Jo Peace

An examination of smoking initiation rates by age: results from a large longitudinal study in New Zealand

Objective: Investigations of smoking initiation often focus on the experiences of children and youth. However, prevalence data from the Tobacco Use Surveys (TUS) and the New Zealand (NZ) census suggest substantial uptake of smoking occurs after 15 years of age, including among young adults aged 18–24 years. Identifying initiation rates is difficult using cross‐sectional prevalence data, particularly among older age groups, which are subject to cohort effects and where quitting and premature mortality reduce prevalence. We aimed to identify initiation rates using a prospective study design.

Support for a tobacco endgame and increased regulation of the tobacco industry among New Zealand smokers: results from a National Survey

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 tobacco-free New Zealand.

Trends in colorectal cancer mortality by ethnicity and socio-economic position in New Zealand, 1981-99: one country, many stories

Background:Ethnicity and socio‐economic position are important determinants of colorectal cancer (CRC) mortality. In this paper, we determine trends in colorectal cancer mortality by ethnicity and socioeconomic position in New Zealand.

Estimating missed government tax revenue from foreign tobacco: survey of discarded cigarette packs

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

Parental behaviours, but not parental smoking, influence current smoking and smoking susceptibility among 14 and 15 year-old children.

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.

Setting a Good Example? Changes in Smoking Prevalence Among Key Occupational Groups in New Zealand: Evidence From the 1981 and 2006 Censuses

Objective: To explore whether parental behaviours related to smoking socialisation and parenting are associated with smoking susceptibility and current smoking in 14–15 year old students.

Research outputs by medical students from routine public health training projects.

INTRODUCTION Role modeling by smokers may influence smoking among children and young adults. Most work on smoking by occupation has focused on health workers. A unique opportunity to explore smoking by occupation is presented in New Zealand (NZ) due to inclusion of a smoking status question in most national censuses since 1976. Our aim was to assess trends in smoking prevalence among potential role model occupational groups in NZ. METHODS Adult smoking status by occupation was obtained from the 1981 census (N = 1,321,323) and 2006 census (N = 1,744,479). Subjects were aggregated into 5 broad groups of potential role-model occupations: teachers, uniformed services, health-related occupations, public figures, and sportspeople/entertainers. Age and sex-standardized current smoking prevalences were calculated using the 2006 NZ employed population as the reference standard. RESULTS Standardized smoking prevalence among the employed population was 34.5% in 1981 and had declined 37% in relative terms and 12.8% in absolute terms to 21.7% in 2006. Relative declines in smoking prevalence between 1981 and 2006 ranged from 35% to 60% among the role model occupational groups and absolute declines from 8.3% to 19.9%. Māori had higher smoking prevalence and lower relative declines in prevalence in each occupational group from 1981 to 2006, compared with non-Māori. Specific occupations mostly had low smoking prevalences--particularly doctors and teachers. But some role model occupations had high crude smoking prevalences in 2006 (up to 47%). CONCLUSIONS Persisting high smoking prevalence among some occupational groups suggest that additional targeted smoking cessation support for role model occupational groups may be justified.

Qualitative exploration of public and smoker understanding of, and reactions to, an endgame solution to the tobacco epidemic.

Previous work in the United Kingdom (Edwards et al. 2001) and the United States (Ahlers-Schmidt et al. 2009a, 2009b) indicates that medical student training activities can result in publications in the scientific literature. This prompted us to consider the situation for such outputs arising from public health projects which are part of the curriculum for medical students at our university. We identified the final reports arising from public health training projects performed by undergraduate medical students over five-week periods (full list available on request). This was for six runs per year over the last five-year period available (up to 2009). We then performed Google searches and Medline searches to determine if the project reports were published in the Medline-indexed literature or on websites. Individual staff supervisors in our Department were also questioned on project outcomes. Of the 30 project reports identified, eight (27%) resulted in Medline-indexed journal publications (n1⁄4 7 articles and one letter; n1⁄4 6 in international journals). In six of these publications, the student authors were the lead authors, and there were a total of 81 student authors listed. In addition, these ‘‘published’’ projects also resulted in conference posters (n1⁄4 2), a conference oral presentation (presented by the students), reports published on websites (n1⁄4 2), follow-on Medline-indexed publications that built on the original work (n1⁄4 2; both with at least one student author), and a subsequent research contract on the topic from the Ministry of Health (which involved the staff supervisors). Of the remaining projects (n1⁄4 22), two had the final report published on a website. This gave a final total of 30% (10/30) of projects resulting in some form of publication, with an average of 4.7 published or conference-presented outputs per 10 projects. These results are encouraging but still may under-estimate the resulting outputs as others may still be in progress from projects in 2009 (e.g., one submitted article and two others still being planned according to supervisors). Our impression from end-of-the-run student feedback is that these public health projects are generally valued by them and that the publication outputs are appreciated. However, a barrier to achieve such outputs is that it usually involves additional after-hours student and staff time after the formal run in public health is completed. This could be partly addressed, along with increasing the level of such outputs, by making more of the formal course time available for the ‘‘write-up’’ stage of the project work. Nick Wilson, Jo Peace & Richard Edwards, Department of Public Health, University of Otago, Wellington, New Zealand. E-mail: Nick.Wilson@otago.ac.nz

Smokers commonly misperceive that nicotine is a major carcinogen: National survey data

BackgroundThere is increasing interest in ending the tobacco epidemic and in applying ‘endgame’ solutions to achieve that goal at national levels. We explored the understanding of, and reactions to, a tobacco-free vision and an endgame approach to tobacco control among New Zealand smokers and non-smokers.MethodsWe recruited participants in four focus groups held in June 2009: Māori (indigenous people) smokers (n=7); non-Māori smokers (n=6); Māori non-smokers (n=7); and non-Māori non-smokers (n=4). Participants were from the city of Whanganui, New Zealand. We introduced to them the vision of a tobacco-free New Zealand and the concept of a semi-autonomous agency (Tobacco-Free Commission [TFC]) that would control the tobacco market as part of an endgame approach.ResultsThere was mostly strong support for the tobacco-free New Zealand vision among all groups of participants. The reason most commonly given for supporting the vision was to protect children from tobacco. Most participants stated that they understood the TFC concept and reacted positively to it. Nevertheless, rather than focusing on organisational or structural arrangements, participants tended to focus on supporting the specific measures which a future TFC might facilitate such as plain packaging of tobacco products. Various concerns were also raised around the TFC, particularly around the feasibility of its establishment.ConclusionsWe were able to successfully communicate a complex and novel supply-side focused tobacco control policy intervention to smokers and non-smokers. The findings add to the evidence from national surveys that there is public support, including from smokers, for achieving a tobacco-free vision and using regulatory and policy measures to achieve it. Support for such measures may be enhanced if they are clearly communicated and explained with a rationale which stresses protecting children and future generations from tobacco smoking.

Smokers have varying misperceptions about the harmfulness of menthol cigarettes: national survey data.

In vitro testing has shown that nicotine may play a role in making cancers more aggressive,1 but the currently available evidence does not suggest that nicotine in itself induces cancer.2 Despite this, many smokers believe that nicotine does cause cancer. For example, in a USA-based study it was found that 65% of smokers believed nicotine causes lung cancer and 71% believed it caused oral cancer.3 Furthermore, some smokers regard nicotine replacement therapy (NRT) as also being carcinogenic.4 These findings are concerning since misperceptions about nicotine may result in underutilisation of NRT. Therefore, we aimed to assess these views in New Zealand (NZ) smokers, with the context being …