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.

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.

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.

Do recycled spectacles meet the refractive needs of a developing country?

PURPOSE: The aim was to compare the power of spectacles donated to a recycled spectacle program to the custom-made spectacle refractive prescriptions dispensed in a developing country. METHODS: Two hundred consecutive prescriptions were audited in an optical dispensary in Timor-Leste, a developing nation. These refractions were compared against measurements of 2,075 wearable donated spectacles. We determined how many of the 200 prescriptions could be matched to a donated spectacle measurement, how many donated spectacles could be tried for each prescription and how long it would take to find the matched spectacles. RESULTS: There were 1,854 donated spectacles identified as being suitable for comparison with the 200 refractive prescriptions. Twenty-nine out of 200 prescriptions (14.5 per cent) were matched to at least one pair of donated spectacles. CONCLUSION: Recycling all spectacles is not cost-effective in a developing country that has the ability to make custom-made spectacles and dispense ready-made spectacles.