Awareness of cancer among adolescents: A study of nine focus groups in Aotearoa New Zealand.

ISSUE ADDRESSED: One third of cancers are potentially preventable by modifying key risk factors that arise during adolescence. To help inform prevention efforts, we investigated adolescents' understanding of cancer risk factors, symptoms and signs and barriers to help-seeking. METHODS: Nine focus groups were conducted with purposefully sampled, binary-gendered friendship groups of 12 to 17-year-olds. Interviews were analysed using a qualitative descriptive method based on the topic schedule, transcripts and field notes. RESULTS: Behavioural, genetic and environmental factors were commonly explored as risk factors. Most cancer symptoms identified focused on physical indicators, such as lumps and skin appearance. Facilitators and barriers to good health choices involved both external and internal factors: education, affordability, attitudes and the social environment. Most participants indicated they would talk to trusted friends and family members about health issues, but only when the condition became 'serious'. The most common source of health information was the internet. CONCLUSIONS: Adolescents have a good understanding of behavioural risk factors, but poor knowledge of some key cancer symptoms. A support system was recognised to be a substantive factor in dealing with health issues, as were youth-focused health services. Understanding of the preventability of many cancers was not widespread with participants. SO WHAT?: The results emphasise a requirement for appropriate, affordable and accessible youth-focused health services. There is a need for age- and culturally appropriate interventions that improve knowledge of cancer symptoms. Immunisation against the viruses implicated in cervical cancer is one example of a clinical cancer prevention intervention in adolescence.

National Sporting Organisation policies: A health promotion opportunity?

ISSUE ADDRESSED: The objective was to identify whether National Sporting Organisations (NSOs) have policy documentation on healthy behaviours (smokefree, sun-protection, healthy food/beverages and alcohol) and, for organisations with such documentation, whether this was in-line with current scientific evidence of past best practice in cancer prevention. METHODS: This cross-sectional policy analysis study was performed September to December 2018 in Aotearoa/New Zealand. A content analysis was undertaken using NSO policy documents matched against a framework of key indicators for best practice within health behaviours of interest. Data analysis of the policy process was undertaken through key informant telephone interviews with NSO staff using semi-structured qualitative interviews. RESULTS: Of 96 NSOs, nearly half (49%) mentioned smokefree at least once in one of their policy documents, and 47% had an alcohol policy, although in both instances the policies lacked comprehensiveness. Two NSOs had a reasonably comprehensive sun protection policy. Seventeen had at least one specific nutrition policy/guideline. The contents of the latter were primarily related to short-term athletic performance rather than non-communicable disease prevention, specifically promoting hydration during sports participation, and food and nutrition to support sporting performance. Two NSOs had policies relating to the promotion of healthy food/nutrition more widely. For some NSOs, the lack of health-related policies was not a conscious choice but just not considered previously. Other NSOs reported they lacked resources or had other priorities. CONCLUSIONS: Although this study clearly demonstrates that many NSOs lack adequate health-related policies, this is not necessarily a conscious choice, but the result of a lack of resources, other priorities, or just that they had not considered developing policies in these areas. A number expressed support for these types of policies although it was apparent that some, particularly smaller NSOs, would require assistance in policy template development. It seems probable that the development of health-related policies will only occur if partner agencies become involved.

Could We See the End of Tobacco Being Sold in Bars and Pubs in New Zealand?

BACKGROUND: Disallowing the sale of tobacco wherever alcohol is consumed is one policy option to help achieve Smokefree 2025. This study aimed to investigate the prevalence of selling tobacco in New Zealand (NZ) on-license premises and explore attitudes toward the sale of tobacco. METHODS: A sample of managers of on-license premises were asked by telephone about the importance of tobacco to their business, advantages and disadvantages of selling tobacco, and the impact of not being able to sell tobacco in the future. Logistic and linear regression analyses were used to investigate associations between on-license characteristics and selling status and importance scores, respectively. RESULTS: Of on-license premises, 6.5% (95% CI: 5.3, 8.0) sold tobacco; 17.4% (95% CI: 14.0, 21.4) of hotels, 17.5% (95% CI: 13.8, 21.9) of taverns, and 1.3% (95% CI: 0.6, 3.2) of restaurants. Both retailer type and population density were associated with selling status. On-licenses were more likely to rate tobacco as "unimportant" (51.7%) to their business than "important" (30.0%), although premises where the closest tobacco retailer was at least 1 km away were associated with a higher score. Similar proportions of businesses were opposed to (45.7%) and supported (47.2%) the policy of removing all tobacco sales from on-license premises. CONCLUSION: Few on-license premises in NZ sell tobacco. Most retailers would support transitioning out of selling tobacco before the 2025 Smokefree goal, and they believed ending sales of tobacco would not negatively affect their business. However, businesses and customers in rural areas may be more affected than others. IMPLICATIONS: Many countries have tobacco-free goals, with several still developing their endgame strategies to achieve these goals. This study provides NZ and other jurisdictions with evidence useful in the development of such strategies. Having on-license alcohol retailers transition out of sales of tobacco would contribute to a reduction in tobacco availability. Moreover, the results of this study suggest that, in part due to declining tobacco sales and increased thefts, such a policy is likely to have the support of retailers. Policy developers should note, however, the potential for different impacts where the distance to the closest tobacco retailer is over 1 km or in rural areas.

What impact would tobacco retailer proximity limit have on tobacco availability in New Zealand?

INTRODUCTION: One policy option to reduce the density of tobacco retailers is to restrict the distance retailers can be located to each other. This study examined the impacts of proximity limits of 150 m, 300 m and 450 m between tobacco retailers in New Zealand and if critical threshold reduction in tobacco retailers of 90%-95% would be achieved. METHODS: Using a spatial modelling approach, tobacco retailers were randomly removed based on a minimum distance between retailers until there were zero retailers within each scenario's minimum distance. This was repeated for all three proximity limit scenarios and descriptive statistics are provided for each. RESULTS: Implementation of 150 m, 300 m or 450 m distance restrictions between tobacco retailers would result in an average reduction in availability of 35%, 49% and 58%, respectively. On average, the current median distance to the closest retailer increases from 110 m to 377 m, to 568 m or to 718 m, respectively. The average median distance from a retailer to the closest school also increases across the three proximity limits, from 1017 m to 1087 m, to 1149 m or to 1231 m, respectively. Reduced clustering in deprived areas would be most apparent if a 450 m restriction policy was implemented. CONCLUSIONS: A proximity limit of 450 m would reduce retailers by 58%, but would not reach proposed critical behaviour-change threshold of 90%-95% required to reduce smoking prevalence independently. There is a need for a combination of policies, which focus on promoting equity, to achieve this bold endgame goal.

Is the tobacco 'footfall' argument justified for tobacco purchases in New Zealand convenience stores?

INTRODUCTION: New Zealand's Smokefree 2025 goal aims to greatly decrease the availability of tobacco. One option is to cease the sale of tobacco from convenience stores. However, tobacco companies and retail trade associations oppose this move and have argued that customers who purchase tobacco drive footfall and spend more than non-tobacco customers. The aim of this study is to test the validity of industry claims about the importance of tobacco to convenience stores. METHODS: During November and December 2019, immediate postpurchase surveys were undertaken with customers on exit from a random sample of 100 convenience stores in two New Zealand cities. We estimated the mean number of items purchased, including tobacco and non-tobacco items, and mean expenditure on non-tobacco items. RESULTS: Of the 3399 transactions recorded, 13.8% included tobacco, of which 8.3% comprised tobacco only and 5.5% included tobacco and non-tobacco items. The mean number of transactions containing both tobacco and non-tobacco items was 1.98, and 1.87 for those containing non-tobacco items only. Customers who purchased tobacco and non-tobacco items spent on average NZ$6.99 on non-tobacco items, whereas customers who purchased non-tobacco items only, spent on average NZ$5.07. CONCLUSIONS: Our results do not support claims that tobacco drives one-quarter of footfall into stores or that customers who purchase tobacco spend almost twice as much as non-tobacco customers. Combined purchases of tobacco and non-tobacco items constituted 5.5% of transactions; the impact on a store's profitability of removing tobacco sales is unknown and could be the focus of future research.

Bar Atmospherics and Smoking: A Qualitative Analysis of New Zealand Young Adult Smokers.

INTRODUCTION: Smoking among young adults is often associated with social contexts and alcohol use. Although many countries, including New Zealand, have prohibited smoking inside licensed premises, outdoor areas have enabled smoking and alcohol co-use to persist. We examined whether and how outdoor bar areas facilitate and normalize young adult smoking and explored potential policy implications. METHODS: We conducted in-depth interviews with 22 young adults who had recently smoked in a New Zealand bar or nightclub and investigated how physical design attributes (atmospherics) influenced experiences of smoking in outside bar settings. We used qualitative description to identify recurring accounts of the outdoor bar environment and thematic analysis to explore how participants experienced the bar in relation to smoking. RESULTS: Participants valued outdoor smoking areas that were comfortable and relaxing, and saw attributes such as seating, tables, heating, protection from inclement weather, and minimal crowding, as important. We identified four themes; these explained how participants used smoking to gain respite and make social connections, showed how bar settings enabled them to manage smoking's stigma, and identified potential policy measures that would decouple smoking and alcohol co-use. CONCLUSIONS: Evidence bar environments facilitate and normalize smoking among young adults questions whether smokefree policies should be expanded to include all bar areas. Introducing more comprehensive smokefree outdoor policies could reduce the influence of design attributes that foster smoking while also reframing smoking as outside normal social practice. IMPLICATIONS: Bar environments contain many stimuli that cue and reinforce smoking and integrate smoking into social experiences. Expanding smokefree bar settings to include outdoor areas would reduce exposure to these stimuli, decrease opportunities for casual smoking, help maintain young people's smokefree status, and support longer-term goals of sustained reductions in smoking prevalence.

An Analysis of E-Cigarette Marketing in New Zealand Tobacco Retail Outlets Prior to Legislative Change.

INTRODUCTION: In 2017, the New Zealand (NZ) Government announced its intention to liberalize the sale and promotion of electronic nicotine delivery systems (ENDS), including permitting any outlet to sell ENDS. This research estimated the proportion of tobacco outlets selling ENDS prior to legislative change, documented ENDS point-of-sale (POS) marketing, and examined associations between ENDS availability and outlet type, area-level deprivation, study region, and proximity to a secondary school. AIMS AND METHODS: After drawing a proportional random sample of 281 tobacco outlets from two NZ regions that included convenience stores, supermarkets, and petrol stations, we conducted observational in-store assessments to record ENDS product ranges and promotions. Data were collected between October and December 2017 and analyzed using descriptive statistics and regression modeling. RESULTS: Of tobacco outlets sampled, 22% sold ENDS; these were typically convenience stores (85%) and located in high deprivation areas (53%). Of stores selling ENDS, products were visible at POS in 89% of stores, including 15% with self-service displays and 15% with displays adjacent to children's products. ENDS advertising was present in 31% of the outlets and generally promoted ENDS as cheaper than smoked cigarettes. CONCLUSIONS: Liberalizing access to ENDS could reduce harms caused by smoking; however, extensive use of POS promotions will reach children and young people as well as smokers. While reducing harm among smokers is important, policy makers also need to ensure that regulations protect children from ENDS promotions. IMPLICATIONS: Careful regulation is required to ensure increases in ENDS availability are not accompanied by an increase in young people's exposure to ENDS marketing at the POS.

The long-term supply of tobacco and nicotine: some goals, principles and policy implications.

There is a growing literature on regulating the supply of tobacco products to achieve tobacco-free goals. This article suggests three goals and eight principles that could underpin regulatory approaches to the supply of tobacco and non-prescription nicotine products. The primary principles are that tobacco and nicotine products should not be seen as normal consumer products, should not be supplied for profit, and that the tax revenue from the supply of the products should first be used to reduce tobacco and nicotine use.

New Zealand tobacco retailers' understandings of and attitudes towards selling Electronic Nicotine Delivery Systems: a qualitative exploration.

INTRODUCTION: In 2017, the New Zealand Government signalled its intent to legalise the widespread sale of Electronic Nicotine Delivery Systems (ENDS), which many New Zealand retailers have actually sold for several years. Although ENDS uptake may reduce the harm smokers face, it requires them to adopt an entirely new practice; we therefore explored how effectively existing non-specialist tobacco retailers could advise and support potential quitters. METHODS: Using in-depth interviews with 18 tobacco retailers (prior to legislative change), we explored knowledge of ENDS, attitudes towards selling ENDS and supporting customers' cessation attempts, perceptions of ENDS' risks and benefits, and views on the proposed legislation. RESULTS: Participants generally had poor knowledge of ENDS products and provided either no advice or gave incorrect information to customers. They believed that the main benefit consumers would realise from using ENDS rather than tobacco would be cost savings; relatively, few saw ENDS as smoking cessation devices. Those who stocked ENDS did so despite reporting very low customer demand, and saw tobacco as more important to their business than ENDS, citing higher repeat business, ancillary sales and rebates. Participants typically supported liberalising ENDS availability, though several expressed concerns about potential youth uptake. CONCLUSIONS: Tobacco retailers' limited understanding of ENDS, and the higher value they placed on tobacco, suggests they may have little capacity or inclination to support ENDS users to quit smoking. Licensing schemes for both ENDS and smoked tobacco could simultaneously reduce supply of smoked tobacco while requiring ENDS retailers to meet minimum knowledge standards.

Estimating the effect of a potential policy to restrict tobacco retail availability in New Zealand.

INTRODUCTION: Reducing tobacco retailer density is suggested to be a key component of tobacco endgames. Where tobacco retail reduction policies exist, 'grandfathering' is typically used, where existing retailers are exempt from restrictions aimed at reducing outlet density. We examined the possible impact on tobacco outlet density in New Zealand of a policy preventing new retail outlets from selling tobacco, but allowing existing retail outlets to continue selling tobacco until they ceased trading or relocated. METHODS: We obtained data on numbers of tobacco outlets and the number of outlet closures recorded annually from 2006 to 2016. We calculated the mean and the lowest and highest 3-year rolling average closure rates for each type of tobacco outlet. We projected decreases in the number of tobacco outlets that would hypothetically be permitted to sell tobacco from 2020 onwards and estimated when the combined number of tobacco outlets would decline by 50% and 95%. RESULTS: Based on mean annual closure rates, the total number of tobacco outlets would decrease by 50% by 2032 and a 95% reduction could be achieved by 2072. By 2025, the number of tobacco outlets would decrease by 27%; by 2050, this reduction would reach 84%. CONCLUSION: A tobacco retail reduction policy that prevented new retail outlets from selling tobacco and grandfathered existing retailers would be unlikely to achieve New Zealand's target of a 95% reduction in tobacco outlet density within several decades of being enacted. Nonetheless, this policy could achieve a 50% reduction in tobacco retail availability in the first decade of implementation.

Butting out: an analysis of support for measures to address tobacco product waste.

BACKGROUND: Cigarette butts are ubiquitous litter items, causing major environmental damage and imposing significant clean-up costs. Tobacco companies frame smokers as both the cause of this problem and the source of its solution. However, an extended producer responsibility perspective challenges this view and holds tobacco companies to account for the full life cycle costs of tobacco product waste (TPW). METHODS: Using an online cross-sectional survey of 396 New Zealand smokers and 414 non-smokers, we estimated awareness of TPW, attribution of responsibility for TPW and support for interventions to reduce TPW. Descriptive analyses and logistic regression models examined associations between demographic attributes and smoking behaviours, and perceptions of TPW and potential solutions to this problem. RESULTS: Most respondents saw butt litter as toxic to the environment and held smokers primarily responsible for creating TPW. However, when knowledge of butt non-biodegradability increased, so too did the proportion holding tobacco companies responsible for TPW. Changes to product design, fines for littering and expanded smoke-free spaces were considered most likely to reduce TPW. Smokers and non-smokers held different views on measures to address TPW, with smokers favouring more educative approaches and non-smokers more restrictive policies. CONCLUSIONS: Strategies to increase awareness of tobacco companies' role in creating TPW could foster political support for producer responsibility measures that require the industry to manage TPW. Nevertheless, policy measures should continue to foster smoking cessation and decrease uptake, as reducing smoking prevalence presents the best long-term solution to addressing TPW.

Prevalence and characteristics of tobacco purchases in convenience stores: results of a postpurchase intercept survey in Dunedin, New Zealand.

INTRODUCTION: Arguments regarding the importance of tobacco to convenience stores could impede the adoption of tobacco retail reduction policies. Although trade associations argue tobacco constitutes two-thirds of convenience store sales and drives footfall, few studies have tested these claims. We therefore examined the prevalence and characteristics of tobacco purchases at convenience stores in Dunedin, New Zealand. METHODS: We conducted a postpurchase survey at 20 convenience stores, each visited for three 60 min intervals over a 4-week period. We used descriptive statistics to determine proportions and 95% CIs of transactions that contained tobacco and those that contained only non-tobacco items. We estimated the mean number of items purchased, the mean number of non-tobacco items purchased and mean expenditure on non-tobacco items. RESULTS: Fourteen per cent of transactions contained tobacco (n=95/679); of those, 64% comprised tobacco only. Only 5% of all transactions included both tobacco and non-tobacco products. The mean number of non-tobacco items purchased was 1.9 for transactions containing only non-tobacco products and 1.7 for transactions containing both tobacco and non-tobacco products. After excluding the cost of tobacco, people who purchased tobacco and non-tobacco products spent on average $5.11 on non-tobacco items, whereas people who purchased only non-tobacco items spent on average $6.85. CONCLUSIONS: Tobacco products constitute a small proportion of items purchased from Dunedin convenience stores and are typically not purchased with non-tobacco items. Our findings are inconsistent with arguments that most small retailers rely on tobacco sales.

The contribution of smokefree outdoor areas in achieving New Zealand's Smokefree 2025 goal.

ISSUES ADDRESSED: With the adoption of Smokefree 2025, further commitment from local government to extend smokefree outdoor area policies is becoming increasingly important in the presence of high public support. The aim of this study was to identify local government commitment in the Canterbury/West Coast (CWC) region to the New Zealand Smokefree 2025 goal through provision of smokefree outdoor areas. METHODS: Document analysis of the different stages of council long-term plans (LTPs) was undertaken, including 239 draft LTP documents, 5926 public submissions on these documents and 13 final LTP documents. A comparison between the 2015 final document and the 2012 final document was undertaken. Following this, semi-structured telephone interviews were undertaken with council staff. RESULTS: No council had referred to Smokefree 2025 or smokefree community spaces in any 2015 LTP draft document. Each of the CWC councils received a number of smokefree-related submissions, with the main theme being the extension of current Smokefree Outdoor Area Policy. The final LTP documents showed that 5 councils had included a brief statement about Smokefree 2025. Smokefree issues were mentioned more often in the 2012 LTP compared to the 2015 LTP. CONCLUSIONS: This research highlights a need for more commitment by local government to achieving the Smokefree 2025 goal. So what? There are opportunities for health groups to work with councils to try and enhance their overall commitment to Smokefree 2025 and promote wellbeing.

Perceptions of Financial Incentives for Smoking Cessation: A Survey of Smokers in a Country With an Endgame Goal.

Introduction: Financial incentives can support smoking cessation, yet low acceptability may limit the wider implementation of such schemes. Few studies have examined how smokers view financial-incentive interventions aimed at reducing smoking prevalence. Methods: We recruited a sample of 623 smokers from an internet panel to a survey assessing support for, and perceived effectiveness of, financial incentives for smoking cessation. We used descriptive statistics, plus logistic regression, to test associations between demographics and smoking, and support. We used qualitative content analysis to analyze open-ended responses to a question that invited respondents to comment on financial incentives. Results: Financial incentives were supported by 38.4% of smokers; 42.2% did not support and 19.4% had no opinion. Support was higher among heavy (OR = 3.96, 95% CI = 2.39 to 6.58) and moderate smokers (OR = 1.68, 95% CI = 1.13 to 2.49), and those with a recent quit attempt (OR = 1.47, 95% CI = 1.04 to 2.07). Support was strongly associated with perceived effectiveness. A Government-funded reward-only scheme was seen as the most acceptable option (preferred by 26.6% of participants), followed by a Government-funded deposit-based scheme (20.6%); few respondents supported employer-funded schemes. Open-ended responses (n = 301) indicated three overarching themes expressing opposition to financial incentives: smokers' individual responsibility for quitting, concerns about abuse of an incentive scheme, and concerns about unfairness. Conclusion: Even amongst those who would benefit from schemes designed to reward smokers for quitting, support for such schemes is muted, despite the evidence of their effectiveness. Media advocacy and health education could be used to increase the understanding of, and support for, financial incentives for smoking cessation. Implications: Given the absolute effectiveness and cost effectiveness of financial-incentive schemes for smoking cessation amongst pregnant smokers and in workplaces, implementing such schemes at a national-level could help reduce overall smoking prevalence and contribute to endgame goals. Our study found that similar proportions of smokers supported and opposed financial-incentive schemes and suggests that much of the opposition was underpinned by information gaps, which could be addressed using education and media advocacy.

Cancer Information Seeking Among Adult New Zealanders: a National Cross-Sectional Study.

Organisations seeking to establish themselves as leading cancer information sources for the public need to understand patterns and motivators for information seeking. This study describes cancer information seeking among New Zealanders through a national cross-sectional survey conducted in 2014/15 with a population-based sample of adults (18 years and over). Participants were asked if they had sought information about cancer during the past 12 months, the type of information they sought, what prompted them to look for information and ways of getting information they found helpful. Telephone interviews were completed by 1064 participants (588 females, 476 males, 64% response rate). Of these, 33.8% of females and 23.3% of males (total, 29.2%) had searched for information about cancer over the past year. A search was most frequently prompted by a cancer diagnosis of a family member or friend (43.3%), a desire to educate themselves (17.5%), experience of potential symptoms or a positive screening test (9.4%), family history of cancer (8.9%) or the respondent's own cancer diagnosis (7.7%). Across the cancer control spectrum, the information sought was most commonly about treatment and survival (20.2%), symptoms/early detection (17.2%) or risk factors (14.2%), although many were general or non-specific queries (50.0%). The internet was most commonly identified as a helpful source of information (71.7%), followed by health professionals (35.8%), and reading material (e.g. books, pamphlets) (14.7%).This study provides a snapshot of cancer information seeking in New Zealand, providing valuable knowledge to help shape resource delivery to better meet the diverse needs of information seekers and address potential unmet needs, where information seeking is less prevalent.

Smokers' Perceptions of the Relative Effectiveness of Five Tobacco Retail Reduction Policies.

INTRODUCTION: Reducing the widespread retail availability of tobacco could help realize tobacco endgame strategies. We assessed New Zealand smokers' perceptions of five potential policies designed to reduce the retail supply of tobacco, relative to a "benchmark" policy of annual tobacco tax increases. METHODS: A sample of 623 smokers was recruited from an internet panel. Participants evaluated one of six randomly assigned policy scenarios that would reduce tobacco outlet density: (1) no tobacco sold at alcohol on-licensed premises, (2) no tobacco sold within 500 m of a high school, (3) no tobacco sold within 1 km of any school, (4) tobacco sold only at pharmacies, and (5) tobacco sold only at half the existing liquor stores. Continued 10% annual tobacco tax increases served as a benchmark condition. Participants rated the likely effectiveness of one policy on preventing uptake by a 15-year-old susceptible never-smoker and supporting quitting by an adult smoker. Analyses involved pooled t tests and logistic regression. RESULTS: The policy scenarios in which tobacco was only sold at half the existing liquor stores or only at pharmacies were rated more likely to prevent youth smoking initiation, and at least as likely to help smokers to quit, relative to the benchmark policy. CONCLUSIONS: This is the first study to compare potential retail interventions against a measure known to reduce smoking prevalence. Policies that substantially reduce tobacco availability and remove it from smokers' usual places of purchase are perceived as being at least as effective in reducing smoking initiation and supporting cessation, as tax increases. IMPLICATIONS: Tobacco control advocates have proposed a range of policies to reduce tobacco retail outlet density, as part of endgame strategies. There are no published data on the relative effectiveness of different approaches, therefore it is unclear which would be most likely to reduce smoking prevalence. This study provides an insight into smokers' perspectives on the effectiveness of retail reduction strategies and indicates that some of these could be at least as effective in reducing initiation and promoting quitting as tax increases. Smokers' perceptions of the relative effectiveness of these policy options may help inform the advocacy efforts of the sector.

Cancer Awareness in Aotearoa New Zealand (CAANZ), 2001 and 2015: Study Protocols.

Population cancer awareness is of interest worldwide, as efforts are made to reduce cancer incidence via changes in risk and protective behaviours. To date, few studies have described changes in awareness over time, despite significant investment in raising awareness about various cancer types and risk behaviours. This paper describes the Cancer Awareness in Aotearoa New Zealand (CAANZ) survey, a cross-sectional telephone survey of adult New Zealanders conducted in 2014/2015 (CAANZ15, n = 1064) and its comparison with a similar 2001 study (CAANZ01, n = 438). Both aimed to describe current cancer awareness among a national sample of New Zealand (NZ) adults, with additional aims for CAANZ15 being to explore emerging issues in information provision and supportive care. Follow-up studies are challenged by changes in communication technologies and, in turn, potential issues in sampling. However, given the value of information about changing awareness, pragmatic steps were taken in CAANZ15 to maximise the response rate and comparability of the surveys. A response rate of 64 % was achieved for both samples. When compared to the adult NZ population, the CAANZ15 sample tended to be older, of higher socioeconomic status and under-representative of people with Pacific, Asian or, to a lesser extent, Maori (the indigenous population of NZ) ethnicity. To compensate for possible disproportionate age-by-ethnicity (Maori/non-Maori) groups in the sample, poststratification weighting was adopted. While caution will need to be exercised in drawing conclusions from comparisons made between these two cohorts, the dearth of such studies means that insights gained should be useful for guiding reflection on future cancer control directions and the generation of new hypotheses.

Point-of-sale tobacco promotion and youth smoking: a meta-analysis.

INTRODUCTION: Previous systematic reviews have found consistent evidence of a positive association between exposure to point-of-sale (POS) tobacco promotion and increased smoking and smoking susceptibility among children and adolescents. No meta-analysis has been conducted on these studies to date. METHODS: Systematic literature searches were carried out to identify all quantitative observational studies that examined the relationship between POS tobacco promotion and individual-level smoking and smoking-related cognitions among children and adolescents, published between January 1990 and June 2014. Random-effects meta-analyses were used. Subgroup analyses were conducted according to extent of tobacco POS advertising environment in the study environment. Sensitivity analyses were performed according to study size and quality. RESULTS: 13 studies met the inclusion criteria; 11 reported data for behavioural outcomes, 6 for cognitive outcomes (each of these assessed smoking susceptibility). The studies were cross-sectional, with the exception of 2 cohort studies. For the behavioural outcomes, the pooled OR was 1.61 (95% CI 1.33 to 1.96) and for smoking susceptibility the pooled OR was 1.32 (95% CI 1.09 to 1.61). CONCLUSIONS: Children and adolescents more frequently exposed to POS tobacco promotion have around 1.6 times higher odds of having tried smoking and around 1.3 times higher odds of being susceptible to future smoking, compared with those less frequently exposed. Together with the available evaluations of POS display bans, the results strongly indicate that legislation banning tobacco POS promotion will effectively reduce smoking among young people.

Tobacco retail outlet density and risk of youth smoking in New Zealand.

INTRODUCTION: Evidence suggests inconsistent findings on the relationship between density of tobacco outlets around schools and risk of smoking among students. This study examines the density of tobacco outlets around secondary schools in New Zealand (NZ) and current smoking, experimental smoking, susceptibility to smoking, and attempted and successful tobacco purchasing. METHODS: Smoking data came from the 2012 ASH Year 10 survey, a national survey of youth smoking in NZ. Geographic Information Systems were used to map tobacco retail outlets; a layer of secondary school locations was obtained from Koordinates.com. Logistic regression examined the relationship between density of outlets around schools and smoking behaviours, adjusting for individual-level and school-level confounders. RESULTS: Of the 27 238 students surveyed, 3.5% (952) were current smokers, 4.1% (n=1 128) were experimental smokers, and 39.8% (10 454) of nonsmokers were susceptible to smoking. An inverse relationship was found between the density of tobacco retail outlets and current smoking. Current smokers were significantly more likely to attempt to purchase tobacco if the density of tobacco retail outlets around their school was high. Non-smoking students were more likely to be susceptible to smoking if the density of tobacco outlets around their school was high. There was no statistically significant association between density of tobacco outlets and successful purchasing, nor experimental smoking. CONCLUSIONS: Restricting the permitted density of tobacco retail outlets around schools should be part of comprehensive tobacco control. In this regard, both smokers and non-smokers support the introduction of increased regulation of the tobacco retail environment to achieve our national smoke-free 2025 goal.

The impact of an increase in excise tax on the retail price of tobacco in New Zealand.

BACKGROUND: In 2010, the New Zealand (NZ) government introduced an annual 10% tobacco excise tax increase. We examined retailers' adherence to recommended retail prices (RRP), and whether the RRP included the full tax increase. METHODS: We collected price data on three British American Tobacco (BAT) factory-made cigarette brands, (premium, mainstream, and budget), and one roll-your-own tobacco brand before and after the 2014 tax increase from a sample of tobacco retailers. We examined price increases in each tobacco brand and compared these with the RRP. The extent to which the excise tax increases had been included in the RRP since 2010 was estimated using data sourced from the Ministry of Health and NZ Customs. FINDINGS: The median increase in price from before to after the tax change was only 3% for the budget brand (461 retailers). This contrasted with the median of 8% for the premium brand (448 retailers), and 11% for both mainstream and roll-your-own brands (471 and 464 retailers, respectively). While many retail outlets made changes according to the RRP set by BAT, several did not comply. Our analyses suggest BAT may be undershifting excise tax on the budget brand, and overshifting tax on brands in other price partitions. CONCLUSIONS: Tobacco companies do not appear to be increasing the RRPs of budget brands in line with tobacco excise tax increases. The increasing price differential between budget brands, and mainstream and premium brands may undermine cessation and impede realisation of New Zealand's Smokefree 2025 goal.