for other countries planning to introduce or refresh existing pictorial health warnings include: (i) strengthening the link between image research and policy; (ii) requiring frequent image development and refreshment; (iii) using larger pictures (e.g. 80% of the front of the packet); (iv) developing themes that recognize concerns held by different smoker sub-groups; and (v) running integrated mass media campaigns when the warnings are introduced. All countries could also support moves by the World Health Organization Framework Convention on Tobacco Control’s Secretariat to develop an international bank of copyright-free warnings.

Citation

Wilson, N., Weerasekera, D., Borland, R., Edwards, R., Bullen, C., Li, J. (2010). Use of a national quitline and variation in use by smoker characteristics. Nicotine & Tobacco Research, 12(Suppl 1), S78-84.

Abstract

Introduction: We aimed to describe use of a national quitline service and the variation in its use by smoker characteristics (particularly ethnicity and deprivation). The setting was New Zealand (NZ), which takes proactive measures to attract disadvantaged smokers to this service.

Methods: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) utilizes the New Zealand Health Survey (a national sample) from which we surveyed adult smokers in two waves (N = 1,376 and N = 923) 1 year apart.

Results: Quitline use in the last 12 months rose from 8.1% (95% CI = 6.3%–9.8%) in Wave 1 to 11.2% (95% CI = 8.4%–14.0%) at Wave 2. Māori (the indigenous people of NZ) were significantly more likely to call the Quitline than were European/other smokers. Relatively higher call rates also occurred among those reporting higher deprivation, financial stress, a past mental health disorder, a past drug-related disorder, and higher psychological distress (Kessler 10-item index). Independent associations in the multivariate analyses of Quitline use were being Māori, reporting financial stress, and ever having been diagnosed with a mental health disorder.

Discussion: This national Quitline service is successfully stimulating disproportionately more calls by Māori smokers and those with some measures of disadvantage. It may therefore be contributing to reducing health inequalities. It appears possible to target quitlines to reach those smokers in greatest need.

Citation

Wilson, N., Peace, J., Weerasekera, D., Hoek, J., Edwards, R. (2010). Smoker (mis)perceptions associated with pack colouring: National survey data. New Zealand Medical Journal, 123(1320), 121-125.

Abstract

Background: Several studies have concluded that “light” and “mild” descriptors on cigarette packs lead smokers to assume that cigarettes labelled in this way pose a lower health risk than “full flavour” or “regular” cigarettes.

In response to the bans several countries have imposed on these descriptors, the tobacco industry has introduced “colour coded” packs and specific pack colours for different brand variants,a pattern that is also evident in New Zealand. As a result, smokers have been conditioned to interpret lighter pack colours (e.g. white, silver or blue) to signify “lighter” cigarettes.

This is a health issue given that smokers mistakenly believe cigarettes from lightly coloured packs are less harmful and less addictive.We therefore aimed to determine how New Zealand smokers interpret cigarette pack colouring.

Citation

Wilson, N., Hoek, J., Peace, J., Gifford, H., Thomson, G., Edwards, R. (2010). Marketing tobacco to New Zealand women: 8 ways to reflect on World No Tobacco Day. New Zealand Medical Journal, 123(1315), 85-90.

Abstract

Background: This year’s “World No Tobacco Day” on 31 May 2010 (“World Smokefree Day” in New Zealand) focuses on how tobacco is marketed to women. This topic is particularly relevant given the current inquiry by the Māori Affairs Select Committee into tobacco issues and the very high smoking prevalence among Māori women. Prior to middle age, the health consequences of women smoking are more serious than those caused by male smokers. This is because of the impacts of smoking in pregnancy to the fetus (e.g., perinatal mortality, low birth weight, preterm delivery etc) and the effects of exposing infants and children to second-hand smoke (e.g., sudden infant death syndrome and asthma). Such impacts are experienced disproportionately by Māori. Evidence from the United States reveals tobacco companies have a long history of marketing to women and brands such as Virginia Slims, Eve, Satin, Capri, and Misty were specifically designed to appeal to women. Overt targeting of women led the US Surgeon General to conclude that “tobacco industry marketing is a factor influencing susceptibility to and initiation of smoking among girls”. Evidence that tobacco companies have systematically and successfully recruited female smokers has prompted us to investigate tobacco marketing to girls and women in New Zealand, an area that has previously been analysed only very briefly.

Methods: We searched for relevant New Zealand literature (Medline) and survey data (e.g., the Ministry of Health website). We also analysed mentholated tobacco use data from the ITC Project survey. This is a national survey of 1376 New Zealand adult (18+ years) smokers surveyed between March 2007 and February 2008. Wave two in the subsequent 12 months involved 923 respondents. Further detail on the survey methods are available in an online Methods Report and in publications. In addition we reexamined a collection of discarded cigarette packs obtained for other research purposes (with the methodology detailed elsewhere). Further contextual data came from a search of tobacco products for sale via online retail websites and hand searching imported magazines held in Wellington Central Library (May 2010). We used a variant of the “five Ps” of marketing as employed by British American Tobacco in the UK (i.e., product, price, place, promotion and packaging) to consider how tobacco companies’ marketing might reach New Zealand women.

Results and Discussion: In total, we identified at least eight mechanisms used to market tobacco products to New Zealand women (see Table 1). These covered four of the “five Ps” of marketing in the framework used (i.e., not particularly “place”). Given the advertising and sponsorship restrictions contained in the Smoke-free Environments Act 1990 (SFEA), persistent marketing represents “policy incoherence” that we have previously discussed.

Citation

Wilson, N., Weerasekera, D., Edwards, R., Thomson, G., Devlin, M., Gifford, H. (2010). Characteristics of smoker support for increasing a dedicated tobacco tax: National survey data from New Zealand. Nicotine & Tobacco Research, 12(2), 168-173.

Abstract

Aim: To examine smoker support for tobacco tax and for increased dedicated tobacco taxes, along with associations forany such support.

Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey utilizes the NZ Health Survey (a national sample). From this sample, we surveyed adult smokers (N = 1,376).

Results: Most smokers considered that the current level of tobacco tax is "too high" (68%), but a majority (59%) would support an increase in tobacco tax if the extra revenue was used to promote healthy lifestyles and support quitting. There was majority support for a dedicated tobacco tax increase among all sociodemographic groups of smokers (including Māori, Pacific, and Asian smokers). In the fully adjusted multivariate model, significant associations with support for a dedicated tax increase included higher deprivation level (adjusted odds ratio [AOR] = 1.15) and suffering one form of financial stress (AOR = 1.81, 95% CI = 1.18-2.78). Other significant associations with support included concern about the smoking impacts on health and quality of life (AOR = 1.41), expressing support for tobacco control regulation (AOR = 1.83), and strength of intention to quit (AOR = 1.30).

Discussion: A majority of smokers from all sociodemographic groups supported an increase in tobacco tax if it was dedicated to quitting support and health promotion. The higher support among smokers with stronger intentions to quit is consistent with other evidence that smokers value tobacco control regulation such as high taxes to help them achieve their long-term quitting goals.

Citation

Wilson, N., Edwards, R., Thomson, G., Weerasekera, D., Talemaitoga, A. (2010). High support for a tobacco endgame by Pacific peoples who smoke: National survey data. New Zealand Medical Journal, 123(1316), 131-134.

Abstract

The attitudes of smokers to tobacco control interventions is highly topical in New Zealand given the current inquiry by the Maori Affairs Select Committee into tobacco issues. Presenters to this Committee have raised the need for a tobacco endgame strategy (e.g.), and this idea has currency among Maori leadership, nongovernmental organisations, and amongst other researchers. In the 2006 Census 30.3% of adult Pacific peoples in New Zealand reported being smokers, compared to 19.4% of the European population.7 Tobacco use is a substantial burden on the health of Pacific peoples and is likely to be contributing significantly to the health inequalities between Pacific peoples and other New Zealanders (e.g. see the emerging differences in lung cancer mortality rates). Harm to health and expenditure on tobacco is also likely to be holding back the social and economic development of Pacific communities. Pacific peoples support improved tobacco control, and in a 2008 national survey (smokers and nonsmokers) there was much stronger support than average for tobacco regulation. This high level of support contrasts somewhat to that of Pacific policymakers—at least for extending smokefree regulations. Here we describe the results of another national survey that considered attitudes of Pacific smokers to a range of tobacco control policy options.

Citation

Wilson, N., Peace, J., Edwards, R., Hoek, J. (2010). Long-term benefit of increasing the prominence of a quitline number on cigarette packaging: 3 years of Quitline call data. New Zealand Medical Journal, 123(1321), 109-111.

Abstract

In 2008 the law required tobacco packaging in New Zealand to include pictorial health warnings (PHWs) and the national Quitline number. Previously, text-only health warnings provided a telephone number, but did not explicitly link this to the “Quitline”. Research indicated that New Zealand smokers became more aware of the Quitline number on packs since PHWs were introduced, and there was an immediate increase in the proportion of new callers who registered with the Quitline following the introduction of PHWs. We investigated whether Quitline callers’ use of packaging to source the Quitline number continued beyond the initial introduction of PHWs.

Methods: The national free-phone Quitline service in New Zealand routinely collects data on where new callers sourced the Quitline number (i.e., a standardised question asked of all new callers). The Quitline service provided us with data on the proportion of new callers who reported obtaining the Quitline number from cigarettes packaging before and after the introduction of PHWs (i.e. for the three-year period March 2007 to February 2010). These data were compared to the proportion of callers who cited television advertising as the source of this number (which was the major source at the start of the study period). We reviewed monthly “target audience rating points” (TARPs) data on the reach and frequency of television advertising for smoking cessation advertisements (most of them showed the Quitline number).

Results and Discussion: During the 12-month pre-PHWs period (March 2007 to February 2008), 7.5% and 34.9% of new callers (out of n=19,558 total callers), cited tobacco packaging and television advertising respectively as their source for the Quitline number (Figure 1). However, in the first full year of the new PHWs (March 2008 to February 2009), the proportions reporting tobacco packaging as the source increased to 26.4% and television advertising declined to 27.1% (out of n=20,152 total callers). The same pattern was still evident in the subsequent 12-month period at 22.9% and 23.3% respectively (n=18,309 for the period March 2009 to February 2010).

Citation

Wilson, N., Weerasekera, D., Hoek, J., Li, J., Edwards, R. (2010). Increased smoker recognition of a national quitline number following introduction of improved pack warnings: ITC Project New Zealand. Nicotine & Tobacco Research, 12(Suppl 1), S72-77.

Abstract

Introduction: We examined how recognition of a national quitline number changed after new health warnings were required on tobacco packaging in New Zealand (NZ).

Methods: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) is a cohort study that surveyed smokers in two waves (N = 1,376 and N = 923). Wave 1 respondents were exposed to text-based warnings with a quitline number but no wording to indicate that it was the "Quitline" number. Wave 2 respondents were exposed to pictorial health warnings (PHWs) that included the word "Quitline" beside the number as well as a cessation message featuring the Quitline number and repeating the word "Quitline."

Results: The introduction of the new PHWs was associated with a 24 absolute percentage point between-wave increase in Quitline number recognition (from 37% to 61%, p < .001). Recognition increased from a minority of respondents to a majority for all age groups, genders, deprivation levels (using small area and individual measures), financial stress (two measures), and ethnic groups (e.g., the level for Maori in Wave 2: 62%, Pacific peoples: 61%, and European/other: 62%). There was also an equalizing effect on previous differences in Quitline recognition by gender, ethnic group, and for both deprivation measures.

Discussion: This study provides some evidence for the value of clearly identifying quitline numbers on tobacco packaging as part of PHWs. While this finding is consistent with previously published studies, the finding that this intervention appeared to benefit all sociodemographic groups is novel.

Citation

Wilson, N., Edwards, R., Thomson, G., Weerasekera, D., Gifford, H., Hoek, J. (2010). High and increased support by Maori and non-Maori smokers for a ban on point-of-sale tobacco displays: National survey data. New Zealand Medical Journal, 123(1317), 84-86.

Abstract

Considerations around advancing tobacco control are particularly relevant to New Zealand at present, given the current Inquiry by the Māori Affairs Select Committee into the tobacco industry. While there are good arguments for a rapid endgame solution to the tobacco epidemic (involving a phase out of tobacco sales over 10 years) other supplementary measures should also be considered to help lower demand for tobacco – regardless of the adoption of endgame policies. There is international evidence, and evidence from New Zealand, that point of-sale (PoS) tobacco displays encourage tobacco uptake among children and undermine cessation among smokers wishing to quit and who have recently quit. Other New Zealand research has identified that the arguments for tobacco displays are contradictory and flawed and that there is poor compliance with the current (albeit relatively weak) law on tobacco displays. New Zealand data indicate majority public support for additional marketing restrictions on tobacco. Around half (53.4%) of respondents to a national survey agreed that “tobacco companies should not be allowed to promote cigarettes by having different brand names and packaging” (22.6% disagreed), and 65.6% wanted fewer tobacco retailers. We have previously reported that a majority (62.5%) of Māori smokers support a ban on PoS tobacco displays. Here we draw on additional survey data to examine this issue further.

Citation

Young, D., Wilson, N., Borland, R., Edwards, R., Weerasekera, D. (2010). Prevalence, correlates of, and reasons for using roll-your-own tobacco in a high RYO use country: Findings from the ITC New Zealand Survey. Nicotine & Tobacco Research, 12(11), 1089-1098.

Abstract

Aim: To describe the prevalence, correlates of, and reasons for use of roll-your-own (RYO) tobacco in a high RYO use and ethnically diverse country: New Zealand (NZ).

Methods: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) is sampled from the New Zealand Health Survey, with boosted sampling of Māori, Pacific peoples, and Asian New Zealanders. We surveyed 1,376 current adult smokers using standard ITC project procedures in 2007-2008.

Results: Prevalence of regularly smoking RYOs was 53% (with 38% of all smokers being exclusive RYO smokers). RYO use was higher among disadvantaged smokers, heavier smokers, those with a relatively low intention of quitting, and those with more friends who smoke. RYO use increased more in the youngest age groups as disadvantage increased. "Lower price" dominated the reasons smokers' cited for smoking RYOs (at 83%). About one fifth cited "less health concerns" as a reason.

Conclusions: RYO smoking is particularly associated with individual deprivation and high levels of dependence. Its capacity to blunt price signals provided by tobacco taxes is accompanied by misperceptions that it is less hazardous to health and it is particularly prevalent among vulnerable disadvantaged populations (including Māori, young people, and those with mental health problems). Governments should reconsider removing any tax advantages given to RYO tobacco, ensure RYO smokers are properly informed of health risks, and supported to quit as strongly as other smokers. However, governments should also examine a broader range of options including a higher differential tax on RYO tobacco, removing flavors, and controlling all tobacco marketing.

Citation

Wilson, N., Weerasekera, D., Blakely, T., Edwards, R., Thomson, G., Gifford, H. (2010). What is behind smoker support for new smokefree areas? National survey data. BioMed Central Public Health, 10(1), 498.

Abstract

Background: Some countries have started to extend indoor smokefree laws to cover cars and various outdoor settings. However, policy-modifiable factors around smoker support for these new laws are not well described.

Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from the NZ Health Survey (a national sample). From this sample we surveyed adult smokers (n = 1376).

Results: For the six settings considered, 59% of smokers supported at least three new completely smokefree areas. Only 2% favoured smoking being allowed in all the six new settings. Support among Maori, Pacific and Asian smokers relative to European smokers was elevated in multivariate analyses, but confidence intervals often included 1.0.

Also in the multivariate analyses, "strong support" by smokers for new smokefree area laws was associated with greater knowledge of the second-hand smoke (SHS) hazard, and with behaviours to reduce SHS exposure towards others. Strong support was also associated with reporting having smokefree cars (aOR = 1.68, 95% CI = 1.21 - 2.34); and support for tobacco control regulatory measures by government (aOR = 1.63, 95% CI = 1.32 - 2.01). There was also stronger support by smokers with a form of financial stress (not spending on household essentials).

Conclusions: Smokers from a range of population groups can show majority support for new outdoor and smokefree car laws. Some of these findings are consistent with the use of public health strategies to support new smokefree laws, such as enhancing public knowledge of the second-hand smoke hazard.