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Aims: To summarise the literature underpinning key recommendations made in the 2021 revision of the Ministry of Health's New Zealand Guidelines for Helping People to Stop Smoking., Methods: A comprehensive literature review of smoking cessation interventions was undertaken in July 2021. Recommendations were formulated from the findings of the literature review and expert advice., Results: Healthcare professionals should ask and briefly advise all people who smoke to stop smoking, regardless of whether they say they are ready to stop smoking or not. They should offer smoking cessation support, which includes both behavioural and pharmacological (e.g., nicotine replacement therapy, nortriptyline, bupropion or varenicline) interventions. The Guidelines also include advice around the use of vaping in smoking cessation. Recommendations are also formulated for priority populations of smokers: Māori, Pacific, pregnant women, and people with mental illness and other addictions., Conclusions: The guidelines will assist healthcare professionals in providing evidence-based smoking cessation support to people who smoke. To be effective and equitable, the ABC model requires organisational commitment, integration into routine practice, and increased attention to the upstream determinants of smoking and quitting., Competing Interests: Nil.

Wald and Law, who popularised the term 'polypill' in 2003, proposed giving everyone above a certain age a polypill to reduce the burden of cardiovascular disease (CVD). A more compelling potential application, proposed in 2001 by the World Health Organization, is to use a polypill containing antiplatelet, statin and blood pressure-lowering therapy among people with established CVD, in whom the components are already indicated but in whom guideline implementation and adherence are suboptimal. This article outlines relevant international and New Zealand evidence on the likely benefits and harms of a polypill for the secondary prevention of CVD. The evidence indicates that the benefits are likely to outweigh the harms, particularly given the persistence of substantial treatment gaps and inequities in the management of and outcomes in CVD. The time is long overdue for the polypill to be funded for the secondary prevention of CVD., Competing Interests: Nil.

Aim: To examine alcohol consumption before and during pregnancy in the mothers of a contemporary sample of New Zealand children., Method: Analysis of data from the antenatal assessment of 6,822 women enrolled in the Growing Up in New Zealand study, using logistic regression models to examine associations between maternal alcohol use and maternal demographics, pregnancy planning and parity., Results: Seventy-one percent of women drank alcohol before becoming pregnant, 23% during and 13% after the first trimester. The odds of drinking alcohol before pregnancy were significantly higher for younger women who were European or Māori with an unplanned pregnancy and in their first pregnancy; during the first trimester, higher for women who were European or Māori with no secondary school qualification, in their first pregnancy, with an unplanned pregnancy; and in the second and third trimesters, higher for European or Māori women aged 30 and over, in their first pregnancy., Conclusions: Drinking is common in New Zealand women before pregnancy, particularly among European and Māori women. Some women consume small amounts of alcohol and some engage in heavy drinking in pregnancy. Both are a risk for fetal harm. Population-wide and targeted measures are needed to reduce consumption overall and provide support to specific population groups., Competing Interests: Dr Newcombe reports: a grant was received from the Health Promotion Agency (2015) for an application to the HPA Research Investment for Priorities in Alcohol. Project entitled: Alcohol use across the lifespan and trends in older adulthood. Andy Towers, Janie Sheridan, David Newcombe - $120,000. Dr Morton reports grants from New Zealand Government during the conduct of the study.

Reducing the exposure of children and young people to the marketing of unhealthy foods is a core strategy for reducing the high overweight and obesity prevalence in this population. The Advertising Standards Authority (ASA) has recently reviewed its self-regulatory codes and proposed a revised single code on advertising to children. This article evaluates the proposed code against eight criteria for an effective code, which were included in a submission to the ASA review process from over 70 New Zealand health professors. The evaluation found that the proposed code largely represents no change or uncertain change from the existing codes, and cannot be expected to provide substantial protection for children and young people from the marketing of unhealthy foods. Government regulations will be needed to achieve this important outcome., Competing Interests: Nil.

Aims: To investigate patterns of exposure to tobacco smoke in pregnancy among a representative sample of New Zealand women., Methods: Analyses of smoking-related data from the first wave of the Growing Up in New Zealand cohort study, ie from the first data-collection point during the antenatal period in 2009-10., Results: Twenty percent of mothers reporting smoking before pregnancy and 9.9% of mothers continued during pregnancy. These figures were higher in younger women (p<.0001), women with lower educational achievement (p<.001) and Māori women (p<.001). Similarly, being Māori (p<.0001) and having a lower education achievement (p<.0029) were associated with smoking during an unplanned compared to a planned pregnancy. Multiparous mothers were more likely to be smokers than primaparous mothers (11%: 95% Confidence Interval [CI] 10.0-12.1 vs 8.3%: 95% CI 7.2-9.4). Second-hand smoke exposure was more common for younger women (Odds Ratio [OR] 3.2: 95% CI 1.6-6.4), Māori women (OR 1.9: 95% CI 1.4-2.5), and women with unplanned pregnancies (OR 3.4 95% CI 12.0-14.8)., Conclusions: There are differences in a range of contextual and behavioural factors related to smoking before and during pregnancy. Low educational achievement, being young, Māori and multiparous were all associated with smoking during pregnancy. A better understanding of why these differences exist is needed in order to find appropriate interventions to support women in becoming smoke-free.

Aim: To assess the level of agreement in aspirin use measured by self-report and dispensing data., Method: We assessed preventive cardiovascular medication use (prescription-only statins and blood pressure-lowering therapy; and aspirin-also available over-the-counter) at baseline in participants in the New Zealand IMPACT trial for whom these medications were prescribed by their general practitioner. A trial nurse not involved in their ongoing health care obtained participants' self-reported aspirin use data. We obtained dispensing data from the national pharmaceutical dispensing database and assessed agreement between the two measures using kappa coefficients., Results: Of the 513 trial participants, 36% were women, 50% were of Māori ethnicity, and 45% had a history of cardiovascular disease. The level of agreement between self-reported aspirin use and dispensing data was substantial (kappa 0.75, 95% CI 0.69 to 0.82). The level of agreement in aspirin use measured by these two sources of data was similar to that for statin and blood pressure-lowering therapy use, for all participants combined, for subgroups according to ethnicity (Māori and non-Māori) and history of cardiovascular disease., Conclusions: Despite its availability over-the-counter, aspirin use in patients for whom cardiovascular medications are indicated can be assessed accurately from dispensing data.

Aim: To describe the awareness and perceived effectiveness of smoking cessation treatments and services among a population of mainly Maori and Pacific parents in South Auckland, New Zealand., Method: Parents of pre-adolescent children from 4 schools were surveyed from 2007-2009 using a self-complete questionnaire. Awareness and perceived effectiveness of cessation treatments and services were analysed by smoking status, ethnicity, gender and age. Relative risks were calculated using log-binomial regression to establish differences between smokers and non-smokers., Results: Awareness of Quitline, nicotine gum, and nicotine patch was higher among smokers (94%, 91%, 90%) than non-smokers (87%, 73%, 64%). Low percentages of smokers reported cessation interventions as effective (only 41% for Quitline--the intervention perceived effective by most). Awareness of varenicline, bupropion and nortriptyline was the lowest among both smokers and non-smokers (<31%)., Conclusion: Poor awareness and low perceived efficacy of smoking cessation treatments and services among priority groups are barriers to accelerating the reduction of smoking prevalence in New Zealand.

Aim: To investigate New Zealanders' use, perceptions and views on the acceptability of electronic cigarettes (e-cigarettes)., Method: 840 current smokers and recent quitters were recruited through random digit dialling as part of the New Zealand Smoking Monitor (NZSM), a 33-item telephone-based survey delivering 120 interviews per fortnight. Two sets of questions were deployed at different times to assess ever-purchase of e-cigarettes, perceptions of the safety and cessation efficacy of e-cigarettes, and acceptability of using them instead of tobacco cigarettes or as a cessation aid., Results: 7% of the sample reported having purchased an e-cigarette. One-third of respondents believed them to be safer to use than tobacco cigarettes, and could help people quit smoking tobacco. Forty-one percent considered it acceptable to use e-cigarettes as a replacement product and 58% as a cessation aid. Responses differed according to ethnicity, age and household income., Conclusion: Purchasing (and therefore we assume, use) of e-cigarettes in New Zealand is uncommon. Despite this finding, many respondents viewed e-cigarettes in a positive light and indicated willingness to use them. Ongoing monitoring on the use of and public attitudes towards this emerging product is recommended.

Aims: To compare self-reported exposure to tobacco smoke in the home or in cars between parents and their pre-adolescent children., Methods: We analysed data on self-reported exposure to secondhand smoke from 3,645 matched pairs of children at baseline (aged between 10 and 13 years) and their parents whether smokers or not, who were participants in Keeping Kids Smokefree (KKS), a community-based study in South Auckland, New Zealand from 2007-2009. The study aimed to reduce children's smoking initiation through parental behaviour change. The responses of the parent-child pairs were analysed using proportions, Kappa scores, and McNemar's Chi-squared test. Additionally, 679 children were biochemically tested for smoking exposure using exhaled carbon monoxide., Results: There was approximately a 30% discordance between the self-reports of children and their parents, with parents reporting less smoking in homes or cars than their children. Kappa scores for parent-child agreement by ethnicity ranged from 0.15 to 0.41 for smoking at home and 0.17 to 0.54 for smoking in cars. Biochemical testing suggested that around 30% of children had been exposed to secondhand smoke, corroborating their self-reported proportion of 37% (baseline in the home) whereas few parents (11%) reported smoking in home or cars., Conclusion: Parents were significantly less likely than children to report smoking inside the home or car. Biochemical testing indicated that children's reporting is more accurate. This has implications for future studies relying on self-reporting by children and/or their caregivers.

As a small island nation, with a population of only 4.4 million, and geographically isolated from the centres of global power, New Zealand could be seen as of marginal relevance to the global health agenda. This paper argues that New Zealand has been and should remain a player in global health, even if current fiscal constraints may suggest otherwise. Involvement fits with our responsibilities and commitments in the Pacific region and our wider interests, including ethical international trade, security, global alliances and the fundamental protection of health.

Aim: To examine the prevalence of and reasons for smoking roll-your-own (RYO) cigarettes in a population of South Auckland adults., Method: Cross-sectional survey of the parents of 2,973 children at four South Auckland Intermediate Schools in 2007-2009., Result: Just over a quarter (813; 27%) of parents were smokers. Most (82%) were Māori or Pacific peoples (47% and 34% respectively) of whom 47% smoked only factory-made (FM) and 38% smoked only RYO cigarettes. Exclusive RYO smoking was more common among European (53%) than Māori (40%), Pacific (38%) and Asian ethnic groups (23%). The most common reasons for preferring RYO over FM cigarettes were lower cost (50%), lasting longer (42%), and taste (8%). A few chose RYO because they perceived them to be less harmful (5%)., Conclusion: Reducing the cost benefit of RYO should lessen the potential use of RYOs as an alternative to quitting. Health education campaigns are needed to counter incorrect beliefs surrounding RYO. Such programmes should include awareness in schools, churches and Pacific communities.

The perception that population health is a poor cousin of the clinically orientated medical specialties has occurred despite a growing acknowledgement of the importance of a population health approach to the provision of medical care in the 21st Century. This perception appears entrenched within academic and clinical institutions, and is inherited by undergraduate students as they move through their training. Competing philosophies within modern medical curricula, medical socialisation, and historical professional belief structures have all contributed to both a covert and an overt scepticism towards population based approaches as being 'soft' and largely irrelevant. In May 2007, the University of Auckland introduced a new initiative for Year 5 medical students, called 'Population Health Intensive'. This was a week aimed at increasing medical undergraduate student's exposure to population health perspectives and initiatives. It challenged students and academic staff alike to reflect on their perceptions of the role of population health in medical practice and raised questions about the relevance of current medical education in light of the changing face of health and healthcare delivery. In this paper we consider the drivers of change and argue that population health has an important and legitimate place in both undergraduate medical training and clinical practice, thus widening the professions' understanding of health and disease.

Aim: To outline competencies to guide smoking cessation delivery by health workers in New Zealand., Methods: The cessation competencies were developed from a literature review of competencies measurable and relevant to New Zealand, the evidence for effectiveness of different interventions from the 2007 New Zealand Smoking Cessation Guidelines, and consultation with an expert group and smoking cessation providers throughout New Zealand., Results: The literature review identified only a handful of relevant documents on smoking cessation workforce competencies. Thirty-nine skill and knowledge-based competencies, based on three standards from the 2007 New Zealand Smoking Cessation Guidelines were identified. Each competency has been assigned a level (core, generalist, and specialist) depending on the provider's role., Conclusions: The New Zealand smoking cessation competencies provide a basis for guiding expectations of the measurable knowledge and skills all workers providing smoking cessation should attain. Their utility should be evaluated and reviewed after at least a year.

Aims: To summarise the key recommendations made in the 2007 New Zealand Smoking Cessation Guidelines., Methods: A comprehensive literature review of smoking cessation interventions was undertaken in November 2006. Recommendations were formulated from the findings of the literature review in line with the methods recommended by the New Zealand Guidelines Group., Results: The Guidelines have been structured around a new memory aid (ABC) which incorporates and replaces the 5A's (ask, advise, assess, assist, arrange). ABC prompts healthcare professionals to ask about smoking status; give brief advice to stop smoking to all smokers; and provide evidence-based Cessation support for those who wish to stop smoking. Healthcare professionals should briefly advise all people who smoke to stop smoking, regardless of whether they say they are ready to stop smoking or not. They should then offer smoking cessation support which includes both behavioural (e.g. telephone and face-to-face support) and pharmacological (e.g. nicotine replacement therapy, nortriptyline, bupropion, or varenicline) interventions. Recommendations were also formulated for priority populations of smokers: Māori, Pacific, pregnant women, and people with mental illness and other addictions., Conclusions: These guidelines will assist healthcare professionals in providing evidence-based smoking cessation support to people who smoke. To be effective, the ABC model needs to be integrated into routine practice.

Aim: To investigate the characteristics of under-18 year old callers to New Zealand's Quitline (smoking-cessation telephone counselling service)., Methods: Analysis of routinely collected demographic and smoking history characteristics of under-18 year old Quitline callers in 2004 and 2005., Results: In the 24 months of 2004-2005, 2371 under-18s called Quitline (for the first time) seeking smoking cessation support. Females (58.9%) and teens in their older teen years called most often. Compared with adult callers, there were significantly higher proportions of Maori (32.9% vs 19.6%) and Pacific (5% vs 3.6%) under-18 callers, and fewer European (64.0% vs 74.6%) and 'Other' (6.0% vs 7.1%) callers. Despite similar levels of nicotine dependence in under-18 and adult callers (70.1% vs 71.4% reported smoking within 30 minutes of waking), under-18s were issued nicotine replacement therapy (NRT) half as often (RR=0.51). Under-18s were more likely than adults to register a mobile phone number (48.9% vs 44.4%)., Conclusions: Under-18 year old smokers are under-represented in the Quitline calling population. Maori and Pacific under-18s require further cessation support to avoid exacerbating existing disparities in smoking. Awareness that under-18 nicotine dependence is equivalent to that of adults should lead to improved provision of NRT for adolescents. Initiatives involving mobile phone technology are particularly appropriate for improving access to information and treatment for under-18s. Adolescent tobacco cessation should be accorded greater priority in tobacco control policy, practice, and research.

Aim: This study examined New Zealand general practitioners' (GPs) and midwives' smoking cessation knowledge and support offered to pregnant women who smoke., Method: Postal survey of a random sample of 776 New Zealand GPs and midwives, undertaken between September and October 2006., Results: Responses were received from 39% (147/376) GPs and 57% (203/355) midwives. Almost all GPs indicated that they were involved in confirming pregnancy during the first trimester, compared with only 55% of midwives. There was high reported routine recording of smoking status (84.5% for GPs and 98.5% for midwives) and almost all participants thought it was consistent with their role to ask about smoking in pregnancy, discuss the effects of smoking, and ask if women who smoke wanted to stop smoking. Whilst 71% of GPs reported usually advising pregnant women who smoke to abstain completely only 11% of midwives said they do this. Midwives were much more likely to advise cutting down. Over 60% of participants said they usually provide cessation counselling to pregnant women. Reported recommendation of nicotine replacement therapy (NRT) was low. Only 34% of GPs and 31% of midwives were likely to recommend nicotine gum., Conclusions: GPs are in a pivotal position to offer stop smoking advice at the time of confirmation of pregnancy, when the motivation to quit is highest. Insufficient emphasis on the importance of early and complete smoking abstinence is being given by most midwives. Intermittent nicotine delivery mechanisms (such as the nicotine gum, inhaler, lozenge, or microtab) are not well known and need to be promoted more to pregnant women who smoke.

Aim: To review the evidence for the effectiveness of workplaces as settings for cardiovascular health promotion and reduction of heart health inequalities in New Zealand., Methods: Literature review and structured appraisal of 154 articles meeting inclusion criteria, of which one review and three trials addressed cardiovascular interventions specifically, and four systematic reviews addressed the effectiveness of workplace health promotion programmes generally., Results: The reviewed studies showed that workplaces have good potential as settings for health promotion. We found mixed but largely supportive evidence that workplace interventions can lead to improvements in health outcomes, workplace environments, lifestyles, and productivity. Workplace programmes that ranked highest in both clinical and cost-effectiveness targeted industries employing large numbers of blue-collar workers, tackled multiple risk factors, intervened at both individual and environmental levels and incorporated occupational safety components. Such programmes appear to offer a substantial return on investment for employers in other countries, but local evidence is lacking., Conclusions: Employers and workers in blue-collar industries should be encouraged to participate in comprehensive heart health promotion programmes as a strategy for reducing existing socioeconomic and ethnic disparities in health. However, high-quality evidence of improved employee health and productivity is needed from well-designed New Zealand-based research to ensure that these programmes are optimally configured for effectiveness and attractive to employers and employees alike.

Aim: To describe current screening and intervention practice for alcohol problems in a New Zealand trauma centre., Methods: Retrospective analysis of a trauma registry database at a metropolitan hospital in New Zealand, and hospital chart review for documentation of alcohol screening and intervention on a random sample of 120 adults, stratified by ethnicity and blood alcohol status, admitted following unintentional injury for the period January 2003 to December 2004., Results: Among 1970 patients admitted following unintentional injury during the study period, 23% had a blood alcohol test at admission. Approximately half of these tests were positive. While 68% of charts reviewed included a general comment on alcohol use, only 7.3% recorded information that suggested a possible drinking problem. No formal alcohol screening interviews were documented, and in only 1.5% of admissions was an alcohol intervention in the hospital setting recorded., Conclusion: Formal screening and interventions for alcohol problems among this group of inpatients were infrequent, indicating missed opportunities to reduce alcohol-related harm and, potentially, trauma recurrence. Effective approaches for alcohol screening and intervention in the New Zealand trauma inpatient setting require review.

Aim: To report on screening coverage and the distribution of HBsAg (a marker of chronic hepatitis B virus infection) among participants in the New Zealand Hepatitis B Screening Programme., Method: Coverage and crude and age-standardised prevalence rates of HBsAg by age group, sex, ethnic group, and region were calculated from data held by the two providers and the New Zealand 2001 Census., Results: 177,000 people were tested for hepatitis B virus infection (51% of the programme targets and 27% of Census 2001 eligible population), with highest coverage among women (28.9%) and Pacific people (34.9%). Overall, 5.7% (10,176) of participants were HBsAg-positive and there were significant regional, ethnic group, and gender differences. 5.6% of Maori, 7.3% of Pacific people, and 6.2% of Asians were HBsAg-positive, and men were more likely to test HBsAg-positive (6.1%) than women (5.4%)., Conclusions: Previous estimates of HBsAg prevalence among Maori and Pacific people from smaller surveys were confirmed and new information obtained about the distribution of hepatitis B virus infection among Pacific Islands and Asian populations in New Zealand. Opportunistic screening of adults in these populations should continue in order to identify others with (as yet undetected) infection. Regular follow-up of people with chronic hepatitis B virus infection should also continue. Ongoing outcome monitoring is now needed to judge whether this unique programme has been an effective component of New Zealand's hepatitis B control strategy and whether it is a worthwhile investment of resources.

Aim: To determine the extent to which Auckland general practitioners (GPs) follow Ministry of Health guidelines recommending the administration of pre-hospital antibiotic treatment to suspected cases of meningococcal disease., Methods: Retrospective audit of notified cases of meningococcal disease referred by Auckland GPs from 1 May 2001 to 30 April 2002., Results: Of 142 meningococcal disease cases that were referred to hospital by GPs, 111 (78%) were 'eligible' or met Ministry of Health guideline criteria for pre-hospital antibiotic treatment. Of these, only 33 (30%) were given parenteral antibiotics. Those with a rash were twice as likely as those without a rash to receive antibiotics (RR 2.1; 95% CI 1.7-2.7). There was no difference in antibiotic administration by age, sex, ethnicity, or where there was an estimated delay of greater than 30 minutes to assessment in hospital., Conclusions: The findings of this audit reinforce the need for GPs to have a higher index of suspicion and lower threshold for treatment for suspected cases of meningococcal disease and to give antibiotics more often than they do at present.