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It was certainly an exciting challenge: reducing tobacco prevalence to 5% or less within our population by 2025. The prospect of New Zealand, once again, leading the way internationally on tobacco control reinvigorated local advocacy efforts and brought a new focus to tobacco control research (Ministry of Health, 2011). The challenge was generally accepted to be optimistic, but with the right measures implemented in a timely way, entirely feasible.However, 5 years after setting the 2015 goal, tobacco smoking remains sharply delineated along lines of ethnicity and socioeconomic position.1 How this came to be is another story. Reflecting on the tobacco control articles in this issue of the New Zealand Medical Journal, a number of facts are clear: tobacco use is not declining among the populations who smoke the most (M1ori, Pacific, people on low incomes, people with mental health conditions); despite public information campaigns about the hazards of smoking in cars, it is still occurring; robust legislation remains a vital tool for leveraging meaningful actions for reducing tobacco use.With a fast approaching Smokefree Aotearoa 2015 deadline, the next steps will be critical.Novel and innovative approaches will be needed to address the discrepancies in these declining rates. Robust evaluation will provide evidence at the appropriate level. Evidence-based interventions should be central to what happens next. However, as Ball and colleagues point out, we lack specificity of evidence to on the cultural antecedents to tobacco use and quitting. As a result, some tobacco control interventions designed to reduce tobacco use are more equal than others. Most starkly, expected declines in tobacco use for M1ori and Pacific people have not been achieved as projected, nor will they be unless a different approach is undertaken. In essence, just when we need to get down to specifics, our tools are found to be too blunt or simply not fit for purpose.Better tracking systems are needed. Repeated cross sectional surveys are a pragmatic, constructive approach to establish consistent measures, over time, of a population in a state of change.5 An example of this approach, applied with some success, is the UK Smoking Toolkit Study (STS)2, a monthly survey of smokers in the UK. The STS provides data, over time, on smoking prevalence and behaviour. The benefit of this approach is that it is regular, methodologically consistent, and can track group changes in response to shifts in policy and other interventions. Ball and colleagues analyses alert us to the risks of relying on omnibus or periodic surveys with significant or unpredictable time lapses between measures.In this issue, we see further evidence of the feasibility of introducing a ban on smoking in cars as a means of protecting children from second-hand smoke. There is no doubt better protection for New Zealand children is a priority, and there is merit in enforcing smokefree environments. Yet, in respect to making real gains in reducing tobacco use, could efforts to eliminate smoking in cars be missing the real issue? Radically reducing tobacco use will lower the amount and frequency of smoking in cars, regardless of who is present in the vehicle. Overall reduction in prevalence will be the result of a combination of efforts. Real, sustained achievements in promoting quitting and halting uptake will result from identifying, trialing and scaling up those initiatives that redefine being smokefree.The idea of a Tobacco Control Act with a Tobacco and Nicotine Authority dedicated to the enforcement of the legislation has been advanced as a mechanism to achieve the 2025 goal. Although high level political support and dedicated taxes are essential for a successful tobacco control programme, is a completely new Act necessary and feasible? In other jurisdictions, dedicated tobacco taskforces or authorities have been proposed, but raise concerns about the risk of excess cost and bureaucracy. In the spirit of ensuring equitable and effective use of resources, why not make the best of the legislation at hand, while at the same time identifying and investing in initiatives that better engage those groups that need the most support to become ex-smokers? Thomson-Evans innovative trial of Tauhere Ringaringa (hand ties) as a means of connecting M1ori with the traditional ritual of quitting tobacco is a good example.4Ad hoc, bespoke initiatives alone are insufficient, but investing in the scale-up of innovative strategies for engaging M1ori, Pacific and other risk groups is likely to be a worthwhile investment. With evidence, tracked via sharper monitoring tools, we will be in a better position to recognise and nurture the emergence of social changes that will lead to smoking becoming a thing of the past for all New Zealanders.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Judith McCool, Senior Lecturer, Department of Epidemiology and Biostatistics, Faculty of Medical and Health Science, University of Auckland, Auckland; Chris Bullen, Professor, Director National Institute for Health Innovation, Faculty of Medical and Health Science, University of Auckland.

Acknowledgements

Correspondence

Judith McCool, Senior Lecturer, Department of Epidemiology and Biostatistics, Faculty of Medical and Health Science, University of Auckland, Auckland.

Correspondence Email

j.mccool@auckland.ac.nz

Competing Interests

- Blakely T, Cobiac L, Cleghorn C, Pearson A, Van Der Deen F, Kvizhinadze G, Nghiem N, Mcleod M, Wilson N. 2015. Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand. PLOS Medicine. Fidler J, Shahab L, West O, Jarvis M, Mcewen A, Stapleton J, Vangeli E, West R. 2011. The smoking toolkit study: a national study of smoking and smoking cessation in England. BMC Public Health, 11. Ministry of Health. 2011. Smokefree 2025 [Online]. Wellington New Zealand: Ministry of Health. Available: http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/smokefree-2025 [Accessed 25 July 2016]. Thompson-Evans T. 2016. Herehere Aukati: Revitalising Tikanga and Kawa to increase quit attempts by Maori [Online]. Auckland, New Zealand. [Accessed 25 July 2016]. Thompson M, Fong G, Hammond D, Boudreau C, Driezen P, Hyland A, Borland R, Cummings K, Hastings G, Mackintosh AM, Laux F. 2006. Methods of the International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 15.-

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It was certainly an exciting challenge: reducing tobacco prevalence to 5% or less within our population by 2025. The prospect of New Zealand, once again, leading the way internationally on tobacco control reinvigorated local advocacy efforts and brought a new focus to tobacco control research (Ministry of Health, 2011). The challenge was generally accepted to be optimistic, but with the right measures implemented in a timely way, entirely feasible.However, 5 years after setting the 2015 goal, tobacco smoking remains sharply delineated along lines of ethnicity and socioeconomic position.1 How this came to be is another story. Reflecting on the tobacco control articles in this issue of the New Zealand Medical Journal, a number of facts are clear: tobacco use is not declining among the populations who smoke the most (M1ori, Pacific, people on low incomes, people with mental health conditions); despite public information campaigns about the hazards of smoking in cars, it is still occurring; robust legislation remains a vital tool for leveraging meaningful actions for reducing tobacco use.With a fast approaching Smokefree Aotearoa 2015 deadline, the next steps will be critical.Novel and innovative approaches will be needed to address the discrepancies in these declining rates. Robust evaluation will provide evidence at the appropriate level. Evidence-based interventions should be central to what happens next. However, as Ball and colleagues point out, we lack specificity of evidence to on the cultural antecedents to tobacco use and quitting. As a result, some tobacco control interventions designed to reduce tobacco use are more equal than others. Most starkly, expected declines in tobacco use for M1ori and Pacific people have not been achieved as projected, nor will they be unless a different approach is undertaken. In essence, just when we need to get down to specifics, our tools are found to be too blunt or simply not fit for purpose.Better tracking systems are needed. Repeated cross sectional surveys are a pragmatic, constructive approach to establish consistent measures, over time, of a population in a state of change.5 An example of this approach, applied with some success, is the UK Smoking Toolkit Study (STS)2, a monthly survey of smokers in the UK. The STS provides data, over time, on smoking prevalence and behaviour. The benefit of this approach is that it is regular, methodologically consistent, and can track group changes in response to shifts in policy and other interventions. Ball and colleagues analyses alert us to the risks of relying on omnibus or periodic surveys with significant or unpredictable time lapses between measures.In this issue, we see further evidence of the feasibility of introducing a ban on smoking in cars as a means of protecting children from second-hand smoke. There is no doubt better protection for New Zealand children is a priority, and there is merit in enforcing smokefree environments. Yet, in respect to making real gains in reducing tobacco use, could efforts to eliminate smoking in cars be missing the real issue? Radically reducing tobacco use will lower the amount and frequency of smoking in cars, regardless of who is present in the vehicle. Overall reduction in prevalence will be the result of a combination of efforts. Real, sustained achievements in promoting quitting and halting uptake will result from identifying, trialing and scaling up those initiatives that redefine being smokefree.The idea of a Tobacco Control Act with a Tobacco and Nicotine Authority dedicated to the enforcement of the legislation has been advanced as a mechanism to achieve the 2025 goal. Although high level political support and dedicated taxes are essential for a successful tobacco control programme, is a completely new Act necessary and feasible? In other jurisdictions, dedicated tobacco taskforces or authorities have been proposed, but raise concerns about the risk of excess cost and bureaucracy. In the spirit of ensuring equitable and effective use of resources, why not make the best of the legislation at hand, while at the same time identifying and investing in initiatives that better engage those groups that need the most support to become ex-smokers? Thomson-Evans innovative trial of Tauhere Ringaringa (hand ties) as a means of connecting M1ori with the traditional ritual of quitting tobacco is a good example.4Ad hoc, bespoke initiatives alone are insufficient, but investing in the scale-up of innovative strategies for engaging M1ori, Pacific and other risk groups is likely to be a worthwhile investment. With evidence, tracked via sharper monitoring tools, we will be in a better position to recognise and nurture the emergence of social changes that will lead to smoking becoming a thing of the past for all New Zealanders.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Judith McCool, Senior Lecturer, Department of Epidemiology and Biostatistics, Faculty of Medical and Health Science, University of Auckland, Auckland; Chris Bullen, Professor, Director National Institute for Health Innovation, Faculty of Medical and Health Science, University of Auckland.

Acknowledgements

Correspondence

Judith McCool, Senior Lecturer, Department of Epidemiology and Biostatistics, Faculty of Medical and Health Science, University of Auckland, Auckland.

Correspondence Email

j.mccool@auckland.ac.nz

Competing Interests

- Blakely T, Cobiac L, Cleghorn C, Pearson A, Van Der Deen F, Kvizhinadze G, Nghiem N, Mcleod M, Wilson N. 2015. Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand. PLOS Medicine. Fidler J, Shahab L, West O, Jarvis M, Mcewen A, Stapleton J, Vangeli E, West R. 2011. The smoking toolkit study: a national study of smoking and smoking cessation in England. BMC Public Health, 11. Ministry of Health. 2011. Smokefree 2025 [Online]. Wellington New Zealand: Ministry of Health. Available: http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/smokefree-2025 [Accessed 25 July 2016]. Thompson-Evans T. 2016. Herehere Aukati: Revitalising Tikanga and Kawa to increase quit attempts by Maori [Online]. Auckland, New Zealand. [Accessed 25 July 2016]. Thompson M, Fong G, Hammond D, Boudreau C, Driezen P, Hyland A, Borland R, Cummings K, Hastings G, Mackintosh AM, Laux F. 2006. Methods of the International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 15.-

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

It was certainly an exciting challenge: reducing tobacco prevalence to 5% or less within our population by 2025. The prospect of New Zealand, once again, leading the way internationally on tobacco control reinvigorated local advocacy efforts and brought a new focus to tobacco control research (Ministry of Health, 2011). The challenge was generally accepted to be optimistic, but with the right measures implemented in a timely way, entirely feasible.However, 5 years after setting the 2015 goal, tobacco smoking remains sharply delineated along lines of ethnicity and socioeconomic position.1 How this came to be is another story. Reflecting on the tobacco control articles in this issue of the New Zealand Medical Journal, a number of facts are clear: tobacco use is not declining among the populations who smoke the most (M1ori, Pacific, people on low incomes, people with mental health conditions); despite public information campaigns about the hazards of smoking in cars, it is still occurring; robust legislation remains a vital tool for leveraging meaningful actions for reducing tobacco use.With a fast approaching Smokefree Aotearoa 2015 deadline, the next steps will be critical.Novel and innovative approaches will be needed to address the discrepancies in these declining rates. Robust evaluation will provide evidence at the appropriate level. Evidence-based interventions should be central to what happens next. However, as Ball and colleagues point out, we lack specificity of evidence to on the cultural antecedents to tobacco use and quitting. As a result, some tobacco control interventions designed to reduce tobacco use are more equal than others. Most starkly, expected declines in tobacco use for M1ori and Pacific people have not been achieved as projected, nor will they be unless a different approach is undertaken. In essence, just when we need to get down to specifics, our tools are found to be too blunt or simply not fit for purpose.Better tracking systems are needed. Repeated cross sectional surveys are a pragmatic, constructive approach to establish consistent measures, over time, of a population in a state of change.5 An example of this approach, applied with some success, is the UK Smoking Toolkit Study (STS)2, a monthly survey of smokers in the UK. The STS provides data, over time, on smoking prevalence and behaviour. The benefit of this approach is that it is regular, methodologically consistent, and can track group changes in response to shifts in policy and other interventions. Ball and colleagues analyses alert us to the risks of relying on omnibus or periodic surveys with significant or unpredictable time lapses between measures.In this issue, we see further evidence of the feasibility of introducing a ban on smoking in cars as a means of protecting children from second-hand smoke. There is no doubt better protection for New Zealand children is a priority, and there is merit in enforcing smokefree environments. Yet, in respect to making real gains in reducing tobacco use, could efforts to eliminate smoking in cars be missing the real issue? Radically reducing tobacco use will lower the amount and frequency of smoking in cars, regardless of who is present in the vehicle. Overall reduction in prevalence will be the result of a combination of efforts. Real, sustained achievements in promoting quitting and halting uptake will result from identifying, trialing and scaling up those initiatives that redefine being smokefree.The idea of a Tobacco Control Act with a Tobacco and Nicotine Authority dedicated to the enforcement of the legislation has been advanced as a mechanism to achieve the 2025 goal. Although high level political support and dedicated taxes are essential for a successful tobacco control programme, is a completely new Act necessary and feasible? In other jurisdictions, dedicated tobacco taskforces or authorities have been proposed, but raise concerns about the risk of excess cost and bureaucracy. In the spirit of ensuring equitable and effective use of resources, why not make the best of the legislation at hand, while at the same time identifying and investing in initiatives that better engage those groups that need the most support to become ex-smokers? Thomson-Evans innovative trial of Tauhere Ringaringa (hand ties) as a means of connecting M1ori with the traditional ritual of quitting tobacco is a good example.4Ad hoc, bespoke initiatives alone are insufficient, but investing in the scale-up of innovative strategies for engaging M1ori, Pacific and other risk groups is likely to be a worthwhile investment. With evidence, tracked via sharper monitoring tools, we will be in a better position to recognise and nurture the emergence of social changes that will lead to smoking becoming a thing of the past for all New Zealanders.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Judith McCool, Senior Lecturer, Department of Epidemiology and Biostatistics, Faculty of Medical and Health Science, University of Auckland, Auckland; Chris Bullen, Professor, Director National Institute for Health Innovation, Faculty of Medical and Health Science, University of Auckland.

Acknowledgements

Correspondence

Judith McCool, Senior Lecturer, Department of Epidemiology and Biostatistics, Faculty of Medical and Health Science, University of Auckland, Auckland.

Correspondence Email

j.mccool@auckland.ac.nz

Competing Interests

- Blakely T, Cobiac L, Cleghorn C, Pearson A, Van Der Deen F, Kvizhinadze G, Nghiem N, Mcleod M, Wilson N. 2015. Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand. PLOS Medicine. Fidler J, Shahab L, West O, Jarvis M, Mcewen A, Stapleton J, Vangeli E, West R. 2011. The smoking toolkit study: a national study of smoking and smoking cessation in England. BMC Public Health, 11. Ministry of Health. 2011. Smokefree 2025 [Online]. Wellington New Zealand: Ministry of Health. Available: http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/smokefree-2025 [Accessed 25 July 2016]. Thompson-Evans T. 2016. Herehere Aukati: Revitalising Tikanga and Kawa to increase quit attempts by Maori [Online]. Auckland, New Zealand. [Accessed 25 July 2016]. Thompson M, Fong G, Hammond D, Boudreau C, Driezen P, Hyland A, Borland R, Cummings K, Hastings G, Mackintosh AM, Laux F. 2006. Methods of the International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 15.-

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