A qualitative analysis of 'informed choice' among young adult smokers.

OBJECTIVE: The tobacco industry often relies on the assertion that smokers make 'informed adult choices'. We tested this argument by exploring how young adults initiate smoking. METHODS: Fifteen in-depth interviews with young adults who had started smoking since turning 18, the legal age of adulthood and tobacco purchase in New Zealand. We undertook a thematic analysis of the interview transcripts. RESULTS: Although participants had a general awareness that smoking is harmful and knew some specific risks, they rarely saw these as personally relevant when they started smoking, and few had made a deliberate decision to smoke. Participants' poor understanding of addiction meant most regarded smoking as a short-term phase they could stop at will. Initiation contexts discouraged the exercise of informed choice, as smoking onset often occurred when participants were influenced by alcohol or located in socially-pressured situations that fostered spur of the moment decisions. CONCLUSIONS: Young adults' ability to exercise 'informed choice' at the time of smoking uptake is constrained by cognitive and contextual factors. We propose an updated informed choice framework that recognises these factors; we outline environmental changes that could make default adoption of smoking less common while promoting more 'informed choices'.

Knowledge, views and experiences of gambling and gambling-related harms in different ethnic and socio-economic groups in New Zealand.

OBJECTIVE: To describe survey findings which measure broader gambling harms and provide benchmark data to evaluate an awareness and education program to minimise harm; part of NZ's public health approach to problem gambling. To assess whether previously reported ethnic and socio-economic disparities are evident when researching broader gambling harms. METHODS: An in-home, nationwide survey captured data from a multi-stage, random probability sample of 1,774 adults and 199 15-17-year-olds. Oversampling Maori (NZ's indigenous people), Pacific and Asian peoples, and people in areas of deprivation, allowed analysis by ethnicity and socio-economic status. RESULTS: Data show high participation levels; around 8 out of 10 people took part in at least one gambling activity in the previous 12 months. Type and frequency of activities was used to define four groups: infrequent gamblers (60.9%); frequent, non-continuous gamblers (17.6%); frequent, continuous gamblers (4%); and non-gamblers (17.5%). Self-reported knowledge of the signs of gambling harm was high. Arguments about gambling and people going without/unpaid bills provided two indicators of broader gambling harm. Around one-sixth of New Zealanders experienced each of these harms. Impacts were greatest for low-income groups, Maori, and Pacific peoples. CONCLUSIONS: The proportion of New Zealander's experiencing broader gambling harms is much higher than the prevalence for problem gambling. Consistent with other research, results show the flow-on impacts of problem gambling - on family, friends and communities. IMPLICATIONS: Measures can be developed to benchmark the wider harms of gambling and evaluate public health programs addressing harm at population and sub-population levels.