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.

Citation

Wilson, N., Weerasekera, D., Edwards, R., Blakely, T. (2009). Smoker support for increased (if dedicated) tobacco tax by individual deprivation level: National survey data. Tobacco Control, 18(6), 512-512.

Abstract

Increasing the price of tobacco products through tobacco taxation is one of the most effective tobacco control interventions. An additional benefit is that a “dedicated tobacco tax” (where some or all of the revenue raised is earmarked for specific spending or programmes) can generate revenue for funding other tobacco control and health programmes. Should dedicated tobacco taxes be introduced, it will be useful for decision makers to know whether there is support from all sociodemographic categories of smokers. Accordingly, we aimed to examine smoker support for tobacco taxes by an individual level measure of deprivation.

Citation

Wilson, N., Thomson, G., Weerasekera, D., Blakely, T., Edwards, R., Peace, J., Young, D., Gifford, H. (2009). Smoker misperceptions around tobacco: National survey data of particular relevance to protecting Maori health. New Zealand Medical Journal, 122(1306), 123-127.

Abstract

To evaluate relevant issues around smoker knowledge and misperceptions about tobacco smoking, a cohort group of 1376 New Zealand smoking adults aged >18 years and 607 Maori respondents were surveyed between March 2007 and February 2008. Specific questions relevant to possible misinformation included perceptions related to light/mild cigarettes/tobacco, to menthols, and to RYO tobacco. Overall results indicated that sizeable minorities of both Maori and European/other smokers had various misperceptions about tobacco products. Regarding light and mild cigarettes, nearly half (48%) of Maori smokers have at least one of three misperceptions which suggest (erroneously) that these cigarettes have health benefits compared to “regular” cigarettes. Also, New Zealand smokers have misperceptions about mentholated cigarettes (“menthols”) being less harmful relative to “non-mentholated” cigarettes. This misperception was significantly more common (13% vs 7%) among Maori smokers. In addition, a minority (up to 10%) of Maori smokers also have specific misperceptions about the adverse health effects of second-hand smoke. Around a fifth of Maori and European/other smokers gave health reasons for smoking RYO cigarettes. Smokers also have high levels of knowledge deficits and misperceptions around smokeless tobacco products. Finally, a substantial group of smokers agree or strongly agree that “tobacco companies have done everything they can to reduce the harm caused by smoking,” and Maori smokers were significantly more likely to have this view (24%) compared to 18% of European/other. In conclusion, these data on smoker misperceptions are likely to be associated with tobacco industry messages on packaging.

Citation

Peace, J., Wilson, N., Hoek, J., Edwards, R., Thomson, G. (2009). Survey of descriptors on cigarette packs: Still misleading consumers? New Zealand Medical Journal, 122(1303), 90-96.

Abstract

Aim: In September 2008, the New Zealand (NZ) Commerce Commission issued a warning to the major tobacco companies to remove “light” and “mild” descriptors from cigarette packaging. Despite published evidence that suggested tobacco companies had started colour-coding their packs in anticipation of the Commission's decision, the investigation did not consider more general misleading packaging. This study explored changes in tobacco packaging that had been introduced to the New Zealand market, by surveying descriptors used on cigarette packs after the Commerce Commission's warning.

Method: A convenience sample of discarded cigarette packs were collected in four cities and six towns/rural areas between November 2008 and January 2009. The majority of packs (93%) were collected in the capital city (Wellington). Information on the descriptors and pack colours was analysed.

Results: Four percent of the 1208 packs collected still included the terms “light” and “mild”. Almost half the packs (42%) used a colour word (e.g. red, blue, gold) as a descriptor to indicate mildness or strength. A further 18% used other words that suggested mildness/strength (e.g. “subtle”, “mellow”). A quarter of packs used a descriptor that did not connote either mildness or strength; however, the majority of these packs still appeared to be colour-coded.

Conclusion: Although the words “light” and “mild” have been largely removed from tobacco packaging in the New Zealand market, these words have been replaced with associated colours or other words that may continue to communicate “reduced harm” messages to consumers. Further research to test how smokers interpret the new words and colours, and how these influence their behaviour, is desirable. However, government-mandated generic (plain) packaging would remove the opportunity to communicate misleading claims and so would afford the highest level of consumer protection.

Citation

Thomson, G., Weerasekera, D., Peace, J., Wilson, N. (2009). New Zealand smokers' attitudes to smokefree cars containing preschool children: Very high support across all sociodemographic groups. New Zealand Medical Journal, 122(1300), 84-86.

Abstract

In 2008 we published the overall support by New Zealand smokers for smokefree cars containing preschool children (96%).1 To provide further detail on the support by different groups, we examined the support by age-groups, gender, ethnicity, level of socioeconomic deprivation, and level of financial stress. The data came from the wave 1 of the New Zealand arm of the International Tobacco Control Policy Evaluation Survey (NZ ITC Project). This wave involved surveying a national sample of 1376 New Zealand adult (18+ years) smokers in 2007–2008. We asked: Do you think smoking should be allowed in cars with preschool children in them? Further detail on the survey methods is available elsewhere.2 We found that smokers in all age-groups, both men and women, those in the four ethnic groups considered, and those in all small area deprivation quintiles, disagreed with the statement at a level of 92%+ (Table 1). Of those smokers who reported suffering from two different types of smoking-related financial stress (those unable to pay any important bills on time due to a shortage of money, and those not spending on household essentials due to spending on smoking) over 92% also disagreed (see Table 1). The key finding is that New Zealand smokers from different socio-demographic groups appear to give very high support for not allowing smoking in cars carrying preschool children. These data are further supported by results from a 2008 national survey of the New Zealand public, which found 91% (82% for smokers) agreeing with the statement ‘that smoking should not be allowed in cars with children under the age of 14 in them’.3 These results indicate that there is strong support across a very wide range of smokers (and from the public) for active government intervention to protect New Zealand children from tobacco smoke pollution in cars. We need to consider why New Zealand is lagging behind 11 states and provinces in Australia, Canada, and the USA, which have all passed laws to protect their children from smoking in cars.4 While further social marketing campaigns on this theme are desirable, we suggest that smokefree car legislation is an appropriate use of the law, and would provide a strong signal on the priority of child protection from tobacco smoke. If the New Zealand Parliament is going to consider banning cell phone use while car driving, they could consider smokefree cars at the same time.

Citation

Wilson, N., Weerasekera, D., Peace, J., Edwards, R., Thomson, G., Devlin, M. (2009). Misperceptions of “light” cigarettes abound: National survey data. BioMed Central Public Health, 9(1), 126.

Abstract

Background: Many smokers believe that "light" cigarettes are less harmful than regular cigarettes, which is at variance with the scientific evidence. The Framework Convention on Tobacco Control (FCTC) aims to address this problem in Article 11 which deals with misleading labelling of tobacco products. In this study we aimed to determine smokers' use and beliefs concerning "light" and "mild" cigarettes ("lights"), including in relation to ethnicity, deprivation and other socio-demographic characteristics.

Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) uses as its sampling frame the NZ Health Survey. This is a national sample with boosted sampling of Maori, Pacific peoples and Asians. From this sample we surveyed adult smokers (n = 1376) about use and beliefs relating to "light" cigarettes. We assessed the associations with smoking "lights" after adjusting for socio-demographic variables, and smoking-related behaviours and beliefs.

Results: Many smokers of "lights" believed that smoking "lights" made it easier to quit smoking (25%), that "lights" are less harmful (42%), and that smokers of "lights" take in less tar (43%). Overall most "lights" smokers (60%) had at least one of these three beliefs, a proportion significantly higher than for smokers of "regular" cigarettes at 45% (adjusted odds ratio (aOR) = 1.96, 95% CI = 1.29 – 2.96). While "lights" smokers had significantly lower tobacco consumption and were more aware of smoking harms, they were no more likely to be intending to quit or have made a previous quit attempt. By ethnicity, both Maori and Pacific people were less likely to smoke "lights" than Europeans (aOR = 0.53, 95% CI = 0.35 – 0.80 and aOR = 0.14, 95% CI = 0.05 – 0.40 respectively). In contrast there was no significant difference by level of deprivation. Roll-your-own (RYO) tobacco smokers were less likely to smoke "light" forms of RYO tobacco while both older and women smokers were more likely to smoke "lights".

Conclusion: Most "lights" smokers have one or more misperceptions about the product they use, and were no more likely to intend to quit or to have made a quit attempt. In response to such misperceptions, governments could act further to eliminate all misleading tobacco marketing. Ideally, they could not only adopt FCTC requirements, but go further by requiring plain packaging for all tobacco products.

Citation

Wilson, N., Edwards, R., Weerasekera, D. (2009). High levels of smoker regret by ethnicity and socioeconomic status: National survey data. New Zealand Medical Journal, 122(1292), 99-100.

Abstract

Some previous international work has studied levels of regret among smokers. In Australia, Canada, the UK, and the US, the proportion of smokers who agreed, or agreed strongly, with the statement “If you had to do it over again, you would not have started smoking”, was very high (range: 89.2% to 91.3%).1 This study also reported significantly lower regret by higher level of education, but no significant differences by ethnicity or income.

Citation

Edwards, R., Wilson, N., Thomson, G., Weerasekera, D., Blakely, T. (2009). Majority support by Maori and non-Maori smokers for many aspects of increased tobacco control regulation: National survey data. New Zealand Medical Journal, 122(1307), 115-118.

Abstract

The Māori Affairs Select Committee is undertaking an Inquiry into “the tobacco industry in Aotearoa and the consequences of tobacco use for Maori”.1 The very high levels of smoking among Māori,2 the important contribution of smoking to poor health and disparities in health,3,4 and the substantial impact of tobacco use on Māori social and economic development, support the timeliness and importance of this Inquiry. A possible outcome of the Inquiry is to recommend substantial strengthening of the measures in place to reduce smoking prevalence by promoting and supporting smoking cessation and reducing smoking uptake. Such measures might include introducing a range of proposed new tobacco control policies, strengthening and intensification of existing interventions, or implementing more radical ‘endgame’ solutions. The latter is probably more efficient at ending the tobacco epidemic and could aim to reduce the use of smoked tobacco products such that the large-scale commercial distribution and sale of smoked tobacco product effectively ceases (e.g. in 10 years time). The aim of this study is to describe the level of support for additional tobacco control policy measures among Māori and non-Māori participants from a nationally representative sample of New Zealand smokers.

Citation

Thomson, G., Wilson, N., Weerasekera, D., Edwards, R. (2009). Most smokers support smokefree council-owned playgrounds: National survey data. New Zealand Medical Journal, 122(1291), 122-123.

Abstract

From an international perspective, New Zealand has been one of the world leaders in passing smokefree environment laws to protect the health of nonsmokers and advance tobacco control.1 It passed a major law in 1990 and the updated 2003 legislation (implemented during 2004) extended smokefree areas to all restaurants, bars and additional indoor workplaces that were not covered by the 1990 law. There has also been progress in terms of outdoor smokefree areas. Smoking in outdoor settings is prohibited in the grounds of all schools by the 2003 legislation. “Educative” smokefree parks policies have been currently adopted by 29% (21/73) of the city and district councils in New Zealand. These are policies which rely on signposts, media coverage and public pressure to limit smoking, rather than on legal enforcement. The grounds of some hospitals, some stadiums, and the campuses of at least one university (Massey) are also covered by smokefree policies. A 2007 survey in Upper Hutt found that 83% of adult park users thought that having a “smokefree parks policy” was a good idea.2 There was even majority support (73%) by smokers for the Upper Hutt smokefree park policy. A 2007 national survey gave options of agreeing that smoking in various settings was acceptable anywhere, in set areas, or not at all. Over a third (38%) said that it was not at all acceptable in local parks or reserves, and 76% said it was not at all acceptable in outdoor children’s playgrounds.3 Nevertheless, there has been no national survey data on what smokers think about smokefree parks – an issue we address in the results below.

Citation

Wilson, N., Blakely, T., Edwards, R., Weerasekera, D., Thomson, G. (2009). Support by New Zealand smokers for new types of smokefree areas: National survey data. New Zealand Medical Journal, 122(1303), 80-89.

Abstract

Aims: To describe smoker support for new smokefree laws covering cars and outdoor settings, in a national sample of New Zealand (NZ) smokers.

Methods: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) uses as its sampling frame the NZ Health Survey (a nationally-representative sample interviewed face-to-face). From this sample we surveyed by telephone adult smokers (n=1376). Along with adjustment for the complex sample design, there was weighting of the results to attempt to adjust for the non-response at various points (i.e. there was an overall response rate of 33%).

Results: A majority of this national sample of smokers supported three new smokefree areas (albeit with some potential for response bias not adequately addressed by the weighting process). That is, only a minority agreed that smoking should be allowed: in cars with pre-school children (3%), anywhere in outdoor eating areas (22%), and at council-owned playgrounds (32%) (with a more equivocal minority for “within 5 metres of the entrance to public buildings” (48%)). These attitudes were generally compatible with the findings that most of these smokers (87%) reported trying to minimise the amount that nonsmokers were exposed to their cigarette smoke, and reported never smoking in a car with non-smokers (73%). Nevertheless, there were still domains where most smokers thought smoking should be allowed-- e.g. on lifeguard-patrolled beaches (55%) and in at least some of the outdoor seating areas of restaurants/cafes (51%) and pubs (83%).

Conclusions: There was majority support by these New Zealand smokers for three new types of smokefree areas not covered by current smokefree legislation (including in cars and some outdoor areas). These findings suggest it is a reasonable option for central government and local government authorities to further study and consider new smokefree laws.

Citation

Wilson, N., Thomson, G., Edwards, R., Peace, J. (2009). Estimating missed government tax revenue from foreign tobacco: survey of discarded cigarette packs. Tobacco Control, 5, 416-418.

Abstract

Aim: To clarify the extent of use of foreign (including duty free, foreign normal retail and smuggled) tobacco, and to estimate missed government tax revenue in a geographically isolated country.

Methods: Discarded cigarette packs were collected on the streets of four cities and six New Zealand towns/rural locations between November 2008 and January 2009.

Results: Out of a total of 1310 packs collected, 42 foreign packs were identified (3.2%, 95% CI 2.4% to 4.3%). Overall, the distribution of packs by country and company was not suggestive of any clustering that might indicate smuggling. At 3.2% of packs being ‘‘foreign’’, the New Zealand government is losing around $36 million per year in tobacco-related tax relative to if all this tobacco was purchased in New Zealand. For various reasons (including that it was not possible to identify packs bought duty free within New Zealand, and other New Zealand survey data indicating duty free product use at 3.8% of packs), the figure reached is probably an underestimate of the true level.

Conclusion: The New Zealand government is missing out on revenue that could be used for improving the funding of tobacco control, and smokers are being exposed to cheaper tobacco thus increasing their risk of continuing to smoke. This government and other governments can and should act at the international and national levels to end the sales of duty free tobacco.

Citation

Lanumata, T., Thomson, G. (2009). Unequal risks, unmet needs: the tobacco burden for Pacific peoples in New Zealand. New Zealand Medical Journal, 122(1303), 39-53.

Abstract

Aim: To review the available published literature and documentary material relevant to smoking by Pacific peoples in New Zealand.

Methods: Electronic databases and websites were searched using a range of search words.

Results: Over 30% of Pacific adults in New Zealand reporting being smokers in the 2006 Census, compared to 21% of the whole adult population. Smoking by Pacific women increased from 23% in 1996 to 27% in the 2006 census. Other survey data indicates some fall in the prevalence of daily smoking from 35% in 2002/3 to 26% in 2006/7. The prevalence of smoking by Pacific Year-10 students declined sharply during 1999-2007, from 29% to 16%. Smoking inside the homes of Pacific students has declined during 2001-7, from 35% to 26%. We found little government attention to smoking by Pacific peoples, and no specific central government plan for Pacific tobacco control.

Conclusions: The threat to health from smoking and secondhand smoke exposure is higher for Pacific peoples and contributes to health inequalities in New Zealand. There is a need for tobacco control interventions specific to Pacific peoples, with some policy shortcomings needing to be urgently addressed. A central government plan for Pacific tobacco control is required. Some progress has occurred, particularly in the decrease of smoking by Pacific youth, and the increase in smokefree Pacific homes.

Citation

Wilson, N., Peace, J., Li, J., Edwards, R., Hoek, J., Stanley, J., Thomson, G. (2009). Distribution of new graphic warning labels: Are tobacco companies following regulations? BioMed Central Public Health, 5(1), 5-14.

Abstract

Objective: To test the hypothesis that tobacco companies would not follow a regulation that required seven new graphic health warnings (GHWs) to be evenly distributed on cigarette packs and that they would distribute fewer packs featuring warnings regarded by smokers as being more disturbing.

Methods: Cross-sectional survey of purchased packs (n = 168) and street-collected discarded packs (convenience sample of New Zealand cities and towns, n = 1208 packs) with statistical analysis of seven types of new GHWs. A priori warning impact was judged using three criteria, which were tested against data from depth interviews with retailers.

Results: The GHWs on the purchased packs and street-collected packs both showed a distribution pattern that was generally consistent with the hypothesis ie, there were disproportionately more packs featuring images judged as "least disturbing" and disproportionately fewer of those with warnings judged "more disturbing". The overall patterns were statistically significant, suggesting an unequal frequency of the different warnings for both purchased (p < 0.0001) and street-collected packs (p = 0.035). One of the least disturbing images (of a "corpse with toe-tag") dominated the distribution in both samples. Further analysis of the street-collected packs revealed that this image appeared disproportionately more frequently on manufactured cigarettes made by each of the three largest New Zealand tobacco companies. Although stock clustering could explain the purchase pack result, there were no obvious reasons why the same uneven warning distribution was also evident among the street-collected packs.

Conclusion: These results suggest that tobacco companies are not following the regulations, which requires even distribution of the seven different GHWs on cigarette packs; further monitoring is required to estimate the extent of this non-compliance. As an immediate measure, governments should strictly enforce all regulations applying to health warnings, particularly given that these are an effective tobacco control intervention that cost tax payers nothing.

Citation

Wilson, N., Edwards, R., Thomson, G. (2009). What’s new in tobacco tax research for New Zealand and is it time for a tax hike now? New Zealand Medical Journal, 122(1293), 89-92.

Abstract

Raising the price of cigarettes through increases in taxation and duties is the tobacco control intervention with the strongest evidence of effectiveness at reducing smoking prevalence. Despite this evidence, the rate of tobacco taxation in New Zealand has not been raised beyond the rate of Consumer Price Index inflation since 2000. To inform evidence-based decision-making, we aimed to briefly review new work on tobacco tax in New Zealand and to put this into context with selected recent international developments. We updated a previous review that covered the use and effects of tobacco tax in New Zealand up to June 20071 with further Medline and Google Scholar searches to cover the period up to the end of February 2009. Findings for all data-based articles and review articles were put in context with relevant international literature and recent developments overseas.

Citation

Thomson, G., Edwards, R., Wilson, N. (2009). At the frontier of tobacco control: A brief review of public attitudes toward smoke-free outdoor places. Nicotine and Tobacco Research, 11(6), 584-590.

Abstract

Introduction: Outdoor smoke-free areas have been adopted increasingly in North America, Britain, Ireland, Australasia, and elsewhere. Their use appears to be one of the frontier areas of tobacco control development. We briefly reviewed the available reports on public attitudes about smoke-free public outdoor areas.

Methods: We included surveys of the general population or of users of public outdoor locations, reported in English language publications to September 2008.

Results: We identified 16 relevant reports that used surveys from 1988 to 2007. Although the evidence remains limited, this research indicates that, in a number of jurisdictions, the majority of the public supports restricting smoking in various outdoor settings. Support for smoke-free outdoor public places appears to be increasing over time. Among respondents ’ reasons for support were the following: litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.

Discussion: Given the recent increase in outdoor smoking restrictions in many developed countries and the growing recognition of the importance of reducing smoking role models for children, this area needs further research related to attitudes and policy evaluation. Given the levels of public support, policy makers in some jurisdictions appear to have an opportunity to establish smoke-free outdoor public places, at least in areas frequented by children.

Citation

Wilson, N., Young, D., Weerasekera, D., Edwards, R., Thomson, G., Glover, M. (2009). The importance of tobacco prices to roll-your-own (RYO) smokers (national survey data): Higher tax needed on RYO. New Zealand Medical Journal, 122(1305), 92-96.

Abstract

There are strong, evidence-based, public health arguments for raising tobacco taxes based on both international,1,2 and New Zealand work.3–6 The benefits include protecting young people from smoking. A systematic review reports evidence for greater price sensitivity among low-income adults, thereby suggesting that such a tax could potentially contribute to reducing health inequalities.7 Despite this, a major report8 has highlighted the lack of a real increase in tobacco prices in New Zealand since 2001. This report also showed that the proportion of tobacco consumed as loose or roll-your-own (RYO) tobacco had increased substantially over time.

Citation

Wilson, N., Borland, R., Weerasekera, D., Edwards, R., Russell, M. (2009). Smoker interest in lower harm alternatives to cigarettes: National survey data. Nicotine & Tobacco Research, 11(12), 1467-1473.

Abstract

Introduction: The aim of this study was to examine knowledge and attitudes to lower harm alternatives to cigarettes among New Zealand (NZ) smokers.

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

Results: Knowledge about smokeless tobacco was poor, with only 16% regarding such products as less harmful than ordinary cigarettes. Only 7% considered such products to be “a lot less” harmful. When participants were asked to assume that these products were much less harmful than cigarettes, 34% of smokers stated that they would be interested in trying smokeless tobacco products, with another 11% saying “maybe” or “don't know.” In the multivariate analysis, Māori smokers were significantly more interested in trying smokeless products than Europeans in all 3 models considered (e.g., Model 1: adjusted odds ratio [AOR] = 1.71, 95% CI = 1.23–2.37). There was also significantly increased interest for those concerned about the impact of smoking on health and quality of life in the future (AOR = 1.44, 95% CI = 1.17–1.78). But interest did not vary significantly by 2 measures of socioeconomic status and varied inconsistently by 2 measures of financial stress.

Discussion: The finding that one third of smokers said that they would be interested in trying smokeless products suggests that these products could have a role as part of a tobacco epidemic endgame that phases out smoked tobacco. Differences in interest level by ethnic group may be relevant to stimulating further work in this area (e.g., among those health workers concerned for smokers with the highest need to quit).

Citation

Fong, G.T., Hammond, D., Hitchman, S.C. (2009). The impact of pictures on the effectiveness of tobacco warnings. Bulletin of the World Health Organization, 87(8), 640-643.

Abstract

Cigarette packages in most countries carry a health warning; however, the position, size and general strength of these warnings vary considerably across jurisdictions.1 Article 11 of the WHO Framework Convention on Tobacco Control (FCTC) and the Article 11 Guidelines adopted at the Third Conference of the Parties in November 2008 have put the spotlight on the inclusion of pictures on tobacco package health warnings. Beginning with Canada in 2001, 28 countries have introduced pictorial warnings and many other countries are in the process of drafting regulations for pictorial warnings (Box 1 and Box 2). This paper presents a brief review of the research studies that support pictorial warnings, reviewed in greater depth by Hammond and by the International Tobacco Control (ITC) Policy Evaluation Project.

Citation

Thomson, G., Wilson, N. (2009). Public attitudes to laws for smoke-free private vehicles: A brief review. Tobacco Control, 18(4), 256-261.

Abstract

As smoke-free car policy is a frontier domain for tobacco control, attitudes to smoke-free private car laws are briefly reviewed. Medline and Google Scholar searches for the period up to midNovember 2008, from English language sources, were undertaken. Studies were included that contained data from national and subnational populations (eg, in states and provinces), but not for smaller administrative units, eg, cities or councils. Jurisdiction, sample size and survey questions were assessed. One reviewer conducted the data extraction and both authors conducted assessments. A total of 15 relevant studies (from 1988) were identified, set in North America, the UK and Australasia. The available data indicates that, for the jurisdictions with data, there is majority public support for laws requiring cars that contain children to be smoke free. There appears to be an increase over time in this support. In five surveys in 2005 or since (in California, New Zealand and Australia), the support from smokers was 77% or more. The high levels of public (and smoker) support for smokefree car laws found in the studies to date suggest that this can be a relatively non-controversial tobacco control intervention. Survey series on attitudes to such laws are needed, and surveys in jurisdictions where the issue has not been investigated to date.

Citation

Thomson, G., Wilson, N., Bushell, L., Al Matar, W., Ball, B., Chiu, J., Culliford, N., Gibson, K., Hudson, J., Hunt, P., Rangamuwa, K., Tapp, D., Wickramaratne, H., Young, V. (2008). Butt lengths differ by area deprivation level: A field study to explore intensive smoking. Nicotine & Tobacco Research, 10(5), 927-931.

Abstract

We collected cigarette butts in a range of residential areas, to assess differences in the length of unburnt tobacco in the butts, and in proportions of roll-your-own (RYO) cigarettes. Two high, two medium, and two low deprivation areas, as classified by deciles of the New Zealand Deprivation Index, were selected for the Wellington region. Collected butts were systematically classified and measured. A mixed model of analysis, treating location clusters nested within deprivation level areas as a random effect, was used to assess differences in mean length of unburnt tobacco in the butts. A total of 6,262 cigarette butts and separate filters were collected, of which 3,509 (56.0%) were measurable manufactured cigarette butts, 1,069 were unmeasurable manufactured butts, 1,450 were RYO butts, and 236 were RYO filters. The RYO butts were not measured because of the extent of their degradation. The unburnt tobacco lengths in manufactured cigarette butts were significantly shorter in the most deprived areas, relative to the least deprived areas (p = .035). Deformed manufactured cigarette butts (i.e., that potentially were stubbed out) showed the same pattern (p = .011 between the most and least deprived areas). We found no significant difference between deprivation areas in the proportion of RYO material found. The shorter mean unburnt tobacco length in the most deprived areas is consistent with more intensive smoking among smokers in those areas. This finding is consistent with other evidence of increased price sensitivity among poorer smokers, and with basic economic theory. Further evidence on observed smoking behavior in the field is necessary to better interpret these preliminary findings.

Citation

Norton, K.J., Wilkins, K., O’Connor, R.J., Wilson, N., Edwards, R., Peace, J. (2008). Properties of “light” cigarettes sold in New Zealand. New Zealand Medical Journal, 121(1281), 107-117.

Abstract

“Light” or “mild” cigarettes have historically been marketed to appeal to health concerned smokers, and positioned as an alternative to quitting.1 But despite this marketing strategy, there is evidence that “light” cigarettes often deliver as much tar as regular cigarettes.2 Furthermore, there is epidemiological evidence that suggests no significant health benefit in terms of lung cancer, heart disease or chronic lung disease for smoking “light” versus other cigarettes.2,3

Citation

Hyland, A., Cummings, K.M., Higbee, C., Dresler, C., Travers, M. (2008). A 32-country comparison of tobacco smoke derived particle levels in indoor public places. Tobacco Control, 17(3), 159-165.

Abstract

Objective: To compare tobacco smoke derived particulate levels in transportation and hospitality venues with and without smoking in 32 countries using a standardised measurement protocol.

Methods: The TSI SidePak AM510 Personal Aerosol Monitor was used to measure the concentration of particulate matter less than 2.5 microns in diameter (PM(2.5)) in 1822 bars, restaurants, retail outlets, airports and other workplaces in 32 geographically dispersed countries between 2003 and 2007.

Results: Geometric mean PM(2.5) levels were highest in Syria (372 microg/m(3)), Romania (366 microg/m(3)) and Lebanon (346 microg/m(3)), while they were lowest in the three countries that have nationwide laws prohibiting smoking in indoor public places (Ireland at 22 microg/m(3), Uruguay at 18 microg/m(3) and New Zealand at 8 microg/m(3)). On average, the PM(2.5) levels in places where smoking was observed was 8.9 times greater (95% CI 8.0 to 10) than levels in places where smoking was not observed.

Conclusions: Levels of indoor fine particle air pollution in places where smoking is observed are typically greater than levels that the World Health Organization and US Environmental Protection Agency have concluded are harmful to human health.

Citation

Wilson, N., Edwards, R., Thomson, G. (2008). Use of four major tobacco control interventions in New Zealand: a review. New Zealand Medical Journal, 121(1276), 71-86.

Abstract

Aims: To identify the extent to which four major population-level tobacco control interventions were used in New Zealand from January 2000 to June 2007.

Methods: We selected the four population-based tobacco control interventions with the strongest evidence base. For each intervention, we undertook literature searches to identify the extent of their use in New Zealand during the study period and made comparisons with the other 29 OECD countries.

Results: Increasing the unit price of tobacco: New Zealand has high tobacco prices, but the policy on tax has several limitations relative to best practice within OECD countries. In particular, the high price appears to be shifting many smokers from factory-made cigarettes to loose tobacco, rather than stimulating quitting.

Controls on marketing: While New Zealand compares favourably with most other OECD countries for tobacco marketing controls, some jurisdictions have made more progress in specific areas (e.g. eliminating point-of-sale product displays and removing misleading descriptors on packaging).

Mass media campaigns: The country routinely invests in these campaigns, but the budget is only around $1.2 per capita per year. Some design aspects of the campaigns are progressive, but comparisons with other countries indicate potential for improvements (e.g. learning from counter-industry campaigns in the USA).

Smokefree environments regulations: New Zealand was one of the first OECD countries to implement comprehensive smokefree workplaces legislation (including restaurants and bars) and it still compares well. But gaps remain when compared to some other OECD jurisdictions (e.g. no smokefree car laws).

Conclusions: There is still substantial scope for New Zealand to catch up to OECD leaders in these key tobacco control areas. In particular, there needs to be higher tax levels for loose tobacco (relative to factory-made cigarettes) and the elimination of residual marketing. There are also important gaps in exploiting synergies between interventions in this country.

Citation

Thomson, G., Wilson, N., Weerasekera, D., Edwards, R. (2008). Ninety-six percent of New Zealand smokers support smokefree cars containing preschool children. New Zealand Medical Journal, 121(1285), 139-140.

Abstract

New Zealand and international research shows that smoking in cars, even with the windows down, produces dangerous levels of pollutants. These levels are far higher than World Health Organization air quality guidelines for particulates in ambient air. While at least 10 Australian and North American jurisdictions (including California) have banned smoking in cars carrying children, New Zealand officials have been reported as hesitant about considering such a move. Perceived questions about public support appear to have contributed to lack of progress on this issue in New Zealand. In a number of areas of Australia and North America, support from smokers (85% or over) and non smokers (90% or over) has been reported for banning smoking in cars with children inside. In a 1997 Wellington area survey, 94% agreed that cars with children in them should be smokefree (86% of smokers). In a 2004 New Zealand wide survey, 76% disagreed that it is “okay” to smoke around non smokers inside cars even when there are windows down.

Citation

Wilson, N., Thomson, G., Edwards, R., Weerasekera, D., Laugesen, M. (2008). Most New Zealand smokers support having fire-safe cigarettes: National survey data. New Zealand Medical Journal, 121(1286), 134-135.

Abstract

A recent New Zealand study on cigarette fires and burns among New Zealand smokers,1 has highlighted again yet another adverse consequence of nicotine addiction. The obvious long-term solution to this problem is to lower smoking prevalence by advancing comprehensive tobacco control measures (as previously advocated by injury researchers in New Zealand2). However, a more direct and supplementary option is for governments to mandate for fire safe (or “reduced ignition propensity”) cigarettes as per Canada and various US states (including New York and California).3,4