E-cigarette use patterns, brand preference and knowledge about vaping among teenagers (13-16 years) and parents of children attending Christchurch Hospital.

AIM: Parents attending hospital with children in New Zealand are routinely asked about tobacco use, but information about vaping is lacking. We assessed e-cigarette use, brand preferences, and knowledge during paediatric outpatient attendance at Christchurch Hospital. METHOD: We undertook an anonymous online survey of teenagers and parents attending paediatric outpatient clinic in December 2021 to February 2022. The sample (n=95) were 16% Maori and 8.4% currently smoked (4.8% teenagers, 11.3% parents). We used descriptive and contingency table analysis. RESULTS: Ever vaping was reported in 33.3% of teenagers and 30.8% of parents, and current use in 7.1% vs 15.1%, respectively. Most teenagers selected "curiosity/just wanted to try them" as their reason for vaping, whereas parents selected vaping to quit or reduce/avoid smoking. More teenagers than parents used nicotine-containing e-cigarettes (100% vs 86.7%) and more parents vaped indoors (in home or car) when other people were present. The most important reasons for choosing particular e-cigarette brands among teenagers were price and flavours, with fruit flavours preferred. No teenagers obtained their e-cigarettes from vape shops versus 40% of parents. The primary source of information about vaping for teenagers and parents was friends/peers. CONCLUSION: Vaping was common among teenagers and parents; teenagers vaped for curiosity and flavours and obtained vape products from sources other than vape shops.

Factors associated with support for reducing and ending tobacco sales among university students in Queensland, Australia and New Zealand.

OBJECTIVE: To assess the factors associated with support for reducing tobacco retail availability and ending the legal sale of cigarettes in Australia and New Zealand (NZ). METHODS: Cross-sectional surveys were conducted in NZ (eight universities, n=1,932) and Queensland (University of Queensland or UQ, n=5,172). Participants were asked how much they agreed or disagreed with reducing the number of places allowed to sell cigarettes/tobacco and ending the legal sale of cigarettes within 10 years. Multinomial logistic regression models assessed associations between support with student characteristics. RESULTS: More than half the respondents in both samples supported reducing the number of tobacco outlets (NZ 69.3%; UQ 62.3%), and ending the legal sale of cigarettes within 10 years (NZ 53.3%; UQ 51.6%) with marginally more support among NZ students. Men and students who smoked or vaped had lower odds of supporting both strategies compared with women and non-users. CONCLUSIONS: The results suggest widespread support for reducing tobacco retail availability among university students in NZ and Queensland, and sex, and smoking and vaping status were strong predictors for support. Around half supported phasing out tobacco sales within 10 years. IMPLICATIONS FOR PUBLIC HEALTH: Collaborative research should be encouraged to enhance cross-country approaches on tobacco control.

Cigarette smoking and e-cigarette use among university students in New Zealand before and after nicotine-containing e-cigarettes became widely available: results from repeat cross-sectional surveys.

AIM: To estimate prevalence and patterns of smoking and vaping, and associations between smoking and vaping, among university students in New Zealand when access to nicotine-containing e-cigarettes was restricted (ie, time point 1 or T1) and 12-months after restrictions were relaxed (ie, time point 2 or T2). METHOD: Cross-sectional surveys of university students across all eight universities: T1, March 2018 (n=1,932), and T2, March 2019 (n=2,004). Chi-squared tests compared responses between T1 and T2 and logistic regression examined associations between smoking and vaping with student characteristics. RESULTS: The patterns of smoking (T1 vs T2): current (10.6% vs 12.1%, p=0.716), daily (5.0% vs 4.6%, p=0.121), and cigarettes/day, time to first cigarette, and avoidance of smoking in smoke-free spaces were not significantly different. In contrast, vaping: current (6.8% vs 13.5%, p<0.001), daily (2.7% vs 5.4%, p<0.001), and possibly vaping in smoke-free spaces, were significantly higher at T2. At both periods, males had higher odds of smoking, vaping and dual use; students aged 25-34 and long-term residents had higher odds of vaping. Asian and Other students had lower odds of smoking at T1, and Other students had higher odds of vaping at T2. CONCLUSION: Vaping was significantly more prevalent at T2 than T1, without their being a corresponding decrease in smoking. Age, sex, student type and ethnicity predicted smoking and vaping.

Cigarette smoking and e-cigarette use among university students in Queensland, Australia and New Zealand: results of two cross-sectional surveys.

OBJECTIVES: Examine the patterns of cigarette smoking and e-cigarette use (vaping), the perceived harm of e-cigarettes compared with tobacco cigarettes, and associations between smoking and vaping with student characteristics. DESIGN: Cross-sectional studies. SETTING: The University of Queensland (UQ), Australia and eight New Zealand (NZ) universities. PARTICIPANTS: Students at UQ: 4957 (70.8% aged <25 years, 63.0% women) and NZ: 1854 (82.5% aged <25 years, 60.1% women). METHODS: Χ2 tests compared smoking by age and gender, and vaping by age, gender and smoking status. Two-sided p<0.05 was considered significant and 95% CIs reported where appropriate. Multinomial logistic regression examined associations between smoking and vaping (exclusive smoking, exclusive vaping, dual use and non-use) with age, gender and student type (domestic vs international). RESULTS: Smoking (UQ vs NZ, 95% CI): ever 45.2% (43.8% to 46.6%) vs 50.0% (47.7% to 52.3%), current 8.9% (8.1% to 9.7%) vs 10.4% (9.1% to 11.9%) and daily 5.2% (4.6% to 5.8%) vs 5.6% (4.6% to 6.7%), and not smoking in indoor 98.3% vs 87.7% or outdoor smoke-free spaces 83.8% vs 65.3%.Vaping (UQ vs NZ, 95% CI): ever 20.9% (19.8% to 22.1%) vs 37.6% (35.4% to 39.9%), current 1.8% (1.5% to 2.2%) vs 6.5% (5.4% to 7.7%) and daily 0.7% (0.5% to 1.0%) vs 2.5% (1.9% to 3.4%), and not vaping in indoor 91.4% vs 79.6% or outdoor smoke-free spaces 84.4% vs 71.3%. Of respondents, 71.7% (70.3% to 73.2%) vs 75.3% (72.9% to 77.6%) perceived e-cigarettes as less harmful than tobacco cigarettes.Men were more likely than women to smoke and vape, and to believe that e-cigarettes are less harmful. Regression models containing all predictors for smoking and vaping were significant and the effect of gender was significant for dual use, exclusive smoking and exclusive vaping (all p<0.01). Men had higher odds for smoking, vaping or dual use. CONCLUSIONS: Results suggest significant differences in patterns of smoking and vaping of university students in Australia and NZ, and a strong influence of gender on smoking and vaping.

Associations of history of mental illness with smoking and vaping among university students aged 18-24 years in New Zealand: Results of a 2018 national cross-sectional survey.

OBJECTIVE: Data on associations of history of mental illness (HMI) with smoking and vaping in New Zealand (NZ) are lacking. This study examines these associations in university students aged 18-24 years. METHODS: Data came from a 2018 national cross-sectional study of university students and included information on demographic characteristics, smoking, vaping and participant health in the previous 12-months. χ2 tests compared patterns of smoking and vaping, and logistic regression assessed associations of HMI with smoking and vaping, controlling for age, gender and ethnicity. An HMI was defined as a diagnosis/treatment for depression, anxiety/nervous disorder, or other mental health condition in the previous 12-months. RESULTS: The sample comprised 1293 students: 61.3% aged 18-20; 62.8% female; 7.8% Maori, 92.2% non-Maori, and 18.5% reported an HMI. Smoking: 49.7% (95% CI 47.0-52.5) reported ever, 10.5% (8.9-12.3) current and 5.0% (3.9-6.4) daily smoking. Vaping: 38.7% (36.0-41.4) reported ever, 6.3% (5.1-7.8) current and 1.9% (1.3-2.8) daily vaping. Participants with HMI were significantly more likely to smoke: ever (64.9% vs 46.3%, p < .001), current (15.1% vs 9.5%, p = .011) and daily (7.5% vs 4.5%, p = .050), and vape: ever (49.4% vs 36.3%, p < .001) and current (9.2% vs 5.7%, p = .044) than participants without HMI. The model containing all predictors of HMI was significant, χ2 (5, N = 1293) = 24.09, p < .001. Gender (OR 0.54, (0.4-0.75)), current smoking (OR 1.82, (1.19-2.78)) and current vaping (OR 1.73, (1.02-2.93)) made unique significant contributions to the model. CONCLUSIONS: The prevalence of smoking and vaping were significantly higher in students with HMI, and there were strong associations between HMI and smoking and vaping.

Factors Associated with Having Family/Whanau or Close Friends Who Used Alcohol or Other Drugs in Harmful Ways among University Students in New Zealand.

The consequences of alcohol and other drug (AoD) use are well documented. This study investigated factors associated with having family/whanau or close friend who used AoD in harmful ways in New Zealand. Data came from a July-August 2020 cross-sectional survey of students from eight universities (n = 946). Participants were asked if they had family/whanau or close friends in New Zealand who consumed alcohol or used other drugs (cannabis, ecstasy/MDMA, methamphetamine, cocaine, heroin, prescription drugs, inhalants, or other) in a way that negatively impacted them, their family, or close friends in the last 12 months. Logistic regression assessed associations of having family/whanau or close friend who used AoD harmfully with student characteristics. Of respondents, 36.2% (33.1-39.4) had family/whanau or close friend who had consumed alcohol harmfully, and 42.9% (39.5-46.3) had family/whanau or close friend who had used at least one drug harmfully. Respondents' age and ethnicity were significantly associated with having family/whanau or close friend who used AoD harmfully. The results suggest widespread harmful AoD use and potentially significant second-hand effects of AoD use in New Zealand. These data can be used to supplement information from traditional in-person surveys of individuals using alcohol and other drug (e.g., the New Zealand Health Survey).

Attitudes towards the New Zealand Government's Smokefree 2025 goal associated with smoking and vaping in university students aged 18 to 24 years: results of a 2018 national cross-sectional survey.

OBJECTIVE: In March 2011, New Zealand (NZ) launched an aspirational goal to reduce smoking prevalence to 5% or less by 2025 (Smokefree 2025 goal). Little is known about university students' awareness of, support for and perceptions about this goal. We sought to narrow the knowledge gap. SETTING: University students in NZ. METHODS: We analysed data from a 2018 cross-sectional survey of university students across NZ. Logistic regression analysis examined the associations between responses about the Smokefree goal with smoking and vaping, while controlling for age, sex and ethnicity. Confidence intervals (95% CI) were reported where appropriate. PARTICIPANTS: The sample comprised 1476 students: 919 (62.3%) aged 18 to 20 and 557 (37.7%) aged 21 to 24 years; 569 (38.6%) male and 907 (61.4%) female; 117 (7.9%) Maori and 1359 (92.1%) non-Maori. Of these, 10.5% currently smoked (ie, smoked at least monthly) and 6.1% currently vaped (ie, used an e-cigarette or vaped at least once a month). RESULTS: Overall awareness of the Smokefree goal was 47.5% (95% CI: 44.9 to 50.1); support 96.9% (95% CI: 95.8 to 97.8); belief that it can be achieved 88.8% (95% CI: 86.8 to 90.7) and belief that e-cigarettes/vaping can help achieve it 88.1% (95% CI: 86.0 to 89.9).Dual users of tobacco cigarettes and e-cigarettes had greater odds of being aware of the Smokefree goal (OR=3.07, 95% CI: 1.19 to 7.92), current smokers had lower odds of supporting it (OR=0.13, 95% CI: 0.06 to 0.27) and of believing that it can be achieved (OR=0.15, 95% CI: 0.09 to 0.24) and current vapers had greater odds of believing that e-cigarettes/vaping can help to achieve it (OR=8.57, 95% CI: 1.18 to 62.52) compared with non-users. CONCLUSIONS: The results suggest strong overall support for the Smokefree goal and belief that it can be achieved and that e-cigarettes/vaping can help achieve it. Smoking and vaping were associated with high awareness of the Smokefree goal, but lower support and optimism that it can be achieved.

Electronic cigarette use among university students aged 18-24 years in New Zealand: results of a 2018 national cross-sectional survey.

OBJECTIVES: To examine electronic cigarette use, reasons for use and perceptions of harm among university students. DESIGN: Cross-sectional study. SETTING: University students across New Zealand. METHODS: We analysed data from a 2018 cross-sectional survey of university students, weighted to account for undersampling and oversampling by gender and university size. χ2 tests were used to compare e-cigarette use, reasons for use and perceptions of harm by age, gender, ethnicity and cigarette smoking. PARTICIPANTS: The sample comprised 1476 students: 62.3% aged 18-20 years, 37.7% aged 21-24 years; 38.6% male, 61.4% female; 7.9% Maori and 92.1% non-Maori. RESULTS: 40.5% of respondents (95% CI 37.9 to 43.1) reported ever, 6.1% (4.9-7.4) current and 1.7% (1.1-2.5) daily use. Regardless of frequency, 11.5% of vapers had vaped daily for ≥1 month, 70.2% of whom used nicotine-containing devices; 80.8% reported not vaping in indoor and 73.8% in outdoor smoke-free spaces. Among ever vapers, curiosity (67.4%), enjoyment (14.4%) and quitting (2.4%) were common reasons for vaping. 76.1% (73.4-78.7) of respondents believed e-cigarettes were less harmful than cigarettes.More males than females reported vaping (ever, current, daily and daily for ≥1 month), nicotine use and belief that e-cigarettes were less harmful than cigarettes. More participants aged 18-20 years reported not vaping in outdoor smoke-free spaces, vaping out of curiosity and belief that e-cigarettes were less harmful than cigarettes, while more participants aged 21-24 years vaped daily for ≥1 month and for enjoyment. More Maori than non-Maori ever vaped. More cigarette smokers than non-smokers vaped (ever, current, daily and daily for ≥1 month), used nicotine and vaped to quit, while more non-smokers did not vape in smoke-free spaces and vaped out of curiosity. CONCLUSIONS: Our results suggest high prevalence of e-cigarette ever and current use, particularly among males and smokers. Many vaped out of curiosity and perceived e-cigarettes as less harmful than cigarettes.

Change in smoking intentions of university students in New Zealand following simulated cigarette price increases: results of the first of two cross-sectional surveys.

AIM: Increasing cigarette prices is one of the most effective strategies to reduce smoking. This study examined changes in smoking intentions of university students following simulated price increases. METHOD: Data came from a 2018 cross-sectional survey of university students. The sample comprised 187 current smokers (47% aged <21 years, 53% ≥21 years; 60% male, 40% female; 10% Maori, 90% non-Maori and 18% current vapers). Students were asked how their smoking behaviour would change if the price of a packet of their regular cigarettes or RYO tobacco was increased by $5.00, $10.00, $15.00 or >$15.00. RESULTS: The proportion of students who would smoke the same amount declined substantially, while students who would switch to e-cigarettes increased by large margins at price increases of $5.00, $10.00 and $15.00. Quit intentions increased at all price levels, but were stronger among younger students and females. Males were almost twice as likely to switch to e-cigarettes as females. Overall, more students would quit than switch to e-cigarettes. CONCLUSION: Results show that increasing cigarette prices by ≥$15.00 per packet could lead to significant reductions in smoking among university students. Follow-up data is required to assess the differential effects of price increases on vaping.

Cigarette smoking among university students aged 18-24 years in New Zealand: results of the first (baseline) of two national surveys.

OBJECTIVES: Although the smoking prevalence continues to decline in New Zealand (NZ) overall, little is known about smoking in university students. A 2013 survey of students aged 17-25 years found that 14% were current smokers, and 3% daily smokers. However, the sample did not include students from all NZ universities. This study examines the prevalence and patterns of cigarette smoking among students aged 18-24 years. SETTING: University students across NZ. METHODS: Data came from a March to May 2018 survey of students from all NZ universities, and were weighted to account for undersampling and oversampling, based on gender and university size. χ2 tests were used to compare smoking by age, gender and ethnicity. PARTICIPANTS: 1476 participants were included: 919 (62.3%) aged 18-20 years and 557 (37.7%) aged 21-24 years; 569 (38.6%) male and 907 (61.4%) female; and 117 (7.9%) Maori and 1359 (92.1%) non-Maori. RESULTS: 49.8% (95% CI 47.2 to 52.4) of respondents reported ever smoking, 11.1% (95% CI 9.5 to 12.9) currently smoked (smoked at least once a month) and 5.9% (95% CI 4.8 to 7.3) smoked at least daily (daily smokers). Of current smokers, 63.6% smoked 1-5 cigarettes/day, 45.8% smoked daily, 73.4% smoked first cigarette >60 min after waking, 86.0% never/almost never smoked in indoor and 64.6% in outdoor smokefree spaces, 69.9% planned to quit and 32.4% had tried to quit. Ever, current and daily smoking were significantly higher in 21-24 compared with 18-20 years olds, and in males compared with females. Older participants were more likely to report smoking more cigarettes/day. Maori were more likely to report ever smoking than non-Maori. CONCLUSIONS: Current smoking among NZ university students aged 18-24 years appears to be declining but daily smoking could be increasing. However, many students appeared less addicted to nicotine, and willing to quit. We recommend increasing the availability of smokefree services for students who wish to quit.

Have higher cigarette taxes in the United States discouraged smoking? A review of data from 1999-2013.

INTRODUCTION: Cigarette smoking continues to be a leading cause of preventable morbidity and premature death in the United States. This study examined the impact of federal and state cigarette excise taxes on adult smoking between 1999 and 2013. METHODS: Data came from the National Health Interview Survey, Behavioural Risk Factor Surveillance System and Tax Burden on Tobacco. Analyses were done from 1999-2013, 2002-6 and 2009-13. Associations between cigarette taxes, prices and smoking were examined in several states based on cigarette tax: Missouri and Virginia (low tax), Florida, Nebraska and Nevada (median tax) and New York and Rhode Island (high tax). RESULTS: Smoking declined nationally from 22.8% (1999) to 19.0% (2013) with rates falling from 25.7% to 20.5% in men and 21.5% to 15.3% in women. Annual cigarette consumption (in millions) declined from 432,758 to 280,534 and per capita consumption from 1,621 cigarettes (1999) to 894 cigarettes (2013). Smoking declined across age, gender, race/ethnicity, education and poverty level in 2009-13 compared to 2002-6 with large reductions in states with higher cigarette taxes. Negative correlations between cigarette tax and smoking, and positive correlations between cigarette tax and price, were seen. CONCLUSIONS: Higher cigarette taxes appear to have had a negative impact on smoking in the US. Our data suggest that states with higher cigarette taxes have lower smoking rates than states with lower taxes. Tax measures are however implemented as part of a comprehensive tobacco control package and further research is needed to assess the relative contribution of cigarette tax on smoking reductions in the states examined.