Smoking prevalence among doctors and nurses-2013 New Zealand census data.

AIMS: To examine recent smoking trends among doctors and nurses in New Zealand. METHODS: Analysis of smoking prevalence in the 2013 New Zealand Census and comparison with previous census data. RESULTS: The 2013 census included 7,065 male and 5,619 female doctors, and 2,988 male and 36,138 female nurses. Non-response to smoking questions was less than 3%. In 2013, 2% of male and female doctors and 9% of male and 8% of female nurses were regular cigarette smokers. This compared with 4% male and 3% female doctors, and 20% male and 13% female nurses in 2006. Psychiatric nurses had the highest smoking prevalence (15% male, 18% female). More Maori doctors (6.8%) and nurses (19.3%) smoked. Around 96% of young (<25 years) doctors and 87% of young nurses had never been regular smokers. CONCLUSIONS: By 2013, New Zealand doctors had achieved the Smokefree 2025 goal of minimal (<5%) smoking prevalence and all nurses except psychiatric nurses were on track to do so. This suggests smokefree cultures can be established among substantial occupational groups. However, smoking among Maori nurses was relatively high. Targeted workplace smoking cessation support may be an efficient means to reduce smoking among key occupational groups, and may help reduce population smoking prevalence.

Achieving the tobacco endgame: evidence on the hardening hypothesis from repeated cross-sectional studies in New Zealand 2008-2014.

INTRODUCTION: The hardening hypothesis proposes that as smoking prevalence declines the proportion of 'hardcore' or 'hardened' smokers will increase. The possible constructs of hardening include reduced motivation to quit, increased levels of addiction, increased levels of disadvantage and reduced quit rates among continuing smokers. Most previous studies have investigated only a single facet of the hypothesis. We used data from a national population monitor to test the hypothesis using measures across all four hardening constructs. METHODS: We analysed data from a biennial population-based survey of New Zealand adults (aged 15 years+) from 2008 to 2014. Data were collected through face-to-face computer-assisted personal interviews. RESULTS: During a period of reducing smoking prevalence, there were no statistically significant changes in indicators of hardening including the proportion of smokers who were unmotivated to quit, unable to quit despite repeated attempts or receiving state benefits or on a low income. Quit rates did not change significantly over the study period. For 2014 versus 2008, the OR for recent (within last 1-12 months) quitting was 1.14 (95% CI 0.53 to 2.46) and for sustained (within previous 13-24 months) quitting was 1.88 (95% CI 0.78 to 4.54). CONCLUSIONS: This study provides evidence that robust tobacco control strategies that result in substantial declines in smoking prevalence are not accompanied by the hypothesised increase in 'hardcore' or 'hardened' smokers who are more addicted and less motivated and able to quit. The findings suggest that there is no need for substantial change in approach to achieve New Zealand's Smokefree 2025 goal on the grounds that the smoker population is becoming increasingly hardened.

Impact on Smoking Behavior of the New Zealand Annual Increase in Tobacco Tax: Data for the Fifth and Sixth Year of Increases.

INTRODUCTION: New Zealand has implemented a series of seven annual increases in tobacco tax since 2010. All tax increases, except for the first in the series, were preannounced. It is unusual for governments to introduce small, persistent, and predictable increases in tobacco tax, and little is known about the impact of such a strategy. This paper evaluates the impact of the fifth and sixth annual increases. METHODS: Smokers' behaviors were self-reported during the 3-month period before, and the 3-month period after, the two annual increases. Responses to the two increases were analyzed separately, and generalized estimating equations models were used to control for sociodemographic variables, recent quit attempts, and the research design. RESULTS: Findings were consistent across years. The proportion of participants who made a smoking-related (54%-56% before and after each tax increase) or product-related change (fifth tax increase: 17%-19%; sixth tax increase: 21%-22%) did not significantly alter from before to after each tax increase. However, it should be noted that the proportion of participants making smoking-related changes was generally high, even prior to each increase. For example, before the 2015 tax increase, 1% reported quitting completely, 21% trying to quit, and 53% cutting down. CONCLUSIONS: In New Zealand, with its series of annual tobacco tax increases since 2010, there were no significant changes in smoking- or product-related behavior associated with the fifth and sixth increases. Nevertheless, overall cessation-related activity was high, with a majority of participants reporting either quitting and/or cutting down recently. IMPLICATIONS: Little is known about the impact of small, persistent, predictable tobacco tax increases on smoking behavior. This study evaluated the impact of the fifth (in 2014) and sixth (2015) tax increases in an annual series implemented in New Zealand. Although there were no detectable changes in smoking behaviors from before to after each tax increase, self-reported cessation-related activity was high overall (i.e., even prior to each increase). Given that there are multiple possible interpretations for these findings, more in-depth time-series analyses are needed to understand how such a tax strategy influences smoking behavior.

Socio-demographic characteristics of New Zealand adult smokers, ex-smokers and non-smokers: results from the 2013 Census.

AIM: To describe the smoking prevalence by key socio-demographic characteristics (age, gender, ethnicity, education, labour status, income and socioeconomic deprivation) in New Zealand in 2013 and make comparisons with 2006. METHOD: Data on cigarette smoking and key socio-demographics variables were obtained from the 2013 New Zealand Census of Population and Dwellings. Age standardised smoking prevalence rates were calculated by gender, ethnicity and socioeconomic deprivation using the WHO Population Standard. Results were compared against 2006 Census data to identify changes in smoking prevalence. RESULTS: In 2013, around one in seven (15.1%) of New Zealand adults aged 15 years and older reported that they were regular smokers (smoked one or more cigarettes per day), a 5.6% absolute decrease in the smoking prevalence since the previous Census in 2006. The number of regular adult smokers dropped from 597,792 in 2006 to 463,194 in 2013, a 22.5% decrease. Falls in smoking prevalence occurred among all demographic sub-groups, including Maori and young adults. There were substantial disparities in smoking by age, ethnicity and socio-economic status. Maori continue to have the highest age-standardised smoking prevalence (32.4%), with the highest prevalence (43.1%) among young Maori women aged 25 to 29 years. Decreases in smoking prevalence were greater between 2006 and 2013 than between 1996 and 2006. CONCLUSION: The findings suggest that the decline in smoking prevalence is accelerating in New Zealand, including among high priority groups like Maori, Pacific peoples and young adults. This study confirms the value of census data for understanding patterns of tobacco use in New Zealand, to inform effective intervention development and monitoring progress towards the Smokefree 2025 goal.

Stages of physical dependence in New Zealand smokers: Prevalence and correlates.

BACKGROUND: Physically dependent smokers experience symptoms of wanting, craving or needing to smoke when too much time has passed since the last cigarette. There is interest in whether wanting, craving and needing represent variations in the intensity of a single physiological parameter or whether multiple physiological processes may be involved in the developmental progression of physical dependence. AIM: Our aim was to determine how a population of cigarette smokers is distributed across the wanting, craving and needing stages of physical dependence. METHODS: A nationwide survey of 2594 New Zealanders aged 15years and over was conducted in 2014. The stage of physical dependence was assessed using the Levels of Physical Dependence measure. Ordinal logistic regression analysis was used to assess relations between physical dependence and other variables. RESULTS: Among 590 current smokers (weighted 16.2% of the sample), 22.3% had no physical dependence, 23.5% were in the Wanting stage, 14.4% in the Craving stage, and 39.8% in the Needing stage. The stage of physical dependence was predicted by daily cigarette consumption, and the time to first cigarette, but not by age, gender, ethnicity or socioeconomic status. CONCLUSION: Fewer individuals were in the craving stage than either the wanting or needing stages. The resulting inverted U-shaped curve with concentrations at either extreme is difficult to explain as a variation of a single biological parameter. The data support an interpretation that progression through the stages of wanting, craving and needing may involve more than one physiological process. WHAT THIS RESEARCH ADDS: Physical dependence to tobacco develops through a characteristic sequence of wanting, craving and needing which correspond to changes in addiction pathways in the brain. It is important to neuroscience research to determine if the development of physical dependence involves changes in a single brain process, or multiple processes. Our data suggests that more than one physiologic process is involved in the progression of physical dependence.

Smoking in cars: knowledge, behaviours and support for smokefree cars legislation among New Zealand smokers and recent quitters.

AIM: Exposure to second-hand smoke (SHS) poses serious health consequences to non-smokers, and normalises smoking. Currently, there is no legislation restricting smoking in private cars in New Zealand. This paper supplements previous New Zealand studies on exposure to SHS in cars by examining smokers and recent quitters' knowledge and behaviours towards smoking in cars, and their support for two possible smokefree cars policy options. METHOD: The New Zealand Smoking Monitor is a fortnightly survey that uses a self-refreshing panel approach. The questionnaire contains smoking- and cessation-related questions, including eight non-core questions addressing smoking in homes or cars. These questions were answered by 364 respondents in 2014. Responses were compared by socio-demographic variables and recent quit attempt status. RESULTS: Smoking in cars was common among the respondents in our sample: 63% had recently smoked in a car when they were the only person in it, and 27% had done so when there were other people present. Some groups of respondents exhibited information gaps around the harms (eg, compared with males, females had reduced odds of agreeing with the false statement: "it's OK to smoke inside cars if there are windows open", OR=0.41, 0.21-0.78); however, support for banning smoking in cars if there are children in them was consistently high across different sub-groups (92% overall). CONCLUSION: Our data show the importance of providing specific information around the danger of smoking in cars, and strategies to enforce a complete smokefree rule in cars. Legislation may be required to further protect children from SHS exposure.

Tripling use of electronic cigarettes among New Zealand adolescents between 2012 and 2014.

PURPOSE: Use of electronic cigarettes (e-cigarettes) among adults has flourished in recent years. However, little is known about their use among adolescents. This article reports on data collected from a New Zealand national youth tobacco use survey in 2012 and 2014. METHODS: The Youth Insights Survey is a biennial self-complete survey of Year 10 students (predominately aged 14-15 years), with a sample size of 3,127 in 2012 and 2,919 in 2014. Ever-use of e-cigarettes was self-reported by participants in both years, and in 2014, e-cigarette ever-users also reported their reasons for first trying e-cigarettes. RESULTS: The rate of e-cigarette ever-use tripled from 7.0% in 2012 to 20.0% in 2014. After adjusting for sociodemographic variables, smoking status (including susceptibility), and other factors associated with tobacco smoking uptake, e-cigarette ever-use was associated with gender, smoking status, close friends' smoking behavior, and risky substance use. Among smokers, desire for a cigarette, quit intention, or past-year quit attempts did not predict e-cigarette ever-use. Irrespective of smoking status, curiosity was the most commonly cited reason for trying e-cigarettes. CONCLUSIONS: In 2014, one in five 14- to 15-year-olds had used e-cigarettes. Our data suggest that for adolescent smokers, cessation was not the main reason for trying e-cigarettes. Instead, most adolescents (smokers and nonsmokers) tried e-cigarettes out of curiosity. Our findings signal a need to continue monitoring the uptake of e-cigarettes among adolescents, including both experimental and long-term use. Controlling access and exposure to e-cigarettes among this young age group is also required.

The prevalence, correlates and reasons for using electronic cigarettes among New Zealand adults.

INTRODUCTION: There is strong interest in the use of electronic cigarettes (e-cigarettes) globally. This paper is the first to report population-based data on ever-use and current use of e-cigarettes among New Zealand adults. The paper also extends previous international studies by exploring the reasons for trying e-cigarettes, ever users' recall of brand(s) they have ever tried, and current users' recall of their current brand. METHODS: The Health and Lifestyles Survey (HLS) is a biennial face-to-face in-house survey of New Zealand adults aged 15 years or over. In 2014, 2594 participants completed the survey. RESULTS: Ever-use and current use of e-cigarettes were 13.1% and 0.8% respectively. Tobacco smoking status predicted the use of e-cigarettes, with current smokers reporting the highest rate of use (50% ever-use and 4% current use). Among current smokers who had tried an e-cigarette, curiosity (49%) and desire to quit smoking (37%) were the most common reasons for trying. About half of the ever-users could not name any of the brand(s) they had ever tried, and one-fifth of current users could not name their current brand. CONCLUSIONS: Compared with other countries, New Zealand has a high rate of ever-use. Among current smokers, one in two had tried an e-cigarette. However, progression to regular use appears to be rare. The finding that 18% of current e-cigarette users could not name their current brand highlights the importance of investigating users' knowledge of e-cigarettes in general and assessing the factors that influence brand choice such as advertising, price, and accessibility.

An annual pre-announced step-increase in tobacco excise in New Zealand.

New Zealand is implementing a policy of pre-announced 10 per cent annual increases in tobacco excise for 7 years (from 2010 to 2016). Internationally, little is known about smokers' receptiveness to persistent step-increases in tobacco excise. This article reports on data collected in 2013 (600 interviews in total). The New Zealand Smoking Monitor is a fortnightly survey of smokers and recent quitters; respondents are maintained on a panel and interviewed up to six times. We found that, one-quarter of respondents supported continuing with a 10 per cent annual increase. Eight in ten were aware that a pack of cigarettes will cost US$16.50 in 3 years, and six in ten believed knowing the future cost of cigarettes gave them a strong reason to stop smoking now. While most respondents did not want the annual excise increase to continue, how they perceived the impact of persistent excise increases suggests this policy has the potential to increase quit attempts.

The use of, and attitudes towards, electronic cigarettes and self-reported exposure to advertising and the product in general.

OBJECTIVE: Very few studies have investigated New Zealanders' use of, and attitudes towards, e-cigarettes, their exposure to e-cigarette advertising and their general exposure to this product. The current study aims to fill this information gap. METHODS: Responses were gathered from a sample of adult smokers and recent quitters who took part in a fortnightly computer-assisted telephone interviewing survey. This paper reports on data collected in 2013 on the use of, and attitudes towards, e-cigarettes and exposure to advertising and the product in general. Responses were compared by socio-demographic status and recent quit attempts. RESULTS: Between 23% and 39% of respondents reported having used e-cigarettes (with the highest level among those who had quit or tried to quit recently), and 8-16% had used e-cigarettes in the past two weeks. About one half reported seeing advertising of e-cigarettes in the past two weeks, 22-41% had seen people they knew using e-cigarettes and 10-15% had seen a stranger using them in the past two weeks. Attitudinal responses are reported in the main text. CONCLUSIONS: The rate of ever-use suggested that smokers and recent quitters are receptive to e-cigarettes and that they were available to many of them to try. Exposure to e-cigarette advertising or the product in general was not uncommon. Future studies should continue monitor the use of e-cigarettes and investigate the impact of the exposure to people's attitudes towards the product and their subsequent use of e-cigarettes.

A qualitative analysis of messages to promote smoking cessation among pregnant women.

OBJECTIVES: Although aware that smoking while pregnant presents serious risks to their unborn children, some women continue to smoke and rationalise their dissonance rather than quit. We explored metaphors women used to frame smoking and quitting, then developed cessation messages that drew on these metaphors and examined the perceived effectiveness of these. PARTICIPANTS: We used a two-phase qualitative study. Phase one involved 13 in-depth interviews with women who were smoking (or who had smoked) while pregnant. Phase two comprised 22 in-depth interviews with a new sample drawn from the same population. ANALYSES: Data were analysed using thematic analysis, which promoted theme identification independently of the research protocol. RESULTS: Participants often described smoking as a choice, a frame that explicitly asserted control over their behaviour. This stance allowed them to counter-argue messages to quit, and distanced them from the risks they created and faced. Messages tested in phase 2 used strong affective appeals as well as themes that stimulated cognitive reflection. Without exception, the messages depicting unwell or distressed children elicited strong emotional responses, were more powerful cessation stimuli, and elicited fewer counter-arguments. CONCLUSIONS: Cessation messages that evoke strong affective responses capitalise on the dissonance many women feel when smoking while pregnant and stimulate stronger consideration of quitting. Given the importance of promoting cessation among pregnant women, future campaigns could make greater use of emotional appeals and place less emphasis on informational approaches, which often prompt vigorous counter-arguments.

The use and acceptability of electronic cigarettes among New Zealand smokers.

AIM: To investigate New Zealanders' use, perceptions and views on the acceptability of electronic cigarettes (e-cigarettes). METHOD: 840 current smokers and recent quitters were recruited through random digit dialling as part of the New Zealand Smoking Monitor (NZSM), a 33-item telephone-based survey delivering 120 interviews per fortnight. Two sets of questions were deployed at different times to assess ever-purchase of e-cigarettes, perceptions of the safety and cessation efficacy of e-cigarettes, and acceptability of using them instead of tobacco cigarettes or as a cessation aid. RESULTS: 7% of the sample reported having purchased an e-cigarette. One-third of respondents believed them to be safer to use than tobacco cigarettes, and could help people quit smoking tobacco. Forty-one percent considered it acceptable to use e-cigarettes as a replacement product and 58% as a cessation aid. Responses differed according to ethnicity, age and household income. CONCLUSION: Purchasing (and therefore we assume, use) of e-cigarettes in New Zealand is uncommon. Despite this finding, many respondents viewed e-cigarettes in a positive light and indicated willingness to use them. Ongoing monitoring on the use of and public attitudes towards this emerging product is recommended.

'The times are changing': New Zealand smokers' perceptions of the tobacco endgame.

BACKGROUND: The New Zealand government's goal of achieving a smoke-free society by 2025 reflects growing interest in 'endgame' solutions to tobacco smoking. However, tobacco companies have framed 'endgame' strategies as contrary to individual freedoms and 'choice'; these claims heighten politicians' sensitivity to 'nanny state' allegations and may undermine tobacco control policies. Public support for stronger policies could strengthen political will; however, little is known about how smokers perceive endgame scenarios or the factors underlying their support or opposition to these. METHODS: The authors conducted 47 in-depth interviews with four priority groups: Maori, Pacific, young adults and pregnant women; all were smokers or very recent quitters. The authors used thematic analysis to interpret the transcripts. RESULTS: Most participants strongly supported the 2025 smoke-free goal, recognised the broader social good that would result and accepted the personal inconvenience of quitting. Yet they wanted to retain control over when and how they would quit and asserted their 'freedom' to smoke. Participants identified interventions that would extend current policy and maintain the autonomy they valued; the authors classified these into four themes: restricting supply, diminishing visibility, decreasing availability and affordability, and increasing quit support. CONCLUSIONS: Politicians may have a stronger mandate to implement endgame policies than they appreciate. Participants' use of industry arguments when asserting their freedom to 'choose' to smoke and quit suggests a need for denormalisation strategies that challenge industry propaganda, demonstrate how endgame measures would empower smokers and re-iterate the community benefits a smoke-free society will deliver.

Access to cigarettes by young New Zealand smokers: little change from 2000 to 2008.

OBJECTIVE: To examine trends in young New Zealanders' access to cigarettes from 2002 to 2008. METHODS: Self-reports of young smokers' commercial sources of cigarettes, requests for proof of age and being refused a sale, and the amount spent on cigarettes, were analysed from the 2002 and 2004 Youth Lifestyles Surveys and 2006 and 2008 Year 10 In-depth Surveys of 14 to 15 year olds in New Zealand (NZ). RESULTS: Most young smokers obtain cigarettes through non-commercial sources; however, one-third bought their cigarettes from shops in 2008, with no evidence of a change in proportions purchasing from major retail outlets since 2000. Few young smokers were asked to show proof of age when purchasing cigarettes, with no evidence over time of more young smokers being asked for proof of age, but reports of being refused the sale of cigarettes decreased from 2000. Participants reporting being asked for proof of age had nearly six times the odds of being refused sale. The amount spent on cigarettes did not change over the study period. CONCLUSION: Many young smokers continue to purchase cigarettes from commercial outlets, with no evidence of change in purchasing from major outlets such as dairies, service stations, supermarkets or liquor stores since 2000. The fact that few young smokers reported being asked to show proof of age suggests the need for stronger measures to ensure that retailers comply with New Zealand legislation regarding under-age sales of tobacco. IMPLICATIONS: With an infringement notice scheme being implemented and tobacco price rises, there may be an increase in accessing cigarettes through social sources. It remains important to monitor commercial tobacco sales to young people to determine the efficacy of policy change.

Youth experiences of secondhand smoke exposure in New Zealand: evidence from 5 national surveys (2000 to 2008).

AIMS: To describe trends in young people's exposure to secondhand smoke (SHS), and to their exposure to household rules around smoking in New Zealand (NZ) over the period 2000 to 2008. METHODS: We examined self-assessed perceptions of exposure to SHS in the home and while travelling in vehicles, and home smoking restrictions, both inside the home (indoor) and on the property (outside). Data were from the 2000, 2002 and 2004 Youth Lifestyle Study and 2006 and 2008 Youth In-depth Survey of 14- to 15-year-olds in NZ. RESULTS: Downward trends in young people being exposed to SHS at home since 2000 (p<0.001) and in vehicles since 2002 (p<0.001) were found. Unrestricted indoor and outdoor smoking declined, with 31% of homes being completely smokefree in 2008. Maori and Pacific young people were significantly more likely to be exposed to SHS at home (OR 3.2 and 2.0 respectively) and in vehicles (OR 3.1 and 2.3 respectively). CONCLUSIONS: Declining rates of SHS exposure for young people in their homes and while travelling in vehicles are encouraging. However, 35% of young people are still being exposed to SHS in their homes and 32% in vehicles. Although smokefree homes are increasing, there is still much work needed to reduce the rates of SHS exposure for our young people, and especially Maori and Pacific young people.

Youth opinions of tobacco control in New Zealand: support for specific measures and the relationship with smoking behaviors among 14-15-year-olds.

INTRODUCTION: The purpose of this study was to assess the attitudes of young people toward tobacco control and explore the association between these attitudes and both smoking intentions and behavior. METHODS: The study used data from a national survey of 14- and 15-year-old students in New Zealand (NZ) investigating tobacco use and attitudes. Attitudes to tobacco control were assessed using student responses to 7 statements relating to specific tobacco control measures; outdoor smoking bans, increased and hypothecated tax, display bans, plain packaging, and reduced access. Analysis was conducted on a final sample of 24,495 students aged 14-15 years. Chi-square testing was used to determine group differences in smoking status and attitudes toward tobacco control measures, while logistic regression was used to test associations between youth attitudes and both smoking susceptibility and current smoking. RESULTS: Our results demonstrate youth support for tobacco control interventions in NZ. Commercial access measures received the most support, while plain packaging and display bans were the least supported measures among young people. Young people's attitudes toward tobacco control measures were found to be associated with smoking behavior; those who were opposed to measures were more likely to be susceptible to smoking or be current smokers. CONCLUSIONS: Young people in NZ have opinions when it comes to tobacco control, and it is important to investigate these when developing tobacco control policies that are aimed to have an effect on this demographic. The results provide evidence to support the proposed "end game" strategies currently being considered in NZ.

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

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. METHOD: Data were sourced from the New Zealand 2006 Year 10 In-depth Survey, a school-based survey of 3,189 students. Outcome measures were susceptibility to smoking and current smoking. Potential determinants were second-hand smoke exposure in the home, parental smoking, parental anti-smoking expectations, anti-smoking rules, pocket money, monitoring of pocket money expenditure, general rule setting and monitoring, and concern about education. Analysis used logistic regression to adjust for potential confounding factors. RESULTS: Exposure to second-hand smoke and lack of parental anti-smoking expectations were independently associated with smoking susceptibility and current smoking. Parental smoking was not independently associated with current smoking or susceptibility. Receiving pocket money and an absence of monitoring of expenditure were associated with smoking susceptibility and current smoking. Lack of parental rule setting was associated with smoking susceptibility. Findings were similar whether or not one or more parents were smokers. CONCLUSIONS: Not allowing smoking in the home, communicating non-smoking expectations to children, monitoring pocket money, and setting rules to guide behaviour are strategies which are likely to reduce risk of smoking uptake. IMPLICATIONS: The study provides evidence to inform the development of parent-focused interventions to reduce the risk of smoking initiation by children.