Smoking remains the leading cause of preventable death in both the US, where it kills nearly half a million people each year, and New Zealand, where around 5000 people die prematurely from illnesses caused by smoking each year. Despite these grim statistics, California and New Zealand have achieved considerable success in reducing smoking prevalence; both have ambitious goals to bring about further declines– in New Zealand’s case, to less than five percent by 2025.
However, shaped by their differing regulatory environments, the intervention strategies used differ sharply. While California has denormalised smoking, run comprehensive mass media campaigns, and introduced smokefree restrictions, tobacco remains widely advertised, packaging still has no pictorial warnings, and the product remains relatively inexpensive. By contrast, New Zealand has prohibited tobacco marketing, introduced highly aversive on-pack warnings, and steadily increased the price of tobacco; but, at the same time, New Zealand has reduced spending on mass media campaigns and avoided industry denormalisation approaches.
Could integrating these very different strategies be the best way to achieve the common goal of reducing the enormous harm caused by smoking? This free lecture will explore that possibility and outline potential components of a best practice tobacco control model that would support international ‘endgame’ initiatives.
Fulbright New Zealand and the Fulbright New Zealand Alumni Association invite you to ‘Harnessing the Best of Both Worlds: Combining US and NZ Expertise to Advance Tobacco Control’ in Dunedin on 11 November, where these topics will be explored. REGISTER HERE.
Professor Janet Hoek is co-director of ASPIRE2025, a multi-disciplinary collaboration of tobacco control researchers based primarily at the University of Otago, New Zealand. Her research interests have focused on tobacco marketing, particularly plain packaging, on-pack warnings, tobacco supply and retailing, and tobacco endgames. She has sat on national and international expert advisory groups and provided expert testimony in tobacco litigation.
In 2011, she was honoured to receive a Fulbright Travel Award that enabled her to develop a new and productive collaboration with the Centre for Tobacco Control Research and Education at the University of California San Francisco.
When did you first become interested in the effects of smoking?
I was an expert witness in the litigation Janice Pou’s family took against New Zealand tobacco companies and I reviewed the marketing those companies had undertaken. I also read and watched Janice’s testimony, given before she died of lung cancer. I met my now colleague, Associate Professor George Thomson, who was also involved in the case and we started collaborating on research. Since I’ve joined the University of Otago, I’ve been lucky to establish collaborations with other people working in public health; we’re now a University of Otago Research Theme ASPIRE2025 and by combining our different perspectives, I think we have developed a very interesting research agenda.
What have been the most successful and unsuccessful anti-smoking initiatives in New Zealand so far?
The most successful smokefree initiatives have undoubtedly been tax increases – we know price is a very powerful policy lever, so the annual tax increase each year is a very important measure; it could be even more effective if the government introduced some unexpected large price increases. The only unsuccessful smokefree initiatives I’m aware of are those the tobacco industry has developed to deter youth smoking, but I don’t believe these have run in New Zealand. However, studies from the United States, where they have run, suggest these campaigns were less effective than campaigns run by health agencies and may even have promoted positive views towards smoking. I think New Zealand’s smokefree initiatives have been well-researched and achieved good results; if we have a problem in New Zealand, it is not that we implement poor policies, but that we do not act on good evidence and take the opportunity to introduce more policies that research shows would be effective. Plain packaging is a classic example of an unwarranted delay in implementing a policy.
What has worked in this space in California and how could New Zealand learn from it?
California has a strong smoking denormalisation programme and has run some innovative mass media campaigns. New Zealand needs to invest much more in mass media smokefree campaigns and could learn a great deal from the approaches taken in California.
What surprised you the most in what you learned in this space while on your Fulbright?
Until I read more of the research analysing formerly secret tobacco industry documents, I had underestimated how deceitful and dishonest tobacco companies are. I still find it surprising to read documents that show tobacco companies’ callous disregard for the millions of people killed by their products.
What would a smokefree New Zealand would look like?
A smokefree New Zealand would see smoking prevalence fall from the current overall level of around fifteen percent to less than five percent; at that level, it would be very unusual to see anyone smoking. The biggest benefits would clearly be to people’s health and well-being, but the benefits are social and economic as well, because smoking results in lost productivity. Smokers would benefit most – we know more than 80 percent of smokers regret the fact they smoke and would like to quit, so programmes that enable them to achieve that goal are very important. Children would also benefit enormously – the smokefree 2025 goal aims to create a country where children grow up free from the harms caused by exposure to smoking. Because there are many inequalities in smoking, with Maori, Pacific peoples, and people in disadvantaged groups disproportionately affected by the harms of smoking, it is crucial that we achieve the smokefree Aotearoa / New Zealand goal for all population groups.
How important is time in changing perceptions about smoking?
We’ve seen enormous changes in how people view smoking and over just a couple of decades it has changed from being quite an acceptable social behaviour to one that most people dislike and won’t allow in their homes. I’ve recently seen an excellent presentation called Putting Smoking Out of Sight, Out of Mind, and Out of Fashion – that’s our challenge!
How realistic do you think it is New Zealand will be smokefree by 2025?
The smokefree 2025 goal is completely realistic, but it depends on strong government leadership. The government urgently needs to develop and implement a strategy to achieve the goal. The National Smokefree Working Group, on which the ASPIRE2025 group has a seat, has developed an action plan – I hope the Government will adopt this plan and move quickly to implement the measured and evidence-based actions it sets out. In particular, they need to implement plain packaging urgently, put in place larger tax increases, reduce the availability of tobacco, use existing measures to make tobacco products less palatable, and provide funding for cessation programmes with strong outreach to disadvantaged communities.
Is it more important to encourage people to quit, deter young people from starting or both?
We need both approaches in the long term. To achieve the 2025 goal, we need large reductions in current smoking so we need to focus on helping existing smokers to quit; the approaches I’ve suggested above would all achieve this outcome. However, we also need to reduce smoking initiation and it’s important we also have measures in place to deter youth uptake of smoking.
What is the single most effective thing in preventing young people smoking in the first place?
I’m not sure there is one single most effective thing – creating a smokefree nation requires a comprehensive strategy Perhaps predictably, I think we should be changing every element of the marketing mix – the product and packaging (less appealing); the price (less affordable); the place (less accessible and less easy to consume) and the promotion (fostering a stronger smokefree culture).
If you could change one thing about New Zealand’s current smoking-related laws and marketing, what would that be and why?
I would pass the plain packaging legislation with urgency. It’s an evidence-based measure, all the evaluations from Australia are positive, other countries are planning to implement plain packaging next year, and New Zealand is lagging behind countries we once led. Our young people and children deserve better.