Seventeen percent of New Zealand ever-smoking children smoked their first cigarette before 10 years old (Mori 26%, Pacific Island 20%, European 10%.)1 Eighteen percent of Mori and 11% of Pacific Island 14-15 year olds are regular smokers children (vs 6% for European youth).2Cross-sectional research has found that teenagers who hold tolerant attitudes, for example that the tobacco industry is truthful and does not target young people, are more susceptible to smoking uptake than those who consider the tobacco industry to be manipulative or who agree that the tobacco industry targets adolescents.3-5 New Zealand cross-sectional research with 14-15 year olds found a significant association between tolerant attitudes of tobacco industry trustworthiness, the tobacco industrys rights and the tobacco industrys responsibility for youth smoking uptake and susceptibility (absence of a definite commitment not to smoke) and having ever smoked (initiation).5We were interested to see if tolerant attitudes towards the tobacco industry was associated with smoking initiation for 10-13 year old pre-adolescents from predominantly Mori and Pacific Islander populations.MethodsStudents from year 7 (10-11 years old) and 8 (11-12 years old) from the control groups of the Keeping Kids Smokefree (KKS) study participated. Ever-smoking students (answered yes to the question, Have you ever smoked a cigarette, even just a few puffs ) at baseline and students who had less than one follow-up measure were excluded.Students were surveyed at baseline and when they reached year 9 (12-13 years old). Ever-smokingwas measured both times. Demographic variables and susceptibility to smoking initiation (without a definite commitment not to smoke), was collected at baseline. The students were asked if they agree, disagree or dont know to nine statements relating to attitudes towards smoking and the tobacco industry.Data were analysed using SAS v 9.2 (SAS Institute., Cary, NC, US) with all tests being two-sided; p<0.05 deemed statistically significant. We produced logistic regression models with outcome smoking initiation (represented by ever-smoking) at follow-up. Smoking at follow- up (Table 1) was adjusted by attitude, age, gender, ethnicity (Mori, Pacific, European, Indian and Asian) and parental smoking at home, friends smoking at home and time to follow-up (1 or 2 years). Ethics approval was obtained from the University of Auckland Human Participants Ethics Committee (Ref. 2006/416).Table 1: Demographics at baseline according to whether they subsequently smoked during follow-up (n=1,505) Smoked counts N=134 (row%) Did not smoke counts N=1,371 (row%) Age at baseline 10-11 122 (8.5%) 1,311 (91.5%) 12-13 12 (16.7%) 60 (83.3%) Gender Boys 61 (8.5%) 659 (91.5%) Girls 73 (9.3%) 712 (90.7%) Ethnicity Mori 41 (16.4%) 209 (83.6%) Pacific 70 (10.8%) 576 (89.2%) European 4 (4.7%) 81 (95.3%) Indian 16 (4.1%) 378 (95.9%) Asian 3 (2.3%) 127 (97.7%) Susceptible Yes 38 (21.1%) 142 (78.9%) No 96 (7.2%) 1,229 (92.8%) Parental smoking at home Yes 46 (14.4%) 273 (85.6%) No 88 (7.4%) 1,098 (92.6%) Friends smoking at home Yes 6 (17.1%) 29 (82.9%) No 128 (8.7%) 1342 (91.3%) ResultsThe overall response rate for KKS was 83% (4,688 of 5,648 students approached at baseline participated). Analysis was restricted to the 1,505 children at baseline who completed all the relevant questions and had a follow-up measurement. Most were 10 and 11 years old (91%); 60% were Mori and Pacific. At the end of two years follow-up, 134 students (9%) had tried smoking for the first time. Table 1 shows the odds ratios of childrens attitudes toward smoking and subsequent smoking initiation at follow-up, with all models adjusted for age, gender, ethnicity parental smoking in the home, friends smoking at home and time to follow- up. The attitudes I would believe it if a tobacco company said they had made a safer cigarette , and Tobacco companies should have the same right to sell cigarettes as other companies have to sell their products ,was associated with initiation of smoking (Table 2).Table 2: Childrens attitudes toward smoking and the Tobacco Industry at baseline and subsequent smoking initiation at follow-up-showing multivariate\u2020 odds ratios and 2 x 2 tables with counts (row %). Response Ever-smoker Never-smoker OR 95% CI Do you think cigarette smoking could make you unwell? Yes No 124 (9%) 10 (10%) 1,281 (91%) 90 (90%) 1.1 1.0 0.53-2.17 Pregnant women shouldnt smoke. Agree Disagree 122 (9%) 12 (9%) 1,245 (91%) 126 (91%) 0.9 1.0 0.49-1.79 People under the age of 16 should not smoke. Agree Disagree 129 (9%) 5 (6%) 1,288 (91%) 83 (94%) 0.6 1.0 0.24-1.58 My parents or caregivers would be upset if they knew I smoked. Agree Disagree 130 (9%) 4 (12%) 1,342 (91%) 29 (88%) 1.4 1.0 0.47-4.40 Tobacco companies are responsible for people starting to smoke. Agree Disagree 97 (8%) 37 (11%) 1,078 (92%) 293 (89%) 1.4 1.0 0.89-2.06 Tobacco companies try to get young people to start smoking. Agree Disagree 95 (8%) 39 (10%) 1,021 (92%) 350 (90%) 1.1 1.0 0.73-1.67 I would believe it if a tobacco company said they had made a safer cigarette. Agree Disagree 30 (15%) 104 (8%) 164 (85%) 1,207 (92%) 2.2 1.0 1.39-3.53* Tobacco companies should have the same right to sell cigarettes as other companies have to sell their products. Agree Disagree 27 (13%) 107 (8%) 173 (87%) 1,198 (92%) 1.6 1.0 1.01-2.65* *p<0.05DiscussionIn this first longitudinal study of childrens attitudes towards the tobacco industry and subsequent smoking uptake, two attitudes were found to predict smoking initiation, both sympathetic to the tobacco industry. McCool et al5 found a significant association between susceptibility to smoking initiation and attitudes towards whether the tobacco industry is trying to get young people to start smoking and the trustworthiness of the industry. However, the current study found that only attitudes relating to trustworthiness of the industry were associated with smoking initiation.Tobacco industry denormalisation campaigns have been found to reduce smoking prevalence among youth, reduce smoking initiation, and reduce perceived peer smoking prevalence,6 but there has been little focus on this in New Zealand campaigns. The predominant focus recently in New Zealand has been on promoting quitting by annually increasing tobacco excise tax and extending smokefree environments. Since July, 2012, tobacco products were no longer allowed to be displayed at point of sale. In February, 2013, the Government announced it would bring in standardised packaging, following Australias lead (though this hasnt happened yet). In response to the announcement, the tobacco industry ran several campaigns to bolster sympathy towards them. To protect children from being influenced by tobacco industry communications it may necessary to run tobacco industry denormalisation campaigns that raise awareness of deceitful behaviours and build critical media-use skills.A strength of this study is the use of a longitudinal design, enabling analysis that shows susceptibility and certain attitudes both preceded smoking initiation. A limitation was that students were predominantly Mori and Pacific Island, limiting generalisability to non-Mori and non-Pacific pre-adolescents.

Seventeen percent of New Zealand ever-smoking children smoked their first cigarette before 10 years old (Mori 26%, Pacific Island 20%, European 10%.)1 Eighteen percent of Mori and 11% of Pacific Island 14-15 year olds are regular smokers children (vs 6% for European youth).2Cross-sectional research has found that teenagers who hold tolerant attitudes, for example that the tobacco industry is truthful and does not target young people, are more susceptible to smoking uptake than those who consider the tobacco industry to be manipulative or who agree that the tobacco industry targets adolescents.3-5 New Zealand cross-sectional research with 14-15 year olds found a significant association between tolerant attitudes of tobacco industry trustworthiness, the tobacco industrys rights and the tobacco industrys responsibility for youth smoking uptake and susceptibility (absence of a definite commitment not to smoke) and having ever smoked (initiation).5We were interested to see if tolerant attitudes towards the tobacco industry was associated with smoking initiation for 10-13 year old pre-adolescents from predominantly Mori and Pacific Islander populations.MethodsStudents from year 7 (10-11 years old) and 8 (11-12 years old) from the control groups of the Keeping Kids Smokefree (KKS) study participated. Ever-smoking students (answered yes to the question, Have you ever smoked a cigarette, even just a few puffs ) at baseline and students who had less than one follow-up measure were excluded.Students were surveyed at baseline and when they reached year 9 (12-13 years old). Ever-smokingwas measured both times. Demographic variables and susceptibility to smoking initiation (without a definite commitment not to smoke), was collected at baseline. The students were asked if they agree, disagree or dont know to nine statements relating to attitudes towards smoking and the tobacco industry.Data were analysed using SAS v 9.2 (SAS Institute., Cary, NC, US) with all tests being two-sided; p<0.05 deemed statistically significant. We produced logistic regression models with outcome smoking initiation (represented by ever-smoking) at follow-up. Smoking at follow- up (Table 1) was adjusted by attitude, age, gender, ethnicity (Mori, Pacific, European, Indian and Asian) and parental smoking at home, friends smoking at home and time to follow-up (1 or 2 years). Ethics approval was obtained from the University of Auckland Human Participants Ethics Committee (Ref. 2006/416).Table 1: Demographics at baseline according to whether they subsequently smoked during follow-up (n=1,505) Smoked counts N=134 (row%) Did not smoke counts N=1,371 (row%) Age at baseline 10-11 122 (8.5%) 1,311 (91.5%) 12-13 12 (16.7%) 60 (83.3%) Gender Boys 61 (8.5%) 659 (91.5%) Girls 73 (9.3%) 712 (90.7%) Ethnicity Mori 41 (16.4%) 209 (83.6%) Pacific 70 (10.8%) 576 (89.2%) European 4 (4.7%) 81 (95.3%) Indian 16 (4.1%) 378 (95.9%) Asian 3 (2.3%) 127 (97.7%) Susceptible Yes 38 (21.1%) 142 (78.9%) No 96 (7.2%) 1,229 (92.8%) Parental smoking at home Yes 46 (14.4%) 273 (85.6%) No 88 (7.4%) 1,098 (92.6%) Friends smoking at home Yes 6 (17.1%) 29 (82.9%) No 128 (8.7%) 1342 (91.3%) ResultsThe overall response rate for KKS was 83% (4,688 of 5,648 students approached at baseline participated). Analysis was restricted to the 1,505 children at baseline who completed all the relevant questions and had a follow-up measurement. Most were 10 and 11 years old (91%); 60% were Mori and Pacific. At the end of two years follow-up, 134 students (9%) had tried smoking for the first time. Table 1 shows the odds ratios of childrens attitudes toward smoking and subsequent smoking initiation at follow-up, with all models adjusted for age, gender, ethnicity parental smoking in the home, friends smoking at home and time to follow- up. The attitudes I would believe it if a tobacco company said they had made a safer cigarette , and Tobacco companies should have the same right to sell cigarettes as other companies have to sell their products ,was associated with initiation of smoking (Table 2).Table 2: Childrens attitudes toward smoking and the Tobacco Industry at baseline and subsequent smoking initiation at follow-up-showing multivariate\u2020 odds ratios and 2 x 2 tables with counts (row %). Response Ever-smoker Never-smoker OR 95% CI Do you think cigarette smoking could make you unwell? Yes No 124 (9%) 10 (10%) 1,281 (91%) 90 (90%) 1.1 1.0 0.53-2.17 Pregnant women shouldnt smoke. Agree Disagree 122 (9%) 12 (9%) 1,245 (91%) 126 (91%) 0.9 1.0 0.49-1.79 People under the age of 16 should not smoke. Agree Disagree 129 (9%) 5 (6%) 1,288 (91%) 83 (94%) 0.6 1.0 0.24-1.58 My parents or caregivers would be upset if they knew I smoked. Agree Disagree 130 (9%) 4 (12%) 1,342 (91%) 29 (88%) 1.4 1.0 0.47-4.40 Tobacco companies are responsible for people starting to smoke. Agree Disagree 97 (8%) 37 (11%) 1,078 (92%) 293 (89%) 1.4 1.0 0.89-2.06 Tobacco companies try to get young people to start smoking. Agree Disagree 95 (8%) 39 (10%) 1,021 (92%) 350 (90%) 1.1 1.0 0.73-1.67 I would believe it if a tobacco company said they had made a safer cigarette. Agree Disagree 30 (15%) 104 (8%) 164 (85%) 1,207 (92%) 2.2 1.0 1.39-3.53* Tobacco companies should have the same right to sell cigarettes as other companies have to sell their products. Agree Disagree 27 (13%) 107 (8%) 173 (87%) 1,198 (92%) 1.6 1.0 1.01-2.65* *p<0.05DiscussionIn this first longitudinal study of childrens attitudes towards the tobacco industry and subsequent smoking uptake, two attitudes were found to predict smoking initiation, both sympathetic to the tobacco industry. McCool et al5 found a significant association between susceptibility to smoking initiation and attitudes towards whether the tobacco industry is trying to get young people to start smoking and the trustworthiness of the industry. However, the current study found that only attitudes relating to trustworthiness of the industry were associated with smoking initiation.Tobacco industry denormalisation campaigns have been found to reduce smoking prevalence among youth, reduce smoking initiation, and reduce perceived peer smoking prevalence,6 but there has been little focus on this in New Zealand campaigns. The predominant focus recently in New Zealand has been on promoting quitting by annually increasing tobacco excise tax and extending smokefree environments. Since July, 2012, tobacco products were no longer allowed to be displayed at point of sale. In February, 2013, the Government announced it would bring in standardised packaging, following Australias lead (though this hasnt happened yet). In response to the announcement, the tobacco industry ran several campaigns to bolster sympathy towards them. To protect children from being influenced by tobacco industry communications it may necessary to run tobacco industry denormalisation campaigns that raise awareness of deceitful behaviours and build critical media-use skills.A strength of this study is the use of a longitudinal design, enabling analysis that shows susceptibility and certain attitudes both preceded smoking initiation. A limitation was that students were predominantly Mori and Pacific Island, limiting generalisability to non-Mori and non-Pacific pre-adolescents.