New Zealand community pharmacists' perspectives on supplying smoked tobacco as an endgame initiative: a qualitative analysis.

INTRODUCTION: Tobacco endgame strategies often include measures to reduce tobacco availability by decreasing retailer numbers. Recently, some US pharmacies have delisted tobacco, though overall retailer numbers have not reduced markedly. Paradoxically, others have suggested limiting tobacco sales to pharmacies, to reduce supply and support cessation. We explored how pharmacists from Aotearoa New Zealand, a country planning to reduce tobacco supply, perceived supplying tobacco. METHODS: We undertook in-depth interviews with 16 pharmacists from Otepoti Dunedin; most served more deprived communities with higher smoking prevalence. We probed participants' views on supplying tobacco, explored factors that could limit implementation of this policy, and analysed their ethical positions. We used qualitative description to analyse data on limiting factors and reflexive thematic analysis to interpret the ethical arguments adduced. RESULTS: Most participants noted time, space and safety concerns, and some had strong moral objections to supplying tobacco. These included concerns that supplying tobacco would contradict their duty not to harm patients, reduce them to sales assistants, undermine their role as health experts, and tarnish their profession. A minority focused on the potential benefits of a pharmacy supply measure, which they thought would use and extend their skills, and improve community well-being. CONCLUSIONS: Policy-makers will likely encounter strongly expressed opposition if they attempt to introduce a pharmacy supply measure as an initial component of a retail reduction strategy. However, as smoking prevalence falls, adopting a health-promoting supply model, using pharmacies that chose to participate, would become more feasible and potentially enhance community outreach and cessation support.

Impact of tax and tobacco-free generation on health-adjusted life years in the Solomon Islands: a multistate life table simulation.

OBJECTIVE: To estimate health-adjusted life years (HALY) gained in the Solomon Islands for the 2016 population over the remainder of their lives, for three interventions: hypothetical eradication of cigarettes; 25% annual tax increases to 2025 such that tax represents 70% of sales price of tobacco; and a tobacco-free generation (TFG). DESIGN: We adapted an existing multistate life table model, using Global Burden of Disease (GBD) and other data inputs, including diseases contributing >5% of the GBD estimated disability-adjusted life years lost in the Solomon Islands in 2016. Tax effects used price increases and price elasticities to change cigarette smoking prevalence. The TFG was modelled by no uptake of smoking among those 20 years and under after 2016. RESULTS: Under business as usual (BAU) smoking prevalence decreased over time, and decreased faster under the tax intervention (especially for younger ages). For example, for 20-year-old males the best estimated prevalence in 2036 was 22.9% under BAU, reducing to 14.2% under increased tax. Eradicating tobacco in 2016 would achieve 1510 undiscounted HALYs per 1000 people alive in 2016, over the remainder of their lives. The tax intervention would achieve 370 HALYs per 1000 (24.5% of potential health gain), and the TFG 798 HALYs per 1000 people (52.5%). By time horizon, 10.5% of the HALY gains from tax and 8.0% from TFG occur from 2016 to 2036, and the remainder at least 20 years into the future. CONCLUSION: This study quantified the potential of two tobacco control policies over maximum health gains achievable through tobacco eradication in the Solomon Islands.

How would the tobacco retail landscape change if tobacco was only sold through liquor stores, petrol stations or pharmacies?

OBJECTIVE: To examine the potential impact of tobacco being available only from pharmacies, only from liquor stores or only from petrol stations on the New Zealand tobacco retail landscape. METHODS: Tobacco retailers and pharmacies were mapped using GIS. Comparisons were made between tobacco retailers and pharmacies. Simple linear regression was used to assess the relationship between outlet types and deprivation. RESULTS: A total of 5,243 tobacco outlets, including liquor stores and petrol stations, and 1,035 pharmacies were identified. The density of all outlets was greater in areas of higher deprivation. The majority of tobacco retailers and pharmacies were located in urban areas. Outlets were mapped in relation to walking distances from secondary schools; significant differences between outlet types are presented. CONCLUSIONS: The policy options examined in this study would considerably reduce the overall availability of tobacco, decrease cues to smoke and reduce the density of tobacco sales around schools. However, inequities in availability would exist with access to tobacco in rural areas disproportionately reduced, and a positive sociodemographic gradient remaining. Implications for public health: Substantially reducing tobacco availability has been identified as a crucial tobacco control strategy. This study provides information on the impact of different policy options to support Smokefree 2025.

Modelling the number of quitters needed to achieve New Zealand's Smokefree 2025 goal for Maori and non-Maori.

AIM: To estimate the numbers of people required to quit smoking in New Zealand to achieve the Smokefree 2025 goal and to compare these with current levels of quitting. METHODS: We used the established BODE3 tobacco forecasting model to project smoking prevalence separately for Maori and non-Maori to 2025 under a business-as-usual (BAU) scenario. We then determined by what factor current annual cessation rates would have to increase to achieve an adult smoking prevalence of under 5% by the year 2025, while annual smoking uptake rates continued to follow BAU patterns. Comparisons were also made in terms of estimated current long-term quitters arising from official reports of smoking cessation service use (Quitline and face-to-face support services). RESULTS: To achieve a below 5% smoking prevalence by 2025, there would need to be additional averages of 8,400 Maori long-term quitters per year (5.2 times the BAU level on average) and 8,800 extra non-Maori quitters per year during 2018 to 2025 (1.9 times the BAU level on average). We estimated that the Quitline and funded face-to-face smoking cessation services are generating 2,000 Maori and 6,100 non-Maori long-term quitters per year. But this represents only 19% of Maori and only 34% of the non-Maori quitters required. CONCLUSIONS: This modelling work suggests that to achieve the Smokefree 2025 goal, there would need to be very major increases in quit rates. To achieve this goal the New Zealand Government will need to massively increase investment in established interventions (smoking cessation support, mass media) while continuing with substantial tobacco tax increases, or else add substantive new strategies into the intervention mix.