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New Zealand's Tobacco Control Programme 1985-1998

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New Zealand's Tobacco Control Programme 1985-1998 Tobacco Control 2000;9:155–162 155 New Zealand’s tobacco control programme Tob Control: first published as 10.1136/tc.9.2.155 on 1 June 2000. Downloaded from 1985-1998 Murray Laugesen, Boyd Swinburn Abstract This paper reviews New Zealand’s national Objective—To review the impact of New tobacco control programme (TCP), asking Zealand’s tobacco control programme whether it has: (1) fulfilled its original aims and from 1985 to 1998 on smoking prevalence targets in reducing smoking; (2) achieved and tobacco consumption, and to estimate reductions in smoking among youth, Maori, the scope for further reduction. and lower income groups; (3) reduced Design—Country case study; interven- exposure to second hand smoke; (4) reduced tions, with outcomes ranked internation- cigarette mortality; and (5) made favourable ally across time. progress compared to other OECD (Organisa- Setting—New Zealand 1985-98; for 1985- tion for Economic Cooperation and Develop- 95, 23 OECD countries. ment) countries. Interventions—Between 1985 and 1998, This review begins in 1985, when the Minis- New Zealand eliminated tobacco advertis- ter of Health publicised a “comprehensive ing, halved the aVordability of cigarettes, policy to promote non-smoking” from his and reduced smoke exposure in work time advisory committee on smoking and health, by 39%. which asked the government to commit itself Main outcome measure—Reduction in to its TCP plan. The plan included public adult smoking prevalence and in tobacco involvement and health education, quit clinics products consumption per adult. for adults, restricted adolescent access to Results—Changes in prevalence 1985-98: tobacco products, regulation of tar yields, in adults (aged 15+ years), −17% (from increased taxation, smokefree environments, 30% to 25%) but short of the 20% target for health warnings, and a ban on advertising tobacco products and on tobacco brand name 2000; in youth (aged 15–24 years), −20% http://tobaccocontrol.bmj.com/ sponsorships.1 (from 35% to 28%); and in Maori adults At the 1996 census, the overall smoking (aged 15+ years), −17% (from 56% in 1981 prevalence for adults (aged 15+ years) was to 46% in 1996). Changes in consumption 23.7%. For Europeans the prevalence was 1985-98: tobacco products per adult aged 23%, for Pacific people 32%, and for Maori 15+ years, −45% (2493 to 1377 cigarette 46%. Maori, who are the indigenous people of equivalents); cigarettes smoked per New Zealand, comprised 11.7% of the total smoker, −34% (22.7 to 15.0 per day). adult population but 22% of the adult smoking Between 1985 and 1995 New Zealand population. reduced tobacco products consumption In this review we have attempted to assess per adult more rapidly than any other the impact of the total TCP because, apart OECD country, and reduced youth preva- from sharp increases in tobacco tax, a single lence more rapidly than most. The component usually cannot be studied in isola- on September 24, 2021 by guest. Protected copyright. acceleration of the decline in cigarette tion from the total programme. We also attributable mortality rates in men and in assessed the scope for the TCP to achieve fur- women age 35–69 years averted an ther reductions in smoking and mortality. additional 1400 deaths between 1985 and 1996. Between 1981 and 1996 smoking prevalence among blue collar workers Methods decreased only marginally, and in 14–15 POPULATIONS AGED 15 YEARS AND OVER year olds, rose by one third between 1992 (1) New Zealand mean resident total and 1997. population 1985-98 (supplied by Statistics Conclusion—In 13 years, New Zealand’s New Zealand 1999). tobacco control programme has been suc- (2) Maori in New Zealand 1981-96, adjusting Health New Zealand, cessful in almost halving tobacco products for the changed census definitions of and Heart Foundation, consumption, particularly by lowering Maori.2 Auckland consumption per smoker. With strong (3) The 23 OECD countries as at January M Laugesen B Swinburn political support for quit campaigns, 1995, after deleting Mexico because of increased taxation, and the elimination of lack of data, were: Australia, Austria, Correspondence to: displays of tobacco products on sale, the Belgium, Canada, Denmark, Finland, Dr Murray Laugesen, Health New Zealand, PO Box 360 consumption could theoretically be halved France, Germany, Greece, Iceland, Waiheke, New Zealand; again in as little as 3–6 years. Ireland, Italy, Japan, Netherlands, New [email protected] (Tobacco Control 2000;9:155–162) Zealand, Norway, Portugal, Spain, Received 23 July 1999 and in Keywords: New Zealand, tobacco control policy; Sweden, Switzerland, Turkey, UK, USA, revised form October 18, 1999. Accepted Organisation for Economic Cooperation and excluding Luxembourg. Federal Republic 9 November 1999 Development of Germany data were used for Germany 156 Laugesen, Swinburn pre-1990. Population data were from (iv) Cigarettes per day (cpd)—This was Tob Control: first published as 10.1136/tc.9.2.155 on 1 June 2000. Downloaded from published WHO/OECD/UN midyear calculated from the formula cpd = ((i) above)/ estimates. [((iii) above) × 365]. This avoids the under (4) Comparisons of mortality: OECD coun- reporting inherent in self reported cpd data. tries were compared on 1990 mortality. (v) Addiction—This was measured as the time Iceland and Turkey were deleted because from waking to first cigarette. of lack of data, and Luxembourg (vi) Costliness and its inverse, aVordability— included.3 Maori mortality was based on Within New Zealand, costliness was estimated 1989-93.2 from the time taken to earn 20 cigarettes at the (5) Prevalence and cigarettes per day (cpd): average hourly ordinary time earnings before data were obtained from 21 OECD coun- income tax. For international comparisons, tries (table 1). costliness was defined as the percentage of per (6) For the existence of smokefree legislation: capita gross domestic product (GDP) required 1996 data.4 to buy 20 cigarettes every day. DATA SOURCES CALCULATION OF AVERTED MORTALITY For total population and Maori, the census Cigarette smoking attributable mortality ignored gave smoking prevalence data for 1976, 1981, deaths: Under the age of 35 years (for example, and 1996. For the total population, a continu- from sudden infant death syndrome), from ous doorstep survey of 10 000 persons gave smoking only pipes or cigars, and from passive prevalence since 1982.5 OECD data for smoking in never smokers. It was calculated by 1985-95 were obtained from the Health New Peto’s indirect method, from the second Zealand database.6 The data are based on sta- American Cancer Society study (ACS-II) tistical yearbooks, oYcial reports, and web cohort study. He attributed lung cancer to sites. smoking according to the diVerence between the national rate and the ACS-II non-smokers’ rate. He then calibrated the severity of the epi- MEASUREMENTS demic in each country and year against the (i) Consumption of tobacco products per adult per ACS lung cancer rate benchmark.3 For other year (hereafter called consumption)—This is a diseases he conservatively attributed to summary measure of smoking and was smoking only half the smokers’ excess mortal- calculated as the annual volume sales of ity. The seven, five year age specific rates were tobacco products (derived from tobacco taxes averaged to give the 35–69 years age standard- paid) per adult aged 15+ years, measured in ised rate. cigarettes, or in the case of roll your own The rate decreases in age standardised, ciga- (RYO) tobacco, in grams. The traditional rette attributable mortality between its 1975 http://tobaccocontrol.bmj.com/ approximation of 1 g of tobacco being equiva- peak in men, or its 1985 peak in women, and lent to one cigarette was used in the absence of the respective 1996 rate, were applied to the data on the weight of tobacco per 1995 population to estimate the number of manufactured cigarette by country and year. cigarette deaths of each sex averted in 1996. (ii) Weight of tobacco in tobacco products—This The TCP’s eVect was calculated from the allows for the fact that tobacco weight per acceleration in those rate decreases after 1985 manufactured cigarette was less than 1 g and in the 35–79 year old population. varied by year. For other tobacco products, tobacco weight was calculated as equalling the ASSUMPTIONS FOR FURTHER REDUCTION IN product weight. CONSUMPTION WITHIN 3-6 YEARS (iii) Smoking prevalence—In New Zealand, this Policy 1—An Australian style quit campaign was defined as the percentage of adults aged 15 could be expected to reduce tobacco products on September 24, 2021 by guest. Protected copyright. years and over who smoked manufactured or consumption per adult by at least 10% if hand rolled cigarettes. In other countries, sustained for 3–6 years, based on the fact that smoking prevalence definitions varied, and in only six months, the 1997 Australian their inclusion of cigar and pipe smoking may campaign reduced prevalence and consump- have given New Zealand an artificially lower tion per adult by 4–5%, by inducing quitting.7 prevalence than a few other countries, but In addition, a media campaign was expected, would not have aVected comparisons based on while it lasted, to double smokers’ reported the rate of prevalence reduction. temporary quit episodes, from 2 to 4 weeks per Table 1 New Zealand trends in tobacco and tobacco products consumption and adult and youth smoking prevalence, with OECD rankings for 1995 values and rate of change 1985-95 1995 OECD rank 1985-95 % OECD rank for rate of 1985 1990 1995 (1st = lowest) change change 1985-95 Tobacco products/adult, consumption, cigarettes or grams 2493 1959 1472 2nd of 23 −41% 1st of 23* countries† RYO per adult per year Cigarettes or grams RYO/ smoker/ day 23 20 15 2nd of 21 −34% 1st of 21‡ Adult smoking prevalence age 15+ years (%) 30 27 26 8th of 21 −12% 9th of 21‡ Youth smoking prevalence 15–24 years (%) 35 32 29 10th of 19 −18% 3rd of 17‡ *1st = largest reduction achieved of any country in group.
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