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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 11-December-2009, Vol 122 No 1307

Majority support by Māori and non-Māori smokers for many aspects of increased tobacco control regulation: national survey data
The Māori Affairs Select Committee is undertaking an Inquiry into “the tobacco industry in Aotearoa and the consequences of tobacco use for Maori”.1 The very high levels of smoking among Māori,2 the important contribution of smoking to poor health and disparities in health,3,4 and the substantial impact of tobacco use on Māori social and economic development, support the timeliness and importance of this Inquiry.
A possible outcome of the Inquiry is to recommend substantial strengthening of the measures in place to reduce smoking prevalence by promoting and supporting smoking cessation and reducing smoking uptake. Such measures might include introducing a range of proposed new tobacco control policies, strengthening and intensification of existing interventions, or implementing more radical ‘endgame’ solutions. The latter is probably more efficient at ending the tobacco epidemic and could aim to reduce the use of smoked tobacco products such that the large-scale commercial distribution and sale of smoked tobacco product effectively ceases (e.g. in 10 years time).
The aim of this study is to describe the level of support for additional tobacco control policy measures among Māori and non-Māori participants from a nationally representative sample of New Zealand smokers.
These data comes from the New Zealand arm of the International Tobacco Control Policy Evaluation Survey (ITC Project).5 The data were collected in a national computer-assisted telephone survey (Wave 1) between March 2007 and February 2008, and in a follow-up survey between March 2008 and February 2009 (Wave 2). Subjects were selected from adult smokers in the New Zealand Health Survey (NZHS) who were willing to participate in further research.
Out of 2438 potential respondents, 1376 (including 607 Māori smokers) completed the Wave 1 questionnaire giving a response rate of 56.4%, and 923 (37.9%) completed a Wave 2 interview. Taking into account the response rate of the NZHS and willingness to participate in further research reduces the overall response rate in Wave 1 was 32.6%.
The particular questions relating to the tobacco industry and regulation were largely derived from Wave 4 of the four-country ITC survey. However, the New Zealand arm of the study added some additional questions in both Wave 1 and Wave 2. Further detail on the survey methods are available in an online Methods Report 6 and in other journal article publications from this project.7,8
In the analysis, where data are available from both waves, results are presented from Wave 1 due to the higher number of participants. Results are presented as a comparison of views among Māori and European/Asian/other smokers. All of the presented results were weighted and adjusted for the complex sample design of the NZHS to make the sample representative of all Māori and European/Asian/other New Zealand smokers.
Table 1 shows that among Māori and European/Asian/other smokers there was strong majority support for greater regulation of the tobacco industry and additional government action on tobacco. There was overwhelming support for introducing regulations to reduce the toxicity and addictiveness of cigarettes. There was also strong majority support for a range of other specific tobacco control policy options, including, point of sale display bans, restricting availability of tobacco for sale to premises where children are excluded, and tax increases on tobacco products (provided the revenue was used for health promotion and to help smokers to quit).
A substantial minority of smokers also supported the introduction of plain packaging of cigarettes. Except for the measures to reduce the addictiveness and toxicity of cigarettes, support was stronger among Māori smokers, and was statistically significantly stronger for several issues. These findings add to previously reported data on support for extensions to smokefree legislation in many outdoor settings and also in private cars where children are present 9. There was also support among almost half of all smokers for the endgame solution of banning cigarette sales in ten years time, provided effective non-smoked nicotine products were available.
Some of these findings have been replicated in other settings. For example, the proportion of smokers agreeing that tobacco products should be more tightly regulated was 61.7% in the USA, 63.8% in Canada, 68.9% in Australia, and 71.1% in the UK in the ITC 4-country study 10. These data refer to support among smokers. Support is likely to be greater still among non-smokers. For instance, 69% of a 2008 national survey of New Zealand smokers and non-smokers agreed that there should be a complete ban on retail tobacco displays. Half agreed ‘cigarettes and tobacco should not be sold in New Zealand in 10 years time’ (30% disagreed), and 53% agreed that ‘tobacco companies should not be allowed to promote tobacco by having different brand names’ 11.
The findings suggest there is strong support among smokers for intensification of current tobacco control efforts as well as for more radical ‘endgame’ approaches to tobacco control. Support was at least as strong and usually greater among Māori smokers. Levels of support among non-smokers will almost certainly be higher still. This high level of support suggests that the public are well ahead of policy-makers. The findings bring into focus successive governments’ failure to fully implement proven tobacco control measures. There has been a failure to introduce or even consider potential endgame solutions to the greatest single cause of avoidable illness and premature death among the New Zealand population. The findings suggest that the Māori Affairs Select Committee should feel empowered to recommend a clear endgame strategy or at least a rigorous programme of measures aiming to end the tobacco epidemic among Māori and all other New Zealanders.
Table 1. Support for increased tobacco regulation among Māori and European/Asian/other smokers in New Zealand
(with all results weighted and adjusted for the complex sample design to represent the national population of smokers in New Zealand)
Question asked

(all Wave 1 data unless otherwise indicated)
Māori
(95%CI)

n=607 in W1
n=369 in W2
European/Other/Asian
(95%CI)

n=679 in W1
n=505 in W2
Crude odds ratios—Māori vs European/Other (95%CI)
General questions about tobacco industry and regulation
Agree or strongly agree that tobacco companies should be more tightly regulated
70.5%
(65.6–75.4)
62.3%
(57.9–66.8)
1.44 (p=0.017)
(1.07–1.95)
Agree or strongly agree that the government should do more to tackle the harm done by smoking
65.9
(60.8–70.9)
54.6
(50.0–59.2)
1.60 (p=0.001)
(1.20–2.15)
Agree or strongly agree that if effective nicotine substitutes that are not smoked became available, the government should then set a date to ban cigarette sales in ten years time (W2)
46.2
(39.0–53.4)
44.4
(38.9–49.9
1.07 (p=0.704)
(0.74–1.55)
Specific questions about tobacco regulation policies
Support a little or a lot laws that would reduce the toxins in cigarette smoke
84.8
(81.2–88.3)
87.8
(84.8–90.9)
0.77 (p=0.199)
(0.52–1.15)
Support a little or a lot laws that would reduce the addictiveness of cigarettes
84.4
(80.4–88.4)
86.1
(83.0–89.2)
0.87 (p=0.511)
(0.59–1.31)
Support a little or a lot complete bans on displays of cigarettes inside shops and stores
62.5
(57.3–67.6)
58.2
(53.6–62.7)
1.20 (p=0.223)
(0.90–1.60)
Agree or strongly agree that tobacco products should only be sold in special places where children are not allowed to go (W2)
66.6
(60.1–73.1)
58.5
(53.0–63.9)
1.42 (p=0.065)
(0.98–2.05)
Agree or strongly agree that tobacco companies should be required to sell cigarettes in plain packages (W2)
42.3
(35.0–49.5)
36.8
(31.5–42.1)
1.26 (p=0.230)
(0.86–1.83)
Support a little or a lot an increase in the tax on tobacco if all the extra money was used to promote healthy lifestyles including helping smokers wanting to quit
64.6
(59.4–69.9)
56.4
(51.8–60.9)
1.42 (p=0.021)
(1.05–1.90)
Richard Edwards*, Nick Wilson, George Thomson, Deepa Weerasekera, Tony Blakely
Department of Public Health, University of Otago, Wellington
*richard.edwards@otago.ac.nz
Competing interests: Although we do not consider it a competing interest, for the sake of full transparency we note that some of the authors have undertaken work for health sector agencies working in tobacco control.
Acknowledgements: The ITC Project New Zealand team thank: the interviewees who kindly contributed their time; the Health Research Council of New Zealand which has provided the core funding for this Project; and our other project partners (see: http://www.wnmeds.ac.nz/itcproject.html).
References:
  1. New Zealand Parliament. Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Maori; 2009. http://www.parliament.nz/en-NZ/PB/SC/BusSum/e/1/6/00DBSCH_INQ_9591_1-Inquiry-into-the-tobacco-industry-in-Aotearoa-and.htm
  2. Ministry of Health. Tobacco trends 2008: a brief update of tobacco use in New Zealand. Wellington: Ministry of Health, 2009.
  3. Blakely T, Fawcett J, Hunt D, Wilson N. What is the contribution of smoking and socioeconomic position to ethnic inequalities in mortality in New Zealand? Lancet 2006;368(9529):44-52.
  4. Wilson N, Blakely T, Tobias M. What potential has tobacco control for reducing health inequalities? The New Zealand situation. Int J Equity Health 2006;5:14.
  5. Fong GT, Cummings KM, Borland R, Hastings G, Hyland A, Giovino GA, et al. The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project. Tob Control 2006;15 Suppl 3:iii3-11.
  6. Wilson N. Methods report for the New Zealand arm of the International Tobacco Control Policy Evaluation Survey (ITC Project). Wellington: University of Otago, Wellington. 2009. http://www.wnmeds.ac.nz/itcproject.html
  7. Wilson N, Weerasekera D, Peace J, Edwards R, Thomson G, Devlin M. Misperceptions of "light" cigarettes abound: national survey data. BMC Public Health 2009;9:126.
  8. Wilson N, Borland R, Weerasekera D, Edwards R, Russell M. Smoker interest in lower-harm alternatives to cigarettes: National survey data. Nicotine Tob Res 2009;[Advance Access published on October 14, 2009]. doi:10.1093/ntr/ntp152.
  9. Wilson N, Blakely T, Edwards R, Weerasekera D, Thomson G. Support by New Zealand smokers for new types of smokefree areas: national survey data. N Z Med J 2009;122(1303):80–9.
  10. Young D, Borland R, Siahpush M, Hastings G, Fong GT, Cummings KM. Australian smokers support stronger regulatory controls on tobacco: findings from the ITC Four-Country Survey. Aust N Z J Public Health 2007;31(2):164–9.
  11. Health Sponsorship Council. Topline results: 2008 Health and Lifestyles Survey Wellington: Health Sponsorship Council, 2009.
     
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