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Background New Zealand has a goal of becoming a smokefree nation by the year 2025. Smoking prevalence in 2012 was 17%, but is over 40% for M_aori (indigenous New Zealanders). We forecast the prevalence in 2025 under a business-as-usual (BAU) scenario, and determined what the initiation and cessation rates would have to be to achieve a <5% prevalence. Methods A dynamic model was developed using Census and Health Survey data from 1981 to 2012 to calculate changes in initiation by age 20 years, and net annual cessation rates, by sex, age, ethnic group and time period. Similar parameters were also calculated from a panel study for sensitivity analyses. ‘Forecasts' used these parameters, and other scenarios, applied to the 2011-2012 prevalence. Findings Since 2002-2003, prevalence at age 20 years has decreased annually by 3.1% (95% uncertainty interval 0.8% to 5.7%) and 1.1% (−1.2% to 3.2%) for non-M_aori males and females, and by 4.7% (2.2% to 7.1%) and 0.0% (−2.2% to 1.8%) for M_aori, respectively. Annual net cessation rates from the dynamic model ranged from −3.0% to 6.1% across demographic groups, and from 3.0% to 6.0% in the panel study. Under BAU, smoking prevalence is forecast to be 11% and 9% for non-M_aori males and females by 2025, and 30% and 37% for M_aori, respectively. Achieving <5% by 2025 requires net cessation rates to increase to 10% for non-M_aori and 20% for M_aori, accompanied by halving or quartering of initiation rates. Conclusions The smokefree goal of <5% prevalence is only feasible with large increases in cessation rates. [ABSTRACT FROM AUTHOR]

Objective To determine if smokers unmotivated to quit reduce usual cigarette consumption when cigarettes priced according to nicotine content are made available. Methods Randomised, parallel-group, trial (ACTRN12612000914864) undertaken in Wakatipu/Central Otago, New Zealand. Dependent adult daily smokers unmotivated to quit were randomly allocated to an intervention group provided with 12 weeks supply of free very low nicotine content (VLNC) cigarettes, or to a control group, who were free to purchase their usual cigarette brand over the same period. The primary outcome was change from baseline in the daily mean number of usual cigarettes smoked over the previous week, measured at 12 weeks. Secondary outcomes at 6 and 12 weeks included cigarettes smoked per week (also measured at weeks 1-6 and 9), salivary cotinine, tobacco dependence, smoking satisfaction/craving, behavioural addiction to smoking, autonomy over smoking, motivation to stop, price at which participants would purchase VLNC cigarettes, quitting and adverse events. Results Thirty-three smokers were randomised (17 intervention, 16 control). A NZ$15 price differential (per pack of 20) based on nicotine content led to a halving in the mean number of cigarettes smoked per day over the previous week, a reduction in tobacco dependence and an increase in quitting. Intervention participants smoked a similar total number of cigarettes (usual plus VLNC) as those in the control group, exposing them to a similar level of toxicants. Conclusions Smokers unmotivated to quit reduce their usual cigarette consumption (and thus nicotine exposure) when VLNC cigarettes are made available at a significantly reduced price. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To identify the proportion of adult cigarette smokers who have experienced cigarette-caused fires and burns and to describe smoker characteristics associated with increased risk of cigarette-caused fires and burns. METHODS: Data on cigarette-caused fires and burns were collected in the baseline questionnaire of a randomised trial of a smoking cessation intervention conducted in New Zealand between March 2006 and May 2007. Participants were adult callers to a national smoking cessation counselling service. Lifetime prevalence estimates of cigarette-caused fires and burns were obtained and associations between smoker characteristics and risk of fires and burns examined using logistic regression. RESULTS: Of 1097 participants in the trial at baseline, 75 (6.8%) reported past experience of 1 fires caused by cigarettes (96 fires reported in total) and 658 (60.0%) described at least 1 cigarette-caused burn. In all, 57 participants (5.2%) reported burns that required medical attention. Male sex and Mori ethnicity (indigenous New Zealanders, who comprise 15% of the national population and among whom 42% of adults are smokers) were associated with increased risk of cigarette-caused fires. Male sex, younger age, younger age of smoking initiation, being unmarried, having a partner who smoked, having a higher education level and an annual income of $20 000 or more were associated with increased risk of cigarette burn injuries. CONCLUSIONS: The results indicate that cigarette-caused fires and burns are common among New Zealand smokers, are a source of inequality and therefore deserve greater attention from health advocates and policymakers. [ABSTRACT FROM AUTHOR]

Background Australian tobacco companies have introduced evocative variant names that could re-create the aspirational connotations plain packaging aims to remove. To inform future regulation, we explored how brand descriptors affected smokers' responses to plain packs featuring different variant name combinations. Methods An online survey of 254 daily smokers or social smokers aged between 18 and 34 used a within-subjects best-worst experiment to estimate the relative effects of variant names. A 2x4x4x4 design contained four attributes: quality (premium or none), taste (smooth, fine, rich or none) connotation (classic, midnight, infinite or none) and colour (red, blue, white or none). In a between-subjects component, respondents evaluated one of two alternative packs according to its perceived harm and ease of quitting. Results The most important variant attribute was connotation, followed by taste, colour and quality; within these attributes, the most attractive descriptors were 'classic' and 'smooth'. We identified four distinct segments that differed significantly in their sociodemographic attributes and variant preferences, although not in their perceptions of the harm or quitting ease associated with two different variants. Conclusions Some descriptors significantly enhance the appeal of tobacco products among different groups of smokers and may undermine plain packaging's dissuasive intent. Policymakers should explicitly regulate variant names to avoid the 'poetry on a package' evident in Australia. Options include disallowing new descriptors, limiting the number of descriptors permitted or banning descriptors altogether. [ABSTRACT FROM AUTHOR]

Background Although tobacco packages have evolved to feature health warnings and, in Australia, dissuasive colours, the format of on-pack cessation information has not changed. We compared how alternative Quitline information formats affected smokers' perceptions and choice behaviours, and their likelihood of seeking cessation support. Methods We conducted an online study comprising a choice experiment using a two (number of panels) by three (panel position: above, middle, below) plus control (current format) design, and a between-subjects comparison of a two-panel format and the control. The sample comprised 608 New Zealand smokers. Results Relative to the current format, respondents regarded each test format as more effective in communicating cessation information (p<0.0001), particularly the two-panel formats. Respondents found the two-panel format tested via paired comparisons significantly easier to read, more visually salient and more likely than the control to encourage them and other smokers to consider quitting (all p<0.0001). Heat map comparisons showed that the Quitline number and affirming message were significantly more salient in the test format than in the current format (p<0.0001), although the headline and warning explanation were more salient in the control. Conclusions Reformatting Quitline information could improve its visual salience and readability and capitalise on the dissonance that pictorial warning labels and plain packaging create. Enhancing stimuli that may prompt smokers to try and quit, affirming their decision to do so and prompting the use of cessation support could increase the number and success of quit attempts. [ABSTRACT FROM AUTHOR]

Background Evidence that exposure to tobacco 'powerwalls' increases young people's susceptibility to smoking has led many countries to require the removal of these displays. Despite this important step, tobacco remains widely available and policy action appears to have stalled. Methods We conducted an online survey of 364 smokers and 402 non-smokers aged 18 years and above, who were sampled from a commercial internet panel in January 2013. Results Six months after the removal of all tobacco products from open display in New Zealand retail outlets, strong support for the new law exists. Although daily smokers were less supportive than other groups, smokers intending to quit within the next 6 months were more likely than not to believe the law would facilitate quitting. Irrespective of their smoking status, respondents supported not selling tobacco products within 500 m of a school, and requiring tobacco retailers to sell nicotine replacement therapy products. Conclusions Public support for more progressive 'endgame' retail measures could catalyse policy action which, in turn, could offer greater protection to young people and accelerate declines in smoking prevalence. Mandatory tobacco-free retail zones around schools, and requiring stores selling tobacco to stock cessation products received strong support, even among daily smokers; both measures would reduce youth exposure to tobacco while providing smokers with better access to cessation aids. [ABSTRACT FROM AUTHOR]

Background There is evidence that smoking is associated with poorer mental health. However, the underlying mechanisms for this remain unclear. We used longitudinal data to assess whether smoking uptake, or failed quit attempts, are associated with increased psychological distress. Methods Data were used from Waves 3 (2004/05), 5 (2006/07) and 7 (2008/09) of the longitudinal New Zealand Survey of Family, Income and Employment. Fixed-effects linear regression analyses were performed to model the impact of changes in smoking status and quit status (exposure variables) on changes in psychological distress (Kessler 10 (K10)). Results After adjusting for time-varying demographic and socioeconomic covariates, smoking uptake was associated with an increase in psychological distress (K10: 0.22, 95% CI 0.01 to 0.43). The associations around quitting and distress were in the expected directions, but were not statistically significant. That is, smokers who successfully quit between waves had no meaningful change in psychological distress (K10: -0.05, 95% CI -0.34 to 0.23), whereas those who tried but failed to quit, experienced an increase in psychological distress (K10: 0.18, 95% CI -0.05 to 0.40). Conclusions The findings provide some support for a modest association between smoking uptake and a subsequent increase in psychological distress, but more research is needed before such information is considered for inclusion in public health messages. [ABSTRACT FROM AUTHOR]

Aim To examine the prevalence of smoker support for a ban on cigarette sales in 10 years time and increased regulation of the tobacco industry and to investigate the independent associations of support for these measures. Methods The authors surveyed opinions among adult smokers in two survey waves (N¼1376 and N¼923) from the New Zealand arm of the International Tobacco Control Policy Evaluation Survey during 2007e2009. The authors report prevalence of support stratified by age, gender and ethnicity. The authors carried out multivariate analyses to identify significant associations among potential determinants (demographics, socioeconomic status, mental health and smoking-related beliefs and behaviours) of support. Results Most New Zealand smokers supported greater regulation of the tobacco industry (65%) and more government action on tobacco (59%). Around half (46%) supported banning sales of cigarettes in 10 years time, provided effective nicotine substitutes were available. In a fully adjusted model, significant associations with support for greater tobacco company regulation included Maori ethnicity, experience of financial stress and greater awareness about the harms of smoking. Significant associations with support for a ban on tobacco sales in 10 years time included increasing area-based deprivation level, increasing intention to quit and greater concern about the health effects of smoking. Conclusions The findings suggest that most smokers will support stronger government action to control the tobacco industry and that many support radical ‘endgame’ approaches. Greater support among Maori, more deprived and possibly Pacific smokers, is an important finding, which could inform the design and implementation of new policies given the very high smoking prevalence among these groups and hence high priority for targeted tobacco control interventions. Perceived difficulties in gaining public support should not impede the introduction of rigorous tobacco control measures needed to achieve a tobacco-free New Zealand. [ABSTRACT FROM AUTHOR]

Background Tobacco industry documents illustrate how packaging promotes smoking experimentation and reinforces existing smokersbehaviour. Plain packaging reduces the perceived attractiveness of smoking and creates an opportunity to introduce larger pictorial warnings that could promote cessation-linked behaviours. However, little is known about the effects such a combined policy measure would have on smokers' behaviour. Methods A 3 (warning size) *4 (branding level) plus control (completely plain pack) best-worst experiment was conducted via face-to-face interviews with 292 young adult smokers from a New Zealand provincial city. The Juster Scale was also used to estimate cessation-linked behaviours among participants. Results Of the 13 options tested, respondents were significantly less likely to choose those featuring fewer branding elements or larger health warnings. Options that featured more branding elements were still preferred even when they also featured a 50% health warning, but were significantly less likely to be chosen when they featured a 75% warning. Comparison of a control pack representing the status quo (branded with 30% front of pack warning) and a plain pack (with a 75% warning) revealed the latter would be significantly more likely to elicit cessation-related behaviours. Conclusions Plain packs that feature large graphic health warnings are significantly more likely to promote cessation among young adult smokers than fully or partially branded packs. The findings support the introduction of plain packaging and suggest use of unbranded package space to feature larger health warnings would further promote cessation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify the impact of a smoking cessation programme on area-based social and ethnic inequalities in smoking rates through social and ethnic differences in enrolment and quitting. METHODS: Analysis of records of 11 325 patients who enrolled in an innovative smoking cessation programme in Christchurch, New Zealand between 2001 and 2006. We compare enrolment, follow-up, quitting and impact on population smoking rates in the most and least deprived neighbourhoods and the neighbourhoods with the lowest and highest proportions of Mori. RESULTS: Enrolment as a proportion of the population was higher from the most deprived areas but as a proportion of neighbourhood smokers, it was lower. Enrolees from the least deprived quintile were 40% more likely to quit than those from the most deprived quintile. Smoking rates were 2.84 (2.75 to 2.93) times higher in the most deprived neighbourhoods. If the programme had not been available we estimate that this differential would have reduced to 2.81 (2.72 to 2.90). In neighbourhoods with the highest proportion of Mori, smoking rates were 2.33 (2.26 to 2.41) times higher and we estimate that without the programme smoking rates would be 2.30 (2.23 to 2.37) times higher. CONCLUSIONS: Although enrolees were drawn from a wide variety of backgrounds, those most likely to quit tended to reside in affluent areas or areas with a low proportion of Mori. There was no evidence that this smoking cessation programme increased or decreased inequalities within the Christchurch population. For smoking cessation programmes to have an impact on health inequalities more effort is required in targeting hard-to-reach groups and in encouraging them to quit. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tobacco retail displays promote smoking experimentation among youth; however, little is known about their effect on smokers making a quit attempt. Calls to ban tobacco retail displays would be strengthened if this measure would deter initiation and support cessation. METHODS: Semistructured in-depth interviews were conducted with 20 individuals, from two New Zealand provincial cities, who had attempted to quit smoking in the last 6 months. RESULTS: Tobacco products had high visibility, and elicited emotional and physical reactions that created on-going temptation, complicated cessation attempts and stimulated impulse purchases. Participants strongly supported banning tobacco retail displays primarily because they thought this would reduce youth initiation, promote greater consistency with smoke-free promotions and assist those attempting to quit. CONCLUSIONS: The effects of tobacco retail displays on smokers making a cessation attempt are explored. The findings are consistent with experimental and survey research, and expand a growing evidence base that supports government-mandated bans on tobacco retail displays. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effectiveness of a mobile phone text messaging smoking cessation programme. Design: Randomised controlled trial. Setting: New Zealand. Participants: 1705 smokers from throughout New Zealand who wanted to quit, were aged over 15 years, and owned a mobile phone were randomised to an intervention group that received regular, personalised text messages providing smoking cessation advice, support, and distraction, or to a control group. All participants received a free month of text messaging; starting for the intervention group on their quit day to assist with quitting, and starting for the control group at six months to encourage follow up. Follow up data were available for 1624 (95%) at six weeks and 1265 (74%) at six months. Main outcome measures: The main trial outcome was current non-smoking (that is, not smoking in the past week) six weeks after randomisation. Secondary outcomes included current non-smoking at 12 and 26 weeks. Results: More participants had quit at six weeks in the intervention compared to the control group: 239 (28%) v 109 (13%), relative risk 2.20 (95% confidence interval 1 .79 to 2.70), P < 0.0001. This treatment effect was consistent across subgroups defined by age, sex, income level, or geographic location (p homogeneity > 0.2). The relative risk estimates were similar in sensitivity analyses adjusting for missing data and salivary cotinine verification tests. Reported quit rates remained high at six months, but there was some uncertainty about between group differences because of incomplete follow up. Conclusions: This programme offers potential for a new way to help young smokers to quit, being affordable, personalised, age appropriate, and not location dependent. Future research should test these findings in different settings, and provide further assessment of long term quit rates. [ABSTRACT FROM AUTHOR]